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Excerpts from The advantages start within 20 minutes of the last cigarette being stubbed out

By The Doctor ( THOMAS STUTTAFORD), The Times [10/05/99]

Thirty years ago smoking was both fashionable and medically acceptable. To offer or accept a cigarette, or to play with one when not addicted to nicotine, was a useful social accessory. Now 70 per cent of adult smokers would like to give up, and an earlier NOP survey showed that half of these are "very keen to do so". Eager or not, the truth is that the addicted are very poor at doing without tobacco. A medical disaster usually provides the necessary boost to a patient's resolution. How much better if smokers could give up before they were grey and sweating in an intensive care unit or in a cancer ward.

Apart from the seriously ill, it can never be too late to throw away cigarettes. The advantages start within 20 minutes of the last cigarette being stubbed out in the ashtray. Most people think only in terms of damage caused by the 4,000 compounds of cigarettes - at least 43 of which can cause cancer - in relation to the lungs. They forget the critical effect on the heart.

Smoking increases the amount of atheroma, the fatty material that looks like porridge and accumulates on the inside of an artery. As it collects it slowly obstructs the artery, which also, in smokers, becomes hardened. The plaque of atheroma is soft and therefore may rupture; any small pieces that break off can block an artery and cause coronary thrombosis. The more the patient smokes, the more rotten their arterial tree. Not only the arteries of the heart are involved but also those leading to the brain, so that strokes are four times more common in smokers than non-smokers. The arteries to the lower limbs are also frequently narrowed so that the patient suffers from poor circulation and sometimes gangrene. The penile arteries are not spared and impotence is much more common in smokers than non-smokers. This may partly explain why a recent survey found that non-smokers had sex twice as often as heavy smokers.

Cigarette smoking increases the vulnerability of the heart to potentially lethal changes in its rhythm, so that after a heart attack it tends to lapse into a fatal arrhythmia.

Within hours of giving up smoking the heart will be less irritable and the chances of surviving a heart attack are increased. Within 20 minutes of the last cigarette blood pressure and pulse rate are returning to normal. Within eight hours of giving up, the nicotine levels in the blood have been reduced by half, oxygen levels are normal and carbon monoxide, like nicotine, are only 50 per cent of what they were when the patient was smoking. It takes 24 hours to eliminate the carbon monoxide from the blood and 48 hours for the last of the nicotine to disappear.

Although initially there may be some increase in the amount of mucus coughed up, in general breathing is easier, and as the bronchial tubes begin to relax breathlessness is improved.

Three months after the end of smoking the patient's coughing improves, hands and feet are not so chilly, and potency, which like fertility is adversely affected by smoking, may show improvement. Five years after the last cigarette the chances of a smoking patient having a heart attack are only twice that of a non-smoker, within ten years the risk of a heart attack is no greater than that of someone who has never smoked at all.

The effect of giving up smoking on cancer is more difficult to measure. The usual suggestion is that it takes ten years before the risk of lung cancer falls to half that of a smoker, and that after 15 to 20 years their risk is compatible with that of non-smokers. As with any carcinogen it is never possible to guarantee that it could not have an effect many years later. Smoking is also frequently associated with cancer of the cervix, bladder, oesophagus, mouth and nasal spaces.

Stopping smoking is never painless, but within a week the former smoker should be sleeping soundly, within two most will have lost the craving for a smoke and concentration will be back to normal. Within a month he/she will no longer be snarling like a tiger. After three months the appetite will be back to normal, but long before this an appreciation of wine and gourmet cooking will have returned.

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