Smoking

Introduction

If you smoke, giving up is probably the greatest single step you can take to improve your health. Seven out of ten smokers say that they want to stop, but most believe they can't. However, half of all smokers eventually manage to stop smoking.

Smoking is the biggest cause of death and illness in the UK. More than 120,000 people die each year from diseases caused by smoking.

Smoking is a major contributor to many serious diseases, such as heart disease and lung cancer. It is also a very expensive habit for the nation, costing the NHS and the taxpayer up to £1.5 billion every year.

Tobacco in cigarettes, cigars and pipe tobacco, contains poisons such as ammonia, acetone, carbon monoxide, cyanide and arsenic. Altogether, cigarettes can often contain over 4000 chemicals.

Treatment

Nicotine replacement therapy (NRT) can double your chances of quitting smoking. It works by getting nicotine into your system without the tar, carbon monoxide and other poisonous chemicals you get from tobacco smoke. Its the nicotine that is addictive. So while you're becoming a non-smoker, you can still get nicotine from NRT. Once you're comfortable not smoking, you can cut out the NRT, gradually.

NRT is available as patches, chewing gum, lozenges, tablets that you put under your tongue, or as an inhaler or nasal spray. Choose whichever suits you best after discussing your options with your GP or counsellor. You can buy products from your chemists, but your GP can also prescribe them to you. You must have a target date for when you will stop smoking before NRT can be prescribed. Its very important not to smoke while you're using nicotine replacement therapy.

Nicotine patches are available in different doses. If you smoke 10 cigarettes or more a day, you may consider starting with the higher dose. You shouldn't use them for more than 12 weeks and you should gradually reduce the dose. They are very convenient but you can't control the dose - say, to get more nicotine quickly when the craving is particularly strong. You can wear a patch just while you're awake or for 24 hours.

Nicotine gum - You can chew this gum whenever you feel a craving. It is available in two strengths. For heavy smokers, the stronger nicotine gum (4mg) seems to work better than the weaker one (2mg). The taste can be unpleasant at first but for most people this lasts only a week or so. It needs to be chewed differently than normal gum, so read the instructions carefully.

Tablets - You should place these under your tongue. Use one or two tablets per hour depending on how much you smoke. You should not need to take them for more that six months.

Lozenges - You should suck these every one to two hours. They are available in two strengths – 2mg and 4 mg.

Nicotine inhaler - This is a plastic holder with nicotine cartridges that you put on the end. You draw on it like a cigarette and nicotine passes into your mouth.

Nicotine nasal spray - This is a nicotine solution, which you spray up your nose. You can absorb nicotine through the nose quicker than with the gum or the patch, but it takes more getting used to, and can irritate the nose. Youll need a GPs prescription for a nasal spray.

Bupropion - This is a drug that works by interfering with the chemicals in the brain that cause addiction. You start taking bupropion for 1 to 2 weeks before you plan to stop smoking. Its only available with a prescription from your GP. If you take bupropion, your chances of stopping smoking for at least a year are two and a half times better than not taking it.

Hypnotherapy - Hypnosis is also sometimes used to help smokers to give up although there is no scientific evidence to prove that it is successful.

Why should it be done?

Giving up smoking increases your chances of living a longer and healthier life. When you are no longer exposed every day to nicotine, carbon monoxide, tar and other poisons, your body begins to repair the damage. As your body starts to return to normal, you will start feeling better within a few weeks, and will have:

• Clearer complexion and whiter teeth; improved breathing and general fitness;
• hair, skin and breath no longer smell of tobacco smoke;
• loss of smokers cough;
• improved sense of smell and taste;
• lack of worry over damage smoking is doing to your health;
• less risk of smoking-related diseases;
• improved life expectancy;
• feel good about yourself for having quit;
• more money to spend.

Smokers who quit before the age of 45 have a life expectancy close to that of people who have never smoked. For people above this age, the gap widens, but smokers who quit over the age of 45 still enjoy considerable health benefits over people who continue to smoke.

Facts

Tobacco smoke contains over 4,000 different chemicals, many of which are poisons. Some might be relatively harmless by themselves, but together in smoke they make a toxic cocktail.

