Smoking Cessation: Online Diagnosis and Treatment

Ready to quit smoking? If so, congratulations on taking the next step toward living a healthier life. Cigarette smoking causes more than 480,000 deaths each year in the United States. Tobacco use is the leading cause of preventable deaths worldwide.¹ Quitting smoking is not easy, but once you meet your quit goals, you will have achieved a goal many people cannot.

Quitting smoking is exceedingly difficult because nicotine is so addictive. It is equivalent to, or perhaps more addictive, than cocaine and heroin.² Nicotine quickly enters your bloodstream and binds to receptors in your brain. Nicotine binding causes many other brain chemicals to be released, having an effect throughout the body. Nicotine causes changes in brain chemistry, but also causes tolerance.

As your body develops a tolerance to nicotine, you need higher and higher doses to achieve the same effect. As your body develops tolerance, you may become dependent on nicotine. This means your body will experience physical and psychological symptoms if you stop smoking.

A lack of nicotine causes withdrawal symptoms. You respond by smoking more to raise your brain’s nicotine levels.

Before you get discouraged, there are many medications that a virtual doctor on the Telegra MD telehealth platform can prescribe to ease your symptoms, and the process is simple and convenient. You will receive a treatment protocol and an appropriate online prescription to start you on your smoking cessation journey. Telehealth for smoking cessation treatment makes it easy to consult with a virtual doctor and receive a smoking cessation medication quickly and easily, even if you don’t have insurance.

What Is a Smoking Cessation Program?

According to the Centers for Disease Control and Prevention, nearly 70% of adults who smoke want to quit, and over half try to quit each year. Fewer the one in ten adults who smoke successfully quit smoking each year.¹

Nicotine is intensely addictive, and withdrawal symptoms can be intense. Smoking cessation programs are designed to ease the transition from smoker to nonsmoker.

Common withdrawal symptoms include:

• Irritability
• Anxiety
• Cravings
• Depressed mood
• Difficulty concentrating
• Fatigue
• Dizziness
• Increased hunger
• Constipation
• Stomach upset
• Insomnia
• Weight gain

Smoking cessation programs typically provide counseling and medications. Counseling helps you maintain your motivation and confidence in your ability to quit. Medications help you safely withdraw from nicotine.

In many cases, you may be prescribed a long-acting nicotine replacement therapy with a short-acting one to minimize the physical and psychological effects associated with decreased nicotine levels in the brain. This combination of medications will replace nicotine in your body so you can stop smoking. The next step is slowly decreasing your medications as you transition from them.

In an analysis of over 52 clinical studies and almost 20,000 patients, smoking cessation was more successful when using a combination of behavioral therapy and medication use than with minimal support alone.³  

Can Smoking Cessation Treatment be Prescribed Through Telehealth?

Consulting a medical professional via telehealth makes starting a smoking cessation program much more convenient. You can schedule an online medical consultation appointment with a virtual doctor using the Telegra MD platform and receive a personalized treatment plan. Your virtual doctor can give you tips on how to combat the challenges associated with smoking cessation and call in your online prescription to a local pharmacy. Online doctors who prescribe smoking cessation medications provide 24-hour appointment access, which means you can expect doctor access whenever you need it, leading to an earlier diagnosis and treatment.

How Do You Get Started on a Smoking Cessation Treatment Plan?

The first step is taking an inventory of your current situation. Consider taking the Fagerstrom Test for Nicotine Dependence (FTND).

1. How soon after you wake up do you smoke your first cigarette?

• Within 5 minutes (3 points)        
• 6 to 30 minutes (2 points)
• 31 to 60 minutes (1 point)
• After 60 minutes (0 points)

2. Do you find it difficult to refrain from smoking in places where it is forbidden (e.g., in church, at the library, or in the cinema)?

• No (0 points)
• Yes (1 point)

3. Which cigarette would you hate most to give up?

• The first one in the morning (1 point)
• Any other (0 points)

4. How many cigarettes per day do you smoke?

• 10 or less (0 points)
• 11 to 20 (1 point)
• 21 to 30 (2 points)
• 31 or more (3 points)

5. Do you smoke more frequently during the first hours after waking than during the rest of the day?

• No (0 points)
• Yes (1 point)

6. Do you smoke when you are so ill that you are in bed most of the day?

• No (0 points)
• Yes (1 point)

Value	Value Meaning	Description	Display Order
0 to 2	Very Low Dependence	Very low level of nicotine dependence.	0
3 to 4	Low Dependence	Low level of nicotine dependence.	1
5	Medium Dependence	Medium level of nicotine dependence.	2
6 to 7	High Dependence	High level of nicotine dependence.	3
8 to 10	Very High Dependence	Very High level of nicotine dependence.	4

After evaluating your nicotine dependence, the next step is to set your quit date. Most people choose a date 3 to 4 weeks into the future to prepare. Learn more about developing a timeline for quitting smoking.

To achieve your stop-smoking goal, it is essential to convert this goal into a plan. To do this, break your goal into smaller goals and develop a timeline. Here are some tips to make your stop date plan more successful:²

• Plan a list of activities to distract yourself if you have a craving.
• Remove as many of your smoking triggers as possible.
• Change your routine, especially for activities associated with smoking.

