Quit Smoking - Dr.Kumaresh Krishnamoorthy Column

There are over 4,000 chemicals in cigarette smoke including formaldehyde (used to preserve dead bodies); ammonia (used in strong cleaning liquids) and cadmium (a highly poisonous metal used in batteries). Stopping smoking represents the single most important step that smokers can take to enhance the length and quality of their lives. Quitting smoking is not easy, but it can be done. To have the best chance of quitting successfully, you need to know what you're up against, what your options are; this article will provide you with some of this information.

Why do people start to smoke?

Common reasons for starting include peer pressure, the desire to be 'grown-up', natural curiosity and a sense of rebellion or freedom. Youngsters with parents who smoke are particularly susceptible. Children see adults smoking in an attempt to relieve stress, tension and boredom. Adult smokers may appear more confident and better able to cope and children want to mimic this 'grown-up' behavior. Very few people start to smoke after the age of 20. Smokers who started as teenagers may have found themselves unconsciously seduced. Many actors, film stars and singers smoke. Indeed, it could be argued that smoking is sold as a lifestyle rather than a product and the illusion of style is that smoking is a 'cool thing' to do.

Why do people continue to smoke?

The main factors that contribute to people continuing to smoke are the physical addiction to nicotine, the daily rituals around the habit and the emotional and psychological dependence.

Physical addiction

Nicotine is a drug found naturally in tobacco and is highly addictive Over time, the body becomes both physically and psychologically dependent on nicotine. When smoke is inhaled, nicotine is carried deep into the lungs, where it is absorbed quickly into the bloodstream and carried throughout the body. Nicotine affects many parts of the body, including your heart and blood vessels and your brain. Nicotine can be found in breast milk of smokers. During pregnancy, nicotine freely crosses the placenta and has been found in the umbilical cord blood of newborn infants... 
. Nicotine produces pleasant feelings that make the smoker want to smoke more. After a while, the smoker develops a tolerance and then smokes to maintain this level of nicotine. In fact, nicotine, when inhaled in cigarette smoke, reaches the brain faster than drugs that enter the body by way of injections!

Psychological and emotional dependence

Smoking means different things to different people. For many, cigarettes are a friend, a relief from boredom, and are also seen as a form of stress relief. For those on a low income, smoking is often identified as their 'one luxury'.


Many smokers believe that smoking relieves stress and there is no doubt that nicotine withdrawal may be followed by unpleasant mood changes. Stress levels can worsen withdrawal, strongly linking tobacco use with poor emotional and mental health. Instead of seeing smoking as a stress reliever, it would be a real breakthrough if the person was able to identify smoking as one of the prime reasons of stress. Talking to a friend or family member about what is causing the stress could be a good way to clearly identify just how smoking is a contributory factor.

Benefits of quitting

Half of all smokers die early from a smoking related disease and one in four smokers die in middle age (35-64) as a result of their habit. Diseases caused by smoking can cause a great deal of pain and suffering for smokers and their loved ones. Additionally, the sudden loss of an only parent can be particularly hard for the surviving children. There are many serious and fatal diseases directly caused by smoking.
The following are the most common causes of smoking-related death:
  • Coronary heart disease, which may result in heart attack, or other vascular disease, perhaps leading to stroke
  • Chronic Obstructive Pulmonary Disease (COPD), which may include chronic bronchitis and emphysema. Infections such as pneumonia are more likely to be fatal
  • Lung cancer, as well as most other forms of cancer.
  • In addition, impotence, peptic and duodenal ulcers and fertility problems may be associated with smoking.
  • Even everyday complaints such as coughing, sneezing and shortness of breath on exertion can be attributed to smoking.
Smoking also causes premature wrinkling of the skin, bad breath, bad smelling clothes and hair, and an increased risk of macular degeneration, one of the most common causes of blindness in the elderly.
For women, there are unique risks. Women over 35 who smoke and use birth control pills are in a high-risk group for heart attack, stroke, and blood clots of the legs. Women who smoke are more likely to have a miscarriage or a lower birth-weight baby. Low birth-weight babies are more likely to die or to be impaired.
No matter what your age or how long you've smoked, quitting will help you live longer. People who stop smoking before age 50 cut their risk of dying in the next 15 years in half compared with those who continue to smoke. Ex-smokers also enjoy a higher quality of life with fewer illnesses.

