What are the risks of smoking?

• Cardiovascular disease. Cigarette smoking doubles the risk of developing coronary heart disease and quitting smoking can rapidly reduce it. One year after stopping smoking, the risk of dying from CAD is reduced by 50 per cent and continues to decline over time. In some studies, the risk of a heart attack was reduced to the rate of non-smokers within five years of quitting smoking.

• Pulmonary disease. Smoking increases the risk of chronic obstructive pulmonary disease. While much of the lung damage is not reversible, stopping smoking can reduce further injury and improve COPD-related chronic cough and phlegm production. In addition, asthma and sudden infant death syndrome are more common among children exposed to smoke. Cigarette smoking makes it more difficult to treat asthma.

• Cancer. Cigarette smoking is responsible for 90 per cent of cases of lung cancer. Quitting smoking reduces this risk within five years of stopping, although former smokers still have a higher lifetime risk of lung cancer than people who have never smoked. Stopping smoking may also reduce the risk of other cancers, such as head and neck, oesophagus, pancreas and bladder.

• Peptic ulcer disease. Cigarette smoking increases the risk of developing peptic ulcer disease.

• Osteoporosis. Smoking increases bone loss and the risk of hip fracture in women. Stopping smoking begins to reverse this risk after about ten years.

• Other diseases. Pregnant women who smoke have an increased risk of birth defects and of having an underweight baby. In addition, smoking causes premature skin wrinkling and increases the risk of impotence.

What are the risks of quitting smoking?

Generally, any risks of quitting smoking are far outweighed by the benefits. Nevertheless, it is reasonable to prepare for the discomforts of stopping:

• Withdrawal symptoms. They generally peak in the first three days and decrease over the next three weeks. They include difficulty sleeping, irritability, anxiety, and difficulty concentrating. Cravings may be brought on by situations associated with smoking, such as stress or drinking alcohol.

• Depression. It can be severe enough that it requires counselling or antidepressant medication and it can cause the person to start smoking again. Depression may also be a side effect of some medications taken to help quit smoking (see below).

• Weight gain. This can occur while stopping smoking because people tend to eat more after quitting. The average weight gain is eight to ten pounds. An exercise programme and eating a reasonable diet can minimise weight gain. The benefits of quitting smoking are much greater than the risk of gaining weight.

How do I quit smoking?

Smoking is recognised as a chronic, addictive disease.

Most people go through three or four trials at quitting before they permanently succeed. The following tips can help you:

• set a quit date

• reducing the number of cigarettes smoked before the quit date

• switch to a brand of cigarettes that is lower in tar before quitting, although this frequently causes the person to inhale more often or more deeply; low-nicotine cigarettes have no known benefits and are not recommended.

• tell family, friends, and co-workers about the plan to quit and ask for their support

• review previous quitting attempts. What worked and what did not? What contributed to relapse?

• prepare to deal with nicotine-withdrawal symptoms and factors/situations that trigger smoking

• make lifestyle changes to reduce stress and improve quality of life, such as starting an exercise programme or learning relaxation techniques

• minimise time spent with smokers

• keep substitutes (sugarless gum, carrots, sunflower seeds, etc) handy for when cravings develop

• avoid thoughts such as “having one cigarette will not hurt”. One cigarette typically leads to many more.

• self-help materials such as pamphlets, videos, information from healthcare providers; a telephone hotline; the internet and support groups can all be helpful

• talk to your healthcare provider about ways to quit via referral to a behavioural therapist and/or taking medication.

There are medications to help you to quit smoking, such as nicotine-replacement therapy.

Without nicotine, most people develop withdrawal symptoms. Nicotine replacement therapy is designed to reduce the intensity of such symptoms, but will not prevent them completely. Nicotine is available in several forms, including as a gum or lozenge, patch, nasal spray or inhaler. They are all similarly effective.

Combinations of these therapies are more effective than one form alone:

• Chantix generic. Varenicline is a prescription medication that works in the brain to reduce cigarette cravings.

It is associated with a low risk of suicidal thoughts and aggressive behaviour and may increase the chance of acute heart problems (likely outweighed by the benefits of quitting smoking).

• Bupropion (Zyban, Wellbutrin). An antidepressant that can be used to help stop smoking. It is not recommended for people with seizure disorder, head trauma, an eating disorder or alcoholism.

• Joe Yammine is a cardiologist at Bermuda Hospitals Board. He trained at the State University of New York, Brown University and Brigham and Women’s Hospital. He holds five American Board certifications. He was in academic practice between 2007 and 2014, when he joined BHB. During his career in the US, he was awarded multiple teaching and patients’ care recognition awards. The information herein is not intended as medical advice nor as a substitute for professional medical opinion. Always seek the advice of your physician. You should never delay seeking medical advice, disregard medical advice or discontinue treatment because of any information in this article