BACKGROUND The aim of the study was to assess the difference in health status between current smokers and ex-smokers of five years or greater standing. METHODS A group of current smokers and a group of ex-smokers (of five years or greater standing) in Aberdeen, north-east Scotland, were each sent a postal questionnaire containing SF-36, EuroQol, condition-specific and socio-demographic questions. The subjects were 3000 adults (1500 smokers, 1500 ex-smokers) randomly selected from the records of nine general practices. The main outcome measures were the eight scales within the SF-36 health profile, EuroQol tariff scores and assessment of respiratory symptoms. RESULTS Smoking cessation leads to an improvement in a range of respiratory symptoms and health-related quality of life. However, in some cases other socio-economic characteristics are better indications of quality of life than smoking status. CONCLUSIONS Smoking cessation leads to a significant improvement in a range of respiratory symptoms. There appear to be significant differences between smokers' and ex-smokers' perceived quality of life. However, these differences are relatively small and in the majority of cases are better explained by variation in age, housing and economic status. When promoting smoking cessation to patients it is possible to highlight expected improvements in respiratory symptoms, impact on global quality of life and longer-term disease effects.