Improved health benefits

Smokers are always being told about the harmful effects of their habit; however, people are far less aware of the dramatic health benefits of quitting and just how quickly they begin. It's always worth emphasizing that the health benefits from stopping begin almost immediately and continue to increase for many years:

20 minutes
- Blood pressure and pulse return to normal
8 hours
- The oxygen level in your blood increases to normal level. Chances of a heart attack start to fall
24 hours
- Carbon monoxide leaves the body. The lungs start to clear out mucus and debris
48 hours
- Nicotine is no longer found in the body. Sense of taste and smell improve
72 hours
- Breathing becomes easier. Energy levels increase
2-12 weeks
- Circulation improves throughout the body
3-9 months
- Coughing, shortness of breath and wheezing improve.
5 years
- Risk of having a heart attack falls to about half that of a smoker.
10 years
- Risk of lung cancer falls to around half that of a smoker.

Stopping smoking provides the best opportunity to improve the family's health and be around and see your children grow up. After quitting smoking, people often take more interest in their own health and wellbeing and may feel more motivated to take up a form of exercise such as walking, jogging, cycling or aerobics. During exercise, chemicals called 'endorphins' are released in the brain, which have a tranquillizing effect and make people feel good
Stopping smoking can bring other opportunities. Having the ability to quit smoking and take back personal control over the habit will give their self-esteem a boost. Many ex-smokers have found that the effort they invested in stopping smoking has helped them to have more belief in themselves and their capabilities. As a result people who have quit smoking have also gone on to make other positive life changes, such as taking advantage of new opportunities at work.


Smoking is expensive. It isn't hard to figure out how much you spend on smoking: multiply how much money you spend on tobacco every day by 365 (days per year). The amount may surprise you. Now multiply that by the number of years you have been smoking and that amount will probably astound you. Multiply the cost per year by 10 (for the upcoming 10 years) and ask yourself what you would rather do with that much money. And this doesn't include other possible expenses, such as the health care costs due to tobacco-related conditions.

Social Acceptance

Smoking is less socially acceptable now than it was in the past. Most workplaces have some type of smoking restrictions. Some employers even prefer to hire nonsmokers. Employees who are ill more often than others can raise an employer's need for expensive temporary replacement workers. Smokers in a building also typically increase the maintenance costs of keeping odors at an acceptable level, since residue from cigarette smoke clings to carpets, drapes, and other fabrics. Friends may ask you not to smoke in their houses or cars. Public buildings, aircrafts, music halls and even cinema halls are largely smoke-free. And more and more communities are restricting smoking in all public places, including restaurants. Like it or not, finding a place to smoke is going to be a hassle.

Health of Others

Smoking not only harms your health but the health of those around you. Exposure to secondhand smoke (passive smoking) includes exhaled smoke as well as smoke from burning cigarettes. Studies have shown that secondhand smoke causes thousands of deaths each year from lung cancer and heart disease in healthy nonsmokers. Smoking by mothers is linked to a higher risk of their babies developing asthma in childhood, especially if the mother smokes while pregnant. It is also associated with sudden infant death syndrome (SIDS) and low-birth weight infants. Babies and children raised in a household where there is smoking have more ear infections, colds, bronchitis, and other respiratory problems than children from nonsmoking families. Secondhand smoke can also cause eye irritation, headaches, nausea and dizziness.

Setting an Example

If you have children, you probably want to set a good example for them. When asked, nearly all smokers say they don't want their children to smoke, but children whose parents smoke are more likely to start smoking themselves. You can become a good role model for them by quitting now.

How can I stop smoking?

