Smoking, Vaping and Nicotine: Health Risks and Getting Help

Smoke damages the tiny hairs (cilia) that clear the airways, which is why a smoker’s cough develops. Over time it narrows and inflames the airways and destroys lung tissue, causing chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis. Smoking also triggers and worsens asthma, and increases the risk of chest infections and pneumonia.

Smoking damages the lining of blood vessels, raises blood pressure and heart rate, thickens the blood and speeds up the furring of the arteries. It raises the risk of heart attack, angina, abdominal aortic aneurysm and peripheral arterial disease, which can cause painful legs and, in severe cases, tissue loss.

Smoking substantially increases the risk of stroke, by damaging blood vessels in the brain and making clots more likely. Stopping reduces this risk over time.

Smoking is the single biggest preventable cause of cancer in the UK. It is linked to cancers of the lung, mouth, throat, voice box, oesophagus, bladder, kidney, pancreas, bowel, stomach, liver, cervix and some blood cancers. Risk falls after stopping, though it does not return to that of a lifelong non-smoker immediately.

Smoking stains teeth, causes bad breath, reduces the sense of taste and smell, and is a major cause of gum disease and tooth loss. It also delays healing after dental treatment and makes mouth cancer more likely.

Smoking weakens bone, contributing to osteoporosis and fractures, and it slows the healing of broken bones and surgical wounds. Many surgical teams ask people to stop before an operation because it lowers the risk of complications and infection.

Smoking reduces fertility in all genders. It can affect sperm quality and count, reduce the chance of conceiving, increase the risk of miscarriage and bring on an earlier menopause. It is also a common cause of erectile difficulties because of its effect on blood vessels.

Smoking in pregnancy restricts the baby’s oxygen supply and increases the risk of miscarriage, stillbirth, premature birth, low birth weight and sudden infant death. Stopping at any stage of pregnancy helps — see the pregnancy section further down this page.

Reduced blood flow and damage to collagen and elastin lead to earlier wrinkling, a dull or greyish complexion and slower skin healing. Smoking also worsens some skin conditions and delays wound repair.

Smoking increases the risk of age-related macular degeneration, cataracts and dry eye, and it can worsen eye complications of diabetes and thyroid eye disease.

Smoking increases the risk of developing type 2 diabetes and makes existing diabetes harder to control. It worsens kidney disease, circulation problems, foot ulcers and many long-term conditions, and it can interact with some medicines.

Nicotine dependence creates a cycle: withdrawal causes tension and irritability, and the next cigarette relieves it, which feels like stress relief. Research suggests that people who stop smoking tend to report improved anxiety, depression and general wellbeing over the following weeks and months, once withdrawal settles.

Manufactured cigarettes burn processed tobacco. Filters and “smoother” blends do not remove the main harms — people often inhale more deeply, which can offset any theoretical difference.

Roll-ups are not a safer choice. They deliver tar, carbon monoxide and the same range of harmful chemicals, and are often smoked without a proper filter.

Cigars contain large amounts of tobacco and produce a high volume of smoke. Even when smoke is not inhaled deeply, cigars raise the risk of cancers of the mouth, throat and oesophagus, and they expose other people to second-hand smoke.

Pipe smoking causes cancers of the mouth, lip, tongue and throat, gum disease and other tobacco-related illness. It is not a gentle alternative to cigarettes.

Shisha is often assumed to be filtered and mild because the smoke passes through water. Water does not remove the harmful chemicals. A single shisha session can last a long time and may involve inhaling a large volume of smoke, along with carbon monoxide from the burning charcoal. Sharing a mouthpiece can also spread infection.

Bidis are small hand-rolled products wrapped in leaf. They are not a safer traditional option — they can deliver high levels of tar, nicotine and carbon monoxide.

Tobacco that is chewed, sucked or held in the mouth is not smoked, but it still causes serious harm, including mouth, gum and throat disease, tooth loss and cancers of the mouth and oesophagus, as well as nicotine dependence.

Paan, gutkha, supari, betel quid and similar products are widely used in some communities, sometimes with tobacco and sometimes without. Areca (betel) nut is itself linked to mouth cancer, and adding tobacco increases the risk further. These products can also cause a stiffening of the mouth that makes it hard to open the jaw. NHS information about paan, bidi and shisha is linked below.

