Smoking - The Facts

Cigarette smoking is the greatest single cause of illness and premature death in the UK. This leaflet gives reasons why smoking is so harmful. It also lists the benefits of stopping, and where to go for help.

Some initial facts and figures

About 100,000 people in the UK die each year due to smoking. Smoking-related deaths are mainly due to cancers, chronic obstructive pulmonary disease (COPD) and heart disease.

About half of all smokers die from smoking-related diseases. If you are a long-term smoker, on average, your life expectancy is about 10 years less than a non-smoker. Put another way, in the UK about 8 in 10 non-smokers live past the age of 70, but only about half of long-term smokers live past 70. The younger you are when you start smoking, the more likely you are to smoke for longer and to die early from smoking.

Many smoking-related deaths are not quick deaths. For example, if you develop COPD you can expect several years of illness and distressing symptoms before you die.

Smoking increases the risk of developing a number of other diseases (listed below). Many of these may not be fatal, but they can cause years of unpleasant symptoms.
The good news is:

•

• Stopping smoking can make a big difference to your health. It is never too late to stop smoking to greatly benefit your health. For example, if you stop smoking in middle age, before having cancer or some other serious disease, you avoid most of the increased risk of death due to smoking.

• Many people have given up smoking. In 1972 just under half of adults in the UK were smokers. By 1990 this had fallen to just under a third. At present, about a sixth of UK adults are smokers.

• Help is available if you want to stop smoking but are finding it difficult.

Fact :

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.

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 :

• Nicotine

This drug is absorbed readily into the blood and stimulates the nervous system to reduce the diameter of arterioles and the adrenal glands to release adrenaline. This increases heart rate and blood pressure and decreases the blood supply to the extremities - for example, the hands and feet.

Another effect is that platelets become stickier which, can lead to an increased risk of blood clots forming.

Nicotine is a drug that stimulates the brain. If you are a regular smoker, when the blood level of nicotine falls, you usually develop withdrawal symptoms, such as craving, anxiety, restlessness, headaches, irritability, hunger, difficulty with concentration, or just feeling awful. These symptoms are relieved by the next cigarette.

So, most smokers need to smoke regularly to feel normal, and to prevent nicotine withdrawal symptoms.

•Tar which contains many chemicals

This is a mixture of aromatic substances, which settles on the airway linings and stimulates changes that may lead to obstructive lung disease and lung cancer.

• Carbon monoxide

This gas diffuses across the alveoli into the blood and onto the red blood cells, combining with haemoglobin to form carboxyhaemoglobin. This stops the haemoglobin from becoming fully saturated and so it carries 5-10% less oxygen.

This places a strain on the heart as the heart muscle receives less oxygen and carbon monoxide can damage directly, the linings of arteries.

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.

Which diseases are caused or made worse by smoking?

• Lung cancer. About 30,000 people in the UK die from lung cancer each year. More than 8 in 10 cases are directly related to smoking.

• Chronic obstructive pulmonary disease (COPD). About 25,000 people in the UK die each year from this serious lung disease. More than 8 in 10 of these deaths are directly linked to smoking. People who die of COPD are usually quite unwell for several years before they die.

•Heart disease. This is the biggest killer illness in the UK. About 120,000 people in the UK die each year from heart disease. About 1 in 6 of these is due to smoking.

• Other cancers - of the mouth, nose, throat, larynx, gullet (oesophagus), pancreas, bladder, cervix, blood (leukaemia), and kidney are all more common in smokers.

• Circulation. The chemicals in tobacco can damage the lining of the blood vessels and affect the level of lipids (fats) in the bloodstream. This increases the risk of atheroma forming (sometimes called hardening of the arteries). Atheroma is the main cause of heart disease, strokes, peripheral vascular disease (poor circulation of the legs), and aneurysms (swollen arteries which can burst causing internal bleeding). All of these atheroma-related diseases are more common in smokers.

• Sexual problems. Smokers are more likely than non-smokers to become impotent or have difficulty in maintaining an erection in middle life. This is thought to be due to smoking-related damage of the the blood vessels to the penis.

• Rheumatoid arthritis. Smoking is known to be a risk factor for developing rheumatoid arthritis. One research study estimated that smoking is responsible for about 1 in 5 cases of rheumatoid arthritis.

• Ageing. Smokers tend to develop more lines on their face at an earlier age than non-smokers. This often makes smokers look older than they really are.

• Fertility is reduced in smokers (both male and female).

• Menopause. On average, women who smoke have a menopause nearly two years earlier than non-smokers.

• Other conditions where smoking often causes worse symptoms include: asthma, colds, flu, chest infections, tuberculosis, chronic rhinitis, diabetic retinopathy, hyperthyroidism, multiple sclerosis, optic neuritis, and Crohn's disease.