Quitting is hard. Usually people make 2 or 3 tries, or more, before finally being able to quit. Each time you try to quit, you can learn about what helps and what hurts. Write down your personal reasons for stopping. Be specific. Keep your list with you so you can look at it when you feel the urge to smoke. To help you understand your smoking habit, keep a diary of when and why you smoke. Using information from this diary, you can make a plan to deal with the things that make you want to smoke.
Smokers often say, "Don't tell me why to quit, tell me how." There is no one right way to quit, but there are some key elements in quitting smoking successfully:

1. Making the Decision to Quit

The decision to quit tobacco use is one that only you can make. Others may want you to quit, but the real commitment must come from you.

Health Belief Model

says that you will be more likely to stop tobacco use if you:
  • believe that you could get a tobacco-related disease and this worries you
  • believe that you can make an honest attempt at quitting
  • believe that the benefits of quitting outweigh the benefits of continuing tobacco use
  • know of someone who has had health problems as a result of their tobacco use

2. Get ready:

Once you've made a decision to quit, you're ready to pick a quit date. This is a very important step. Pick a specific day within the next month as your "Quit Day." Picking a date too far in the future allows you time to rationalize and change your mind. But do give yourself enough time to prepare and come up with a plan. Set a quit date 2 to 4 weeks from now so you'll have time to get ready. Change your environment. Get rid of ALL cigarettes and ashtrays in your home, car and place of work. Don't let people smoke in your home. Review your past attempts to quit. Think about what worked and what did not. Practice saying, "No thank you, I don't smoke."

3. Get support and encouragement:

 You have a better chance of being successful if you have help. Tell your family, friends and coworkers that you are going to quit. Ask them not to smoke around you or leave cigarettes out where you can see them.

4. Get medication and use it correctly:

 Medicines such as bupropion help some people stop smoking. These medicines do not contain nicotine, but helps you resist your urges to smoke.

5. Keep trying:

 Be prvepared for relapse. What if you do smoke? The difference between a slip and a relapse is within your control. You can use the slip as an excuse to go back to smoking, or you can look at what went wrong and renew your commitment to staying off smoking for good. Don't be discouraged if you start smoking again. Remember, most people try several times before they finally quit.
Here are some difficult situations to watch for:
  • Alcohol.

    Avoid drinking alcohol. Drinking lowers your chances of success
  • Other smokers.

    Being around smoking can make you want to smoke.
  • Bad mood or depression.

    There are a lot of ways to improve your mood other than smoking.

How should I get ready to stop smoking?

Just before your stop date, get rid of all of your cigarettes, matches, lighters and ashtrays.Quitters can approach their attempt in different ways.

Cold turkey:

The phrase 'going cold turkey' means stopping smoking immediately. In other words if someone smoked a pack today, they would be going 'cold turkey' if from tomorrow they smoked none at all. Stopping outright is most likely to be successful.

Cutting down:

Cutting down over a length of time can be particularly difficult, as consumption often goes back to what it was before. Smokers may inhale longer and harder to get the nicotine they want.

Drug therapies:

It is important to encourage people to consider using nicotine replacement therapies or medications (bupropion) as they have been shown to double the quitter's chance of success.

Complementary therapies:

Methods such as hypnosis, acupuncture, and other complementary therapies can and do help some people, but as yet there is no formal evidence that they are more effective than comparable support.

What will happen when I stop smoking?

How you feel when you stop depends on how much you smoked, how addicted your body is to nicotine and how well you get ready to stop smoking. These things happen because your body is used to nicotine. They are called nicotine withdrawal symptoms. The symptoms are strongest during the first few days after you stop smoking, but most go away within a few weeks.


An intense desire to smoke which typically lasts 2 to 3 minutes before subsiding. This becomes less frequent and less intense during the first 3 weeks.

Increased appetite

Nicotine is known to suppress a person's appetite, which leaves many smokers able to skip meals. When people give up, the resulting lack of nicotine can cause cravings, which may also be interpreted as hunger and an increased appetite cause weight gain.


Anxiety, irritability and loss of concentration - all these can be attributed to the disturbance of breaking a long-established habit and adjusting to the physical problems.