Pod systems use pre-filled or replaceable pods. Tank systems are refilled from bottles of e-liquid. E-liquids vary in nicotine strength and in the type of nicotine used. In the UK, nicotine e-liquid sold to consumers is limited to a maximum strength of 20 mg/ml, refill bottles to 10 ml and tanks to 2 ml.

Some vapes contain no nicotine. These are not risk-free either — the aerosol and flavourings are still inhaled — and non-nicotine products are sometimes mislabelled. Nicotine-free does not mean harm-free.

Legally sold UK nicotine vapes must be notified to the MHRA, meet limits on strength and volume, carry warnings and ingredient information, and use child-resistant, tamper-evident packaging. Illegal or counterfeit products can bypass all of that — with unknown contents, excessive nicotine or oversized tanks. See the section on illegal vapes below.

Coughing, a dry or irritated throat, a dry mouth, headache, nausea, dizziness or a racing heartbeat can occur — particularly with a nicotine strength that is too high for the person. If symptoms persist or are severe, seek advice from a pharmacist or GP.

Vaping is relatively new, so the long-term effects over several decades are not yet known. Current UK evidence reviews conclude that vaping poses a small fraction of the risk of smoking in the short and medium term, while making clear that it is not risk-free and that non-smokers should not start.

Some people have allergic-type reactions to flavourings or ingredients. Devices can also be faulty, leak or overheat. Suspected side effects and defective products can be reported through the MHRA Yellow Card scheme.

Regular nicotine use can lead to dependence, and the teenage brain is still developing. Young people who vape often may find they need it more frequently, feel uncomfortable without it, and struggle to cut down.

Cravings, irritability, restlessness and feeling on edge between vapes are signs of dependence. These feelings are real, they are not bad behaviour, and they do ease with support.

Some young people notice difficulty concentrating in lessons, low mood or irritability, and disturbed sleep — particularly if they wake to vape or use it late at night.

Coughing, a sore or dry throat, dizziness, headaches and nausea are commonly reported, especially with high nicotine strengths or heavy use.

Vaping is often social. Young people may feel pressure to join in, to share a device, or to avoid standing out. Talking through how to say no — and having a ready phrase — helps more than a warning.

Vaping content circulates widely online, often designed to look appealing and sometimes posted by sellers. Content promoting products to under-18s can be reported to the platform, and misleading advertising can be reported to the Advertising Standards Authority.

Sweet flavours, bright packaging and small, easily hidden devices are attractive to young people and are a key reason for tighter UK rules. Any product designed to look like sweets or a children’s item should be treated as a serious warning sign.

Most schools and colleges prohibit vaping on site and may confiscate devices. Policies differ, and a young person who is dependent needs support alongside any rule enforcement, not punishment alone.

Selling nicotine vapes or tobacco to under-18s is illegal, as is buying them on a young person’s behalf (proxy purchasing). Retailers suspected of underage sales can be reported to Trading Standards.

Products bought from unofficial sellers, social media or friends may contain unknown substances or far more nicotine than allowed. They are also more likely to have unsafe batteries.

Some devices sold informally have been found to contain illegal drugs, including synthetic cannabinoids (sometimes called “spice”). These have caused young people to collapse, have seizures and need emergency care. If a young person becomes seriously unwell after using an unknown device, call 999 and say what may have been used.

A young person can speak to a GP, pharmacist, school nurse or local stop-smoking service. Many local services now support young people with vaping as well as smoking. Childline is available free on 0800 1111 at any hour.

Local services offer weekly one-to-one or group support, carbon-monoxide monitoring and access to treatments. In England use the NHS service finder; in Scotland, Quit Your Way; in Wales, Help Me Quit; in Northern Ireland, services listed on nidirect and through local pharmacies.

Many pharmacies run stop-smoking schemes and can supply nicotine-replacement therapy, sometimes on the NHS. A GP can review health conditions and medicines and refer to specialist support.

Structured support helps people plan for triggers, change routines, handle cravings and stay motivated. It can be face to face, by phone, by text or through an app, and it works best alongside a treatment.

