Side effects of stopping smoking after 50 years: what to expect

The side effects of stopping smoking after 50 years are mostly the same ones any smoker gets when they quit: cravings, irritability, broken sleep, foggy concentration, a low or anxious mood and a bigger appetite. On top of those, many people cough more and get cold-like symptoms or mouth ulcers in the first two weeks, about one in six become constipated, and most put on some weight. The hardest part is usually over within a few days to a couple of weeks.

Two things are different after half a century of smoking. Smoke changes how the liver handles some common medicines, so doses may need adjusting once you stop. And health problems that built up over decades sometimes come to light around the time people quit, which can make it look as if quitting caused them. It did not. Stopping is safe at any age, and the evidence says it still adds years.

Side effects of stopping smoking after 50 years: the short answer

Here is what to expect, roughly in the order it tends to show up:

Side effect	When	How long it usually lasts
Cravings, irritability, restlessness	From the first day	Strongest for a few days to a couple of weeks, then weaker and less frequent
Poor sleep, foggy thinking, low or anxious mood	First days	Usually eases over the first few weeks
Cough, sore throat, sneezing, cold symptoms	Week 1 to 2	Short-lived; a smoker's cough then improves over 1 to 12 months
Mouth ulcers	Week 1 to 2	Temporary
Constipation	Peaks around week 2	Can stay raised for some weeks
Bigger appetite and weight gain	From the first weeks	Most of the gain happens in the first 3 months
Stronger effect from some medicines (and coffee)	After you stop	Until your doctor checks or adjusts the dose

Smokefree.gov, run by the US National Cancer Institute, lists the core withdrawal symptoms as cravings, feeling irritable or grouchy, trouble sleeping, trouble thinking clearly, feeling restless or jumpy, feeling sad, anxious or depressed, and feeling hungrier. It says the symptoms are strongest in the first few days or weeks and then get weaker, and that withdrawal "can be uncomfortable, but is not harmful."

That last point matters to people who have smoked for 50 years, because a common worry is that stopping suddenly will be a shock the body cannot cope with. Withdrawal feels bad, but it is not harmful. Carrying on smoking is.

Is withdrawal worse after 50 years of smoking?

It can be somewhat harder. In a 2003 study of how withdrawal varies between quitters, published in Experimental and Clinical Psychopharmacology, smokers who were more dependent, older and prone to negative moods reported more severe withdrawal. Someone who has smoked for five decades often ticks the first two boxes.

The timeline is not longer, though. The symptoms follow the same curve as for anyone else: worst in the first days, fading over the following weeks. What tends to last longer for lifelong smokers is the habit side. Fifty years of a cigarette with the morning coffee, after meals and at the end of the day leaves a lot of cues, and each one has to be met a few times without a cigarette before it loses its pull. Our hour-by-hour withdrawal timeline shows what the first days look like in more detail.

The cough, cold symptoms and mouth ulcers

Many long-term smokers are surprised to find they cough more in the first weeks after quitting. In a study of 174 smokers on a seven-week stop-smoking programme, published in Tobacco Control, reports of cold symptoms and mouth ulcers rose significantly in the first and second weeks after quitting. After one week there were also significant increases in coughing, sore throat and sneezing. The participants were using nicotine patches, so these effects happened even with nicotine replacement. The authors' advice was that quitters should be told to expect them, because being prepared may make them easier to cope with.

After that first rough patch, the cough improves. The CDC says coughing and shortness of breath decrease within 1 to 12 months of quitting, and the NHS says that after 3 to 9 months coughs, wheezing and breathing problems will be improving as lung function increases by up to 10%. For more on the healing process, see how long it takes your lungs to recover.

A cough that does not settle is a different matter, and after 50 years of smoking it should be checked. The NHS says most coughs clear up within 3 to 4 weeks and advises seeing a GP for a cough lasting more than 3 weeks or unexplained weight loss.

Constipation and weight gain

Nicotine speeds up the bowel, and without it things slow down for a while. In a study of more than 1,000 people who stopped smoking, about one in six developed constipation after quitting, and for about one in eleven it was severe. It peaked at two weeks and stayed higher than before for the rest of the follow-up. More water, more fibre and a daily walk help. Our guide to bloating after quitting covers the gut side in more detail.

Weight gain is the side effect people mention most. A 2012 meta-analysis of 62 studies in the BMJ found that people who quit without medication gained an average of 1.1 kg after one month, 2.9 kg after three months and 4.7 kg after a year. Most of the gain came in the first three months. The range was wide: 16% of quitters lost weight, and 13% gained more than 10 kg. If weight is a concern, our article on quitting without gaining weight has practical steps.

Mood, sleep and concentration

Low mood, anxiety, short temper and poor sleep are among the classic withdrawal symptoms, and they can feel worrying in someone who has used cigarettes to cope with stress for half a century. They pass. In the longer run, quitting tends to leave people calmer than smoking did. A 2014 review of 26 studies in the BMJ found that people who stopped smoking had less anxiety, depression and stress, and better mood and psychological quality of life, than people who kept smoking.

If your mood drops sharply or stays low for more than a couple of weeks, talk to your doctor. That applies especially if you have a history of depression.

