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7.Risks of smoking

CIGARETTE SMOKING IS THE BIGGEST RISK FACTOR FOR SUDDEN DEATH. THE BEST ADVICE IS: IF YOU SMOKE – QUIT; IF YOU DON`T SMOKE - DON’T START

Question: I have smoked since my teens just as my father and grand father did. My father is still alive and my grandfather lived until he was 65. What are my risks of heart disease?

Answer: There is overwhelming evidence that smoking causes hardening of the coronary arteries as well as hardening of your arteries to the brain and legs; this hardening leads to narrowed arteries and thus poor blood flow to your heart. It also leads to chronic lung diseases as well as lung cancer, and increases your chances of developing a stomach ulcer. Whilst some people escape the consequences of cigarette smoking, the majority do not.

Question: There is a lot of talk about the harmful effects of passive smoking. Can other people’s smoke really harm me?

Answer: Smoking harms any non-smokers who are breathing in the same air as a smoker, increasing their chance of heart and lung disease.

It may also cause sore red eyes, headaches and make asthma worse.

This has become known as passive smoking. Children brought up in a household of smokers suffer more infections and disease, compared to those who live in non-smoking households.

Question: The government gives us dire warnings about smoking but I know many people who smoke who are in their seventies or eighties. Are the statistics regarding the harmful effects of smoking really as bad as the press makes out?

Answer: Yes. Smoking causes one in five deaths in our population and at least a third of these are due to heart disease. This means that, in each of the most developed countries of UE, smoking kills over 100000 people a year. It kills 90% of the 40000 who die from lung cancer, 75% of the 20000 who die from chronic lung disease such as emphysema, and 25% of the 117000 who die each year from coronary artery disease. Smoking respects no one – it is an equal opportunity killer attacking both sexes and all races. Out of the total number of people who smoke, a quarter will die early as a result, losing an average 10-15 years of life. Worldwide, smoking kills three million people a year. This is predicted to increase to 10 million by 2025, which means that 200 million of today’s children and teenagers will be killed by tobacco. Add these to today’s adults and we get a staggering half a billion of the world’s population being killed by tobacco – 250 million dying young (aged 35-69 years) and each person losing 20 years of expected life. Many people die only after a long disabling disease.

Question: I have changed to a low-tar brand of cigarettes, with a filter. Why will smoking be so harmful to me now?

Answer: Components of tobacco, such as tars, are harmful to your health but the main cause is the nicotine in cigarettes as this is an addictive drug. Nicotine increases your heart rate and blood pressure making your heart work harder, whilst at the same time narrowing the arteries. Oxygen is removed from the blood and replaced with carbon monoxide. Carbon monoxide reduces the ability of the blood to carry oxygen and, in heavy smokers, may reduce it by as much as 50%. We have all read of tragedies caused by faulty gas heaters-carbon monoxide build-up is the cause. This means that there is less energy circulating to your heart to cope with the demands that nicotine places on it. The carbon monoxide level in the blood after smoking one cigarette exceeds the legal limit for pollution allowed in industry by eight times. Low tar cigarettes are nice in theory, because it is the tar in cigarettes that causes lung cancer, but actually they make matters worse in that most low tar smokers inhale deeper and increase their carbon monoxide and nicotine blood levels. Smoking can cause roughening of the smooth lining of your arteries (the endothelium) and this may lead to the development of narrowed areas in the arteries caused by fat being deposited there.Smoking lowers the good cholesterol known as the high density lipoprotein (HDL) (see the section Risks of high cholesterol levels) and increases the blood ingredient (fibrinogen) that promotes clotting. Smoking therefore not only cause hardening of your arteries but increases the chance of clots forming on the narrowed areas and thus a heart attack.

Question: I have tried again and again to give up smoking. Are there any ‘safe’ cigarettes?

Answer: No. All cigarettes, ‘light’ or not, are just as harmful to your heart. Filters have no advantages and may actually increase the carbon monoxide inhaled. Changing to low tar/nicotine cigarettes may reduce your risk of lung cancer, but not heart disease, and it is heart disease that is the major killer.

Question: I cannot stop smoking. Would it help if I just cut down on my smoking?

