November 10, 2014

Am I Too Old to Stop Smoking?

Dr Christopher Worsnop MBBS BSc PhD FRACP FCCP, Respiratory and Sleep Physician, Austin Hospital, Melbourne; Adjunct Associate Professor, RMIT University, Melbourne

Conflict of Interest: Registered Victorian Masters athlete who gets out there and has fun!

Smokers are never too old to stop smoking. None of us is ever too old to start doing something positive with our lives. This includes people who smoke making a real effort to finally get rid of the cigarettes and get the most out of their lives by being as healthy as possible.
Most of us are familiar with the large number of nasty effects that cigarettes can have on our bodies. As the smoke is inhaled directly into the lungs, cigarette smoke has particularly nasty effects on these delicate and very valuable organs. One of these is lung cancer, another is emphysema, and another is damage to the airways that take air in and out of the lungs.

Emphysema means that there has been irreversible damage to the air sacs that are critical in getting oxygen from the air into the blood stream. If we look hard enough with lung biopsies we can find some emphysema in all smokers. Smokers also have damage to their airways – they become narrowed and they produce much more phlegm. We call the emphysema and narrowed airways COPD (chronic obstructive pulmonary disease).

Lung Cancer

If cigarettes did not exist, lung cancer would be a rare disease. Lung cancer is the leading cause of cancer death among males and females in Australia, with lung cancer alone accounting for one in every five deaths due to cancer (19%). Tobacco smoking is the largest single cause of lung cancer; about 90% of lung cancer in males and 65% in females is estimated to be a result of tobacco smoking. While incidence and mortality rates of lung cancer have decreased for men, they have increased for women over the past 26 years. This can be attributed to their different histories of tobacco smoking. As overall tobacco consumption began to decline in males in the second half of the 20th century, the incidence rate of lung cancer for males also declined, with a time lag of about 20 years. Cigarette smoking in women peaked later than in men, which may explain why the lung cancer incidence rate for females is still rising. (Cancer Australia. Report to the Nation – Lung Cancer 2011. Cancer Australia, Sydney, NSW, 2011). In addition, evidence shows that one third of heavy smokers will die from lung cancer (Annals of Internal Medicine 2005; 142: 233).

The good news is that stopping smoking reduces the risk of dying from lung cancer. The risk of lung cancer continues to fall for months and years after you stop, so the sooner you stop the better off you will be in the long run. My advice is to hurry up and stop smoking now.

COPD

Some of you who are getting a little older may have noticed that various bodily functions are declining. This includes the lungs. Those of us who have never smoked and have healthy lungs will have a gradual decline in lung function as we get older, but this does not matter as we are built with extra lung capacity so even older lungs do not slow us down. It is the heart that slows us down as we get older.
However, those smokers who develop COPD lose lung function at a much faster rate than normal. This can make people with COPD get short of breath quite easily. As those of you with COPD know, getting breathless is not much fun and it can really limit what you are able to do in your lives.

The good news is that inhaled medications, regular exercise, participation in a pulmonary rehabilitation program and stopping smoking can all reduce the breathlessness experienced with COPD. The best of all of these treatments is stopping smoking. In fact, giving up the cigarettes is the best way to stop the lungs losing their function in COPD. This has been known for nearly forty years, as Fletcher and Peto did a famous study in Great Britain that showed that stopping smoking helps COPD (Fletcher C, Peto R. BMJ 1977; 1: 1645—8). The Fletcher and Peto graph shows that even in older people and people with severe COPD, stopping smoking still works in preventing COPD from getting worse. You can access a copy of the article at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1607732/

The message is that it is never too late to stop smoking.

“We don’t stop playing because we grow old; we grow old because we stop playing.”

So do yourself a favour, throw away the smokes and get out and have some fun.