Physician's Guide To The Management of HD

Chapter 6

Smoking

Smoking sometimes becomes a problem for people with HD, for two reasons. Changes in the person's behavior related to disinhibition, personality changes, and perhaps boredom may turn smoking into a consuming passion, leading to irritability and even violence if thwarted.

Simultaneously chorea, impairment of voluntary movements, impaired judgement, and diminished capacity for self observation may make the act of smoking unsafe.

A variety of approaches have been helpful in decreasing the behavior and improving safety. Non-pharmacologic interventions include the establishment of smoking schedules and general safety measures such as ensuring that the patient does not smoke in bed, limiting smoking to rooms without rugs, and use of adaptive devices, such as a flexible tube smoker or a "smoker's robot," available through rehabilitation supply and safety product catalogs  (see Appendix 3 Physician's Guide)

We have also used nicotine patches with some success. The goal is not necessarily to wean the patient completely off cigarettes or patches, but to decrease the drive for cigarettes, and the periods of nicotine withdrawal, which may worsen irritability. A variety of the antidepressant buproprion has also recently been marketed for use in smoking cessation and may be worth a try.