Smoking Never too Late to Quit


Rodgers J, Friede T, Vonberg FW, Constantinescu CS, Coles A, Chataway J, Duddy M, Emsley H, Ford H, Fisniku L, Galea I, Harrower T, Hobart J, Huseyin H, Kipps CM, Marta M, McDonnell GV, McLean B, Pearson OR, Rog D, Schmierer K, Sharrack B, Straukiene A, Wilson HC, Ford DV, Middleton RM, Nicholas R; MS Register group. The impact of smoking cessation on multiple sclerosis disease progression. Brain. 2021 Oct 8:awab385. doi: 10.1093/brain/awab385. Epub ahead of print.

The negative impact of smoking in MS is well established, however, there is much less evidence as to whether smoking cessation is beneficial to progression in MS. Adults with MS registered on the United Kingdom MS Register (2011-2020) formed this retrospective and prospective cohort study. Primary outcomes were changes in 3 patient reported outcomes (PROs): normalised MS Physical Impact Scale (MSIS-29-Phys), normalised MS Walking Scale (MSWS-12) and the Hospital Anxiety and Depression Scale (HADS-Anxiety and HADS-Depression). Time to event outcomes were clinically significant increases in the PROs. 7983 participants were included, 4130 (51.7%) of these had ever smoked; of whom 1315 (16.5%) were current smokers and 2815/4130 (68.2%) were former smokers. For all PROs, current smokers at the time of completing their first questionnaire had higher PRO scores indicating higher disability compared to those who had never smoked (∼10 points difference in MSIS-29-Phys and MSWS-12; 1.5-1.8 point for HADS-anxiety and HADS-depression). There was no improvement in PRO scores with increasing time since quitting in former smokers. 923 participants formed the prospective parallel group, which demonstrated that MSIS-29-phy 5.03, [3.71, 6.34], MSWS-12 5.28, [3.62, 6.94] and HADS-depression 0.71, [0.47, 0.96] worsened over a period of 4 years, whereas HADS-anxiety remained stable. Smoking status was significant at year 4; current smokers had higher MSIS-29-Phys and HADS-Anxiety scores (3.05 [0.22, 5.88], 1.14 [0.52,1.76]) while former smokers had a lower MSIS-29 score of -2.91[-5.03, -0.79]. 4642 participants comprised the time to event analysis. Still smoking was associated with a shorter time to worsening event in all PROs (MSIS-29-Phys: n = 4436, p = 0.0013; MSWS-12: n = 3902, p = 0.0061; HADS-anxiety: n = 4511, p = 0.0017; HADS-depression: n = 4511, p < 0.0001). Worsening in motor disability (MSIS-29-Phys and MSWS-12) was independent of baseline HADS-anxiety and HADS-depression scores. There was no statistically significant difference in the rate of worsening between never and former smokers. When smokers quit, there is a slowing in the rate of motor disability deterioration so that it matches the rate of motor decline in those who have never smoked. This suggests that smoking cessation is beneficial for people with MS.

General Disclaimer: Please note that the opinions expressed here are those of the author and do not necessarily reflect the positions of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust and are not meant to be interpreted as personal clinical advice.

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    • Peter 😂😂😂😂😂
      My same thought as I read through. However in answer to your chocolate biscuits… I bet I can predict the outcome… 85% of the participants had a larger waistline, more disability, higher A1C glucose levels, and of those 85%, 65% of participants exercise regularly while 20% also ate a high quantity of fresh kale & spinach while 2% also were type 1 diabetics & 15% were already Type 2 diabetics at start if trial and by end of trial, 30% were Type 2 diabetics. 😂😂

    • Yep. ‘Z’actly what I was thinking too. Another worthless factoid that will have zero effect on anything or anyone.

      Put this gem under “D’uh of The Day”:

      “When smokers quit, there is a slowing in the rate of motor disability deterioration so that it matches the rate of motor decline in those who have never smoked. ***This suggests(???) that smoking cessation is beneficial for people with MS.***”


      How much more money will be wasted finding another repetition of what we all know by now: smoking is going to kill you or make whatever you have worse. Period.

  • Well, I have planned to quit for 2022 (“when I’m 64”, t-dum). Been a half pack or so addict, outdoors, for many many years. But I’ll keep on with the nicotine juice and patches during my eventual transition to nicotine free (if that ever happens (?). Which brings up the question, what is the chemical in the cig that is responsible for greater MS deterioration?

    • Tobacco smoke is made up of thousands of chemicals, including at least 70 known to cause cancer. These cancer-causing chemicals are referred to as carcinogens. Some of the chemicals found in tobacco smoke include:

      Nicotine (the addictive drug that produces the effects in the brain that people are looking for)
      Hydrogen cyanide
      Radioactive elements, such as polonium-210 (see below)
      Carbon monoxide
      Tobacco-specific nitrosamines (TSNAs)
      Polycyclic aromatic hydrocarbons (PAHs

    • Well, now I see the point of the study! What a breathtakingly naive question. Google is a wonderful resource, and there’s no excuse for not finding out what smoking does to your heart, your lungs, your blood circulation, your consequent level of energy and ability to fight infection, your peace of mind… you might as well ask how sharp does a knife has to be to cut yourself.

    • Probably not any particular chemical, but the smoke itself, which is massively pro-inflammatory (so don’t smoke marijuana, either). Nicotine on its own is actually very likely to be both prophylactic against the development of MS and neuroprotective once you have MS. In Sweden they discovered that regular users of snuff develop MS at a significantly lower rate than the general population.

      • To anonymous: is this anecdotal or peer reviewed ?(about snuff)
        It seems that the above study will have its justification in future trial designs. Neuros smile wanly, patients rage uncomprehendingly.

        • Hedström AK, Hillert J, Olsson T, Alfredsson L. Nicotine might have a protective effect in the etiology of multiple sclerosis. Mult Scler. 2013 Jul;19(8):1009-13.
          if is snus wet snuff not snuff

    • I pretty much knew the answer to my question, but thought perhaps there was new info. Naive? (Sorry to take your breath away, Peter.) The world to me is not black and white. There are degrees of everything and co-factors and hidden variables contributing to it all. I’ve been addicted since I was a fetus and my mother smoked. That 1st hit off the cig was fantastic,.. wonderful!

      It’s a complicated world. Alcohol; living/working in the city/suburbs; driving a car; eating sugar, salt, beef (what’s in the beef?)- they can all lead to bad outcomes, and so, so much more stuff does the same. We all die anyway. How much satisfaction did you get? It’s a complicated disease. My cousin, who’s mother didn’t smoke and she (my cousin who lived far away from me) has led a pristine life- was diagnosed with MS at about the same time I was. We both are doing well with it. My mother, dead from the consequences of dementia and therefore being unable to treat emphysema from smoking, at 82. My father, who told me all the time that smoking would kill me- dead at 82 from Alzheimer’s. We all die anyway; not to be forgotten. That’s black and white.

      Stopped sugar and my levels are now normal, Lost weight and my BP is normal. So I’m a good rebounder. I’m 63, time is good to stop intake of all those chemicals Luis mentions. I’d like to get another 15-20 yrs. But who knows?

      THC (“Tea”) had a bad rep until recently. Can nicotine overcome it’s bad reputation? Thanks ANONYMOUS for the tid-bit on nic & MS. So I wonder, again, how the specific chemical itself effects MS, all the other chems- ‘gots to go.

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