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Stop Smoking - A Guide to Quitting

Stopping smoking can make a major improvement to your health
and prevent diseases such as COPD and lung cancer.

Introduction
Smoking Facts
Smoking Risks
Why you should quit smoking
Treatment and help to stop smoking
Stop smoking self help

Introduction

Smoking in England

The rates of smoking have fallen sharply in England. In 1980, approximately one in three adults smoked, but by 2007 this figure had fallen to one in five adults.

Levels of smoking are highest in younger adults aged 20-34 and lowest in adults aged over 60. Slightly more men (22%) smoke than women (19%).

Children Smoking

Despite it being against the law, levels of smoking are unacceptably high in children.

It is estimated that 6% of children aged 11 to 15 are regular smokers. This is particularly worrying as the longer a person smokes, the more likely it is that they will die from a smoking-related disease.



Health Impact

Smoking’s impact on public health is huge.

In the years from 2007 to 2008 there were 1.4 million NHS hospital admissions for diseases caused by smoking.

Smoking is responsible for one in every five deaths in adults aged over 35 in England, and half of all long-term smokers will die prematurely due to a smoking-related disease. In 2008, smoking caused 83,900 deaths in England.

Smoking is a leading risk factor for many debilitating and, in many cases, potentially fatal health conditions such as:

Smoking law

Since July 1 2007, virtually all enclosed public places and workplaces in England have been smoke-free. It is illegal to smoke inside pubs, bars, nightclubs, cafes and restaurants, lunch rooms, membership clubs and shopping centres.

The smoke-free law was introduced to protect employees and the public from the harmful effects of passive smoking (secondhand smoke).

Under the smoke-free law, you are unable to smoke inside at work, including in smoking rooms.

Public transport and work vehicles that are used by more than one person are also smoke-free. No-smoking signs must be displayed in all smoke-free premises and vehicles.

Anyone who smokes in a smoke-free place may face an on-the-spot fine of £50 (or up to £200 if the matter goes to court). Anyone in charge of smoke-free premises or vehicles can face fines for two separate offences: failing to prevent smoking in a smoke-free place and failing to display no-smoking signs.

Since October 2007 in England, Scotland and Wales, it is illegal to sell tobacco to anyone under the age of 18. The age limit was previously 16. This includes the sale of cigars, rolling tobacco, rolling papers and cigarettes from vending machines. This change in the law makes the age restriction the same as the age restriction for buyingalcohol.

Help Stop

Around 65% of smokers say they want to stop smoking, but most believe they are unable to. However, around half of all smokers eventually manage to give up.

The primary service for people who want to quit smoking is theNHS Stop Smoking Service (NHS SSS). The NHS SSS offer a range of free treatments, advice and support for people who want to quit smoking, and it has a good track record of success. It is estimated that since its launch in 2000, the NHS SSS has saved 70,000 lives.

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Smoking Facts

Tobacco smoke contains nicotine, which is highly addictive. One expert on addiction has estimated that nicotine is as addictive as cocaine.

As well as nicotine, each cigarette contains more than 4,000 different chemicals, many of which are toxic (harmful to the body). More than 60 of them cause cancer (are carcinogenic).

Below are some of the toxins found in tobacco smoke, and the way they harm the body.

Nicotine

When you smoke a cigarette, nicotine affects your brain within seconds of inhaling. It increases your heart rate and causes a surge in the hormones noradrenaline and dopamine in your brain. This has a positive effect on your mood and your ability to concentrate. In between cigarettes, the levels of these hormones drop, leaving you feeling irritable, anxious and in need of another cigarette.

Within 24 hours, withdrawal from nicotine can cause the following side effects:

  • depressed mood
  • difficulty sleeping
  • irritability
  • frustration or anger
  • anxiety
  • difficulty concentrating
  • restlessness
  • decreased heart rate
  • dizziness
  • increased appetite

As well as being addictive, nicotine can be dangerous if you have high blood pressure (hypertension). It increases the risk of accelerated hypertension, which is a sudden rise in already-high blood pressure that can cause headaches, blurred vision and vomiting.

Nicotine also slows down your body's ability to heal itself by making your skin dehydrated (lacking in water).

That said, nicotine is arguably the least dangerous substance in cigarettes. Other substances found in cigarettes are far more dangerous. These are listed below.

Tar

Every breath of tobacco smoke deposits tar in your lungs. The tar in cigarette smoke contains chemicals called carcinogens, which encourages the development of cancer cells in your body.

