Benefits and risks of smoking cessation
- Nancy A Rigotti, MD
Nancy A Rigotti, MD
- Professor of Medicine
- Harvard Medical School
- Section Editors
- James K Stoller, MD, MS
James K Stoller, MD, MS
- Section Editor — Chronic Obstructive Pulmonary Disease
- Jean Wall Bennett Professor of Medicine, Samson Global Leadership Academy Endowed Chair
- Cleveland Clinic Lerner College of Medicine
- Chairman, Education Institute, Cleveland Clinic
- Mark D Aronson, MD
Mark D Aronson, MD
- Editor-in-Chief — Primary Care (Adult); Hospital Medicine
- Section Editor — General Medicine
- Professor of Medicine
- Harvard Medical School
Cigarette smoking is the leading preventable cause of mortality, responsible for nearly six million deaths worldwide and over 400,000 deaths in the United States annually [1,2]. If current trends continue, tobacco will kill more than eight million people worldwide each year by the year 2030. The three major causes of smoking-related mortality are atherosclerotic cardiovascular disease, lung cancer, and chronic obstructive pulmonary disease (COPD) .
Smokers who stop smoking reduce their risk of developing and dying from tobacco-related illnesses [3,4]. Screening all patients for tobacco use and providing smokers with behavioral counseling and pharmacotherapy to stop smoking are among the most valuable preventive services that can be offered in health care .
This topic will discuss the benefits and risks of smoking cessation. Management of smoking cessation, including the use of behavioral and pharmacologic therapies, is discussed in detail separately. (See "Overview of smoking cessation management in adults" and "Behavioral approaches to smoking cessation" and "Pharmacotherapy for smoking cessation in adults".)
BENEFITS OF SMOKING CESSATION
Smoking cessation is associated with substantial health benefits for all smokers . The extent of benefit partly depends on the intensity and duration of prior tobacco smoke exposure. Smokers who stop smoking can be expected to live longer and are less likely to develop tobacco-related diseases, including coronary heart disease, cancer, and pulmonary disease. Smokers also benefit from quitting smoking even after the development of smoking-related diseases, such as coronary heart disease or chronic obstructive pulmonary disease (COPD).
All-cause mortality — Up to one-half of all smokers can be expected to die from a tobacco-related illness . In one population-based cohort of nearly 50,000 people aged 40 to 70 years in Norway, the years of life lost were 1.4 years in women and 2.7 years in men among those who smoked ≥20 cigarettes daily, compared with those who never smoked .
- World Health Organization Report on the Global Tobacco Epidemic, 2011: Warning about the dangers of tobacco. World Health Organization, Geneva 2011. http://whqlibdoc.who.int/publications/2011/9789240687813_eng.pdf (Accessed on September 27, 2011).
- Centers for Disease Control and Prevention (CDC). Smoking-attributable mortality, years of potential life lost, and productivity losses--United States, 2000-2004. MMWR Morb Mortal Wkly Rep 2008; 57:1226.
- Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ 2004; 328:1519.
- Anthonisen NR, Skeans MA, Wise RA, et al. The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial. Ann Intern Med 2005; 142:233.
- Maciosek MV, Coffield AB, Edwards NM, et al. Priorities among effective clinical preventive services: results of a systematic review and analysis. Am J Prev Med 2006; 31:52.
- Rigotti NA. Clinical practice. Treatment of tobacco use and dependence. N Engl J Med 2002; 346:506.
- Vollset SE, Tverdal A, Gjessing HK. Smoking and deaths between 40 and 70 years of age in women and men. Ann Intern Med 2006; 144:381.
- Kenfield SA, Stampfer MJ, Rosner BA, Colditz GA. Smoking and smoking cessation in relation to mortality in women. JAMA 2008; 299:2037.
- Ikeda F, Ninomiya T, Doi Y, et al. Smoking cessation improves mortality in Japanese men: the Hisayama study. Tob Control 2012; 21:416.
- Cao Y, Kenfield S, Song Y, et al. Cigarette smoking cessation and total and cause-specific mortality: a 22-year follow-up study among US male physicians. Arch Intern Med 2011; 171:1956.
