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Half of all smokers die prematurely of a smoking-related ailment. 90% of smokers aged 45-64 say that they would not smoke given their time again. 4 million smokers a year attempt to quit but only 3% of these succeed. Surveys reveal a "delusion gap" as 53% expect to stop within two years but only 6% manage it. The widespread disaffection with smoking plus the tendency to be deluded about how easy it is to stop justifies promoting chances to stop. The ban on smoking in virtually all enclosed public places and workplaces in England from 1st July 2007 has offered a further window of opportunity.

Cigarette smoke contains the following

Nicotine is a drug that stimulates the brain. If you are a regular smoker, when the blood level of nicotine falls, you usually develop withdrawal symptoms such as craving, anxiety, restlessness, headaches, irritability, hunger, difficulty with concentration, or just feeling awful. These symptoms are relieved by the next cigarette.

So, most smokers need to smoke regularly to feel 'normal', and to prevent nicotine withdrawal symptoms.

Tar which contains many chemicals
These deposit in the lungs and can get into the blood vessels and be carried to other parts of the body. Cigarette smoke contains over 4000 chemicals, including over 50 known carcinogens (causes of cancer) and other poisons.

Carbon monoxide
This chemical affects the oxygen-carrying capacity of the blood. In particular, in pregnant women who smoke, this causes a reduced amount of oxygen to get to the growing baby. This is thought to be the most important cause for the bad effects of smoking on the growing baby.

Which diseases are caused or made worse by smoking?

  • Lung cancer. About 30,000 people in the UK die from lung cancer each year. More than 8 in 10 cases are directly related to smoking.
  • Chronic obstructive pulmonary disease (COPD). About 25,000 people in the UK die each year from this serious lung disease. More than 8 in 10 of these deaths are directly linked to smoking. People who die of COPD are usually quite unwell for several years before they die.
  • Heart disease is the biggest killer illness in the UK. About 120,000 people in the UK die each year from heart disease. About 1 in 7 of these deaths are due to smoking.
  • Other cancers - of the mouth, nose, throat, larynx, gullet (oesophagus), pancreas, bladder, cervix, blood (leukaemia), and kidney are all more common in smokers.
  • Circulation. The chemicals in tobacco can damage the lining of the blood vessels and affect the level of lipids (fats) in the bloodstream. This increases the risk of atheroma forming (sometimes called 'hardening' of the arteries). Atheroma is the main cause of heart disease. It is also the main cause of strokes, peripheral vascular disease (poor circulation of the legs), and aneurysms (swollen arteries which can burst causing internal bleeding). All of these atheroma-related diseases are more common in smokers.
  • Sexual problems. Smokers are more likely than non-smokers to become impotent or have difficulty in maintaining an erection in middle life. This is thought to be due to smoking-related damage of the the blood vessels to the penis.
  • Ageing. Smokers tend to develop more 'lines' on their face at an earlier age than non-smokers. This often makes smokers look older than they really are.
  • Fertility is reduced in smokers (both male and female).
  • Menopause. On average, women who smoke have a menopause nearly two years earlier than non-smokers.
  • Other conditions where smoking often causes worse symptoms include: asthma, colds, flu, chest infections, tuberculosis, chronic rhinitis, diabetic retinopathy, hyperthyroidism, multiple sclerosis, optic neuritis, and Crohn's disease.
  • Smoking increases the risk of developing various other conditions including: optic neuropathy, cataract, macular degeneration, cryptogenic fibrosing alveolitis, psoriasis, gum disease, tooth loss, osteoporosis and Raynaud's phenomenon.

Smoking in pregnancy increases the risk of:
  • Miscarriage
  • Complications of pregnancy, including bleeding during pregnancy, detachment of the placenta, premature birth, and ectopic pregnancy.
  • Low birth weight. Babies born to women who smoke are on average 200 grams (8 oz) lighter than babies born to comparable non-smoking mothers. Premature and low birth weight babies are more prone to illness and infections.
  • Congenital defects in the baby - such as cleft palate.
  • Stillbirth or death within the first week of life - the risk is increased by about one-third.
  • Poorer long-term growth, development, and health of the child. On average, compared to children born to non-smokers, children born to smokers are smaller, have lower achievements in reading and maths, and have an increased risk of developing asthma.

Other problems with smoking
  • Your breath, clothes, hair, skin, and home smell of stale tobacco. You do not notice the smell if you smoke, but to non-smokers the smell is obvious and unpleasant.
  • Your sense of taste and smell are dulled. Enjoyment of food may be reduced.
  • Smoking is expensive.
  • Life insurance is more expensive.
  • Finding a job may be more difficult as employers know that smokers are more likely to have sick leave than non-smokers. More than 34 million working days (1% of total) are lost each year because of smoking-related sick leave.
  • Potential friendships and romances may be at risk. (Smoking is not the attractive thing that cigarette advertisers portray.)

What are the benefits of stopping smoking?
The benefits begin straight away. You reduce your risk of getting serious disease no matter what age you give up. However, the sooner you stop, the greater the reduction in your risk.

If you have smoked since being a teenager or young adult:

  • If you stop smoking before the age of about 35, your life expectancy is only slightly less than people who have never smoked.
  • If you stop smoking before the age of 50, you decrease the risk of dying from smoking-related diseases by 50%.

But, it is never too late to stop smoking to gain health benefits. Even if you already have COPD or heart disease, your outlook (prognosis) is much improved if you stop smoking.

Timeline of health benefits after stopping smoking

72 hours -  Breathing becomes easier. Bronchial tubes begin to relax and energy levels increase
1 month - Skin appearance improves owing to improved skin perfusion
3-9 months -  Cough, wheezing, and breathing problems improve and lung function increases by up to 10%
1 year -  Risk of a heart attack falls to about half that of a smoker
10 years - Risk of lung cancer falls to about half that of a smoker
15 years - Risk of heart attack falls to the same level as someone who has never smoked

How can I stop smoking?
About 2 in 3 smokers want to stop smoking. Some people can give up easily. Willpower and determination are the most important aspects when giving up smoking. However, nicotine is a drug of addiction and many people find giving up a struggle. Help is available.

  • GPs, practice nurses, or pharmacists can provide information, encouragement, and tips on stopping smoking. Also, throughout the country there are specialist NHS 'Stop Smoking Clinics' which have a good success in helping people to stop smoking. Your doctor may refer you to one if you are keen to stop smoking.
  • Various medicines can increase your chance of quitting. These include Nicotine Replacement Therapy (NRT) which comes as gums, sprays, patches, tablets, lozenges, and inhalers. You can buy NRT without a prescription. Also, medicines called bupropion (trade name 'Zyban') and varenicline (trade name 'Champix) can help. These are available on prescription.

How does Champix (varenicline) work?
Champix tablets contain the active ingredient varenicline, which is a medicine used to help people who are addicted to nicotine to give up smoking. It acts in the brain, but is not the same as nicotine replacement therapy.

Varenicline is a type of medicine called a nicotinic acetylcholine receptor partial agonist. This means that it acts on the same receptors in the brain as nicotine.

Varenicline works by stimulating the nicotinic receptors in the brain. This produces an effect that relieves the craving and withdrawal symptoms you can get when you stop smoking.

At the same time, varenicline blocks nicotine from acting on the nicotinic receptors. This prevents any nicotine inhaled in tobacco smoke from having a rewarding and enjoyable effect.

You should set a date on which you will stop smoking and start taking this medicine one to two weeks beforehand. This is because the medicine needs time to start working.

The dose is increased gradually in the first week of treatment (follow the instructions given by your doctor or pharmacist) and the medicine should then be taken twice a day for 12 weeks. If you have successfully managed to stop smoking at the end of 12 weeks, your doctor may offer you a further 12 week course of treatment.

The tablets should be swallowed whole with a drink of water. They can be taken with or without food.

You should seek help and support as much as possible while giving up smoking, even while taking this medicine, as this will increase your chance of success. Your doctor, practice nurse or local pharmacist can all provide this support.

Important Information about Champix

  • This medicine might make you feel dizzy or sleepy and so could impair your ability to perform potentially hazardous tasks such as driving or operating machinery. You should avoid driving or operating machinery until you know how this medicine affects you and are sure that it won't affect your ability to perform such activities safely.
  • There have been reports of suicidal thoughts or behaviour in people taking this medicine to help them give up smoking. It is very difficult to know if this is due to the medicine, as giving up smoking itself can make people depressed, especially if they already have a mental health problem, and depression is associated with suicidal thoughts. However, not all people experiencing depression and suicidal thoughts while taking this medicine had a previous history of psychiatric illness, or had stopped smoking. For this reason, if you begin to feel agitated or depressed, or experience any changes in your behaviour or thoughts about suicide or harming yourself during treatment with this medicine, you should stop taking it and consult your doctor immediately.
  • Some people may find that when they stop taking this medicine their urge to smoke returns. They may also feel irritable, depressed or have difficulty sleeping. To avoid this, your doctor may consider reducing your dose slowly when you finish treatment with this medicine, rather than stopping it abruptly. Discuss this with your doctor.

Smoking cessation - Clinical Knowledge Summaries (April 2008), NetDoctor, Patient UK, Quit, Smokefree, Smoking cessation - NICE (2006).

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