Giving up smoking

Smoking related diseases

Everyone we spoke to knew that smoking had health risks. Smoking increases the risk of over 50 serious health conditions and is one of the biggest causes of death and illness in the UK. Research in the early 1950s by Richard Doll and colleagues showed a clear link between smoking and lung cancer. Although smoking causes 85% of lung cancers (NHS Choices 2015), smoking is also associated with other cancers, including cancer of the mouth, larynx (voice box), oesophagus (gullet) and bladder. Smoking can also harm the heart and blood vessels, something that some people we spoke to seemed to know less about.

Some people were prompted to give up when a family member or friend contracted a smoking related disease.

Khan had not connected heart problems with smoking until his dad was taken to hospital.

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Khan had not connected heart problems with smoking until his dad was taken to hospital.

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Age at interview: 29

Sex: Male

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And before your Dad had his health problems…

Yes.

Had you made the connection between smoking and heart problems specifically?

How do… no, no, not really, I did and I didn’t. I think it did hit me then as well, but not as much. I think when my Dad had the problem then…

So when you were reading the leaflets in the hospital and so on…

Yes. Well I made a vow to myself, I promised my wife, I said, “You know, you started it. I should do it for myself, but you said something.” Partners in life, in life I think... certain things in life you have to compromise, you have to work as a team. You’ve got the spark, you’ve got to take it. Because if I was still smoking now, I don’t know, it would have caused me more problems. I think to myself I’ve done a really good thing that I’ve stopped. But when I was in that hospital I thought to myself, you know, it was the icing on the cake, looking at leaflet, them pictures and that they said to me when she looked… because I’m the only son… and she said to me, talk a bit about myself, and if I smoked and I said, “No, I’ve stopped.” And even as she said, “Stop.” And looking at leaflets, I thought to myself, whatever side effects or little time there might be, it might be a bit hard for me. I might be snappy, I might feel a bit weird, because you do, ‘cause you’re having a little change. But go for it, like what’s the problem, just take it at a month, and I stopped in April, yes, and then I used to get certificates as well over certain things. I just kept one, because I thought to myself, no point, just look back at it every time, that I have stopped smoking, and when did I stop smoking. So I’d just kept the first month – one. So it was a big thing that my Dad had to go to hospital. I had to look at the leaflets, I spoke to the nurse, looked at my wife, and the doctor, and was like you know what, I don’t want to be in them shoes. Whether it is written or not. I don’t need this. It’s not food. It’s not something, like it’s not a cup of tea or biscuits. It’s something what I don’t need. It’s just going inside my body. Like a car, if you put water in it, instead of petrol, it’s not going to work is it? It needs petrol, the same thing, we need food. We don’t need something like cigarette in our system.

Those who were diagnosed with a smoking related disease such as COPD (chronic obstructive pulmonary disease), or a pulmonary embolism or who had a TIA (transient ischaemic attack or ‘mini stroke’) were sharply reminded of the negative effects of smoking. Rukmini had a history of health problems in her family such as heart problems and diabetes and felt that smoking increased her risk.

We talked to people who had resolved to stop smoking after being diagnosed with a heart condition, COPD (which includes chronic bronchitis or emphysema) or as they learnt about the relationship between their smoking and worsening control of long-standing health problem such as asthma or diabetes.

Aged 17, Cassie had a serious asthma attack and was taken to hospital.