NRT provides nicotine without burning tobacco, so it eases withdrawal while the smoke, tar and carbon monoxide stop. There are slow-acting products that release nicotine steadily through the day, and fast-acting products used when a craving arrives. Many people are advised to use one of each together. This page does not give doses or strengths — a pharmacist, GP or stop-smoking adviser will discuss what suits you, your health conditions and your medicines, and the supplied patient information leaflet should always be read.

Separate expanders below explain what each type of product is for. Nothing here is a recommendation of any brand or retailer.

A patch is worn on the skin and releases nicotine steadily, giving background relief from withdrawal rather than instant help with a sudden craving. Some patches are designed for daytime wear only and others for 24 hours; an adviser will explain which pattern suits your sleep and your cravings on waking. Patches are simple for people who would struggle with frequent dosing or who dislike the taste of oral products. Skin can occasionally become itchy or red, and moving the site each day usually helps. A used patch still contains nicotine, so fold it inwards and dispose of it out of reach of children and pets.

Nicotine gum is chewed in a particular way — chewed briefly, then rested against the inside of the cheek — so the nicotine is absorbed through the lining of the mouth rather than swallowed. It works quickly, which makes it useful for a craving triggered by coffee, a break at work or a stressful moment. It can cause hiccups, jaw ache, a sore mouth or indigestion, particularly if chewed continuously. It is not suitable for everyone, including some people with dental work or jaw problems, so ask a pharmacist.

Lozenges dissolve slowly in the mouth and are moved from side to side rather than sucked hard or crunched. They suit people who cannot or would rather not chew gum, and are discreet. Like gum they can cause a sore mouth, hiccups or indigestion if used too quickly. Because they look like sweets, they must be kept in their packaging and well out of reach of children.

An inhalator is a small plastic holder with a nicotine cartridge that is drawn on like a cigarette. Nicotine is absorbed through the mouth and throat, not the lungs. Some people find the hand-to-mouth action helpful because it replaces part of the habit as well as the nicotine. It can cause mild throat or mouth irritation and a cough at first. Cartridges must be stored safely away from children and pets.

A mouthspray is aimed at the inside of the cheek and acts within a minute or two, which some people find the most effective option for intense cravings. A nasal spray acts quickly too but commonly causes sneezing, a runny nose, watering eyes or throat irritation for the first few days, and is usually considered for people with strong dependence after discussion with a clinician. Both are liquids containing nicotine and must be capped and stored out of sight and reach.

A prescription tablet that reduces cravings and the reward from smoking. It returned to UK availability as a generic medicine and is recommended by NICE as an option. Suitability, monitoring and side effects must be discussed with a prescriber.

A plant-derived tablet that works in a similar way to varenicline and is recommended by NICE as an option for adults. Availability varies locally. A prescriber will advise on suitability.

A prescription tablet that can help some people stop smoking. It is not suitable for everyone, including people with certain conditions, and requires a prescriber’s assessment.

NHS services offer vaping as one recognised route out of smoking for adults. It works best when the person switches completely, uses a nicotine strength that genuinely satisfies cravings, and has behavioural support alongside. It is not recommended for anyone who does not already smoke.

Choose a date within the next couple of weeks, tell people who will support you, clear cigarettes, lighters and ashtrays from home and car, and have your chosen treatment ready before the date arrives.

Common triggers include the first coffee, driving, alcohol, breaks at work, phone calls, stress, boredom and being around other smokers. Plan a specific alternative for each one rather than hoping to resist.

A slip is not the end of the attempt. Note what happened, adjust the plan, and continue. Most people who stop permanently have had several attempts — that is the normal path, not evidence of failure.

Arrange the next contact before you leave an appointment. Support in weeks two to twelve, when the initial determination fades, makes a real difference.

Carbon monoxide leaves the blood after smoking stops, so blood can carry oxygen normally again. Many people notice that everyday effort — stairs, walking uphill, carrying shopping — becomes easier over the following weeks, and that circulation to the hands and feet improves.

Stopping reduces the risk of heart attack and stroke, and the benefit continues to grow the longer you stay smoke-free. Lung function declines faster in people who smoke; stopping slows that decline, which is why stopping matters even after a diagnosis of asthma, COPD or heart disease.