Your medicines may need adjusting

This is the side effect long-term smokers most need to plan for. Chemicals in tobacco smoke called polycyclic aromatic hydrocarbons speed up a set of liver enzymes, mainly one called CYP1A2. Smokers clear drugs that use this pathway faster, and their doses are often set with that in mind. When you stop smoking, the enzymes slow down and the same dose can build up to a higher level in your blood.

A 2007 review of drug interactions with smoking in the American Journal of Health-System Pharmacy names caffeine, clozapine, fluvoxamine, olanzapine, tacrine and theophylline among the affected drugs, and concludes that people who stop smoking "may require a reduction in the dosage of an interacting medication." Theophylline is used for COPD and asthma, and clozapine and olanzapine for mental health conditions, so these are medicines older smokers do take.

Not every medicine is affected, and many people need no change at all. But it takes one conversation to find out. Tell your doctor and pharmacist your quit date before you stop, and ask whether any of your regular medicines need monitoring. Caffeine follows the same rule, so your usual coffee may feel stronger and keep you awake or jittery. Our article on caffeine after quitting smoking explains how much to cut back.

Why some people feel worse after quitting late in life

Most people know someone who smoked for decades, quit, and then got seriously ill. It is easy to conclude that quitting did it. The evidence points the other way.

Long-term smokers often stop because they already feel unwell, have been diagnosed with something or have been told to by a doctor. So illness and quitting tend to arrive at the same time, a pattern sometimes called the sick quitter effect. The NIH-AARP study of 160,113 Americans over 70 shows it clearly. People who had quit only one to four years before joining the study had a higher death rate than people still smoking. Those who had quit five to ten years earlier were about level with them, and those who had quit more than ten years earlier had a death rate about a third lower. The authors also noted that people who had quit in their 60s were just as likely as current smokers to report fair or poor health.

Diseases like COPD and cancer develop over many years. If one shows up soon after you stop, it was already under way. What quitting changes is how fast things get worse from here. In the Lung Health Study, which followed 3,926 smokers with early COPD for five years, people who quit saw their lung function improve by an average of 47 ml (2%) in the first year. After that it declined about half as fast as in those who kept smoking: 31 ml a year against 62 ml. The researchers concluded that smokers with airflow obstruction benefit from quitting "despite previous heavy smoking, advanced age, poor baseline lung function, or airway hyperresponsiveness."

Is it worth stopping after 50 years?

Yes. The CDC states that quitting has health benefits at any age, "no matter how long or how much you have smoked," and that even people who have smoked heavily for many years will benefit. The long-running studies put numbers on it:

• In the 50-year study of male British doctors, stopping at 60 gained about 3 years of life expectancy, stopping at 50 about 6, and stopping at 40 about 9.
• In the NIH-AARP study of people over 70, current smokers were more than three times as likely to die during follow-up as people who had never smoked. Those who had quit in their 60s had a 23% lower risk than people who kept smoking, and those who quit in their 50s a 36% lower risk.
• A 2012 meta-analysis of 17 studies of people aged 60 and over, from 7 countries, found that current smokers had 1.83 times the death rate of never smokers and former smokers 1.34 times, and that the extra risk in former smokers fell clearly the longer they had been smoke-free.

The gains start quickly and keep building. Here is the CDC's timeline after the last cigarette:

Time after quitting	What changes
Minutes	Heart rate drops
24 hours	Nicotine level in the blood drops to zero
Several days	Carbon monoxide in the blood falls to the level of someone who does not smoke
1 to 12 months	Coughing and shortness of breath decrease
1 to 2 years	Risk of heart attack drops sharply
3 to 6 years	Added risk of coronary heart disease drops by half
5 to 10 years	Added risk of mouth, throat and voice box cancers drops by half; stroke risk decreases
10 to 15 years	Added risk of lung cancer drops by half

If you are weighing this up in your 50s rather than after 50 years of smoking, our guide to quitting smoking in your 50s covers that age group.

How to make the first weeks easier

See your doctor or pharmacist first. Bring a list of your regular medicines and your quit date. Ask whether anything needs monitoring or a dose change, and ask about stop-smoking medicines. Our comparison of nicotine patches, gum and lozenges explains how the options differ.

Expect the first two weeks to be the hardest. Knowing that a cough, a sore mouth or a sluggish gut is a normal part of stopping makes them much less alarming. Plan an easy fortnight if you can.

Rework your oldest routines. Write down every moment of the day when you would normally smoke, and decide in advance what you will do instead. Change the chair, the cup or the order of the morning if the old one keeps triggering cravings.

Cut back on coffee and tea. If you drink a lot, try halving it for the first few weeks to avoid the jitters and poor sleep that come from caffeine building up.

Keep moving. A daily walk helps with constipation, mood, sleep and weight all at once.

The bottom line

After 50 years of smoking, the side effects of stopping are real but short. Expect cravings, irritability, poor sleep and a bigger appetite, and possibly a cough, mouth ulcers and constipation for the first couple of weeks. None of it is dangerous. The one thing to plan is a check of your medicines with your doctor or pharmacist before you quit.

If illness turns up soon after you stop, it was most likely already there, and quitting gives your body the best chance of dealing with it. The studies of people in their 60s and 70s all point the same way: it is not too late.