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Researchers have published a review of the medical literature relating to multiple sclerosis and cigarette smoking from 1965 to 2018. The paper cites previous evidence that smoking increases the risk of developing MS, and provides numerous reasons for people with MS who smoke to quit now because it can make MS substantially worse. The authors are Mattia Rosso, MD, and Tanuja Chitnis, MD (Harvard Medical School).

• The authors explain that a burning cigarette contains more than 7,000 compounds. Many compounds affect the immune system, starting an inflammation-promoting cascade that begins in the lungs and travels to the nervous system. Other compounds are toxic to nerve cells and cells that make nerve-protecting myelin, possibly explaining why people with MS who smoke are more likely to have a worse disease course.
• Smoking can increase a person’s chance of getting MS, worsen MS disease activity, and speed up disease progression and loss of brain tissue volume. It can also worsen other health conditions that are increased in people with MS, such as heart, respiratory and circulatory disorders. 
• Physician counseling is key for people with MS who smoke. The authors recommend that healthcare providers assess their patients’ willingness to quit at every office visit, but nonjudgmentally, keeping in mind that people likely have tried to quit previously and may feel helpless.
• Smoking may be a pleasant habit for people with MS, and a coping mechanism, so quitting – or attempting to quit – can increase stress. Healthcare providers and their patients can work together to determine the best time and method for quitting.
• “Association Between Cigarette Smoking and MS, A Review” was published December 16, 2019, in JAMA Neurology.
• Get tools and tips for quitting smoking