Category: Advancing Modules

Stop smoking services include:

• NHS Smoking Helpline
• Smoking cessation groups – held in health centres, community centres, and workplaces
• Self referral or referral by health professional
• Specialist smoking cessation nurses available in acute hospitals to support patients
• NHS Specialist training advisers available who provide:
  • One-to-one support
  • Help in making personalised quit date
  • Ongoing support and encouragement
  • Relaxation and stress management techniques
  • Advice on habit-breaking, healthy eating and exercise
• Community pharmacy smoking cessation service:
  • Pharmacies provide 12 weeks NRT and brief support
  • Clients can register for this service at any time by visiting the pharmacy of their choice

Useful websites:

• ASH Scotland
• CHSS Stopping Smoking Essential Guide
• National Institute for Health and Clinical Excellence
• NHS Inform Scotland – Healthy Living/Stopping Smoking
• NHS- Stop smoking services help you quit
• Scottish Government: Smoking electronic cigarettes

• Nicotine Replacement Therapies (NRT) include – patches, lozenges, gum, nasal sprays, inhalers and tablets.
• After stroke NRT should be started under medical supervision and treatment can last up to 3 months.
• It is important to realise that the risk of smoking is far greater than the risk of using NRT after stroke.
• Champix – this is a non-nicotine medication to help reduce the cravings and withdrawal symptoms and it also reduces the satisfaction gained from cigarettes
• Zyban – it works on neurotransmitters in the brain to reduce nicotine cravings and withdrawal reactions.
• The main reason why many smokers find it difficult to stop is nicotine dependence. Nicotine deprivation precipitates a withdrawal syndrome producing both physical symptoms and mood disturbances. These include mouth ulcers, concentration, irritability and urges to smoke.
• The occurrence of these symptoms, especially urges to smoke and depressed mood, can lead to relapses early in a quit attempt.
• As a healthcare professional providing smokers with signposting to smoking cessation services and  providing ongoing support can be pivotal to their success.
• E-cigarette (or vaping) is a form of nicotine replacement therapy. E-cigarettes seem to be less harmful than smoking tobacco. However the long-term effects of smoking e-cigarettes have not yet been fully established. Current advice in Scotland is that vaping or e-cigarettes have less overall risk but they are not currently prescribed to people who wish to stop smoking. If a person chooses to use e-cigarettes, it should be as a stepping stone to quitting.
• Smoking tobacco and using e-cigarettes together (dual usage) is not recommended as there is no benefit. 

For more information on smoking cessation visit: NHS stop smoking services

For more information on e-cigarettes visit: https://www.gov.scot/policies/smoking/electronic-cigarettes/

Stopping smoking is one of the best things a person can do for their health. It not only reduces the risk of stroke it also reduces the risk of other serious health conditions including: heart disease, chronic obstructive pulmonary disease (COPD) and cancer.

Benefits of not smoking:

• After 1 year the risk of a heart attack is HALF that of a smoker
• After 5 years the risk of stroke has fallen to the same as someone who has never smoked
• After 10 years the risk of lung cancer has fallen to Half that of a smoker
• After 15 years the risk of heart attack falls to the same as someone who has never smoked

For more information see CHSS: Stopping smoking essential guide.

Evidence of stroke risk

Smoking is a significant public health issue in Scotland and a leading cause of preventable ill health, premature death and disability (Public Health Scotland (PHS) and people who smoke are twice as likely to suffer a stroke compared to non smokers (NHS Greater Glasgow & Clyde).

Smoking:

• Has an overall increased risk of stroke compared with non smokers and former smokers (Pan et al 2019)
• With increased cigarette consumption the risk of stroke is increased by 12% for each increment of 5 cigarettes per day (Pan et al 2019)
• If you smoke 20 cigarettes a day you are 6 times more likely to have a stroke compared
  to a non smoker (CHSS 2019)
• The risk associated is present at all ages, in both sexes and among different racial/ethnic groups
• Passive smoking increases stroke risk by 45% (Pan et al 2019)
• Smoking rates are still highest in the most deprived areas, with 35% of people living in the most deprived areas of Scotland smoking compared to 10% in the least deprived areas (PHS)
• Smoking also carries the risk of developing other conditions such as cancer and respiratory (lung) disease
• Smoking cessation and avoidance of second-hand/passive smoking are important strategies in the prevention of stroke and stroke recurrence (Stroke Association 2017)

Relationship to stroke risk

Carbon monoxide, a poisonous gas found in tobacco smoke, makes it easier for cholesterol to pass through into blood vessels & cause a fatty build up; which can lead to increased risk of heart disease and stroke.

Smoking:

• Increases the risk of high blood pressure – a major risk factor to stroke (Stroke Association 2017)
• Makes the smooth lining of blood vessels rough which encourages the build-up of atheroma, the fatty material that narrows and blocks vessels
• Increases the amount of fibrinogen in the blood and makes blood stickier, increasing the chance of blood clots forming which cause strokes