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Quitting smoking

 

If you smoke, giving up is probably the greatest single step you can take to improve your health.

Smoking in Ireland

It is estimated that there are about 1 million people who smoke regularly in Ireland.

Levels of smoking are highest in younger adults aged 20-34 and lowest in adults aged over 60.

Smoking in children

 
The Health Behaviour in School-aged Children(HBSC) study reported in 2006 that 15% of children were smokers.This represented a reduction from the 2002 figure of 18.6% .This is still worrying as the longer a person smokes, the more likely it is that they will die from a smoking-related disease.

Impact on health

Smoking's impact on public health is huge. In Ireland in 2008, smoking was responsible for 36,000 hospital admissions costing €280 m.

Smoking is responsible for over 5,000 deaths in each year in Ireland and half of all long-term smokers will die prematurely due to a smoking-related disease.

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

Smoking and the law

Since March 2004, virtually all enclosed public places and workplaces in Ireland 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.Breaches of the legislation can lead to fines of up to €3000.

It is illegal to sell tobacco to anyone under the age of 18. 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 buying alcohol.

Getting help

Around 70% 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.

For information and support in quitting smoking you can

·       Visit www.quit.ie the HSE Quit website which aims to encourage smokers to quit. The website includes a Quitplan which you can sign up to that will support you during the quitting process.

·       Join www.facebook.com/HSEquit

·       Call the National Smokers Quitline 1850 201 203

·       Contact your local HSE smoking cessation counsellor (see www.quit.ie)

·       Talk to your GP or Pharmacist who may advise on using nicotine replacement therapy or other medications to help you make that quit attempt successful.

 

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). 

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:

Cancer

Smoking is responsible for 85-90% of all cases of lung cancer, which is the second most common type of cancer in Ireland and the leading cause of cancer-related deaths. Over three years between 2005 and 2007, there were over 2400 deaths in Ireland as a result of lung cancer.

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

Respiratory diseases

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

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.

An estimated 440,000 people in Ireland live with COPD.

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 Ireland, 10,000 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:

Cardiovascular diseases are a leading cause of death, with an estimated 10,000 people dying due to a cardiovascular disease each year in Ireland

Other conditions

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

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. 

No such thing as a safe limit

Some people who smoke only occasionally wrongly believe they are not threatening their health.

Exposure to cigarette smoke is always dangerous, whether you are a social smoker who just smokes one to two cigarettes on a night out, or whether you only smoke tobacco when you mix it with cannabis to make a joint (homemade cigarettes mixed with cannabis).

For example, if you only smoke one cigarette a day, you are still 30% more likely to develop coronary heart disease compared with a non-smoker.

And while cannabis smokers tend to smoke less than tobacco smokers, they usually inhale more deeply and hold the smoke in their lungs for longer.

One researcher has estimated that smoking four joints may be as damaging to the lungs as smoking 20 cigarettes. 

 

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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No such thing as a safe limit

Some people who smoke only occasionally wrongly believe they are not threatening their health.

Exposure to cigarette smoke is always dangerous, whether you are a social smoker who just smokes one to two cigarettes on a night out, or whether you only smoke tobacco when you mix it with cannabis to make a joint (homemade cigarettes mixed with cannabis).

For example, if you only smoke one cigarette a day, you are still 30% more likely to develop coronary heart disease compared with a non-smoker.

And while cannabis smokers tend to smoke less than tobacco smokers, they usually inhale more deeply and hold the smoke in their lungs for longer.

One researcher has estimated that smoking four joints may be as damaging to the lungs as smoking 20 cigarettes. 

 

 

 

For information and support in quitting smoking you can

  • Visit www.quit.ie the HSE Quit website which aims to encourage smokers to quit. The website includes a Quitplan which you can sign up to that will support you during the quitting process
  • Join www.facebook.com/HSEquit
  • Call the National Smokers Quitline 1850 201 203
  • Contact your local HSE smoking cessation counsellor (see www.quit.ie)
  • Talk to your GP or Pharmacist who may advise on using nicotine replacement therapy or other medications to help you make that quit attempt successful

Treatment and support from your GP

If you do not want to be referred to a smoking cessation service 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.Nicotine replacement therapy is available over the counter in your pharmacy but you will need a prescription from your GP to get it free on the medical card.

Treatment and support from a Smoking Cessation Advisor

One-to-one support

This form of intensive support combined with drug treatments has the highest success rates. This service is usually free of charge and is run by health services. Smoking cessation advisors are specially trained to support you through the quitting process. You can attend smoking cessation clinics for one-to-one sessions that are tailored to meet your needs. They usually take place for 1-4 weeks before your quit date and continue for up to one year after you quit.

These sessions will:

  1. look at your desire and readiness to quit,
  2. take a history of your smoking habit,
  3. assess your nicotine addiction,
  4. identify your reasons for quitting and any difficulties or risks of relapse,
  5. create a personal plan for your quitting,
  6. measure your carbon monoxide levels,
  7. recommend suitable medical treatment, refer you to doctor for prescription and follow-up.

Contact the National Smokers’ Quitline on callsave 1850 201 203 to talk to an advisor or to find you nearest HSE stop smoking service.

Group support

Group courses are usually six weeks long and meet once a week for about an hour. They are usually run by smoking cessation advisors and can be very effective. In the first session the members of the group introduce themselves, they review past attempts to quit, determine reasons for quitting and set a quit date for the group. At follow-up meetings, members discuss their progress, address any difficulties, swap coping tips, and encourage one another to stay quit. The advisors will measure each member’s carbon monoxide levels (before and after quitting), their level of nicotine addiction, and recommend medical treatment. Contact the National Smokers’ Quitline on callsave 1850 201 203 to talk to an advisor or to find you nearest HSE stop smoking service.

Self-help

There are leaflets and books available which give you information on how to give up, what to expect when you give up smoking, the health effects of smoking and tips on how to stay stopped. Others focus on changing your attitude towards smoking. These are better than having no form of support but you are more likely to succeed with one-to-one or group support.

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 like plastic 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's health 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 under 18
  • 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.

Nicotine-assisted reduction

If you do not yet feel ready to stop smoking completely, your GP may suggest a method of quitting known as nicotine-assisted reduction to stop. This involves using NRT to progressively reduce the number of cigarettes you smoke, before eventually stopping smoking altogether.

If your GP suggests using nicotine-assisted reduction to stop, you will be prescribed NRT gum or an inhalator to use in between cigarettes. These forms of NRT are best for use between cigarettes because they release a short burst of nicotine rather than a steady, constant supply.

It is necessary to use short-release NRT when you are still smoking, because taking in the nicotine from your cigarettes combined with that from a steady-release NRT could make you feel very unwell.

For this reason, you must only use your prescribed NRT in between cigarettes to combat cravings.

You should also try and prolong your smoke-free intervals for as long as you can, and steadily reduce the number of cigarettes you smoke. By six weeks of NRT treatment, you should aim to have cut down on your usual cigarette consumption by half.

With the advice of your GP, you can stop smoking whenever you feel ready, but this should be no more than six months after the start of your NRT treatment.

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.

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.

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 9 euros a day (at 2011 prices). After six months of not smoking, you would have saved 1600 euros; enough to pay for a holiday for you and your family.

Craving
A craving is a powerful, often uncontrollable urge for a particular thing.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.