Sleep disturbance

It is not uncommon to have an initial week of sleeping badly followed by a week of difficulty staying awake.

Worsened cough

The millions of tiny hairs designed to keep the air passages clean start to clear away the dirt caused by cigarette smoke. This can cause a temporary cough.

Light-headed / dizzy feelings

This may occur as the level of carbon monoxide in the blood starts to fall and oxygen supply to the brain increases.

Tingling sensations in the body

This could be a sign of better circulation to the hands and feet.


Tobacco has a laxative effect on which the bowels learn to rely.
The above are signs of recovery and all the symptoms are temporary and none of them are life threatening, unlike smoking!

How do I deal with urges to smoke?

If you have tried to quit before, you will probably recognize many of these common rationalizations. I'll just use it to get through this rough spot.
  • Today is not a good day; I'll quit tomorrow.
  • It's my only vice.
  • How bad is tobacco, really? My uncle chewed all his life and he lived to be 90.
  • You've got to die of something.
  • Life is no fun without smoking.
You probably can add more to the list. As you go through the first few days without tobacco, write down any rationalizations as they come up and recognize them for what they are: messages that can trap you into going back to using tobacco.

Use the ideas below to help you keep your commitment to quitting:


people and places where you are tempted to smoke. Later on you will be able to handle these with more confidence.


your habits. Switch to juices or water instead of alcohol or coffee. Take a different route to work. Take a brisk walk instead of a coffee break.


Use oral substitutes such as sugarless gum or hard candy, raw vegetables such as carrot sticks


Learn how to handle stress and the urge to smoke Try and distract yourself from urges to smoke. Talk to someone, go for a walk, or get busy with a task. Take a hot bath, exercise, read a book.

Deep breathing:

When you were smoking, you breathed deeply as you inhaled the smoke. When the urge strikes now, breathe deeply and picture your lungs filling with fresh, clean air. Remind yourself of your reasons for quitting and the benefits you'll gain as an ex-smoker.


If you feel that you are about to light up, delay. Tell yourself you must wait at least 10 minutes. Often this simple trick will allow you to move beyond the strong urge to smoke.

What you're doing is not easy, so you deserve a reward. Put the money you would have spent on tobacco in a jar every day and then buy yourself a weekly treat. Buy a book, go out to eat, or save the money for a major purchase.

What about nicotine replacement products to help me stop smoking?

When you light up, nicotine gives you the hit, the rest of the smoke does the damage. Nicotine is not one of the cancer causing agents, it's simply the reason you crave a cigarette. Nicotine replacement products are ways to take in nicotine without smoking. These products come in several forms: gum, patch, nasal spray, inhaler and lozenge.

How does Nicotine Replacement Work?

Nicotine substitutes treat the difficult withdrawal symptoms and cravings that 70% to 90% of smokers say is their only reason for not giving up cigarettes. By using a nicotine substitute, a smoker's withdrawal symptoms are reduced. This lets you focus on the changes you need to make in your habits and environment. Once you feel more confident as a nonsmoker, dealing with your nicotine addiction is easier. It's very important that you don't smoke while using nicotine replacement products. The nicotine contained in nicotine substitutes is absorbed differently to that in cigarettes, so is much less addictive. Nicotine substitutes do not cause cancer.
While a large number of smokers are able to quit smoking without nicotine replacement, most of those who attempt quitting are not successful on the first try. By reducing these symptoms with the use of nicotine replacement therapy and a support technique, smokers who want to quit have a better chance of being successful.

Will I gain weight when I stop smoking?

For most people the increase after a year is small, approximately 4kgs. The small amount of weight gained is a lesser health risk than that of continued smoking. Dieting while you're trying to stop smoking will cause unnecessary stress. Instead, limit your weight gain by having healthy, balanced diet with plenty of fruit and vegetables, low-fat snacks and being physically active.