 Answer: Yes, but there is no such thing as safe smoking. Smoking five cigarettes a day doubles your risk of heart disease and smoking 20 a day increases your risk by at least 10 times. Reducing the number of cigarettes smoked helps, but quitting is better.

Question: Both my husband and I smoke one pack of cigarettes a day. I have recently read that women are as much at risk as men. Is this true?

Answer: Yes and, if anything, more so. Women seem to be more sensitive to the effects of cigarettes, so for a similar number smoked (20 per day) you are twice as likely as your husband to develop coronary artery disease. Smoking is especially dangerous if you are on the contraceptive pill, particularly if you are aged over 35 years or have been continuously on the pill for 5 years or more.

Women who smoke have almost four times as great a risk of heart attack but, three years after quitting, the risk is the same as for non-smokers.

Question: If I could stop smoking, would this do any real good?

Answer: The benefits of stopping begin quickly. By 24 hours the carbon monoxide is eliminated from the blood and the lungs begin to clear the mucus. Smell and taste improve by 48 hours. By 3 months, breathing is easier as the circulation improves, making exercise easier.

By one year, the risk of a heart attack is halved, and four to five years after quitting smoking your risk of heart disease will be the same as for a non-smoker. Stopping smoking is one of the most important actions you can make – not starting is the best educational message of all. The benefit to your lungs regarding cancer takes longer - about 20 years in total, but the risk is halved by 10 years.

Question: I am 58 and have been smoking for many years. Is it ever too late to stop?

 Answer: No. The benefit to your heart is rapid and helps you, no matter what your age.

Question: My girlfriend has suggested that I change to a pipe as she is convinced that pipes and cigars are safer than cigarettes. Is this true?

Answer: Smoke from pipes and cigars contains a higher concentration of tar and nicotine compared with cigarettes, but pipe and cigar smokers usually inhale less than cigarette smokers so the risks are less, but they are still greater than in non-smokers. Cigarette smokers who switch to a pipe usually inhale the smoke automatically, thereby not significantly reducing their risks. Inhaling from a large cigar is the same as inhaling from a pack of 20 cigarettes! Studies have shown that smokers who switch to pipes and cigars,

and don’t inhale, reduce their risks of lung cancer and heart disease by 50%, but the risk is still 50% higher than quitting altogether. However, by not inhaling, pipe and cigar smokers increase the risk to non-smokers from passive smoking. The best option is not to smoke at all. The principal reason pipe smokers have less risk is that they spend most of their time trying to light the pipe rather than puffing on it!

Question: I have tried to stop smoking but always lapse. What can I do to quit smoking and avoid the temptations?

 Answer: Stopping smoking is difficult but it is the biggest single improve ment to your health that you, as a smoker, can make. Some people find that reading a book on quitting gives them the confidence that they need to actually stop. There are some suggestions on end of the course that may be helpful.Cutting down is a help but only if your aim is to stop completely (see question above). Remember that after 3–5 years you will have your heart’s health back. Here are some guidelines to help you.

1.  Make a list of your reasons for stopping, keep it with you and read it every day. The best reasons are:

 

  • It is bad for my health;
  • The cough is unpleasant;
  • My clothes always smell;
  • It is expensive;
  • I cannot taste my food;
  • Non-smokers are upset by my smoking.

 

2. Set a day to stop or take part in a sponsored ‘stop’ with friends or business colleagues.

3. Take time for exercise, drink plenty of water and have plenty of fresh fruit to hand (not cakes or biscuits).

4. Each day place the money saved to one side and put it into a savings account. After 1 week you will have saved over 30 Euros, by 1 month over 120 Euros, and by 6 months at least 720 Euros, which you can spend on a well-earned holiday. Put another way, if you place the price of a packet of cigarettes at around 4 Euros per day into an individual savings account (ISA), after 20 years the fund could be worth 44100 Euros (at 6% interest). In a pension plan, it could give you 4,350 Euros (at 7% interest) per year in extra annual income! The more the price rises, the move you will save. Of course, if you carry on smoking, you may never reach your pensionable age.

5. Be disciplined and don’t talk yourself into smoking ‘to calm me down’. If the craving is unbearable, go for a brisk walk, relax with a hot bath and drink plenty of water.

