I cannot stop smoking. Would it help if I just cut down on my smoking?

Yes, but there is no such thing as safe smoking. Smoking five cigarettes a day doubles your risk of heart disease and smoking 20 a day increases your risk by at least 10 times. Reducing the number of cigarettes smoked helps, but quitting is better.

Both my husband and I smoke one pack of cigarettes a day. I have recently read that women are as much at risk as men. Is this true?

Yes and, if anything, more so (see Figure 2.1). Women seem to be more sensitive to the effects of cigarettes, so for a similar number smoked (20 per day) you are twice as likely as your husband to develop coronary artery disease. Smoking is especially dangerous if you are on the contraceptive pill, particularly if you are aged over 35 years or

Women who smoke have almost four times as great a risk of

Figure 2.1 Women who smoke have almost four times as great a risk of

heart attack but, three years after quitting, the risk is the same as for non-smokers. Solid line = women who smoke; dotted line = non-smokers.

have been continuously on the pill for 5 years or more (see Women and coronary artery disease on p. 73).

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 five years 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.

Cigarette smoking is the biggest risk factor for sudden death. The best advice is: If you smoke - QUIT; if you don

Figure 2.2 Cigarette smoking is the biggest risk factor for sudden death. The best advice is: If you smoke - QUIT; if you don't smoke - DON'T START.

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 improvement 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 months at least £720, which you can spend on a well-earned holiday. Put another way, if you place the price of a packet of cigarettes at around £4 per day into an individual savings account (ISA), after 20 years the fund could be worth £44 100 (at 6% interest). In a pension plan, it could give you £4,350 (at 7% interest) per year in extra annual income! The more the price rises, the move you will save. Of course, if you carry on smoking, you may never reach your pensionable age.

Be disciplined and don't talk yourself into smoking 'to calm me down'. If the craving is unbearable, go for a brisk walk, relax with a hot bath and drink plenty of water.

• Think positively.

• Don't carry matches or a lighter.

• Go to the dentist and have your teeth cleaned to get rid of the tobacco stains.

• Keep being positive, keep reading your reasons for quitting, reward yourself with a treat after your first week of not smoking - you've saved enough money, so go ahead!

• Avoid certain activities that are linked with smoking:

• Try to avoid alcohol and take a drink that is not associated with smoking, such as a tomato juice.

• After a meal, instead of a cigarette, clean the table, wash up, brush your teeth and go for a walk.

• Do not have cigarettes in the car; have chewing gum to hand instead.

• Outside the UK and Ireland, avoid smoky restaurants and bars.

• Holiday in countries where smoking is not allowed in public places, such as the UK or France.

• Tell your smoking friends that you will be unavailable other than on the 'phone, unless they are giving up as well.

• Keep your hands busy (fiddle with paper clips, write a letter, do the crossword, clean the car, help in the garden or with the housework).

• Use sugarless chewing gum to replace the urge to put a cigarette in your mouth.

• Take deep breaths, relax your muscles, and think of anything but cigarettes, for example your holiday plans or a previous happy experience.

• Remove everything from the house that reminds you of cigarettes: get rid of your ashtrays and matches, then have a spring clean to remove all the smell and stains of smoking, open the windows and let the fresh air circulate.

If you tell yourself you don't want to smoke rather than wishing you could smoke, you can reinforce this by noticing that your breath is better, your clothes are cleaner, the car smells better, food tastes again and that early morning cough has improved or stopped! Remember the 10 million people who have already broken the habit. The first few days are always the worst, so it does get easier! Remember that you will save over £1,825 a year.

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