Hello.
Thank you for your query at DoctorSpring.com
Cigarette smoke contains over 4000 chemicals, which may differ from company to company. among which some are cocca, caffeine, menthol and a few other substances, added for aroma. All of them have - to a certain effect of bronchodilation. This gives a feeling of relief of breathlessness, and chest tightness after smoking.
The carbon dioxide that is produced on burning also has a mild bronchodilator effect.
So a chain / heavy smoker usually gets a withdrawl and rebound breathlessness on tobacco cessation. so these group of patients will require a gradual reduction in number of cigarretes, rather than an abrupt cessation. The sense of breathlessness usuaaly persists for 2- 3 weeks, and afterwards it does come down as body copes with new internal milleu.
The long term benefits of cigarrete cessation outruns that of smoking / short term dyspnoea, hence i strongly advice smoking cessation
Regards
Dr. Jacob George P
MD, IDCCM, FCCP
Patient replied :
Hi, Thank you very much for your answer, I asked another md doctor from another website and he thinks it could be psychological hyperventilation and physical dependence on tobacco and its all in my head and not my lungs and said I should take wellbutrin or escitalopram because it mught be stress or anxiety related, but you are telling me it is the chemicals in the cigarette that causes bronchodilation and why i try to quit causes breathlessness. So I am little confused? What are your thoughts on what the other doctor said?
Let me explain my short breath a little better for you, when I quit cigarettes, I start to feel as if i cant breathe, I have a kind of weird tingling feeling in middle of belly area under ribcage, I feel as if i cant get a full breath of air, I have to yawn to get a full breath of air, I hold my breath unconsciously, i dont know why, no matter how hard I try to breathe in, i can never get a full breath of air, sometimes if i press down in the middle of the belly area it eases up a little. But as soon as I smoke a cigarette it disappears, everything is alright. I quit for 2 months and was short of breath and as soon as i smoked gain it disappeared. Now if the chemicals in the cigarette according to you is a bronchodilator, Is there anything else I could take medicine etc while trying to quit again to ease it up. Thanks very much. I await your reply.
Dear patient,
Let me sum up your query. You are asking :
-whether it could be psychological hyperventilation and physical dependence on tobacco and if its all in your head and not the lungs.
-whether you should take wellbutrin or escitalopram because it mught be stress or anxiety related.
-what are your thoughts on what the other doctor said?
Here are my answers :
Smoking does have a physical and psychological level of dependence. Both are interlinked, and not independent of each other. So if you ask me whether it is in your head? It is possible. Is it only (entirely) in your head? Not necessarily.
It is a well known fact that after quitting cigarette smoking, you may also find yourself gaining a bit of weight. As smoking over expresses fat breakdown, when you stop smoking, fat isn't broken down as fast and you tend to gain weight. Depression also is a common side effect of smoking cessation.
So what to do? You will need help from another person - a friend, partner or anyone who can motivate you / keep your spirits high, along with other steps to help you quit without adverse effects.
Whether I advice antidepressants - Well, the management of smoking cessation has pharmacologic (medication/drugs) and non-pharmacologic measures, and I suggest them to be undertaken in parallel and not drugs as a sole measure. I would advise against anti-depressants as the sole measure, that too unsupervised as a method for smoking cessation.
There are other methods like nicotine patch, chewing gums etc to be added along with non-pharmacologic measures of smoking cessation.
So to make a long story short, I don't differ that there might be something in your head, but I do suggest that its not entirely in your head.
I am against anti-depressants as the first line, that too unsupervised as treatment.
As for a substitute for the bronchodilatory effects, it is best that you get yourself examined for any wheeze etc by your GP and if there are positive findings, something like Albuterol can be prescribed.
I hope that this is helpful.
Regards.