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Age at interview: 22

Sex: Female

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I had an asthma attack and I was 17. I was at home. It just came on. I can’t really remember how I was, either it just happened or I was in the bathroom in the steam. And it was, it was quite bad. I used to have a lot of asthma attack when I was a child like. I was in hospital every two weeks or every month, you know, and but this was my worst. So because of my previous, I knew what an asthma attack felt like, but this felt different. You know, I was very hysterical and I was shouting and screaming, “Don’t let me die.” I still refused to go in an ambulance because I feel like that’s defeat, so you know, I stumbled to A & E. I got there. They put me in, they weren’t listening to me properly. They, I was telling them I can’t breathe. They thought I was just over reacting. They gave me medication but it took a long time, and I was sent to Intensive Care. I told the nurse that was on duty that my neck was hurting, and my throat was hurting and my neck, and they were like, “Oh it’s just because of the steroids.” And I’d been having steroids. I take steroids every day and night, you know, since I was 9 months old. So I knew I wasn’t the steroids. Then she said they got me some ice cream. Got me some ice cream and left me there for the rest of the night. I couldn’t sleep, because I couldn’t breathe. And then when the doctor came round in the morning I told her, and she felt my neck, and it was like is it bubble wrap? Yes. You could pop it, because I had a hole, I’d got a hole, well I’ve got a scar here now and at the back and all the air had escaped and gone into my throat underneath, between the layer between my skin and so you could pop it. And they said it was emphysema and pneumothorax and usually that’s associated with like old women isn’t it? Older women. But yes, it was very, it was very traumatic. And that should have stopped me from smoking really, because I mean that’s quite, that’s quite a big deal, especially at a young age to go through that, and to have that happen to you, when usually it’s an older women. But it didn’t. As soon as my friends came I was out there smoking, and I just carried on smoking. And they said it was caused by too much coughing. So as soon as they said that I didn’t think, yes, is it anything to do with smoking. I think they should have said to me, you need to stop smoking now. It’s not, it’s really not helping you. And I think people need to be more graphic, because I think we say, “Oh it will give you cancer.” People just think, oh that’s a possibility, it might not happen, I’ll take my chance. But I think we need to be more graphic and you know, have real people, you know, that have been affected and have got cancer and share their story.

Judith thought she had a ‘smoker’s cough’ but was diagnosed with asthma and emphysema at the age of 32.

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Age at interview: 36

Sex: Female

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I was known to everyone as Judith the Chimney. I never ever thought I would be able to give up. I finally was able to think about when unfortunately I was diagnosed with emphysema and I was diagnosed when I was about 32 after a good few years of coughing to the point of unconsciousness. And for years it was put down to smokers cough, which we all know there, there is no such thing. It’s a problem if you have a cough for more than three weeks, there’s a problem. I think that old adage still goes on with a certain generation, that it was just a smoker’s cough. I eventually went to the doctor and told him I was losing consciousness that I was hitting my head off the floor when I did, and various things like that. He then sent me for tests at the Respiratory Clinic and they came back with the fact that I had a mixture between asthma and emphysema. He also gave me an idea of how much lung function I had left, which was 55% at that point 55-60% at that point. Which was quite shocking.

And that really upset me, because there was nothing I could do about that. I mean obviously I could have given up smoking, but that was a huge thing that I was struggling to do. I just couldn’t even entertain it. I had tried to give up smoking in the past and it really compromised my mental health.

Keith was determined to give up smoking after having a TIA (minor stroke).

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Age at interview: 59

Sex: Male

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I was just terrified in hospital, I was, I was quite deeply worried and it was a real shock to my system, and if there’s anything good that’s come out of it it’s meant that I have stopped smoking and taking more care of my health overall or at least thinking more about my health overall. Smoking just wasn’t an option after that. That was such a shock, and looking round and seeing people much, much worse off than I was. And seeing how they couldn’t get about, they couldn’t move without help and they were really in need, they’d lost all their independence and that really did shock me and so what did, I thought then that I was going to have to do everything I possibly could to make sure I didn’t end up in that position. Because once people have had a stroke, a minor stroke, apparently the chances of having a full stroke or a further stroke is heightened and so I’m determined to try and do everything I can to, including stopping smoking, to lower the risk.

And how did you know what those things were?

Well I took advice and when, we were in the [name of hospital], we had absolutely excellent support and was given good information and good backup support, and a lot of information and I read a lot about it, and I didn’t need anybody to tell me that smoking isn’t good for you per se. If it didn’t cause the stroke, if it wasn’t the factor it could cause, it could have been a contributory factor and probably was, but it could cause all the other things that go along with smoking, such as lung cancer and goodness knows what else. Hm.

So did I think about it when I was lying there? As a part of the whole package yes. I just knew as I was in hospital that I was never going to smoke again. And I won’t.

Bethan had a suspected asthma attack and was later diagnosed with COPD. She gave up smoking a few years after her diagnosis when she started to get out of breath.