Carbon monoxide

When it is inhaled, the poisonous gas carbon monoxide binds itself to the haemoglobin in your bloodstream and prevents it from carrying enough oxygen around your body.

This is particularly dangerous for pregnant women, because it causes a severe lack of oxygen in an unborn baby (known as foetal hypoxia). Foetal hypoxia is thought to be the main cause of the harmful effects that smoking can have on unborn babies.

Oxidant gases

Oxidant gases are gases that react with oxygen. They make your blood more likely to clot, which increases your risk of having a heart attack or stroke.

Benzene

Benzene is a chemical that used to be added to petrol. This practice has now been stopped due to health concerns.

Exposure to benzene can cause cell damage at the genetic level, and has been linked to a range of different cancers, such as leukaemia and kidney cancer.

Polonium

Polonium is one of the most highly radioactive substances in the known universe. Even a millionth of a gram of polonium can cause extensive damage to human tissue.

Other harmful substances

In addition to the above, there are many other poisonous substances found in tobacco smoke. These substances can have harmful effects, such as causing the thickening and fatty degeneration of your arteries, which then causes heart disease.

Tobacco smoke can also increase the acidity of your stomach acid, putting you at risk of peptic ulcers (ulcers in your stomach or small intestine).

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Smoking Risks

Risks to yourself

Smoking is bad for your health and increases your risk of getting many serious and often fatal diseases. Some of the most harmful conditions that smoking can cause are detailed below.

Premature death

A medical study on smoking found that, on average, men who smoked throughout their lives died 10 years younger than those who had never smoked. Most of these men died from smoking-related illnesses, including:

  • lung cancer
  • coronary heart disease
  • chronic obstructive pulmonary disease(COPD) – a long-term lung disease, such as chronic bronchitis (infection of the main airways in the lungs) or emphysema (damage of the small airways in the lungs), which can occur together

Cancer

Smoking is responsible for 85-90% of all cases of lung cancer, which is the second most common type of cancer in England and the leading cause of cancer-related deaths. During 2007, there were 29,660 deaths in England and Wales as a result of lung cancer.

As well as lung cancer, smoking also increases your risk of developing:

  • cervical cancer
  • bladder cancer
  • pancreatic cancer
  • stomach cancer
  • kidney cancer
  • oesophageal cancer
  • oral cancer (cancer of the mouth)

Respiratory diseases

Smoking is also a leading risk factor for a range of respiratory diseases (conditions that affect breathing), such as:

  • chronic obstructive pulmonary disease (COPD)
  • pneumonia (inflammation of the lungs)
  • influenza (the flu)

These conditions can be extremely debilitating in terms of their effects on your quality of life. For example, many people with severe COPD are unable to take part in normal daily activities due to their symptoms.

COPD is also a leading cause of death, with an estimated 30,000 people dying each year in the UK as a result of the condition.

Cardiovascular and cerebrovascular diseases

Smoking is a leading risk factor for two types of conditions:

  • cerebrovascular diseases – which are conditions that affect the supply of blood to the brain
  • cardiovascular diseases – which are conditions that affect the heart and arteries

Both types of disease can cause serious symptoms and are a leading cause of disability and death.

Cerebrovascular diseases linked to smoking include

  • dementia – a condition where a person progressively loses their mental functions
  • stroke

In England, 111,000 people have a stroke each year. Stroke is the third largest cause of death and the leading cause of disability in adults.

Cardiovascular diseases linked to smoking include:

  • high blood pressure(hypertension)
  • coronary heart disease
  • angina – chest pain because the heart is not receiving enough blood
  • atherosclerosis – hardening and narrowing of the arteries
  • heart failure
  • heart attacks

Cardiovascular diseases are a leading cause of death, with an estimated 198,000 people dying due to a cardiovascular disease each year in the UK.

Other conditions

Other conditions that can be caused by smoking, or for which smoking is a significant risk factor, include:

  • Crohn’s disease– a digestive condition that causes abdominal pain and diarrhoea
  • stomach ulcers
  • periodontitis – a serious type of gum disease
  • asthma
  • diabetic retinopathy–loss of sight caused by diabetes
  • erectile dysfunction(impotence)
  • macular degeneration breakdown of the retina (light-sensitive layer of the eye), causing gradual blindness
  • infertility –in both men and women
    skin wrinkling
  • osteoporosis –weak and brittle bones

Risks to others

When you smoke, it is not just your health that is at risk, but the health of anyone who breathes in cigarette smoke (including those around you). The smoker only inhales about 15% of the smoke from a cigarette. The other 85% is absorbed into the atmosphere or inhaled by other people.

