Smoking and MS

From the day the Surgeon General’s report on the hazards of cigarette smoking was released in 1964, the public has been aware of its negative health effects, but few know that for patients with multiple sclerosis (MS) smoking may have a direct impact on the progression of their disease.

In a recent study conducted in the Department of Neurology at the Guilan University of Medical Sciences in Rasht, Iran, researchers found that patients suffering from relapsing-remitting multiple sclerosis (RRMS) who also smoked more than ten cigarettes per day had a greater risk than non-smokers of progressing to secondary progressive MS, or SPMS.

While relapsing-remitting MS is characterized by periods of disease activity followed by periods of remission, those with secondary progressive MS no longer experience remission, but rather their disease remains on a “low simmer” and, as the damage to their brain and spinal cord progresses, they experience ever greater disability.

The study participants were all patients registered with the MS Society in Guilan, Iran. The authors concluded that, “smokers have an increased risk for progression of RRMS to SPMS compared with non-smokers. We also showed that the disease progression may be influenced by [an] increase in cigarette smoking.”

Another study on the effects of smoking on MS progression conducted by researchers at the Harvard School of Public Health in 2005 suggested that “the risk of developing secondary progressive multiple sclerosis was more than three times higher in smokers than in non-smokers who had a relapsing–remitting clinical onset of multiple sclerosis.” 

However, smoking may be part of an overall unhealthy lifestyle, which can contribute to the worsening of disease. "Information on other habits was not available and thus we could not adjust for them," said Dr. Miguel A. Hernán of the Harvard School of Public Health in an interview with Healthline. "This is certainly a limitation of the study."

Cause and Effect

While the findings suggest a correlation between cigarette smoking and disease progression in MS, it’s unclear just what mechanism is at work. MS is a chronic, inflammatory autoimmune disease in which the immune system attacks the protective myelin sheath covering nerve cells in the brain and spinal cord.

In order to launch an attack on this myelin sheath, T-cells from the immune system must first traverse the blood-brain barrier (BBB) which, according to Johns Hopkins University, is "a dynamic interface that separates the brain from the circulatory system and protects the central nervous system from potentially harmful chemicals.”

In a study on the effects of cigarette smoking on the BBB, researchers at the Cleveland Clinic Learner College of Medicine found that “compounds contained in TS [tobacco smoke] may affect the viability of cells comprising the BBB and trigger an inflammatory response that, in turn, may further lead to loss of BBB integrity.”

While studies have yet to be conducted on the effects of a BBB compromised by cigarette smoking on the escalation of disease progression in MS patients who smoke, these conclusions suggest that further research needs to be done.

Getting Help to Quit Smoking

In the meantime, MS patients should read the smoke signals and take charge of one of the few aspects of their health they can control.

"MS patients may know that smoking is associated with an increased risk of developing MS, and smoking appears to speed up the progression of MS," said David Antonuccio, Ph.D., Professor Emeritus of Psychiatry and Behavioral Sciences at the University of Nevada School of Medicine, in an interview with Healthline. "The hope is that quitting smoking will slow the progression. Nevertheless, some patients may fear a flare-up if they quit, though I have not seen any convincing evidence that quitting smoking can increase the risk of a flare-up.

"Most patients will feel uncomfortable (increased anxiety, insomnia, increased craving, gastrointestinal problems, headaches) when they quit smoking for a few days to a couple of weeks initially after quitting, whether they have MS or not, but after withdrawal is completed, they usually feel better," he added.

Antonuccio, who ran the stop smoking clinic at the Reno Veteran's Administration Medical Center for 24 years and authored the self-help ebook Butt Out!, advises MS patients to take advantage of the tools provided by doctors and clinics to help them quit, including "setting a target quit day, tracking smoking prior to quit day, learning relaxation skills, using nicotine replacement like a nicotine patch on quit day and for several weeks thereafter, cleaning out the house and car of all smoking remnants, seeking social support, [and] developing healthy substitute behaviors like exercise or healthy snacking.

"Nicotine replacement as an adjunct to behavioral skills can be very helpful," he added. "From my perspective though, it doesn't make sense to add other medications (like bupropion or varenicline) out of concern for complicating the MS patient's already complicated medical condition with such medications that can increase the risk of side effects and adverse events. "

By eating right, getting plenty of rest, and avoiding things we know to be unhealthy—including cigarettes—an MS sufferer may be able to positively affect the course of the disease.

For more information on how you can quit, visit the website of the American Lung Association. With the proper tools and support you can quit smoking, which could give you a greater sense of control and have a positive effect on your quality of life.

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