6. Think positively.

7. Don’t carry matches or a lighter.

8. Go to the dentist and have your teeth cleaned to get rid of the tobacco stains.

9. Keep being positive, keep reading your reasons for quitting, reward yourself with a treat after your first week of not smoking – you’ve saved enough money, so go ahead!

10. Avoid certain activities that are linked with smoking:

11.  Try to avoid alcohol and take a drink that is not associated with smoking, such as a tomato juice.

12. After a meal, instead of a cigarette, clean the tables, washes up, brushes your teeth and go for a walk.

13. Do not have cigarettes in the car; have chewing gum to hand instead.

14. Outside many coutries, avoid smoky restaurants and bars.

15. Holiday in some countries where smoking is not allowed in public places.

16. Tell your smoking friends that you will be unavailable other than on the ’phone, unless they are giving up as well.

17.  Keep your hands busy (fiddles with paper clips, write a letter, do the crossword, clean the car, help in the garden or with the housework).

18.  Use sugarless chewing gum to replace the urge to put a cigarette in your mouth.

19. Take deep breaths, relax your muscles, and think of anything but cigarettes, for example your holiday plans or a previous happy experience.

20. Remove everything from the house that reminds you of cigarettes: get rid of your ashtrays and matches, then have a spring clean to remove all the smell and stains of smoking, open the windows and let the fresh air circulate.

If you tell yourself you don’t want to smoke rather than wishing you could smoke, you can reinforce this by noticing that your breath is better, your clothes are cleaner, the car smells better, food tastes again and that early morning cough has improved or stopped! Remember the 10 million people who have already broken the habit. The first few days are always the worst, so it does get easier! Remember that you will save over 1,825 Euros a year.

Question: I’ve given up smoking but I am afraid that I might begin again. Will it put me back to square one if I start again?

Answer: Try to avoid the urge but, if you do slip, don’t despair: you can get back the ground you’ve lost, but you must act quickly. It is not a crime, you are not a failure, and you must not feel guilty. Look for the reason: were you tense or stressed? Were you upset or angry? Were you in a situation that you automatically associated with smoking? Then take action to avoid it happening again.

Question: I have heard that meditation can help people to stop smoking. Do you think it works and is it worth the effort?

 Answer: Alot of people benefit from learning to relax and meditate. It is particularly useful in times of stress. Relaxation tapes are available and can be helpful, as can relaxing music. A friend of mine went to an acupuncturist to help her stop smoking and she has not smoked now for some months.

Question: I have also read that hypnosis can help. Do you think that any of these methods is any good?

Answer: There is no trial (research) evidence that acupuncture or hypnosis is effective in helping people stop smoking. However, if you are struggling, it may be worth trying either or both as they are popular with smokers and people can be helped by unproven methods. Make sure that you go to registered practitioners and keep an open mind. Always enquire about the cost before treatment begins.

Question: I don’t do much exercise. Would exercise help me to give up smoking?

Answer: Exercise is very helpful. It not only improves your overall physical condition, but it is also a great way of relieving stress and improving your mood. It takes your mind off cigarettes as well as helping to control your appetite and weight. Before you exercise, practise deep breathing and repeat this as you cool down afterwards. Dynamic exercise is best and this includes walking as briskly as possible, cycling, swimming and playing tennis or golf.

Question: I know people who have given up smoking, but then put on weight. How can I avoid this?

Answer: People who smoke are on average 3-4 kg (7-8 lb) lighter than nonsmokers.

It is, however, the wrong way to stay slim. When you stop it doesn’t automatically mean your weight will go up, but gaining 1kg (2-3 lb) is not as important as quitting cigarettes.

Weight is gained when you eat more than you burn up. The trick is to watch what you eat and take up regular exercise. You need to plan positively not to let it happen. Eat fresh fruit and vegetables; avoid cakes, chocolate and biscuits; use wholegrain cereals, porridge without sugar, pasta and bread; and drink plenty of water or low calorie drinks. You will not control your weight unless you match your intake with regular exercise – you must do both. Think of it as a lifestyle change, not a diet.

