Smoking makes you twice as likely to die if you have a stroke, and the more you smoke, the greater the risk of stroke. If one smokes 20 cigarettes a day, one is six times more likely to have a stroke compared to a non-smoker. Tobacco smoke has many harmful effects on the body including thickening blood, increasing the risk of blood clots and narrowing arteries, as well as restricting oxygen in the blood.
The impact of smoking
Smokers are at risk of dying earlier due to stroke, heart disease and cancers.
How does smoking cause stroke?
Tobacco smoke contains over 7,000 toxic chemicals including carbon monoxide, formaldehyde, arsenic and cyanide. These chemicals are transferred from our lungs into our blood stream, changing and damaging cells all around our body. The changes that these chemicals cause can increase the risk of stroke. Cigarette smoke can affect cholesterol levels. Cholesterol is a vital substance in your body, but if there is too much in your blood it can cause heart disease and stroke.
Smoking reduces the levels of ‘good’ cholesterol (also called HDL) in your bloodstream and increases levels of ‘bad’ cholesterol (also called LDL). Having low levels of ‘good’ cholesterol in your body increases your risk of stroke. When you inhale cigarette smoke, carbon monoxide and nicotine enter your bloodstream. The carbon monoxide reduces the amount of oxygen in your blood, and the nicotine makes your heart beat faster and raises your blood pressure. This increases your risk of a stroke.
Smoking can also trigger an episode of atrial fibrillation, a heart condition that is a risk factor for stroke. The chemicals in smoke also make your platelets, a type of blood cell, more likely to stick together. This increases the chance of a clot forming. These factors increase smokers’ risk of developing atherosclerosis, a condition where arteries become narrowed and harden. This reduces the blood flow and makes blood clots more likely to form. If a clot occurs in an artery leading to the brain, it can cause a stroke when it blocks the Smoking and the risk of stroke. This type of stroke is known as an ischaemic stroke.
Smoking nearly doubles your risk of having an ischemic stroke. Smokers are also more likely to develop high blood pressure, which is a major risk factor for stroke. Smoking is particularly dangerous for people who already have high blood pressure, because high blood pressure contributes to damage to the arteries. If you are a smoker with high BP, your arteries will narrow at a much faster rate, significantly increasing your risk of stroke.
Why should one stop smoking?
Quitting smoking will reduce your risk of a stroke and reduce your risk of other health problems. If you have had a stroke, you’ll be advised to stop smoking to reduce your risk of another stroke. The benefits start right away Within eight hours, your oxygen levels return to normal and carbon monoxide and nicotine levels reduce by more than half and 48 hours later your ability to taste and smell improves. Within 72 hours breathing becomes easier and your energy levels go up.
After 2-12 weeks your circulation improves. Between three and nine months, any coughing and wheezing eases and your lung function improves by up to 10%. After one year your risk of a heart attack is half that of a smoker. After 10 years your chances of developing lung cancer fall to half that of a smoker. After up to 15 years your risk of having a stroke is around the same as someone who has never smoked. Passive smoking Breathing in someone else’s smoke is hazardous.
Children are particularly vulnerable to passive smoking as they have less well-developed airways, lungs and immune systems. Children of smokers are more likely to develop respiratory problems and babies are at greater risk of cot death. By stopping, you are greatly reducing the risks you are posing to your family, friends and people around you.
Help to stop smoking
If you want to stop smoking, more help is available than ever before. In countries abroad, this includes one-to-one and group support with trained advisors (including prescriptions for medicines and patches to help with withdrawal symptoms), support via social media, an email support programme, a quitting app and a telephone helpline.
Because nicotine is so addictive, and the smoking habit becomes so automatic, many people need support to help them stop smoking. Research shows that you are four times more likely to succeed at stopping if you have support. It is normal for people to make more than one attempt before they stop smoking and quit for good, so don’t be disheartened if you have tried to quit before and didn’t manage it at that time.
Stopping smoking can result in a number of withdrawal symptoms such as cravings, restlessness, irritability, difficulty concentrating, sleep disturbance or an increased appetite. These symptoms are temporary and usually disappear within a few weeks. Many people are concerned about gaining weight if they give up smoking. Although many people do put on some weight after giving up, it’s possible to avoid this. If you combat your cravings using medications or e-cigarettes, it can help you avoid extra snacking. Keep healthy snacks around like nuts, fresh fruit and vegetable sticks. Doing some exercise can also help by reducing cravings and burning calories.
