Stop smoking

The information on this page looks at how stopping smoking can reduce your risk of a stroke, and offers tips and advice about quitting.

If you have been advised to give up smoking after a stroke, you might be unsure where to start. You may be dealing with quite a few things at the same time, like new medication, rehabilitation therapy and adjusting to life after a stroke. It can feel like a lot to cope with.

Giving up smoking is never an easy thing to do. But it is one of the best things you can do to help you stay healthy and reduce your risk of another stroke. As soon as you quit, your risk of a stroke starts to go down. Within a few years, your risk is similar to a non-smoker.

You don't have to do it alone: free help and advice is available to all smokers in the UK.

See below for practical tips about finding the right time to quit, managing cravings, and getting support for yourself.

The information on this page can be accessed in the following formats:

Download this information as a pdf or large print document.
Order a printed copy from our shop.
To request a braille copy, email helpline@stroke.org.uk

How does smoking cause stroke?

It's thought that smokers are around three times more likely to have a stroke than non-smokers. And the more you smoke, the bigger your chance of a stroke.

Tobacco smoke contains over 7,000 toxic chemicals, including nicotine, carbon monoxide, formaldehyde, arsenic and cyanide. When you breath smoke, the chemicals enter your bloodstream, changing and damaging cells all around your body.

Smoking can:

Reduce oxygen levels in your blood.
Increase your risk of high blood pressure.
Trigger atrial fibrillation (a type of irregular heartbeat).
Raise levels of 'bad' cholesterol.
Raise your risk of a blood clot.

E-cigarettes and vapes

Vaping has become popular in the past few years. The nicotine is delivered as a vapour, and delivered as a vapour you can inhale through an electronic device. Some people use them when trying to give up traditional cigarettes, and others use them as a substitute.

They are less harmful than cigarettes, but they aren't completely safe. The healthiest option is to aim to give up using tobacco products entirely.

What happens when you quit?

The benefits start right away. Your oxygen levels return to normal, and carbon monoxide and nicotine levels reduce by more than half within eight hours. (Carbon monoxide is a poison because it reduces the oxygen going to your body and brain.)
You'll notice the difference within 48 hours as your ability to taste and smell improves.
In a few days your breathing becomes easier and your energy levels go up.
After 12 weeks, blood will be pumping to your heart and muscles more efficiently.
Between three and nine months, any coughing and wheezing eases and your lung function improves by up to 10%.
After one year your risk of a heart attack is half that of a smoker.
After five years your risk of having a stroke is around the same as someone who has never smoked.

Quit or cut down?

Although your risk of a stroke goes down the less you smoke, even smoking one cigarette per day still gives you a significantly higher risk of stroke. That's why you'll be advised to try quitting.

How can I quit?

Quitting isn't easy. But you're much more likely to succeed if you have a little help.

This can include using stop-smoking aids like nicotine replacement products or stop-smoking medication.

Joining a free stop-smoking service can be very helpful. These give you access to professional advisers, and stop-smoking treatments on prescription. You'll get individual advice, and support to keep going with your attempt to quit. You might be able to join a group, use a quitting app or get email support.

You'll discuss with your adviser why you want to give up, and decide if you want to quit. If you decide you want to quit, you'll work with your adviser to make an action plan and set a quit date. Your action plan can include a prescription for stop-smoking treatment as well as practical advice and support for you.

Find a stop-smoking service

There are stop-smoking services in all areas of the UK. Your GP can refer you for help. You can also contact a local service yourself. Details are available from your GP surgery or pharmacist, or look online for details. Click here for details for services in Wales, Scotland, Northern Ireland and England.

Getting motivated

Write down all the reasons you want to quit. This could include how passive smoking affects your family, and your reasons for wanting to stay healthy and active.
You could work out how much money you can save by quitting, and what you could do with it. Try an online saving calculator like this one.
Stay positive: tell yourself that you are going to do it!
Getting support and encouragement from friends and family can be helpful too.

What if I start smoking again?

Giving up smoking is a long-term change, and it can take a few tries to stop for good. If you start smoking again, it can be a chance to learn more about the things that trigger your smoking, and how to change them.

If you do start smoking again, there's help available to get back on track. There is some useful advice on the NHS Quit Smoking page.

Managing cravings

When you first stop smoking, your craving for nicotine will decrease gradually over a few weeks. But even after you have stopped smoking, cravings can come back at moments of stress, or at certain times and places where you used to smoke.

A craving could last several minutes before it passes. Some practical tips to avoid smoking when you have a craving include:

Keep nicotine replacement therapy with you. If you know you'll be going somewhere you're likely to get cravings, try to take a fast-acting type such as a mouth spray.
Delay responding to the urge. It's very intense, but it should reduce within a few minutes.
Make it hard for yourself to smoke. Avoid places where people smoke or where you could ask someone for a cigarette. Don't buy a packet or keep any cigarettes at home.
Avoid triggers. If you tend to smoke after dinner, while chatting to a friend or in your lunch break, try doing something different at these times. For instance, if you usually have a cigarette after dinner, get up and wash the dishes straight away, or go into a room where you don't smoke. Changing your pattern of behaviour for a while could help you break the association with smoking.