It is not a good idea to stop smoking just as you go on holiday, as there will be a temptation to overeat anyway. Weigh yourself no more than once a week, at the same time of day and in the same or no clothing, to monitor your progress. Try not to become obsessed by weight. Do not start to smoke if your weight goes up; watch what you are eating and take plenty of exercise. I’ve not yet tried quitting as I am frankly unable to cope with going cold turkey.

Question: What can I expect as withdrawal symptoms when I stop smoking?

Answer: There is often a worsening of the smoker’s cough until all the rubbish is out of your lungs. You may feel thirsty, in which case drink water and avoid caffeinated drinks and excess alcohol. Some people become constipated and hungry, and this is helped by fresh fruit and a high fibre diet. Some people become anxious, irritable and have difficulty concentrating – these feelings may last up to 4 weeks but are worse in the first 2 weeks. Drink plenty of water and take regular exercise; try to fill your time with positive activities.

Question: I have seen adverts for nicotine gum and patches. I smoke about 20 a day. Would nicotine replacement help me?

Answer: Some people are so addicted to nicotine that they need to be weaned off – they tend to be the people who need their first cigarette within 30 minutes of waking in the morning.

There are five sorts of nicotine replacements.

1. The patch is like a thin plaster, which slowly gives out nicotine through the skin. It does not help if you have a sudden craving but, if you normally smoke steadily over a day, it will almost certainly suit your needs. Studies have shown that people using the patch, compared to those using a dummy patch (with no nicotine), had twice the success rate in stopping smoking. Patches come in different strengths, and heavy smokers (over 20 a day) may need to start high, weaning down to lower strengths over 2–4 weeks. Common products are Boots and Nicorette (5, 10 and 15 mg) and Nicotinell and NiQuitin CQ (7, 14 and 21 mg).

2. Nicotine gum, inhalator, tablet or nasal spray help you respond to a sudden craving because they act quickly – so you may be more likely to need these if you smoke in response to sudden stress. Boots, Nicorette and Nicotinell gum (flavoured or plain) come in two strengths, 2 and 4 mg, and can be bought in chemist shops. Again, heavy smokers may need to start with the 4 mg strength; 8–12 pieces of either strength each day are recommended starting doses.

3. The Nicorette nasal spray is prescription only (one spray each nostril up to twice an hour for 16 hours in every 24).

4. Boots and Nicorette inhalators consist of a mouthpiece and replaceable nicotine cartridge – you should suck the nicotine vapour into the mouth (it does not reach the lungs). Each cartridge provides up to three 20-minute periods of intense use, and you may need 6–12 cartridges a day for 8 weeks, reducing to zero over the following 4 weeks. These can be bought in chemist shops.

5. The Nicorette tablet (Microtab) is placed under the tongue and dissolves over 30 minutes, providing 1 mg of nicotine from a 2mg tablet. You may need one or two every hour at first, and they can be bought in chemist shops.

The instructions must be followed carefully, and any concerns should be discussed with your family doctor or chemist. Do not use nicotine products if you are pregnant or breastfeeding.

Question: Are there any side effects to the nicotine preparations?

Answer: For most people, side effects are not a problem. The gum may be awkward if you have dentures, and the patches may cause the skin to itch, so you may need to move them to a different place each day. The nasal spray may irritate the nose and throat and make your eyes water; the inhalator may cause a cough or irritation of the throat. The tablet can mildly irritate the mouth, but this tends to wear off with use. Sleep disturbance, vivid dreams, flushing or rashes, and nausea sometimes occur.  Nicotine can upset a stomach (peptic) ulcer, so, if you are on treatment for an ulcer, check with your doctor first. If you have a history of heart attack, stroke, high blood pressure, diabetes or hardening of the arteries generally, check with your doctor first. If you are taking warfarin, inform your clinic, as there may be an interaction between the two drugs. Too much nicotine may make you feel sick, so do not smoke at the same time as using gum or patches. Whilst combining nicotine preparations is not recommended by the manufacturers, some studies have shown improved success rates when the gum and patches, or the nasal spray and patches, are combined. Only do this after getting your doctor’s advice.

Question: Can I become addicted to the nicotine patches?

Answer: This is not a problem with the patches. However, the gum, spray, tablet or inhalators, which deal with cravings, may need to be used for over a year. When you are trying to stop using nicotine replacements, wean off gently to avoid a withdrawal reaction. You will be more successful if you combine nicotine replacement with the support of smokers’ clinics and family, rather than going it alone.

