Considerations for Multiple Sclerosis and Smoking
It is common knowledge that smoking is bad for your health in general, causing a range of complications and conditions in the cardiovascular and respiratory systems, such as cancer and emphysema.
Smoking, while living with a long-term condition, can not only exacerbate symptoms but also reduce the efficacy of disease-modifying drugs (DMDs) due to interactions with the drugs by the toxic chemicals present in cigarette smoke. As well as this, smoking is not good for stress. Research shows that it increases anxiety and tension, rather than relieving it. Although nicotine can induce feelings of relaxation, the chemicals in smoke biologically counteract this.
There are now many online resources which comment on the negative impacts of smoking on long-term medical conditions. From debunking the myth that smoking reduces stress to highlighting links to the heightened risk of disease progression as well as the compound effects of smoking which may mask MS diagnosis as other health conditions may also present themselves and ‘mask’ MS symptoms.
Smoking as a causal factor in developing MS
Multiple Sclerosis has both genetic and environmental causes. Leading environmental risk factors include infections, such as the Epstein-Barr virus (or glandular fever) and exposure to vitamin D (or lack thereof), and smoking. This is evidenced by a wealth of research dating back decades showing that smoking can impact MS risk, among other adverse health effects.
Supporting this is a study from the 1960s in Israel, that “revealed that a greater proportion of MS patients had smoked before clinical MS onset” (Antonovsky et al 1965), and in a 1993 study “cigarette smoking was one of the variables found to be significantly associated with MS risk” (Wingerchuk, 2012). In the noughties “a significant detrimental effect” (Wingerchuk, 2012) was also found across most investigations studying the link between the risk of developing MS and smoking.
In fact, around 67% of smokers are expected to develop conditions like MS, and as many as 17% of people currently living with MS are smokers. It should be noted that this is also affected by a person’s genetic predisposition to developing MS. If say, a relative has MS and you smoke, it would be strongly advised for you to consider stopping smoking.
A 2017 study by Poorolajal et al reviewed studies on smoking and MS and highlighted evidence of smoking as a cause of MS as well as significant association with MS progression. At present, it is believed that the toxic chemicals in cigarettes and tobacco are responsible for these links, rather than nicotine and that dosage of smoking also has an impact. That is, the longer you smoke, the risk of developing conditions including MS significantly increases.
Smoking and MS progression
There is also abundant evidence for the link between smoking and MS progression. Many studies have shown that smoking can influence the course of established MS, such as relapses and new lesions and more rapid conversion from an initial first MS event (Clinically Isolated Syndrome) to confirmed diagnosis of MS; and progression from relapsing-remitting to secondary progressive MS and increased severity of neurological damage in progressive MS.
In 2013 UK based study on MS progression and disability by Manouchehrinia et al found that long term smokers (referred to as ‘ever’ smokers) with Multiple Sclerosis experienced more instances of disability than those who never smoked. In addition, a 2021 study by Rodgers et al of 7983 people from the MS Register, where 41% of these were smokers, also found that the smokers reported higher instances of disability than those who had never smoked.
Although these studies point to an increased likelihood of health complications and progression in MS, the benefits of stopping smoking are clear. From preventing further progression to improving overall health, reducing your exposure to the toxic chemicals in tobacco smoke simply decreases the harm that can be done. As stated by a 2019 study from Rosso and Chitnis, “efforts should be made to diminish the prevalence of cigarette smoking in patients with MS”.
If you require support to quit smoking, the NHS has good advice available at this link here. You can also seek advice and help from your GP or even your MS Nurse.
As always MS Research aims to fund investigations and researchers whose studies will positively impact the MS community. If you are studying the impacts of Smoking on Multiple Sclerosis and require funding, get in touch with one of our team today.
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