Dr. Roach: How to help a smoker quit

Keith Roach
To Your Health

Dear Dr. Roach: I need your help to get my husband to stop smoking.

My husband and I have been together for 27 years. He has smoked cigarettes daily for at least 30-35 years. Recently, he had an attack where he couldn't breathe, and we took him to the clinic, where they did a breathing test. My son and I watched as my husband agonized to get through the test. They gave him an albuterol machine, prescribed him Advair and sent him on his way. His father also smoked for many years, and now is on oxygen for COPD — he is miserable every day. My husband quit smoking about two years ago using Chantix, but he started smoking again shortly after that. I don't want to watch him suffer like his father.

Please tell me what I can do to help him quit for good.


Dear P.Z.: Quitting smoking is perhaps the most difficult recommendation to follow. There are some definite red flags in your husband's case as you have described it, but some reason to hope, as well.

The fact that your husband can see the effects of smoking on his father, but has not successfully quit is worrisome. On the other hand, quitting now will greatly slow down damage to his lungs. Similarly, although he restarted quickly after quitting, he was able to quit. He needs to know that most people who quit successfully have tried several times to quit in the past and went back. It's worth trying again, and he knows that he is able to quit.

Varenicline (Chantix), bupropion (Zyban and Wellbutrin) and nicotine replacement therapies definitely are helpful for most people in quitting. I am sure his doctor will be happy to partner with you, his family, in helping him quit.

Dear Dr. Roach: At age 45, I was diagnosed with bipolar II disorder. Can you tell me something about it?


Dear D.T.: Bipolar disorder is a complex spectrum of diseases that have in common drastic changes in mood and behavior. Depression is the most common initial mood disorder in bipolar disorder. Bipolar I disorder is diagnosed when there are manic episodes. A manic episode is defined medically as an abnormal, persistently elevated mood with increased activity or energy, lasting at least a week.

In bipolar II, true manic episodes are not present. Depression always is, as is at least one episode of hypomania, which is similar to manic episodes, but less severe or long-lasting. Bipolar II is probably underdiagnosed, partly because hypomania can be hard to recognize. It is important to make the diagnosis, since treatment is different, and it is worth reconsidering the diagnosis if treatment is ineffective.

Email questions to ToYourGoodHealth@med.cornell.edu.