- Health benefits of smoking cessation. A report of the Surgeon General. DHHS Publication No. (CDC) 90-8416, Department of Health and Human Services, Washington, DC 1990.
- Gellert C, Schöttker B, Brenner H. Smoking and all-cause mortality in older people: systematic review and meta-analysis. Arch Intern Med 2012; 172:837.
- Nash SH, Liao LM, Harris TB, Freedman ND. Cigarette Smoking and Mortality in Adults Aged 70 Years and Older: Results From the NIH-AARP Cohort. Am J Prev Med 2017; 52:276.
- Ezzati M, Henley SJ, Thun MJ, Lopez AD. Role of smoking in global and regional cardiovascular mortality. Circulation 2005; 112:489.
- Office of the Surgeon General. Chapter Six: Cardiovascular diseases. In: A Report of the Surgeon General: How Tobacco Smoke Causes Disease. US Department of Health and Human Services 2011. Available at: http://www.surgeongeneral.gov/library/tobaccosmoke/report/chapter6.pdf (Accessed on December 06, 2011).
- Vineis P, Alavanja M, Buffler P, et al. Tobacco and cancer: recent epidemiological evidence. J Natl Cancer Inst 2004; 96:99.
- Willemse BW, Postma DS, Timens W, ten Hacken NH. The impact of smoking cessation on respiratory symptoms, lung function, airway hyperresponsiveness and inflammation. Eur Respir J 2004; 23:464.
- Kanner RE, Connett JE, Williams DE, Buist AS. Effects of randomized assignment to a smoking cessation intervention and changes in smoking habits on respiratory symptoms in smokers with early chronic obstructive pulmonary disease: the Lung Health Study. Am J Med 1999; 106:410.
- Au DH, Bryson CL, Chien JW, et al. The effects of smoking cessation on the risk of chronic obstructive pulmonary disease exacerbations. J Gen Intern Med 2009; 24:457.
- Arcavi L, Benowitz NL. Cigarette smoking and infection. Arch Intern Med 2004; 164:2206.
- Nuorti JP, Butler JC, Farley MM, et al. Cigarette smoking and invasive pneumococcal disease. Active Bacterial Core Surveillance Team. N Engl J Med 2000; 342:681.
- Willi C, Bodenmann P, Ghali WA, et al. Active smoking and the risk of type 2 diabetes: a systematic review and meta-analysis. JAMA 2007; 298:2654.
- Kanis JA, Johnell O, Oden A, et al. Smoking and fracture risk: a meta-analysis. Osteoporos Int 2005; 16:155.
- Cornuz J, Feskanich D, Willett WC, Colditz GA. Smoking, smoking cessation, and risk of hip fracture in women. Am J Med 1999; 106:311.
- Oncken C, Prestwood K, Kleppinger A, et al. Impact of smoking cessation on bone mineral density in postmenopausal women. J Womens Health (Larchmt) 2006; 15:1141.
- Parasher G, Eastwood GL. Smoking and peptic ulcer in the Helicobacter pylori era. Eur J Gastroenterol Hepatol 2000; 12:843.
- Suzuki T, Matsuo K, Ito H, et al. Smoking increases the treatment failure for Helicobacter pylori eradication. Am J Med 2006; 119:217.
- Fagerström K. The epidemiology of smoking: health consequences and benefits of cessation. Drugs 2002; 62 Suppl 2:1.
- Tatsuta M, Iishi H, Okuda S. Effects of cigarette smoking on the location, healing and recurrence of gastric ulcers. Hepatogastroenterology 1987; 34:223.
- Zee KY. Smoking and periodontal disease. Aust Dent J 2009; 54 Suppl 1:S44.
- Tomar SL, Asma S. Smoking-attributable periodontitis in the United States: findings from NHANES III. National Health and Nutrition Examination Survey. J Periodontol 2000; 71:743.
- Carter BD, Abnet CC, Feskanich D, et al. Smoking and mortality--beyond established causes. N Engl J Med 2015; 372:631.