More practical tips are available from your local stop smoking service, or you can search online for advice.

Staying healthy after quitting

Emotional wellbeing

Smoking can give you a feeling of relaxation because nicotine alters mood chemicals in the brain. The problem is that you become dependent on nicotine to give you that feeling. When you quit, cravings can make you feel anxious and irritable at first. But after a while your mood and anxiety levels should improve.

If you feel that low mood or anxiety is affecting you, or if you take medication for anxiety or depression, contact your GP. They can help make sure you get the help and support you need.

Stay active and eat well

Being as active as possible will help your overall health and wellbeing, and reduce your risk of a stroke. It's great for improving mood and better sleep. Walking, swimming or indoor exercise like housework are all great ways of starting to move more.

We have loads of great suggestions for getting motivated and adding more movement into your day plus free exercise videos for stroke survivors on our get moving after a stroke page.

Try to follow healthy diet advice like having plenty of vegetables and fruit, and reduce salt and sugar. Have healthy snacks ready if you crave sweet food. Things like fresh fruit, nuts and vegetable sticks are good. If you're eating more than usual, try to keep your portion sizes small. Keep using any stop-smoking treatment regularly, as cravings can make you eat more.

Medication and stop-smoking aids

There are several different types of medicine and stop-smoking aids that can help you stop smoking. Speak to your doctor, pharmacist or the advisor at your local stop smoking service about which type of treatment is most suitable for you.

Nicotine replacement therapy (NRT) including patches, gum, lozenges, microtabs, inhalators and nasal sprays.
Zyban tablets (bupropion).
E-cigarettes.
Other stop-smoking techniques.

Nicotine replacement therapy (NRT)

NRT steadily releases nicotine into your bloodstream without you having to inhale cigarette smoke. Using NRT helps to relieve smoking withdrawal symptoms, such as cravings, restlessness and irritability. After setting a stop date, you can start on your chosen NRT. You might use more than one type at the same time, such as a long-acting type, plus a fast-acting kind to deal with cravings.

There is a wide range of NRT products available. They are available on prescription from an NHS Stop Smoking Service. You can also buy them over the counter from a pharmacy or supermarket.

Types of nicotine replacement therapy (NRT)

Patches deliver a continuous supply of nicotine into the bloodstream. There are two kinds available: 16 hours for daytime use and 24 hours to be worn day and night for those with particularly strong cravings. They come in various strengths to reflect how much you smoke, and users should aim to reduce the level of nicotine gradually whilst quitting.

Gum delivers bursts of nicotine through chewing. The strength of the gum and number of pieces you use will be determined by how much you have smoked. You chew this type of gum slowly, until the taste becomes stronger and hold it between your gums and cheek to allow the nicotine to be absorbed into the bloodstream, repeating this action when the taste fades.
Lozenges work in a similar way to gum, providing short bursts of nicotine. You suck the lozenge until the taste becomes stronger and store it inside your cheek until it fades, starting again when this happens. They usually dissolve after 20-30 minutes.
Nasal sprays can work for heavy smokers or people who get severe withdrawal symptoms. The nicotine is quickly absorbed into the blood vessels in the nose, relieving cravings quickly, although they can produce side effects such as nose and throat irritation, coughing and watery eyes.
Inhalators made of plastic and shaped to look like cigarettes. Users suck on the tube to release a burst of nicotine. They are particularly suited to people who miss the physical action of smoking.
Microtabs are very small tablets that dissolve under your tongue and should not be chewed. The dosage amount depends on how much you have smoked. They may suit users who are seeking a more discreet aid to stopping smoking.

Using nicotine replacement therapy (NRT) after a stroke

NRT should only be started under medical supervision in someone who has had a very recent stroke (within the last four weeks). In most cases, NRT will still be prescribed as the risks associated with continuing to smoke are usually greater than the risk of using NRT after a stroke.

Stop-smoking medication

Zyban (bupropion hydrochloride)

Zyban is usually taken for a couple of months. It alters brain chemistry in such a way that nicotine is less effective and the desire to smoke is reduced. It is unsuitable for people with some health conditions and only available on prescription.

E-cigarettes and vaping

Advisors at Stop Smoking Services can suggest trying vapes as part of your quitting plan, but they are not currently available on prescription.

Other stop-smoking techniques

Acupuncture and hypnotherapy may help some people, but have not been through any large-scale clinical trials and are not licensed as stop-smoking treatments on the NHS. If you wish to try one of these therapies, make sure you see a qualified practitioner.