Patient information from BMJ

Quitting smoking

Last published:Sep 29, 2022

Smoking can damage your health in many ways, but it can be hard to stop. That’s because most people who smoke become addicted to nicotine, a chemical in tobacco. But there are treatments available that can help you stop smoking.

You can use our information to talk with your doctor or pharmacist and decide which treatments are best for you. 

Why should I stop smoking?

You probably already know that smoking is one of the worst things you can do for your health. Every year in the US about 500,000 (half a million) people die from diseases caused by smoking.

• Every time you breathe in smoke you breathe in poisons that harm your body. The tar and chemicals in tobacco smoke damage your lungs, making it harder to breathe.

• Smokers get more coughs and lung infections than nonsmokers. 

• You may get permanent lung damage, like chronic obstructive pulmonary disease (COPD) or lung cancer.

• Carbon monoxide from tobacco smoke gets into your blood and stops your blood carrying as much oxygen as it needs to. This puts a strain on your heart and can make you feel tired.

• Smoke damages your blood vessels and makes them narrower. This increases your chance of a heart attack or stroke.

• About half of all smokers die of a disease caused by smoking. The most common ones are lung cancer, heart disease, and strokes.

• As well as lung cancer, smokers are more likely to get cancer of the intestine, throat, pancreas, kidneys, bladder, or cervix.

• On average, people who smoke live about 16 years less than people who don't smoke.

Your smoke can also harm other people around you. This is called passive smoking or second-hand smoke.

For example, children's asthma is worse when they breathe in tobacco smoke. And smoking around children means they get more coughs, chest infections, and ear infections.

If you smoke when you’re pregnant you can damage your baby’s health.

What makes it so hard to stop smoking?

If you're addicted to nicotine and you go longer than usual without a cigarette you may feel depressed, irritable, anxious, unable to concentrate, or restless.

It's these feelings that make you reach for another cigarette. But once you break your addiction, you stop getting these withdrawal symptoms. You’ll stop needing a cigarette to feel better. 

Certain things seem to increase a person's chances of getting addicted to nicotine. These include:

• smoking as a teenager

• your genes

• family problems

• feeling depressed or having other mental health problems

• having substance abuse problems

• having parents who smoke.

What treatments are available?

The good news is that people stop smoking every day. And there are treatments that give you a better chance of stopping smoking than if you rely on willpower alone.

You may need to try several - or even many - times before you're able to stop smoking for good. But the important thing is to keep trying. It could save your life.

Professional help

Asking your doctor for help is a great first step. Research shows that getting advice, counseling, and support from a doctor, nurse, or counselor increases your chances of stopping successfully.

There are many different types of counseling. Here are some examples:

• One-off advice from your doctor, backed up with leaflets and the phone numbers of helplines

• A regular weekly session with someone trained to help people stop smoking (a nurse, psychologist, or counselor)

• Group therapy with a counselor, where you and other people meet regularly to share your experiences of giving up.

You may want to try other types of help as well as counseling: for example, taking medications. However, taking medications, including nicotine replacement products, is not recommended for pregnant or breastfeeding women.

Nicotine replacement therapy (NRT)

NRT products provide a small supply of nicotine to your body. If you use NRT it's recommended that you use it for up to three months after you stop smoking.

NRT comes as patches, gum, inhalers, lozenges, pills that you put under your tongue, and a nasal spray. You can buy these products from a pharmacy, or you might be able to get them on prescription from your doctor.

But if you've recently had a heart attack or you have an unusual heart rhythm (a condition called arrhythmia), you should talk to your doctor before trying NRT.

Some people get some side effects while using NRT. For example

• Nicotine gum can cause hiccups, an upset stomach, jaw pain, or dental problems

• Nicotine patches can cause itching where you've worn a patch, and

• Nicotine inhalers and sprays may irritate your mouth or nose.

But these side effects only last as long as you need to use the NRT products.

NRT products are not recommended if you are pregnant or breastfeeding, or if you are under 18 years old.

Medications

Bupropion is a medication usually used to treat depression, but it can also help people stop smoking. You will need a prescription from your doctor for this treatment.

You start taking bupropion one or two weeks before the day you plan to stop and continue taking it for seven to 12 weeks after you stop smoking.

Some antidepressants, including bupropion, may increase the risk of suicide or self-harm, especially in young people. If you are worried by any thoughts or feelings you have while taking bupropion, see your doctor.

If you're pregnant or breastfeeding you shouldn't take bupropion. Other people who should not take bupropion include:

• those with diabetes

• those aged under 18

• people with a history of seizures

• people with eating disorders, and

• people who take medications called monoamine oxidase inhibitors.

Varenicline is another drug than can help people stop smoking. You need a prescription from your doctor for this medication. It helps ease withdrawal symptoms and blocks the effects of nicotine if you start smoking again. It seems to be the most effective medication for helping people stop smoking. 

You start taking varenicline one or two weeks before you plan to stop smoking, and you take it for 12 weeks. If you stop smoking, you can continue taking it for an additional 12 weeks.

Varenicline can cause side effects in some people. The most common ones are nausea and vomiting, headaches, and sleep problems. 

You can't take varenicline if you are pregnant or breastfeeding, or if you are under 18.

Electronic cigarettes (vaping)

Many people prefer electronic cigarettes (e-cigarettes or vaping) to other NRT methods, because it is more like smoking a real cigarette. 

But, as well as nicotine, vaping products can contain many substances that could be harmful. So, vaping is not completely safe, and it's not as safe as other NRT methods.

Vaping is thought to be safer than smoking real cigarettes. But vaping hasn't been around for long enough to know about it's long-term effects.

If you're pregnant or breastfeeding

NRT and drug treatments are not recommended for women who are pregnant or breastfeeding.

But this doesn't mean that there isn't any help available. Doctors are really keen to help pregnant or breastfeeding women to stop smoking, so do ask for help. The recommended treatment will probably be counseling.

If you can't stop, try cutting down

Stopping smoking is hard - so hard that some people think they can't do it.

But if you don't think you can stop altogether, you can reduce the harm smoking does to you by smoking less (cutting down). And research suggests that people who start by cutting down often go on to stop smoking altogether.

Obviously the best thing for your health is not to smoke at all. But cutting down is the next best thing. Many people find that using NRT products helps them to smoke less. You can talk to your doctor about the approach that's best for you.

What to expect in the future

Giving up smoking is the best thing you can do for your health. Almost as soon as you stop smoking, your body starts to clear itself of the poisonous chemicals found in smoke. Here's what happens:

• Your blood pressure and pulse rate will drop within 60 minutes of stopping

• The amount of carbon monoxide in your blood will return to normal within 48 hours

• Your sense of taste and your sense of smell will improve within a few days

• Your blood circulation will improve in two to 12 weeks.

Stopping smoking reduces the chances that you'll get lung cancer or any of the other health problems that are linked with smoking. If you stop smoking before the age of 35, you avoid most of the health problems linked with smoking. But even if you stop after the age of 50, you reduce your chances of dying from a disease linked to smoking.

You may face some temporary problems when you stop smoking and are getting over your nicotine addiction. For example, some people feel depressed and anxious, or find it hard to concentrate. Some smokers who stop may get sore throats, coughs, and other cold symptoms.

But these symptoms seem to last for just a few weeks after you stop. For many people, the biggest drawback to stopping smoking is putting on weight. The average weight gain is about 10 pounds.

But you could work on a plan to minimize weight gain through better diet and exercise. In fact, many people choose to see stopping smoking as part of a more general approach to healthier living.

Where to get more help

If you want to stop smoking, your doctor is a good place to start. Doctors are more than happy to offer help to people who want to stop smoking. And they might be able to help you find a support group in your area.