March 6, 2014 | News | Living with MS

Smoking: how bad is it?

The perils of smoking are well known. What may be less known is the impact that smoking can have on people with multiple sclerosis, specifically on their risk of dying.

Many people with MS have smoked at one time or another. In fact, in some studies, ex-smokers outnumber the never-smokers (Marrie and colleagues. Neuroepidemiology 2009;32:72-79), although many people try to quit after they’re diagnosed.

For people who continue to smoke, there is some evidence to suggest that inflammatory flare-ups in the brain are more severe and there is a greater risk of disability progression at an earlier age (Healy and colleagues. Arch Neurol 2009;66:858-864), although this is a matter of debate (Handel and colleagues. PLoS One 2011;6:e16149). The degree of severity appears to be in line with how much a person smokes (Pittas and colleagues. J Neurol 2009;256:577-585). Heavier smokers pay a heavier price.

As with all things tobacco-related, there is also a cultural aspect to the question of smoking that needs to be considered. A Canadian study found that there was a considerable delay in being diagnosed with MS if you were a smoker (or if you were obese or had physical or mental illness) (Marrie and colleagues. Neurology 2009;72:117-124). This could mean that smokers are stoic, solitary figures (as the old cigarette ads would have us believe) who are willing to put up with their symptoms for a longer time before visiting their doctor. Or there is the more unappealing thought that doctors tend to be less attentive to the health complaints of smokers, the overweight and the mentally ill.

Several recent studies have focused on the impact of smoking on mortality risk among people with MS, and their findings are remarkably consistent. A UK analysis found that the mortality rate was comparable in non-smokers with MS compared to non-smokers in the general population (Manouchehrinia and colleagues. J Neurol Neurosurg Psychiatry 2014; epublished February 25, 2014). However, the risk of death was twice as high among ex-smokers, and almost 4-fold higher in current smokers compared to the general population.

A second study of people in the UK found that the mortality rate among smokers with MS was even higher – about 7-fold higher – but found no impact on mortality if the person had quit smoking (Lalmohamed and colleagues. Eur J Neurol 2012;19:1007-1014). The reasons for dying earlier were largely because of infections and respiratory illnesses, followed by cardiovascular disease (heart attack, stroke) and cancer.

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