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Age at interview: 53

Sex: Female

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When I was 36 years of age, I had this terrible, well, they say it was an asthma attack, and I put it down to everything that I’d gone through in my little life. And you know, moving with the children, and going through a divorce and everything. And I think it was nerves more than anything.

But I carried on smoking. Because I think that smoking was the only thing that actually relaxed me. And then, I made a couple of attempts, well more than a couple of attempts between the ages of 36 and now, you know, all full of good intentions. I thought yes, I’ve got to give up, you know, think of my health. And oh yes, after that I was diagnosed with COPD, which is chronic obstructive pulmonary disease. And I thought, oh better try again [laughs]. And I went to the, to the hospital and saw the specialist. Had all the tests taken and you know, he told me then, in ten years time you’ll be coming back to us for oxygen [inhales]. So again I tried to give up, I’ve given up numerous occasions but it wasn’t, I wasn’t ready. And then what I did was stop smoking in the house. I never smoked upstairs anyway. I did smoke in, in the living room, and so for about two or three years I stopped smoking in the house and only smoked in the garden. But I, I smoked all the way through work, because works 22 miles away and so I’d smoke two or three in the car. Habit. Get to work. Any bits of stress, I’d be out having a cigarette [laughs]. You know, so and then my partner [name of partner], he’s always, always, always going on at me to give up smoking and because I’m, I suppose, whether it’s my background or whether it’s my work, I wouldn’t let anybody control me [laughs]. So, no ,no. But anyway. I don’t know why, why I did it this year. It was April this year, and I thought, that’s it. Because I was getting short of breath and because I enjoy walking in the mountains and cycling and activities, I’ve, I’ve suddenly thought. I thought, I won’t be able to do this. I mean I’ve got four grandchildren now, and you know, I would like to spend a bit of time with them. And I thought, well this is my time really to feel better, because I was, I was starting to, you know, I wouldn’t give in. I’d still carry on doing my exercise, but it was just harder. And even just walking from here to the shop. I was out of breath. I thought this is ridiculous. Sort yourself out girl [laughs].

Chris had always had a ‘bad cough’ and was diagnosed with emphysema and bronchiectasis.

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Age at interview: 65

Sex: Female

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Yes. I smoked for over 50 years. And I tried for at least the last fifteen years, to try and stop smoking and at any time I’ve not been very successful, slightest thing starts me of again, and I always suffered with a bad chest. I always had a bad cough. Even when I was young, and never gave it a thought, until one day the breathing started to get really bad, and I had quite a few tests at the hospital, and they suddenly said then that I’d got emphysema and also got bronchiectasis and one of them was down to smoking for definite. The other one they weren’t sure about, and I would need to stop smoking because the smoking was aggravating it, and I wouldn’t live as long as I’m supposed to live.

That didn’t work. I tried to stop, but I didn’t stop. I carried on smoking, and until, and until at the hospital one day, they said, I think you’ll have to go on oxygen, which was a bit of a shock to begin with but even that didn’t stop me straight away. I had a couple of attempts. And then I had to go on 24 hour oxygen and they said I had another five years onto my life. So whatever I’d got left, I’ll hopefully get another five years out of it.

But I’m not sure, my breathing is still getting really bad. I move about and I’m just completely out of breath, completely wore out all the time. So, in hindsight I wished I’d have stopped earlier, you know, if, if this can help anybody else, because I feel quite young in myself, although I’m not, I was 65, but... there’s a lot of 65 people I know that are really fit and healthy and can do lots of things. I’m limited, very limited now, to what I can do, and I’ve got some gorgeous grandchildren and I love them very much and they love me, and I just want to be here for them.

Roger was diagnosed with COPD and that prompted him to give up smoking. Some people weren’t sure whether smoking had directly caused their health problems, but they wanted to give it up to improve their physical health.

People who gave up smoking often noticed fairly soon that their health had improved. Even those who had smoked for many years and had developed serious health problems noticed that their health improved.

Neil managed to give up after 44 years of smoking, after a series of serious health problems.