- Godtfredsen NS, Holst C, Prescott E, et al. Smoking reduction, smoking cessation, and mortality: a 16-year follow-up of 19,732 men and women from The Copenhagen Centre for Prospective Population Studies. Am J Epidemiol 2002; 156:994.
- Tverdal A, Bjartveit K. Health consequences of reduced daily cigarette consumption. Tob Control 2006; 15:472.
- Gerber Y, Myers V, Goldbourt U. Smoking reduction at midlife and lifetime mortality risk in men: a prospective cohort study. Am J Epidemiol 2012; 175:1006.
- Godtfredsen NS, Prescott E, Osler M. Effect of smoking reduction on lung cancer risk. JAMA 2005; 294:1505.
- Aveyard P, Lindson-Hawley N, Hastings G, de Andrade M. Should smokers be advised to cut down as well as quit? BMJ 2014; 348:g2787.
- Cook JW, Piper ME, Leventhal AM, et al. Anhedonia as a component of the tobacco withdrawal syndrome. J Abnorm Psychol 2015; 124:215.
- Filozof C, Fernández Pinilla MC, Fernández-Cruz A. Smoking cessation and weight gain. Obes Rev 2004; 5:95.
- Chinn S, Jarvis D, Melotti R, et al. Smoking cessation, lung function, and weight gain: a follow-up study. Lancet 2005; 365:1629.
- Flegal KM, Troiano RP, Pamuk ER, et al. The influence of smoking cessation on the prevalence of overweight in the United States. N Engl J Med 1995; 333:1165.
- Williamson DF, Madans J, Anda RF, et al. Smoking cessation and severity of weight gain in a national cohort. N Engl J Med 1991; 324:739.
- Covey LS. Tobacco cessation among patients with depression. Prim Care 1999; 26:691.
- Glassman AH, Covey LS, Stetner F, Rivelli S. Smoking cessation and the course of major depression: a follow-up study. Lancet 2001; 357:1929.
- Schroeder SA. Depression, smoking, and heart disease: how can psychiatrists be effective? Am J Psychiatry 2011; 168:876.
- Prochaska JJ. Smoking and mental illness--breaking the link. N Engl J Med 2011; 365:196.
- Bolam B, West R, Gunnell D. Does smoking cessation cause depression and anxiety? Findings from the ATTEMPT cohort. Nicotine Tob Res 2011; 13:209.
- Ussher M, West R, Steptoe A, McEwen A. Increase in common cold symptoms and mouth ulcers following smoking cessation. Tob Control 2003; 12:86.
- Marakoğlu K, Sezer RE, Toker HC, Marakoğlu I. The recurrent aphthous stomatitis frequency in the smoking cessation people. Clin Oral Investig 2007; 11:149.
- Dicpinigaitis PV, Sitkauskiene B, Stravinskaite K, et al. Effect of smoking cessation on cough reflex sensitivity. Eur Respir J 2006; 28:786.
- Croghan IT, Offord KP, Evans RW, et al. Cost-effectiveness of treating nicotine dependence: the Mayo Clinic experience. Mayo Clin Proc 1997; 72:917.
- Cromwell J, Bartosch WJ, Fiore MC, et al. Cost-effectiveness of the clinical practice recommendations in the AHCPR guideline for smoking cessation. Agency for Health Care Policy and Research. JAMA 1997; 278:1759.
- Karnath B. Smoking cessation. Am J Med 2002; 112:399.
- Javitz HS, Zbikowski SM, Deprey M, et al. Cost-effectiveness of varenicline and three different behavioral treatment formats for smoking cessation. Transl Behav Med 2011; 1:182.
- Shearer J, Shanahan M. Cost effectiveness analysis of smoking cessation interventions. Aust N Z J Public Health 2006; 30:428.
- BENEFITS OF SMOKING CESSATION
- All-cause mortality
- Cardiovascular disease
- Pulmonary disease
- Osteoporosis and hip fracture
- Reproductive disorders
- Peptic ulcer disease
- Periodontal disease
- Postoperative complications
- QUESTIONABLE UTILITY OF SMOKING REDUCTION
- RISKS OF SMOKING CESSATION
- Nicotine withdrawal syndrome
- Weight gain
- Cough and mouth ulcers
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS