Yes, you should quit smoking. No matter how bad your heart disease is now, continuing to smoke can make it worse. The constituents of tobacco smoke include carbon monoxide, nicotine, and tars. All of these conspire to cause disease in your heart, lungs, and arteries. The carbon monoxide in cigarette smoke interferes with your body’s oxygen-carrying ability.

This decreases the amount of oxygen in the bloodstream and ultimately decreases the amount of oxygenated blood reaching the heart muscle. Cigarette smoke contains nicotine, a substance that causes the adrenal gland to stimulate the release of a hormone that causes your blood pressure to rise abruptly.

Nicotine also narrows the vessels that carry the blood, making your already weakened heart pump against increased pressure. Smoking is a risk factor for high blood pressure, heart failure, and coronary artery disease, which lead to heart attack. Smoking harms the heart extensively. The best action you can take to manage CHF is to stop smoking.

In December 2004, a study was published by the Nicotine & Tobacco Research Journal that alarmed physicians. This U.S. survey suggests that despite years of consumer education in print and TV ads and in-office patient education, the great majority of smokers are misinformed about the health risks of their habit.

Researchers found that 94 percent of the 1,046 adult smokers they surveyed believed they were adequately informed about the dangers of smoking.

However, many either didn’t know the answer or answered incorrectly when asked specific questions about those health risks—most importantly, that smoking increased their risk for developing heart disease, cancer, and chronic obstructive pulmonary disease or COPD.

The survey also found a high degree of confusion when it came to “low-tar” and “light” cigarettes, products that have been heavily criticized because of the suggestion by their manufacturers that they are “safer,” even though research has not shown them to lower smoking-related disease risk.

About two thirds of the survey respondents indicated they thought these products were less harmful than regular cigarettes. In light of this information, it seems appropriate to state the risks of smoking here, so that everyone reading this, at least, is informed. Facts you should know include:

• Smoking cessation is essential in preventing and slowing the progression of heart and lung diseases such as heart attacks and emphysema. In fact, in 1990 the U.S. Surgeon General stated, “Smoking cessation (stopping smoking) represents the single most important step that smokers can take to enhance the length and quality of their lives.”

• Tobacco use is the leading cause of preventable deaths in the United States, claiming 430,000 lives annually. In fact, smoking causes more deaths each year than alcohol, auto accidents, homicide, suicide, and AIDS combined!

• Based on data collected from 1995 to 1999, the U.S. Centers for Disease Control and Prevention (CDC) estimated that adult male smokers lost an average of 13.2 years of life and female smokers lost 14.5 years of life because of smoking.

• 85 percent of lung cancer is caused by smoking.

• 90 percent of COPD is caused by smoking.

• Using smokeless tobacco in any form (including chewing tobacco or snuff ) is dangerous and can also lead to addiction and serious health conditions like mouth, throat, and larynx cancer.

• Herbal cigarettes only switch one supply of tar and carbon monoxide for another. Herbal cigarettes are not a healthy substitute for cigarettes.

• While nicotine can be dangerous to your health, the real danger in cigarettes is not nicotine. Instead it is the thousands of toxins present in tobacco and its combustion products that are responsible for the vast majority of tobacco-caused disease.

• Cigarettes are far more addictive than nicotine gum or the patch primarily because of the way in which they deliver nicotine. Therefore, these replacement therapies are helpful in conquering your addiction.

How do I stop smoking?

Physicians know that many smokers continue smoking not through free choice but because they are addicted to the nicotine in cigarettes. In February 2000, the Royal College of Physicians published a report that concluded that nicotine complied with the established criteria for defining an addictive substance.

Cigarette smoking, therefore, should be treated like an addiction. Like any addiction, stopping is difficult but not impossible. Successful smoking cessation is achieved through education, planning, and support from your physician, friends, and family. Quitting does not usually happen on the first try.

Research scientists have found that most people try to quit seven times before they succeed. Unsuccessful quit attempts, while frustrating, are actually part of the process of quitting. For most people, the best way to quit will be some combination of medicine, a method to change personal habits, and emotional support. The following describe these tools and how they may be helpful for you.

Get professional help. Doctors are trained on how to help you stop smoking. They can counsel you, help you choose from a number of quitting strategies, and even prescribe medication that can increase your chances of quitting for good.

If you are not interested or can’t work with your physician, the American Lung Association, American Cancer Society, Will Rogers Foundation, and others offer courses in how to stop smoking. Your doctor, dentist, or pharmacist can also point you to places to find support or toll-free “quit” lines.

You may want to join a smoking cessation program or support group to help you quit. These programs can work well, if you’re willing to commit to them. With the wide array of counseling services, self-help materials, and medicines available today, smokers have more tools than ever before to help them quit smoking successfully.

Quitting “cold turkey” isn’t your only choice. Although some smokers are successful with this approach, medical studies reveal that adding nicotine replacement to your smoking cessation plan will double your success rate at quitting for good.

The most important element of the cessation process is the smoker’s decision to quit, with the aid or method of secondary importance. Talk to your doctor about other ways to quit. Most doctors can answer your questions and give advice. They can suggest medicine to help with withdrawal. Some of these medications require a doctor’s prescription; others can be purchased over the counter.

Join a quit smoking (smoking cessation) program. How do quit-smoking programs and support groups work? They help smokers spot and cope with problems they have when trying to quit. The programs teach problem-solving and other coping skills. A quitsmoking program can help you quit for good by:

• Helping you better understand why you smoke.
• Teaching you how to handle withdrawal and stress.
• Teaching you tips to help resist the urge to smoke.

A review of smoking cessation products and services found that smokers are up to four times more likely to stop smoking by attending specialist smokers’ clinics than by using willpower alone.

If you cannot see your doctor, you can get some medicines without a prescription that can help you quit smoking. Go to your local pharmacy or grocery store for over-the-counter medicines like the nicotine patch, nicotine gum, or nicotine lozenge. Read the instructions and ask the pharmacist if the medicine is right for you.

Prepare mentally for your quit date. You are not alone in your struggle against your smoking habit! Most smokers in the United States want to quit. However, it can be tough and you will need lots of willpower to break the hold of nicotine, a powerful and addictive drug.

Set a date to stop smoking—any day will do—but choosing a date will help mental preparation. Pick a date within the next 2 weeks to quit, but don’t wait too long! If you smoke at work, quit on the weekend or during a day off. That way you’ll already be cigarette-free when you return.

In your mental preparation, it is helpful to make a list of all the reasons why you want to stop smoking. Place this list prominently in your home (e.g., your bathroom mirror or refrigerator door) to remind yourself why you’re quitting. Here are some sample reasons to get you thinking:

• You’ll have better all-round health. Stopping smoking reduces the risk of 50 different illnesses and conditions.
• Heart attack risk drops to the same as that of a nonsmoker 3 years after quitting.
• The risk of cancer drops with every year of not smoking.
• Live longer and stay well. One in two longterm smokers dies early and loses about 16 years of life.
• Set a good example to the kids (or other people’s kids). You don’t want to be a smoking role model.
• You’ll have lots of money to spend on other things. Smoking a pack a day can cost $1,800 per year.
• Improved fitness and easier breathing will be the results; you’ll be able to participate in sports and get up stairs better.
• You’ll have a better chance of having a healthy baby.
• Food and drink taste better.
• Better skin and complexion and no early wrinkles will be a result of smoking cessation.
• Everything smells better—fresher smelling breath, hair, and clothes, and no more cigarette smells around the house.
• You’ll be back in full control, no longer craving or being distracted when not smoking or not able to smoke.
• Travel on trains, aircraft, and buses will be easier.
• Work will be easier and you won’t have to spend so much time outside or in the smoking room.
• You don’t want to support the tobacco companies.

Understand what to expect when you stop. Most people find the first few days difficult and for some it can be a long struggle, but things will typically start to get better after the third or fourth day. Nicotine withdrawal may make you restless, irritable, frustrated, sleepless, or accident prone but these things will pass and you will quickly start to feel the benefits.

Anticipate nicotine withdrawal. When smokers try to cut back or quit, the absence of nicotine leads to withdrawal symptoms. Withdrawal is both physical and psychological. Physically, the body is reacting to the absence of nicotine. Psychologically, the smoker is faced with giving up a habit, which is a major change in behavior. Both must be dealt with if quitting is to be successful.

Withdrawal symptoms can include any of the following:

• Depression
• Feelings of frustration and anger
• Irritability
• Trouble sleeping
• Trouble concentrating
• Restlessness
• Headache
• Tiredness
• Increased appetite

These uncomfortable symptoms lead the smoker to again start smoking cigarettes, to boost blood levels of nicotine back to a level where there are no symptoms.

If a person has smoked regularly for a few weeks or longer and abruptly stops using tobacco or greatly reduces the amount smoked, withdrawal symptoms will occur. Symptoms usually start within a few hours of the last cigarette and peak about 2 to 3 days later.Withdrawal symptoms can last for a few days to several weeks.

Deal with nicotine withdrawal. Nicotine is a drug found naturally in tobacco. It is highly addictive—as addictive as heroin and cocaine. Over time, the body becomes physically and psychologically dependent on nicotine. Studies have shown that smokers must overcome both of these to be successful at quitting and staying quit.

You can roughly double the chances of successfully quitting smoking by using nicotine replacement therapies such as patches or gum. The idea is to come off nicotine gradually by using a low nicotine dose to take the edge off the cravings and have a “soft landing.”

Examples of nicotine products include Nicorette gum and lozenges. An alternative to nicotine products is the drug Zyban, which is only available by prescription. Although it is proven to be effective, as with all drugs, there is a risk of side effects and you will need to discuss with your doctor whether this form of therapy would be suitable for you.

Remove cigarettes and other tobacco products from your home, car, and work. Getting rid of the things that remind you of smoking will also help you get ready to quit.Try these ideas:

• Throw away all your cigarettes, matches, lighters, and ashtrays. Remember the ashtray and lighter in your car!
• Get rid of the smell of tobacco in your home and other places where you once smoked. Clean your drapes, carpets, clothes, and car.
• Have your dentist clean your teeth to get rid of the smoking stains.

Don’t use herbal cigarettes. Herbal cigarettes, sometimes referred to as “smokeless tobacco,” can also harm your health. These cigarettes are not recommended as aids to giving up smoking because they produce both tar and carbon monoxide. Some brands have a tar content that is higher than tobacco cigarettes. In addition, the use of herbal cigarettes reinforces the habit of smoking which smokers need to overcome.

Don’t use other forms of tobacco instead of cigarettes. Light or low-tar cigarettes are just as harmful as regular cigarettes. All tobacco products contain harmful chemicals. Some smokers switch to pipes, cigars, or chewing tobacco in the belief that this is a less dangerous form of smoking. However, such smokers may incur the same risks and may even increase them.

Consider the financial costs. 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 using tobacco and that amount will probably astound you.

Involve friends or family. If you live with someone who smokes, it will be much easier to quit if you do it together. When expecting a baby, both parents should do it together. One common mistake is not to take the effort to quit smoking seriously enough. Really putting your whole commitment behind it will help you have the right frame of mind to face the challenge.

If quitting is a struggle, consider seeking out other treatments that may help. Hypnosis, acupuncture, or other treatments may help some people, but there isn’t much formal evidence supporting their effectiveness. Use these treatments or services with caution; beware of requests for high fees or claims of “cures” or guarantees of smoking cessation. If you consider these as aids in your struggle or a distraction from nicotine craving, then they have some value.

Find a (temporary) substitute habit. Smoking also involves having something to do with the hands or mouth. Nonsmokers manage without this, so it will not be necessary in the long term. But if this is part of the smoking habit, you may need to deal with it. It might be an idea to use chewing gum; drink more water, fruit juice, or tea; or to chew or eat something (but consider weight gain when choosing!).

Deal with any weight-gain worries. Yes it is true; many people (more than 80 percent) do gain weight when they quit smoking. The possibility of weight gain is often of particular concern to those who want to give up smoking. Nicotine changes the appetite and body’s energy use (metabolism).

However, for a smoker who quits, the long-term weight gain is on average only 6–8 lbs. Keep in mind that this weight gain occurs without the person trying to diet or add extra exercise to the daily regimen.

Further, this weight gain presents only a minor health risk when compared to the risk of continued smoking. In addition, improved lung function and some of the other health benefits of giving up smoking are likely to make exercise both easier and more beneficial.

Watch out for a relapse. You will need to be on your guard especially in the first few days and weeks. “I’ll have just one; it can’t hurt” is the top of a long and slippery slope. If you are upset or under pressure, it is really important to fight off the temptation to smoke; don’t let this be an excuse for slipping back. You could lose everything you’ve achieved in a momentary lapse.

Use smoking cessation aids. Unfortunately, smoking cessation medications have had little use among smokers. The vast majority of smokers attempt to quit smoking on their own, even though unaided quitting has extremely high failure rates compared to other strategies.

Hopefully, with the help of their physicians, patients can employ the effective medications available to quit smoking for good. There are two proven pharmaceutical aids to stopping smoking: nicotine replacement therapy and bupropion, known by its trade name, Zyban.

Nicotine replacement therapies, such as chewing gum, skin patch, tablet, nasal spray, or inhaler, are designed to help the smoker to break the habit while providing a reduced dose of nicotine to overcome withdrawal symptoms such as craving and mood changes. Ideally, use of these medications should be accompanied by counseling, which some drug manufacturers provide by means of a toll-free line.