Risk of smoking-related cancers falls after stopping, and keeps falling with the years. It does not drop to zero immediately and, for some cancers, stays somewhat higher than in someone who never smoked. This is a reason to stop sooner rather than a reason not to bother.

Taste and smell commonly sharpen within days or weeks, and food often becomes more enjoyable. Appetite can increase, which is normal and can be planned for with an adviser rather than treated as a reason to start again.

Wounds tend to heal better and surgical complications are less likely in people who do not smoke, which is why hospitals offer stop-smoking support before planned operations. Chest infections often become less frequent.

Gum health usually improves and staining stops getting worse. Skin circulation improves, though existing lines and changes will not disappear.

A smoke-free home and car removes second-hand smoke exposure for children, pregnant people, older relatives, disabled household members, visitors and pets, and removes the residue left on soft furnishings, clothing and surfaces.

Smoking is expensive, and the amount saved depends entirely on what somebody smokes — work it out from your own spending rather than from a national average. Many people also describe a quieter kind of relief: no longer planning journeys, work breaks, social events or holidays around when they can next smoke, and no longer worrying about running out.

• What do I use — cigarettes, roll-ups, cigars, a pipe, shisha, smokeless or oral tobacco, heated tobacco, pouches, a vape, or a combination?
• Roughly how much each day, and how soon after waking do I have the first one?
• Which times or places are hardest to imagine without it?
• Am I using both cigarettes and a vape? If so, how do I move to one or the other?

• Have I stopped before? For how long, and what helped most?
• What was happening when I started again — stress, illness, a social occasion, bereavement, running out of treatment?
• Which products or approaches have I already tried, and how did they suit me?

• Which routines are tied to smoking — coffee, meals, driving, breaks, phone calls, going outside?
• Which feelings are tied to it — stress, anger, boredom, sadness, loneliness, celebration?
• Who do I smoke with, and does anyone in my household smoke?
• Does alcohol change my plans?

• Which long-term conditions do I have — asthma, COPD, heart disease, high blood pressure, diabetes, kidney disease, cancer or cancer treatment?
• What medicines, inhalers, injections and over-the-counter products do I take? (Bring a list or the boxes.)
• Do I have a mental-health condition, or a history of seizures?
• Could stopping smoking affect how any of my medicines work, and who will review that?
• Am I pregnant, planning pregnancy or breastfeeding?
• Do I have upcoming surgery, dental treatment or a hospital procedure?

• One-to-one, group, telephone, video, text or app support?
• Pharmacy, GP practice, local service, hospital service or maternity service?
• What times and days can I realistically attend, and can appointments fit around work or caring?

• Do I need written information, large print, easy read, plain English or translation?
• Do I need a British Sign Language interpreter, a hearing loop or a quiet room?
• Do I need longer appointments, step-free access, or a familiar time of day?
• Do I want a family member, friend, carer or advocate with me? (Say so — it is your choice.)

• Which treatments are suitable for me, and why?
• Would combining a slow-acting and a fast-acting product be recommended?
• What side effects should I expect, and what would mean I should contact someone?
• How do I get supplies, is there a charge, and what happens if I run out?
• If I use a vape to quit, how do I get the strength right and plan to stop vaping later?

• What is my quit date, or my agreed reduction plan?
• What are my three go-to actions when a craving hits?
• Who are my trusted supporters, and what will I ask them to do?
• When is my next appointment or call, and who do I contact between appointments?
• If I have a cigarette, what exactly will I do next — and who will I tell?
• What would make me contact 111, my GP or my mental-health team urgently?

Say what you need when you book, not only when you arrive — for example a longer appointment, a quiet waiting area, the first appointment of the day, a phone or video call instead of attending in person, or a room with step-free access. Ask for your adjustments to be recorded so you do not have to repeat them each time.

Ask about step-free entrances, accessible toilets, room to use a wheelchair or walking aid, a chair with arms, parking and how far the walk is from the drop-off point. If travel is the barrier, ask whether the service offers telephone, video or home-based support.

Services can arrange a British Sign Language interpreter, a language interpreter, a hearing loop, or information by email or text rather than phone. If speaking on the phone is difficult, ask for written or text-based contact instead.

