ABC of Vascular Disease

Smoking

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1. How does smoking cause illness?
Burning the tobacco in a cigarette generates dozens of chemical products in the smoke that, when inhaled into the lungs, are absorbed into the blood and distributed by the blood all around the body.  One of these chemicals is called nicotine and it is this that causes the pleasant "buzz" that smokers get.  Unfortunately, nicotine is an addictive drug, after a while the body cannot do without it.  The direct damage caused by smoking is not from the nicotine; it is the dozens of other chemicals in the tar that are absorbed into the body and which irritate and poison the bodies cells.  The delicate lining of the arteries is damaged by these chemicals and over time this causes the arterial disease.  These chemicals also get into other cells and interfere with them, sometimes damaging the cell growth regulation and resulting in uncontrolled growth: otherwise know as cancer.  Smoking is the commonest cause of lung cancer.  The problem with smoking is that, even though the smoker knows it is unhealthy, the addiction to nicotine makes it hard to give up.

2. Who is safe to smoke?
The simple answer is no-one.  However, some people are at much greater risk of serious illness than others.  If you already have symptomatic arterial disease, or a condition that is a risk factor for arterial disease (sugar diabetes, hyperlipidaemia, hypertension) then smoking is very, very bad for you.  Patients with respiratory disease are also at high risk (e.g. asthma, chronic bronchitis, emphysema).  The longer you smoke for and the more you smoke the greater the cumulative damage.  Occasionally you will hear of very old people who have smoked their whole lives: these are rare exceptions.  Most people who smoke for a long period of time will die younger and from a potentially very unpleasant smoking related disease than someone who doesn't!  

I3. If I stop smoking will the risk go away?
The good news is that, provided you don't already have a serious smoking related disease such as lung cancer, if you stop smoking your risk gradually returns to that of a non-smoker, but this takes about five years.  The other benefit you will get immediately is financial.  Smoking is very expensive.

4. What can I do to stop smoking?
Some people are able just to decide to stop and do so.  Others need some form of help to stop and to keep them from relapsing.  Much of smoking is a habit, and by changing the habitual behaviour it will be easier.  If other members of a household also smoke it is more difficult for one of the household to give up.  Psychological support from friends, family and support groups can be vital to success.  The craving caused by the nicotine addiction can be eased by using nicotine replacement therapy (NRT) that comes in the form of chewing gum, patches and cigarette-style inhalers.  NRT is now available on prescription.  There is also a drug that can help with nicotine withdrawal but this can only be used for a short period of time (3 months) and does have side effects, some of which are rare but potentially serious (epileptic fits).

5. Where do I go for help?
Your chemist or GP practice nurse will be able to give you information leaflets on stopping smoking.  There are lots of helplines as well, such as Quitline on 0800 00 22 00

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S.R.Dodds 2001

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