• Smoking increases the risk of developing various other conditions including: dementia, optic neuropathy, cataracts, macular degeneration, pulmonary fibrosis, psoriasis, gum disease, tooth loss, osteoporosis and Raynaud's phenomenon.

Smoking in pregnancy increases the risk of:

-- Miscarriage.

-- Complications of pregnancy, including bleeding during pregnancy, detachment of the placenta, premature birth, and ectopic pregnancy.

-- Low birthweight. Babies born to women who smoke are on average 200 grams (8 oz) lighter than babies born to comparable non-smoking mothers. Premature and low birthweight babies are more prone to illness and infections.

-- Congenital defects in the baby - such as cleft palate.

-- Stillbirth or death within the first week of life - the risk is increased by about one-third.

-- Poorer growth, development, and health of the child. On average, compared with children born to non-smokers, children born to smokers are smaller, have lower achievements in reading and maths, and an increased risk of developing asthma.

How does smoking affect other people?

• Children

Children and babies who live in a home where there is a smoker:

• Are more prone to asthma and ear, nose and chest infections. About 17,000 children under five years old in England and Wales are admitted to hospital each year due to illnesses caused by their parents' smoking.

• Have an increased risk of dying from cot death (sudden infant death syndrome).

• Are more likely than average to become smokers themselves when older.

• On average, do less well at reading and reasoning skills compared with children in smoke-free homes, even at low levels of smoke exposure.

•Are at increased risk of developing COPD and cancer as adults.

Passive - 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.

Other problems with smoking

•Your breath, clothes, hair, skin, and home smell of stale tobacco. You do not notice the smell if you smoke, but to non-smokers the smell is obvious and unpleasant.

• Your sense of taste and smell are dulled. Enjoyment of food may be reduced.

• Smoking is expensive.

• Life insurance is more expensive.

• Finding a job may be more difficult as employers know that smokers are more likely than non-smokers to have sick leave. More than 34 million working days (1% of total) are lost each year because of smoking-related sick leave.

•Potential friendships and romances may be at risk. (Smoking is not the attractive thing that cigarette advertisers portray.)

How can I stop smoking?

About 2 in 3 smokers want to stop smoking. Some people can give up easily. Willpower and determination are the most important aspects when giving up smoking. However, nicotine is a drug of addiction and many people find giving up a struggle. Help is available:

• GPs, practice nurses, or pharmacists can provide information, encouragement, and tips on stopping smoking. Also, throughout the country there are specialist NHS Stop Smoking Clinics which have a good success in helping people to stop smoking. Your doctor may refer you to one if you are keen to stop smoking.

• Various medicines can increase your chance of quitting. These include Nicotine Replacement Therapy (NRT) which comes as gums, sprays, patches, tablets, lozenges, and inhalers. You can buy NRT without a prescription. Also, medicines called bupropion (trade name Zyban®) and varenicline (trade name Champix®) can help. These are available on prescription. See separate leaflets called 'Smoking - Nicotine Replacement Therapy', 'Smoking - Helping to Stop with Bupropion' and 'Smoking - Helping to Stop with Varenicline'.

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. Don't allow yourself to be tempted.

Don't 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.

What are the benefits of stopping smoking?

The benefits begin straight away. You reduce your risk of getting serious disease no matter what age you give up. However, the sooner you stop, the greater the reduction in your risk.

If you have smoked since being a teenager or young adult:

• If you stop smoking before the age of about 35, your life expectancy is only slightly less than people who have never smoked.

• If you stop smoking before the age of 50, you decrease the risk of dying from smoking-related diseases by 50%.

But, it is never too late to stop smoking to gain health benefits. Even if you already have COPD or heart disease, your outlook (prognosis) is much improved if you stop smoking.
Timeline of health benefits after stopping smoking ...

After ...	Health Benefit ...
72 hours	Breathing becomes easier. Bronchial tubes begin to relax and energy levels increase.
1 month	Skin appearance improves, owing to improved skin perfusion.
3-9 months	Cough, wheezing, and breathing problems improve and lung function increases by up to 10%.
1 year	Risk of a heart attack falls to about half that of a smoker.
10 years	Risk of lung cancer falls to about half that of a smoker.
15 years	Risk of heart attack falls to the same level that it would be for someone who has never smoked.

Other benefits of stopping smoking include the following:

•Chest infections and colds become less frequent.

• The smell of stale tobacco goes from your breath, clothes, hair, and face.

• Foods and drinks taste and smell much better.

• Finances improve. You will save well over £1,000 per year if you smoked 20 a day.

• You are likely to feel good about yourself.

• Clearer complexion and whiter teeth

• improved breathing and general fitness

•loss of smokers cough

• lack of worry over damage smoking is doing to your health

• less risk of smoking-related diseases

• improved life expectancy

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

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