Medication and stop-smoking aids
There are several different types of medicine and stop-smoking aids that can help you stop smoking:
o nicotine replacement therapy (NRT) including patches, gum, lozenges, microtabs, inhalators and nasal sprayso Champix tablets (varenicline)o Zyban tablets (bupropion)o e-cigaretteso other stop-smoking techniques. Speak to your doctor about which type of treatment is most suitable for you.
Nicotine replacement therapy (NRT) NRT steadily releases nicotine into your bloodstream without you having to inhale cigarette smoke. Using NRT helps to relieve smoking withdrawal symptoms, such as cravings, restlessness and irritability. After setting a target stop date, you can start on your chosen NRT. There is a wide range of NRT products available. They are available on prescription from. You can also buy them over the counter from a pharmacy or supermarket.
Types of nicotine replacement therapy (NRT) patches, which deliver a continuous supply of nicotine into the bloodstream. There are two kinds available: 16 hours for daytime use and 24 hours to be worn day and night for those with particularly strong cravings. They come in various strengths, and users should aim to reduce the level of nicotine gradually whilst quitting. Gum delivers bursts of nicotine through chewing. The strength of the gum and number of pieces you use will be determined by how much you have smoked. You chew this type of gum slowly, until the taste becomes stronger and hold it between your gums and cheek to allow the nicotine to be absorbed into the bloodstream, repeating this action when the taste fades.
Lozenges work in a similar way to gum, providing short bursts of nicotine. You suck the lozenge until the taste becomes stronger and store it inside your cheek until it fades, starting again when this happens. They usually dissolve after 20-30 minutes.
Nasal sprays can work for heavy smokers or people who get severe withdrawal symptoms. The nicotine is quickly absorbed into the blood vessels in the nose, relieving cravings quickly, although they can produce side effects such as nose and throat irritation, coughing and watery eyes. Inhalators made of plastic and shaped to look like cigarettes. Users suck on the tube to release a burst of nicotine. They are particularly suited to people who miss the physical action of smoking.
Microtabs are very small tablets that dissolve under your tongue and should not be chewed. The dosage amount depends on how much you have smoked. They may suit users who are seeking a more discreet aid to stopping smoking. Using NRT after a stroke NRT should only be started under medical supervision in someone who has had a very recent stroke (within the last four weeks). In most cases, NRT will still be prescribed as the risks associated with continuing to smoke are usually greater than the risk of using NRT after a stroke.
Champix (varenicline) is a tablet that mimics the effects of nicotine on the body. It helps to reduce cravings, withdrawal symptoms and reduces the satisfaction gained from smoking. It is available on prescription, and treatment usually lasts for three months. You begin to take the tablets whilst still smoking and set a quit date for one or two weeks afterwards. It is not suitable for people with some other conditions, so talk to your doctor for further advice. Zyban (bupropion hydrochloride) Zyban is a tablet available on prescription. It is usually taken for a couple of months. Tell your doctor about any other pre-existing conditions you have, as Zyban is not suitable for some people.
Some people use e-cigarettes (electronic cigarettes) as a way to quit smoking. E-cigarettes provide nicotine without all of the toxins in tobacco smoke. They are not currently available on prescription. Other stop-smoking techniques Acupuncture and hypnotherapy have been successful for some, but have not been subjected to any large-scale clinical trials and are not licenced as remedies for quitting smoking.
If you wish to try one of these therapies, make sure you see a qualified practitioner. Tips to help you stop Write down all of the reasons you want to quit. Think about how smoking can affect your family, the health reasons or even the financial cost. Keep the list on you and read it when you start to feel tempted to smoke. Set a date to stop and stick with it. You can choose your birthday, New Year’s Day. The important thing is to choose a day and stick to it. Seek help and support. Get your friends and family to give you encouragement. This can help keep you going. Combat those cravings. A craving can last for five minutes; have a plan on how you will cope with them. Distract your hand by doodling. Do a crossword, brush your teeth, have a shower, go for a walk or call a friend. Stay positive: tell yourself that you are going to do it!
The author is Senior Consultant – Neurology, Head, Movement Disorders Clinic and In-Charge, Deep Brain Stimulation (DBS) at Global Hospital, Parel, Mumbai. Views are personal.
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