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Age at interview: 64

Sex: Male

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And then... your health pulls you up sharply, with a heart attack, and but prior to that I knew I’d got problems. I’d got breathing problems and still smoked. I got blocked arteries in my legs, bifemoral arteries and they offered to do a by-pass on them, because I was struggling to walk and all that was through smoking and then I had the heart attack as I said, followed by a quadruple by-pass surgery, which wasn’t at all pleasant [clears throat] and I still carried on smoking. And then it was about six, seven months later, I had a stroke, and I was still smoking when I was in the hospital. And it was at that point when I came out of the hospital and I decided that I didn’t want to end up a cabbage if you like, and decided to, I was going to stop smoking. So I decided to blitz it by taking tablets from the doctor and by having hypnotism from my rehab nurse. And she hypnotised me and I was taking the tablets at the same time, and from there on in I’ve never touched a cigarette since.

Professor Aveyard describes the benefits people get from stopping smoking even though they have a smoking related disease.

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Can you tell me what are the main risks that are involved with smoking?

Well people do know that smoking is risky. What they often don’t quite appreciate is, firstly how risky it is, and secondly how beneficial stopping smoking is. So in terms of risk, essentially smoking knocks years off your life. And how many years, well if you take a lifetime smoker they will lose about ten years of life from a lifetime of smoking.

To put that into context of other things, for example, obesity, that’s the equivalent of being what we call morbidly obese, in other words about as fat as about 1-2% of the population. So really the largest people in our society, run roughly the same kind of risk of smoking. So, smoking is, you know, as a widespread behaviour, about the sort of riskiest of those sort of things that we all know about as sort of bad behaviours that we do.

And obviously people have a number of other health conditions, which can be affected by smoking. Can you talk me through some of the effects of that, say diabetes, heart conditions, COPD?

Yes, yes, yes. Well a lot of people will know that all of the things you mentioned, perhaps not diabetes, is so widely known, but I think we’re now clear that smoking is a relatively minor but important risk factor for diabetes. It’s the main risk factor for chronic lung disease called COPD or Chronic Obstructive Pulmonary Disease. And it’s a very important risk factor for heart disease. So many people know that. What’s really important for them also to know, is that they’ve already developed these, again like I said before, it’s just not too late to stop smoking. We know that the only real treatment that makes any difference to the long term outcome of COPD for example is stopping smoking. Doctors will give patients with COPD various inhalers. And they help. They help with the symptoms and make people feel less breathless, but they don’t alter the long term decline in lung function which is what’s happening in COPD. Only stopping smoking does that.

People with heart disease, if they stop smoking that reduces their risk of a heart attack by about a third, within a year or two of them stopping smoking. So, even though you’ve already got diseases that are caused by smoking, it can make quite an important difference to the outcome of those diseases, in helping getting better from asthma, a very common disease, lots of people smoke who’ve got asthma. Much less like to need the inhalers, often can reduce the dose of the preventer inhaler that people are using, and certainly improve the symptoms of asthma when you stop smoking.

So there’s lots of good reasons for people to want to stop when they have got diseases that they kind of know smoking is bad for.

Professor Aveyard explains why it is important to stop smoking regardless of how long you have smoked.

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The thing is that stopping smoking is remarkably effective at reducing the risks that arise from smoking. So even if you stop smoking when you’re 60 years of old, then you probably smoke for at least 40 years then. You still get a benefit you still seem to live about three years longer.

So from about middle age, well let’s say early middle age onwards, 35 years of age onwards, a smoker can think of their remaining life as one day. So whatever their length of life, think of it as one day. If they continue to smoke during that whole day they will lose six hours of their day, and if they stop when they are 35 or 40 or so they will get all of those six hours back, so they won’t have lost anything. Even though they smoked for may be 15 or 20 years at that sort of age.

So what the main message is that stopping smoking is remarkably good at reversing a lot of the damage that smoking has done. And the sooner you stop, the better the benefits are of course. But even stopping in older ages is still worthwhile.

(Also see ‘Life events and their effect on people’s motivation to stop smoking’, ‘Being a non-smoker’ and ‘Effects of not smoking’).

Last reviewed August 2018.
Last updated August 2018.