Poisons in tobacco smoke

• Carbon monoxide is a poisonous gas linked with heart disease, stroke and other circulation problems.
• Tar is deposited in the lungs with every breath of cigarette smoke taken. Tar causes cancer and damages your lungs. 
• Benzene is a solvent and is a known cause of cancer and is associated with leukaemia. 
• Formaldehyde is a poison used to preserve dead bodies. It is known to cause cancer, respiratory, skin and gastrointestinal problems.
• Ammonia is used in cigarettes - it is also found in cleaning fluids.
• Cadmium is a poisonous metal, used in batteries. It causes liver, kidney and brain damage.

Passive smoking - damage to others around you

Smoking puts at risk anyone nearby who breathes in the smoke. As the smoker inhales only 15% of the smoke from a cigarette, 85% of it is absorbed into the atmosphere or inhaled by other people. The act of breathing in this secondary smoke is called passive smoking. Children are particularly vulnerable to the effects of passive smoking and those who live with smokers may become prone to chest, ear, and nose and throat infections, and to more serious conditions such as bronchitis and pneumonia.
The UK Scientific Committee on Smoking and Health has estimated that about 300 non-smokers in this country die each year from lung cancer caused by passive smoking. Recent research has also linked strokes and heart attacks to passive smoking.
The British Medical Association has conservatively estimated that passive smoking causes at least 1,000 deaths a year in the UK. Apart from the direct health risks, smoking causes over 3,000 house fires a year in England, resulting in the deaths of nearly 100 people.

Risks

Smoking is bad for your health. Smokers are at greater risk from illness and early death than non-smokers.

Also breathing the smoke from other peoples cigarettes, or passive smoking, can affect your health.

Smoking increases the risk of getting many serious and often fatal diseases, such as:

• lung cancer,
• other cancers, of the mouth, throat, larynx, oesophagus, bladder, kidney, pancreas and stomach,
• coronary heart disease,
• stroke,
• chronic bronchitis and emphysema.

§         Smoking is the biggest cause of death and illness.

Recommendations

Quitting

Deciding to quit 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,
• and staying stopped.

It can take up to 3 months to become a non-smoker, although it usually takes less time. The physical craving for a cigarette often goes in less than a week. The psychological craving can last longer.

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 benefits: less coughing, cleaner clothes, better breathing (for you and your friends and family), more money, and a lower risk of developing smoking-related illnesses.

When you have decided to stop, make a plan:

• choose a day to quit; ask family and friends for their support;
• plan a reward for the end of your first day, and the end of the first week, and the first month;
• and the day before, get rid of cigarettes, ashtrays and lighters.

You could also talk to your doctor or pharmacist about nicotine replacement therapy. Used properly, these products can double the success rate of stopping smoking.

Stopping

Your goal is to get through the first day without smoking. If you need to put something in your mouth chew sugar-free gum or something healthy and non-fattening. Drink juice and eat fruit. If you feel a strong craving, try taking some deep breaths and delay giving in to the urge. It will usually pass in a couple of minutes.

If you need to do something with your hands, find something to fiddle with - a pencil, a coin, anything but a cigarette.

You may wish to ease the withdrawal symptoms with nicotine replacement therapy. Consult your GP and follow the manufacturers instructions to make sure you use enough, for long enough.

Staying stopped

Take it one day at a time. 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 would normally encourage you to smoke such as going to the pub.

After the first weeks, especially if it was easy, people may stop encouraging you, and even forget you're stopping. This period is crucial. Try not to be complacent. Dont allow yourself to be tempted.

Dont be tempted to smoke one cigarette. This can easily lead to two or three cigarettes and you risk becoming a smoker again.

Save the cigarette money. For an average smoker it could be over £100 a month. Six months without smoking could buy you a holiday and this is a great incentive to keep going.

Side effects

Side Effects of Quitting

Nicotine affects the brain with seconds of inhaling cigarette smoke. It increases the heart rate and blood pressure, constricts the small blood vessels under your skin, causes changes in blood composition and metabolism, and increases the production of hormones. Nicotine can also affect your mood and behaviour.

Withdrawal from nicotine can cause (within 24 hours):

• depressed mood,
• difficulty in sleeping,
• irritability,
• frustration or anger,
• anxiety,
• difficulty with concentration,
• restlessness,
• decreased heart rate,
• dizziness,
• and increased appetite.

As soon as you stop your body starts to clear itself of the toxins in tobacco smoke.

• Your blood pressure and pulse rate will quickly drop (within an hour of stopping).
• Carbon monoxide levels will return to normal (within 2 days).
• Your sense of taste and smell will improve (within a couple of days).
• Your circulation (the movement of blood around your body) will improve (within a few weeks).

Healthcentral 2005

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