Why do People Decide to Stop Smoking?

A burning cigarette contains over 4,000 chemicals, including at least six known or suspected carcinogens.²

Short-term effects of smoking and inhaling nicotine include:

• Bad breath
• Skin staining
• Fatigue
• Coughing
• Dulled sense of smell and taste
• Dizziness
• Nausea
• Headache
• Shortness of breath
• Increased blood pressure
• Increased heart rate

According to the Centers for Disease Control and Prevention, long-term smoking increases your risk of many chronic diseases, including:²

• Asthma
• Cancers: lung, laryngeal, pancreatic, bladder and kidney, cervical, stomach, leukemia
• Cataracts
• Gum disease
• Heart disease: abdominal aortic aneurysm, coronary heart disease, blood vessel disease
• Impaired immune function
• Lung disease: upper and lower respiratory tract infections, chronic obstructive pulmonary disease, resistant asthma symptoms, reduced lung function
• Macular degeneration
• Osteoporosis
• Stroke
• Tuberculosis
• Type 2 diabetes
• Reduced fertility

When Should You See a Doctor for Smoking Cessation Therapy?

Once you decide to stop smoking, schedule an appointment for a full health evaluation and discuss smoking cessation options. Schedule an appointment with a virtual doctor using telemedicine for smoking cessation to get started on your smoking cessation plan today.

What Medications are Prescribed for Smoking Cessation?

Medications used for smoking cessation can be divided into two categories: nicotine-replacement therapies (NRT) and non-nicotine-based therapies.

Non-nicotine-based therapies

Medication	Length of Action	Mechanism of Action	Over the counter (OTC)/ Prescription (Rx)
Bupropion SR	Take regularly, start 1 to 2 weeks prior to your quit date	Mimics nicotine’s effect in the brain, sustained release anti-depressant	RX
Varenicline	Take regularly. Start one week before your quit date	Binds to nicotine receptors in the brain to reduce cravings	RX

Nicotine-replacement therapies

Medication	Length of Action	Mechanism of Action	Over the counter (OTC)/ Prescription (Rx)
Nicotine gum	1-2 hours	Delivers nicotine through the gum	OTC
Nicotine lozenge	1-2 hours	Delivers nicotine through the gum	OTC
Nicotine patch	All day	Delivers nicotine through the skin	OTC
Nicotine nasal spray	1-2 hours	Delivers nicotine across the lining of the nose	RX
Nicotine oral inhaler	1-2 hours	Delivers nicotine through the mouth and throat	RX

How do You Avoid Smoking Triggers?

Smoking is a habit, and, like all habits, most people have triggers that make it more difficult to meet their smoking cessation goals.  

Common triggers for smoking include:

• Anxiety
• Boredom
• Excitement
• Fighting
• Going to a bar or club
• Loneliness
• Smelling cigarette smoke
• Stress
• Taking a break
• Talking on the phone
• Waiting in line
• Watching television

When creating your smoking cessation strategy, consider the people, places, and circumstances that cause you to reach for a cigarette reflexively. Identify ways to avoid or at least mitigate the effects of your triggers, if at all possible.

What Are the Benefits of Smoking Cessation?

The good news is that quitting smoking provides immediate health benefits, and the benefits increase with time. Within minutes of stopping smoking, your blood pressure and heart rate will decrease to normal. Within two days, your blood carbon dioxide and oxygen levels return to normal. Over the next few weeks, breathing and circulation improve. After ten years, lung cancer risk drops to about the same level as nonsmokers.²

The steps for obtaining a smoking cessation treatment plan after seeing a doctor online through telemedicine are similar to seeing your local doctor. In both cases, you would:

• Make an appointment: Typically, appointments to see virtual doctors through telehealth are much easier to make and are more convenient than in-person appointments, as many telemedicine companies provide online telehealth services for smoking cessation treatment at any time, day or night.
• Provide a medical history: Whether completing forms in your local doctor’s office or online before consulting with your virtual doctor, you will need to provide a medical history.
• Consult with your doctor: After reviewing your medical history forms, your virtual doctor will discuss your smoking cessation options.
• Treatment: After deciding on an optimal and personalized treatment plan for smoking cessation, your virtual doctor will transmit your prescriptions to your local pharmacy.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1. Rigotti NA. Strategies to Help a Smoker Who Is Struggling to Quit. JAMA. 2012;308(15):1573–1580. doi:10.1001/jama.2012.13043

2. Brunette P, Harris S et al. UCSF Medical Center Fontana Tobacco Treatment Center Stop Smoking Workbook. Accessed July 6, 2023. extension://oemmndcbldboiebfnladdacbdfmadadm/https://www.ucsfhealth.org/-/media/project/ucsf/ucsf-health/pdf/fttc-tobacco-workbook-011912.pdf

3. Stead LF, Koilpillai P, Fanshawe TR, Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database Syst Rev. 2016 Mar 24;3(3):CD008286. doi: 10.1002/14651858.CD008286.pub3. PMID: 27009521; PMCID: PMC10042551.