Staying Quit (Maintenance)

Maybe you, too, have quit many times before. You can use the same methods to stay quit as you did to help you through withdrawal. Think ahead to those times when you may be tempted to smoke, and plan on how you will use alternatives and activities to cope with these situations.
More dangerous, perhaps, are the unexpected strong desires to smoke that occur sometimes months (or even years) after you've quit. To get through these without relapse, try the following:
  • Review your reasons for quitting and think of all the benefits to your health, your finances and your family.
  • Remind yourself that there is no such thing as just one cigarette - or even one puff.
  • Ride out the desire. It will go away, but do not fool yourself into thinking you can have just one.
  • If you are worried about gaining weight, put some energy into eating a healthy diet and staying active with exercise

What if I smoke again?

Staying stopped is the key issue for most smokers. Many quitters can get through their first few days when their own motivation, determination, support and praise from others. But from then on motivation may begin to diminish and other people around them have lost interest while cravings continue.
Lack of success is often related to the onset of withdrawal symptoms. And most relapses occur within the first 3 months of quitting. So don't be discouraged if you start smoking again. Don't feel like a failure. Think about why you smoked and what you can do to keep from smoking again. Set a new stop date. Many ex-smokers did not succeed at first, but they kept trying. In fact, smokers usually need several attempts before they are able to quit for good.
Never condemn the relapse. Use it as an opportunity to congratulate yourself on first thinking about it, and then for managing to stop, even if it was only for one day Just remember that even one puff on a cigarette can cause a relapse, so don't risk it.

Taking Care of Yourself

Any past or current tobacco use is important information for your doctor to know so he or she can be sure that you have appropriate preventive health care. It is well known that tobacco use puts you at risk for certain health-related illnesses, so part of your health care should focus on related screening and preventive measures to help you stay as healthy as possible. Periodic checkups should include oral cavity (mouth) exams for any changes or problems. By doing this tobacco users may be able to prevent, or detect early, oral changes, leukoplakia (white patches on the mouth membranes), and oral cancer.
You should also be aware of any change in cough, a new cough, coughing up blood, hoarseness, difficulty breathing, wheezing, headaches, chest pain and loss of appetite, weight loss, general fatigue and repeated respiratory infections. Any of these could be signs of lung cancer or a number of other lung conditions and should be reported to your doctor. While these can be signs of a problem, many lung cancers do not cause any noticeable symptoms until they are advanced and have spread to other parts of the body.
Remember that tobacco users have an increased risk for other cancers as well, depending on the way they use tobacco. Other risk factors for these cancers may be more important than your use of tobacco, but you should be aware of the additional risks that might apply to your situation.
If you have any health concerns that may be related to your tobacco use, please see your doctor as quickly as possible. Taking care of yourself and getting treatment for small problems will give you the best chance for successful treatment. The best way, though, to take care of yourself and decrease your risk for life-threatening lung problems is to quit using tobacco.

Quitting takes hard work and a lot of effort, but you can quit smoking.

If you are a smoker encourage your children not to smoke by:
  • Telling them from personal experience why you wish you hadn't started
  • Never letting them try a cigarette, even as a joke
  • Never asking them to light a cigarette
  • Not giving them sweet or joke cigarettes
  • Never asking them to buy cigarettes or matches
  • Asking them to work out how much smoking costs each year
  • Explaining that the majority of the populations don't smoke and most smokers want to stop
  • Discouraging older brothers, sisters and other family members from smoking in their presence

Questions to Think About

Think about the following questions before you try to stop smoking.
  • Why do you want to quit?
  • When you tried to quit in the past, what helped and what didn't?
  • What will be the most difficult situations for you after you quit? How will you plan to handle them?
  • Who can help you through the tough times?
  • What pleasures do you get from smoking? What ways can you still get pleasure if you quit?


s Dr.Kumaresh Krishnamoorthy, M.S (ENT)
Head and Neck Surgery Fellowship (Buffalo, USA)
Neurotology & Skull Base Surgery Fellowship (Cincinnati, USA)
Senior Consultant in ENT - Head and Neck Surgeon and Skull Base Surgeon
Apollo Hospitals, 154/11, Bannerghatta Road, BANGALORE 560 076, INDIA
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