Question: How much do these products cost?

Answer: These are the approximate costs for 3 months, if you are paying yourself.

• Boots 2mg gum 120 Euros

• Nicorette inhalator 300 Euros

• Nicorette spray 110 Euros

• Nicorette patches up to 150 Euros

You will save your money and your life for many years ahead – think of this cost as a down payment towards better health. The good news is that nicotine replacement therapy is now approved by the National Health Service and is regarded as the drug treatment of choice. The family doctor and the patient must follow an agreed protocol and set a target stop date before a prescription is allowed.

Question: I have been trying to find a support group – can they help me?

Answer: They certainly help. You will feel less alone, get support and help from others and be amongst people all trying to succeed. Some developed countries have the service “QUITELINE”. Check with your local health authority for locations. QUITLINE  provides trained counsellors to give advice, support and encouragement

Question: Are herbal cigarettes or dummy cigarettes worth trying?

Answer: Dummy cigarettes, such as Crave Away, Flowers or Everlasting Cigarettes, are neither harmful nor proven to be effective. Herbal cigarettes do not contain nicotine but still expose your body to tar and carbon monoxide, and are of no proven value.

Question: Would it be better if I used a filter?

Answer: Filters can be a good idea, but unfortunately do not work for most people. Nicobrevin may help in the first weeks but should not be relied on as a long-term prop. It should be avoided if you are pregnant. Note that filters remove some of the tar but little of the risk of heart disease!

Question: Why do some people smoke like chimneys but live a long life all the same?

Answer: Most people know someone like this. It is all about statistics: if 90% of people die from smoking, then 10% won’t. The point is that the odds are against you, and trying to get away with it, or believing it can’t happen to you, is courting disaster.

If someone introduced a product onto the market now that was addictive, removed oxygen from your blood, caused blood clotting, heart attacks and lung cancer, do you think they would get a licence?

Question: I have heard a lot about Zyban. Does it help stop smoking and how does it work?

Answer: Zyban is the trade name for the drug buproprion. It is a drug used to treat depression but it was also found to help people stop smoking. How it does this is unclear but it seems to reduce the urge for nicotine and is effective for some people. It should be started 1–2 weeks before the target stop date and continued for 7–9 weeks after. It should not be used in anyone with a history of seizures (fits) or eating disorders. It also has the potential to react with some drugs. Zyban should only be used after careful discussion with your family doctor – it is available on NHS prescription.

Question: One of my friends is taking Champix – does it work?

Answer: Champix is one of the trade names for varenicline, a new prescription-only drug which acts like nicotine and so reduces the craving for smoking. It has been shown to be very effective. You need to start it 1–2 weeks before the target stop date you agree with your doctor. The course of the treatment is about 3 months and can be repeated to prevent a relapse, though the evidence to support this is limited. Side effects include stomach upsets, dry mouth, taste disturbance, headaches, sleep disturbance, dizziness and abnormal dreams. If stopped suddenly, irritability and depression can occur.

There are reports of hallucinations, suicidal thoughts and reports of suicide after starting varenicline. No definite connection with Champix has been made, but any change in mood or behaviour should be reported to your doctor.

Question: I had a heart attack a year ago when I was 61. Is it too late to stop smoking?

Answer: It is never too late. Stopping smoking after a heart attack reduces by half your chance of having another one in the next 5 years. Stopping smoking after a heart bypass operation reduces your chances of a bypass failure over the next 10–15 years and helps prevent further disease developing.

Question: What is a smoking cessation clinic – is it worth a try?

Answer: Special clinics and specially trained nurses and smoking cessation advisors provide support and achieve high success rates in smoking cessation (quitting). Support is usually given in groups over 6 weeks and most services also offer one-to-one counselling. Clinics take direct referrals from those wanting to stop (in a walk-in service) as well as working in partnership with family doctors. They are recommended for heavily dependent smokers needing intensive support or pregnant women especially. However, they are available to all, either in a clinic setting or as part of a local primary care service. Stopping smoking is so important: if you are having any difficulty, certainly give them a try.

 

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