Smoking is the biggest cause of preventable morbidity (ill health) and mortality (death) in the developed world. It also plays a key role in increasing the risks involved in surgery and possible recovery from most surgical procedures. For this reason, most doctors would strongly recommend cutting down on smoking well before an operation and best of all, to quit smoking completely.
Tobacco is thought to contain several thousand different chemicals, but most notably, is known to contain such poisons as tar, benzene, formaldehyde, cadmium, arsenic, cyanide, carbon monoxide, ammonia and acetone. These, amongst other chemicals are known to cause damage to cells all around the body, thus leading to conditions such as heart and circulatory disease, lung problems and cancer. Therefore, the sooner you quit, the sooner your body can start to recover from these toxins. There is more information about these toxins at the end of this fact sheet.
However, it is not these toxins that are themselves addictive, but a chemical called nicotine. It is the craving for nicotine that makes cigarettes, cigars and other forms of tobacco so addictive, pleasurable and difficult to give up.
So why should I give up?
The benefits for general health and well-being are clear. Here are some other reasons also;
- reduced risk of smoking related diseases
- better oral hygiene with whiter teeth and less bad breath
- a reduction in tobacco smells from hair, skin and clothes
- an improvement in smell and taste sensations
- financial savings from not buying cigarettes which can be very expensive
- increased life expectancy
- reduced risks to others, especially those closest to you from the effects of passive smoking – this particularly applies to babies and children.
What exactly are the medical risks of smoking?
The individual risks for your health are numerous but mainly include an increased likelihood of the following;
- heart disease: angina and heart attacks
- diseases of the circulation: blocked blood vessels leading to poor circulation, gangrene and possible amputations
- cerebro-vascular disease (strokes)
- lung diseases such as emphysema, chronic bronchitis and increased problems with asthma
- cancer: mainly of lungs, mouth, throat, voice box (larynx), oesophagus, stomach, pancreas, kidney and bladder
- a generalised reduction of fitness
- in children who are exposed to passive smoking, increased susceptibility to infections of the ears, nose, throat and sinuses
- detrimental effects on pregnancy and the unborn foetus.
How do I quit?
Firstly, you must really and truly want to quit and be prepared to give it 100% of your commitment as it is still a difficult thing to do successfully. There are 3 stages to becoming a non-smoker.
- Preparing to quit
- Stopping smoking
- Staying a non-smoker for life
This whole process may take 3 months but can take less time, depending on how much tobacco you smoke and how determined you are to stop smoking.
Preparing to quit:
set a date and write it down in a diary or calendar. Talk to family and friends who are supportive so that they can help you through cravings at any stage. Be clear in your own mind why you want to quit, the benefits to health for you and your family, the increased level of fitness, the financial savings and the cleaner, less tobacco smoke filled environment in which you’ll live. Write down these reasons in a list so that you can refer to them. Before quitting, get rid of any unused cigarettes or tobacco, matches, lighters and ashtrays. You can also discuss your options with your pharmacist, doctor or practice nurse who will be able to advise on nicotine replacement therapy. If used properly, this can double your chances of success.
Stop smoking:
get a goal of getting through the first day without smoking. Physical cravings can be reduced by using NRT (nicotine replacement therapy) which is available in various forms such as chewing gum, patches, tablets, inhalers and nasal sprays. Various forms of NRT are available to suit different people and are listed near the end of this fact sheet. Psychological cravings can be particularly difficult to combat but distraction can be useful, by fiddling with other things such as coins, pens or anything else which stops you from smoking again. Eating chewing gum or fruit is also helpful – and healthier.
Staying a non-smoker for life:
take each day a step at a time. Keeping reminding yourself why you are going through this process. Keep that list of reasons you wrote down earlier with you so that you can refer to it and start to enjoy the fact that with each day that passes without smoking, your health continues to improve. Avoid the temptation to smoke – even 1 cigarette, as this will inevitably lead to 2 and then more – and keep distracting yourself. Use your family and friends for support if available and avoid falling back into the routine and lifestyle that may lead you back to smoking such as going to the pub. Finally, think of what you’re going to do with all the money you’ve saved. If you smoke 20 cigarettes a day in the UK, at £5.00 a pack, that’s £150 per month or £1800 per year.
Where can I get more help?
There are several ways to obtain more help when trying to stop smoking. These include the following;
- your family doctor or GP who will be aware of most of the local services that are available to people who are serious about quitting. Your GP can also prescribe NRT or drugs such as bupropion which can help. You may also be able to collect leaflets with further information,
- your practice nurse for the same reasons as above,
- your local pharmacist,
- a specially trained smoking counsellor who can suggest further ways in helping yourself to stop smoking. This will involve regular sessions of counselling,
- group therapy sessions,
- The NHS Smoking helpline available to UK patients on 0800 1690169
- Hypnotherapy: although the scientific evidence for the effectiveness for hypnotherapy remains unclear, some people may find this useful.