Breathing in this secondary smoke is known as passive smoking, or secondary smoking. Passive smokers also have an increased risk of smoking-related diseases, particularly lung cancer and heart disease.

For example, research has found that non-smoking women who share their house with a smoking partner are 27% more likely to develop lung cancer than non-smoking women who live with a non-smoking partner.

Risks to children

Children are at particular risk from the effects of passive smoking because they have an increased risk of developing chest infections during their first five years. Babies who are exposed to cigarette smoke are also at a greater risk of sudden infant death syndrome (SIDS), which is also known as cot death.

As well as making children more vulnerable to ear infections, such as otitis media, passive smoking makes children more likely to develop asthma.

Risks during pregnancy

Smoking can make you less fertile. Therefore, not smoking can improve you chances of conceiving.

If you smoke, there is a greater chance of complications occurring during pregnancy and labour, such as sickness, miscarriage and bleeding. Smoking while pregnant can also increase the risk of premature birth and stillbirth.

Smoking during pregnancy can also affect your developing baby. Your baby may have a lower birth weight, be weaker and grow more slowly, throughout their childhood. Research suggests that children exposed to smoke in the womb may do less well at school.

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Why you should quit smoking

Giving up smoking increases your chances of living a longer and healthier life. It instantly cuts your risk of death or serious illness due to smoking-related conditions, such as lung cancer, heart disease and chronic obstructive pulmonary disease (COPD).

Health benefits

When you stop smoking, the benefits to your health begin straight away. As your body starts to return to normal you will start to feel healthier, and within a few weeks you will also start to notice the benefits. For example:

  • After one month your skin will be clearer, brighter and more hydrated.
  • After three to nine months your breathing will have improved, and you will no longer have a cough or wheeze. Your lung function may have improved by up to 10%.
  • After one year your risk of heart attack and heart disease will have fallen to about half that of a smoker.
  • After 10 years your risk of lung cancer will have fallen by half.
  • After 15 years your risk of heart attack and heart disease will be the same as someone who has never smoked.

Research into smoking shows that people who quit smoking before age 35 have a life expectancy that is only slightly less than people who have never smoked. Those who quit before they are 50 reduce their risk of dying from a smoking-related disease by 50%.

As well as the immediate and long-term benefits to your health, there are many other good reasons to quit smoking, such as those outlined below.

  • You are no longer harming others through passive smoking, particularly babies and children, who are at risk of sudden infant death syndrome (SIDS), asthma, and ear and chest infections.
  • It is less likely that your children will become smokers. Research shows that children living with parents who smoke are almost three times more likely to start smoking themselves.
  • You limit harm to your unborn baby. Although smoking at any stage of pregnancy can harm your baby, most of the harmful effects of smoking occur in the second trimester (weeks 14-26) and third trimester (week 27-birth). Therefore, if a woman quits smoking during her first three months of pregnancy, she will have a similar risk of giving birth to a low-weight baby as a non-smoker.

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Treatment and help to stop smoking

NHS Stop Smoking support services

If you want to quit smoking, initially it is a good idea to see your GP. They can provide help and advice about quitting, and can refer you to an NHS Stop Smokingsupport service. These services offer the best support for people who want to give up smoking. Studies show that you are four times more likely to quit smoking if you do it through the NHS.

For more information, call the NHS Stop Smoking helpline on 0800 022 4332 (England only).

Treatment and support from your GP

If you do not want to be referred to an NHS Stop Smoking support service, your GP can still provide treatment, support and advice to help you quit smoking.

At your first appointment, they will ask you about your smoking habits to assess your level of addiction and to outline the benefits of quitting. They can also help you identify any factors that may make quitting difficult for you, such as living with others who smoke, or any stress that you experience in day-to-day life.

Your GP can prescribe a smoking cessation treatment to help you quit. There are several different treatments available from your GP. The type you are prescribed will depend on your own personal preference, any previous smoking cessation medication that you have taken and any side effects they may cause. The different types of smoking cessation treatments, their side effects and the way they will be prescribed are detailed below.