Ask for plain English, easy read, large print or a simple one-page plan you can keep. It is reasonable to ask an adviser to write down the agreed plan, the product you are using and who to contact, rather than relying on remembering a conversation.

Ask for one thing to be explained at a time, and for the reasons behind a suggestion. You can ask for thinking time, take the information away, and decide at the next appointment. If a product is fiddly — gum, an inhalator, a device with small buttons — say so; there are usually alternatives that are easier to handle with arthritis, tremor, limited grip or low vision.

If change is difficult, a gradual plan with a fixed routine may work better than a sudden switch. Keeping the shape of the day — the break, the walk outside, the mug of tea — while removing the cigarette can be easier than removing the whole routine at once.

Tell the adviser about tastes, smells and textures you cannot tolerate, and about noise, lighting or crowded waiting rooms. Some products irritate the mouth, throat or nose, and some are strongly flavoured; there is usually an alternative. If withdrawal is likely to increase distress or meltdowns, plan calming strategies and support in advance.

You can bring a partner, relative, friend, carer, support worker or advocate, and you can ask for them to be kept informed — but only with your consent, and only as much as you want. You can also ask to be seen on your own for part of an appointment. If you need help to make or understand decisions, ask about advocacy support in your area.

Alcohol loosens intentions, is strongly linked with smoking for many people, and often happens in places and company where others are smoking. Early in a quit attempt some people choose to drink less, drink in different places, or avoid the first few social occasions altogether. If you do go, decide beforehand how long you are staying, what you will hold, where you will sit, and what you will say if you are offered a cigarette.

If a break has always meant a cigarette, replace the break rather than losing it — walk a different route, sit somewhere else, take a drink or a piece of fruit, or arrange to spend it with a colleague who does not smoke. For driving, clear the car, remove the ashtray, keep a fast-acting product and water within reach, and plan what you will do at the point in the journey where you always used to smoke.

Change what follows the trigger: get up from the table, clean your teeth, make a hot drink somewhere else, go outside for two minutes, phone someone. The urge after a meal or with coffee usually passes within a few minutes even when it feels overwhelming.

Smoking can feel calming because nicotine briefly relieves withdrawal, not because it treats stress. It is still worth having other things ready: a short walk, breathing slowly, a phone call, a message to a supporter, or a task that occupies your hands. If low mood, anxiety or distress is significant, get proper support alongside stopping rather than trying to manage it alone.

Living or working with people who smoke makes stopping harder. Ask — calmly and specifically — for what would help: smoking outside, not leaving packets or lighters in shared rooms, not offering you one, and not commenting on your progress. Offer them information about support too, without pressing.

The most reliable protection is a completely smoke-free home and car. Smoking in another room, by an open window or with a fan does not remove the risk, because smoke moves and residue settles on furnishings, carpets, clothing and skin. Agreeing one clear household rule — nobody smokes or vapes indoors — is easier to keep than several partial ones.

Where it feels safe, a short, non-accusing conversation works better than a note: explain what you notice, when it happens, who in your household it affects, and ask whether anything could change — a different spot, a window closed, a different time. Keep a simple record of dates and times in case you later need to raise it formally. Do not approach anyone if you feel threatened.

Social landlords, housing associations and managing agents usually have a complaints procedure, and tenancy or lease agreements sometimes include terms about nuisance, or about smoking in communal areas. Put your complaint in writing, keep copies, ask for a reference number, and ask what they will investigate and by when. If the response is inadequate, ask about the next stage of their complaints process and, for social housing, about escalating it further. Private tenants can also ask their local council’s housing or environmental health team for advice.

Smoke-free law across the United Kingdom covers enclosed and substantially enclosed public places and workplaces, which includes shared indoor areas such as stairwells, lobbies and lifts in blocks of flats, and most work vehicles. It does not generally cover the inside of a private home. Smoking in a car carrying anyone under 18 is prohibited. If smoking is happening in an enclosed communal area, report it to the building’s managing agent or landlord, or ask your local council which team handles smoke-free enforcement in your area.

Focus on what can change rather than on blame: keeping bedrooms and the car smoke-free, opening up smoking to outside the back door, and offering to help them get support when they are ready. Nobody should be pressured or shamed, and progress in stages still protects other people.