What are the side effects of stopping smoking?
Within a day of stopping smoking, the effects of nicotine withdrawal can be felt symptom such as;
- depressed mood,
- difficulty in sleeping,
- irritability,
- frustration or anger,
- anxiety,
- difficulty with concentration,
- restlessness,
- decreased heart rate,
- dizziness,
- increased appetite
Additionally, as soon as you stop smoking, your body will start to get rid of the poisons that have accumulated in your body and the particles that have accumulated in you lungs and airways. Therefore;
- your pulse and blood pressure will fall with an hour or so of stopping,
- carbon monoxide levels will fall back to normal within a couple of days,
- your sense of smell and taste will improve within a couple of days
- your circulation will improve within a few weeks.
You may initially note that coughing increases with phlegm or sputum also being produced which is discoloured or foul as the lungs start to clear. This effect may last a week or two afterwhich your breathing will be much improved.
The Conclusion
There are several valid and proven medical and non-medical reasons for everyone to stop smoking. There are health benefits not just for you, but also for those cloest to you such as your spouse, children, work collegues and even unborn babies.
There are also clear reasons that you should quit smoking if you’re serious about going abroad for surgery and even if you’re considering surgical treatment closer to home.
Whether you succeed or not in stopping smoking and staying stopped depends on a number of factors such as what help you have and how you prepare yourself for stopping but most importantly is the question of how determined and single minded you are about succeeding and knowing the reasons why you should quit.
Nicotine Replacement Therapy (NRT)
Although there are thousands of chemicals in cigarette smoke, it is nicotine that is mainly responsible for the addictive element of smoking. Nicotine can be taken without exposure to all the other harmful toxins that are present in smoke, thus reducing your chances of the harmful effects of smoking. Once you become a non-smoker, you can withdraw from NRT gradually. Many different methods for nicotine are available as listed below;
- Patches: these are available in different strengths and each patch may be used for either 16 hours (waking hours only) or 24 hours. They are simple and convienent to use and are usually used for a maximum of 12 weeks. If you smoke more than 10 cigarettes daily, then start on the higher dose and gradually reduce the dose. However, the doses of nicotine obtained are not flexible as you cannot control the dose on a craving to craving basis. Rather, you get a steady stream of nicotine intsead.
- Gum: this is available in 2 strengths, 4mg for heavier smokers and 2mg for lighter smokers. You can start chewing a piece of gum every time you have a craving for a cigarette. Some people complain of an unpleasant taste (although there are different flavours to choose from), but this effect is transient and settles. The gum is slowly chewed for 30mins when a craving is felt and can be used for 3 months.
- Tablets: these are placed under the tongue when a craving is felt. 1 or 2 tablets can be used every hour. These are used for a maximum of 6 months.
- Lozenges: these are sucked when a craving is felt and can be used every 1-2 hours. They are available in 2 different strengths.
- Inhaler: this plastic device contains nicotine cartridges which you can draw on like a cigarette and nicotine is inhaled. This gives the user the advantage of having a similar touch and feel of something in their hand resembling a cigarette without actually smoking one.
- Nasal spray: a nicotine solution can be sprayed into the nostrils and nictoine gets absorbed quicker than with gum or patches. However, this method can take some getting used to and can also irritate the nose.
A glossary of some of the poisons found in tobacco smoke
- Carbon Monoxide (CO): a highly poisonous gas which is present in high concentrations in tobacco smoke. It reduces the ability of blood to carry oxygen to the body tissues, thereby starving them of oxygen. CO also affects the electrical conductivity of the heart muscle and combined with other changes, is likely to lead to fatty deposits on wall of arteries leading to blockage. This in coronary vessels leads to serious heart disease and in other vessels leads to peripheral vascular disease possible leading to gangrene and amputation.
- Tar: this toxic chemical is deposited into the lungs with every breath of tobacco smoke. There, it causes airways (bronchioles) to narrow, increases cough and reduces the lungs defences against disease and infection by a process called ciliastasis. Tar is also known to cause cancer.
- Benzene: this is a solvent and known to cause cancer and leukaemia.
- Ammonia: a highly toxic agent used in cleaning fluids such as bleach.
- Cadmium: a poisonous metal used in batteries and known to cause brain, kidney and liver damage.
- Formaldehyde: a preservative used for dead bodies, this poison causes cancer, skin, abdominal and breathing problems.
- Cyanide: a highly toxic gas which has been used in chemical weapons.
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