Electronic Cigarettes

Over recent years electronic cigarettes have come on to the market as and aid to stopping smoking. They are, among other names, called e-cigarettes. They are an inhaler shaped, most in a form similar to a cigarette that simulates the act of tobacco smoking. The vegetable based mist inhaled intends to act as nicotine without containing the additional harmful chemicals in tobacco. The chosen products nicotine strength can be chosen by the user. As with other therapies an electronic cigarette may be a productive route to accomplish cessation for some smokers.

electronic cigarette

Nicotine replacement therapy (NRT)

Nicotine is highly addictive, and it is the nicotine in cigarettes that causes people to become addicted to smoking. Nicotine replacement therapy (NRT) works by releasing nicotine steadily into your bloodstream at much lower levels than in a cigarette, without the tar, carbon monoxide and other poisonous chemicals present in tobacco smoke.

This helps to control the cravings for a cigarette that occur when your body starts to miss the nicotine from smoking.

NRT is the most common smoking cessation treatment and it comes in many different forms, including:

  • transdermal patches (which stick to your skin), available in formulations that release nicotine for either 16 hours or 24 hours
  • chewing gum that is available with either 2mg or 4mg of nicotine
  • inhalators, which look likeplastic cigarettes through which nicotine is inhaled
  • tablets and lozenges, which are placed under your tongue
  • nasal spray, which passes nicotine through the lining of your nose

NRT can be prescribed by your GP. All forms of NRT can also be bought from a pharmacist over the counter.

There is no evidence that one particular type of NRT is more effective than another, so the one you choose is largely a matter of personal preference.

When deciding, think about the type of smoker you are. For example, are you a heavy smoker who needs a cigarette as soon as you wake up, or are you an occasional smoker who only smokes when they are out having a drink, or after a meal?

Some heavy smokers find a 24-hour patch useful, as it helps to relieve the cigarette craving when waking up. Others prefer using a NRT nasal spray, because it is the fastest-acting form of NRT.

Some smokers find it useful to combine NRT products. For example, they wear patches throughout the day, then use gum or an inhalation to help relieve a sudden craving for a cigarette.

Most courses of NRT last eight to 12 weeks before you gradually reduce the dose and eventually stop. Most people stop using NRT altogether within three months, although heavy smokers may need to use it for longer.

Side effects of NRT include:

  • skin irritation when using patches
  • irritation of nose, throat or eyes when using a nasal spray
  • disturbed sleep, sometimes with vivid dreams
  • upset stomach
  • dizziness
  • headaches

Side effects are usually mild to moderate, but if they become particularly troublesome, contact your GP as your dosage or type of NRT may need to be adjusted.

Also, use of the nasal spray can cause sneezing and watering eyes for a short time after use. For this reason, if you are prescribed an NRT nasal spray, do not use it while driving, or just before driving.

Nicotine replacement therapy and pregnancy

If you are pregnant or breastfeeding and you want to quit smoking, it is best for your and your baby'shealth that you stop completely and immediately without any smoking cessation treatment.

However, if you feel you cannot stop smoking without help from smoking cessation treatment, your GP may recommend that you stop smoking completely and use NRT to control your cravings.

Nicotine is not good for your baby, but the greatest risk to an unborn baby's health from smoking is posed by carbon monoxide, which can cause foetal hypoxia (a severe lack of oxygen). So although using NRT is not ideal for your baby, the risks of nicotine are far outweighed by the risks of continuing to smoke.

As with any other patient who wants to stop smoking, the form of NRT you are prescribed will depend on your personal preference, ease of use and your level of addiction.

Medication

There are two medications that are currently licensed to help people give up smoking. These are discussed below.

Bupropion

Bupropion is a medication originally designed to treat depression, but it was discovered that it helped people quit smoking. It is still not entirely clear why this is the case.

Most experts believe it has something to do with the medication affecting parts of the brain that are involved in addictive behaviour.

Bupropion is prescribed in tablet form, with people taking one to two tablets a day, as directed by their GP.

Take bupropion for 7-14 days before you try to quit smoking as the medication takes this amount of time to reach its maximum effect. A course of treatment usually lasts for seven to nine weeks.

Bupropion is not suitable for:

  • children and young people under 18
  • women who are pregnant or breastfeeding
  • people with anorexia or bulimia
  • people with a central nervous system tumour
  • people with severe cirrhosis of the liver

Bupropion can also increase your risk of having a seizure (fit), so it is not suitable for people who already have a higher-than-average risk of having seizures, such as:

  • people with epilepsy
  • people with bipolar disorder
  • people with serious alcohol misuse problems
  • people who are treating diabetes with hypoglycaemic medication or insulin

Bupropion can cause several side effects, including:

  • dry mouth
  • upset stomach
  • insomnia (trouble sleeping)
  • headaches
  • difficulty concentrating
  • dizziness
  • drowsiness

If you feel drowsy after taking bupropion, do not drive or operating heavy or complex machinery.

Varenicline

Varenicline is currently the only medication that has been specifically designed to help people quit smoking.

It works by preventing nicotine from binding to receptors (parts of your brain that respond to nicotine), which eases cravings and reduces the rewarding and reinforcing effects of smoking.

If you have not stopped smoking completely before starting varenicline, aim to do so within 7-14 days of starting treatment. The recommended duration of varenicline is 12 weeks. If you successfully stop smoking in this time, you may be prescribed another 12 weeks of treatment to ensure that you do not start smoking again.

Varenicline is not suitable for:

  • children and young people under18
  • women who are pregnant or breastfeeding
  • people with epilepsy
  • people with advanced kidney disease

Side effects of varenicline include:

  • nausea and vomiting
  • headaches
  • insomnia (trouble sleeping)
  • unusual dreams
  • increased appetite
  • constipation or diarrhoea
  • swollen stomach
  • slow digestion
  • flatulence
  • dry mouth
  • tiredness
  • dizziness
  • drowsiness
Do not drive or operate machinery while taking varenicline if it makes you feel drowsy.

There have been reports of a number of people experiencing feelings of depression and suicidal thoughts after beginning treatment with varenicline.

While there is no evidence that these symptoms are directly linked to the medication, if you do feel depressed or have thoughts of suicide,stop taking varenicline immediately as a precaution, and contact your GP.

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Stop smoking self help

Deciding to give up smoking and really wanting to succeed are important steps in becoming a non-smoker. There are three stages to giving up smoking:

  • preparing to stop
  • stopping
  • stopping permanently

It can take up to three months to become a non-smoker, but it usually takes less time. The physical craving for a cigarette often disappears in less than a week, but the psychological craving can last longer.

Stage 1 - Preparing to stop

It is important that you stop smoking because you want to. Write down your reasons and keep the list to hand over the next few months. Think of the many benefits you will gain by stopping smoking, including:

  • less coughing
  • better breathing
  • feeling healthier
  • cleaner clothes
  • more money
  • a significantly lower risk of you and your family developing smoking-related illnesses

Try to remember that most of the pleasure you get from smoking comes from relief of your nicotine withdrawal, not the cigarette itself. Nicotine replacement therapy (NRT) can provide the same effect without the need for smoking, and helps you quit at the same time.

The NHS Stop Smoking Service also offers a free Quit Kit, which has been designed by experts and former smokers and contains many useful tools to help you quit. The Kit can take several weeks to arrive via the post, so order it well in advance of your quit date.

Do not expect giving up smoking to be easy. The first three to four days will be the most difficult. If you can, give up with a friend or family member who also wants to quit.

When you have decided to stop, make a plan that may include:

  • a specific date to give up, and cutting down on the number of cigarettes that you smoke before that date
  • the support of your family and friends to help you give up
  • a reward for the end of your first day, first week, first month
  • getting rid of everything smoking-related on the day before you give up, such as cigarettes, ashtrays and lighters

Stage 2 - Stopping

Your initial goal is to get through the first day without smoking. If you need to put something in your mouth, chew sugar-free gum or eat something else that is healthy and non-fattening, such as fruit. If you feel a strong craving, take some deep breaths and delay giving in to the urge. The feeling will usually pass within a couple of minutes.

If you need to do something with your hands, find something to fiddle with, such as a pencil, a coin, or a stress-relief ball. (The NHS Quit Kit contains a plastic toy that has been specifically designed to give people something to do with their hands when they have a craving. Many ex-smokers have said this is one of the most useful tools in the Quit Kit).

Stage 3 - Staying stopped

Take it one day at a time, and each day congratulate yourself on having made it so far. Keep reminding yourself of your reasons for giving up, and what you are gaining by not smoking. Think positively, remain determined and reward yourself. At the beginning, it may help to change your normal routine to avoid situations that you would normally associate with smoking. Avoiding alcohol for a while may also help.

After the first weeks, particularly if you have found it easy not to smoke so far, people may stop encouraging you and even forget that you have stopped. This period is crucial, so try not to be complacent. Do not let yourself be tempted to smoke one cigarette because this can easily lead to two or three cigarettes, which increases your risk of becoming a smoker again.

Saving the money that you would have spent on cigarettes is a great incentive to keep going. For example, if you smoked a pack of cigarettes a day, that works out at around £6.13 a day (at 2010 prices). After six months of not smoking, you would have saved almost £1,200; enough to pay for a holiday for you and your family.

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