If I could stop smoking, would this do any real good?
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 fiveyears 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 (Figure 2.2). The benefit to your lungs regarding cancer takes longer – about 20 years in total, but the risk is halved by 10 years.

I am 58 and have been smoking for many years. Is it ever too late to stop?
No. The benefit to your heart is rapid and helps you, no matter what your age.
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?
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!

I have tried to stop smoking but always lapse. What can I do to quit smoking and avoid the temptations?
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 book titles that may be helpful in Appendix 3.
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.
• 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.
•    Set a day to stop or take part in a sponsored ‘stop’ with friends or business colleagues.
•    Take time for exercise, drink plenty of water and have plenty of fresh fruit to hand (not cakes or biscuits).
•    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, by 1 month over £120, and by 6

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?
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.
I have heard that meditation can help people to stop smoking. Do you think it works and is it worth the effort?
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. I have also read that hypnosis can help. Do you think that any of these methods is any good?
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.
I don’t do much exercise. Would exercise help me to give up smoking?
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 (see Chapter 10).

I know people who have given up smoking, but then put on weight. How can I avoid this?
People who smoke are on average 3–4 kg (7–8 lb) lighter than non¬smokers. 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 (see Chapters 9 and 10). 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’. What can I expect as withdrawal symptoms
when I stop smoking?
T here 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 (see Chapter 9). 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 (see the question above).

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

•    Thepatch 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).
•    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 Nicotinellgum (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.


•    The Nicorettenasal spray is prescription only (one spray each nostril up to twice an hour for 16 hours in every 24).
•    Boots and Nicoretteinhalators 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.
•    The Nicorettetablet (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.

Are there any side effects to the nicotine preparations?
F or 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.
Can I become addicted to the nicotine patches?
This is not a problem with the patches. However, the gum, spray, tablet or inhalator, 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.

How much do these products cost?
These are the approximate costs for 3 months, if you are paying yourself.
•    Boots 2mg gum £120
•    Nicorette inhalator £300
•    Nicorette spray £110
•    Nicorette patches up to £150.

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.
I have been trying to find a support group – can they help me?
They certainly help. You will feel less alone, get support and help from others and be amongst people all trying to succeed. Phone QUIT on 020 7388 5775, or check with your local health authority for locations. QUITLINE (0800 00 22 00) provides trained counsellors to give advice, support and encouragement. The website is www.quit.org.uk (see Appendix 2).
There are now NHS helplines in England and Wales (0800 1690169), Scotland (0800848484) and Northern Ireland (0800 858585). Also try www.sickofsmoking.com to see what other smokers say. Other good sites are www.ash.org.uk andwww.givingupsmoking.co.uk.
Are herbal cigarettes or dummy cigarettes worth trying?
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.

Would it be better if I used a filter?
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!
Why do some people smoke like chimneys but live a long life all
the same?
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 awaywith 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?
I have heard a lot about Zyban. Does it help stop smoking and how does it work?
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.

One of my friends is taking Champix – does it work?
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.
I had a heart attack a year ago when I was 61. Is it too late to stop smoking?
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.

What is a smoking cessation clinic – is it worth a try?
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.