I am 45, male with COPD. How do I quit smoking?

Question

Hello doctor,

I am a 45-year-old man who recently joined an anti-smoking campaign after struggling with cigarette addiction for over 20 years. I used to smoke around 18 to 20 cigarettes a day, and since joining the program, I have reduced my intake to five cigarettes daily, but quitting completely still feels very difficult.

I already have chronic obstructive pulmonary disease (COPD), with my latest FEV₁ at 58 percent of the predicted value, and I often experience shortness of breath on exertion. My oxygen saturation sometimes drops to 93 percent.

I also have hypertension, with blood pressure readings around 148/92 mmHg, and I am on Amlodipine. My lipid profile shows LDL 162 mg/dL, HDL 33 mg/dL, and triglycerides 210 mg/dL, indicating high cholesterol. My BMI is 28.7 kg/m², and I was recently diagnosed with prediabetes, with an HbA1c of 6.3 percent.

I am very motivated to quit smoking because of my health and my role in the campaign, but withdrawal symptoms such as irritability, poor sleep, and cravings make it challenging.

I would like to know what the most effective options are for me, such as nicotine replacement therapy, Varenicline, or Bupropion, and whether these are safe considering my COPD, high blood pressure, and cholesterol problems.

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Quitting smoking is the most important step you can take to protect your health, especially given your COPD (chronic obstructive pulmonary disease), high blood pressure, high cholesterol, and prediabetes, all of which place you at significant cardiovascular risk.

Since you have already reduced your cigarette use, structured therapies can greatly improve your chances of quitting completely. Those include:

Nicotine replacement therapy in the form of patches, gum, or lozenges can help control withdrawal symptoms and is generally safe in people with COPD and hypertension when used correctly, although blood pressure should still be monitored.
Varenicline is considered one of the most effective medications for smoking cessation, as it reduces both cravings and the rewarding effects of cigarettes. Studies suggest it is generally safe in people with COPD and cardiovascular risk factors, though close follow-up is recommended to monitor for any changes in mood or cardiovascular symptoms.
Bupropion is another effective option, particularly if you struggle with irritability or low mood during withdrawal, but it can increase blood pressure, so careful monitoring would be necessary in your case.

Combining nicotine replacement with either Varenicline or Bupropion under medical supervision can sometimes be more effective than using one treatment alone.

In addition to medication, behavioral support, counseling, and stress management strategies such as regular exercise, mindfulness, and avoiding smoking triggers are essential for long-term success.

Given your medical conditions, the safest approach is to work closely with your doctor to choose a therapy that balances effectiveness with cardiovascular safety, while also ensuring that your COPD and metabolic risk factors are optimally managed.

I hope this has helped you.

Please feel free to reach out to me again if you have further queries.

Thank you.