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Smoking

An industrially manufactured cigarette burning in an ashtray; today the most common form of smoking.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2], Seyedmahdi Pahlavani, M.D. [3], Aravind Kuchkuntla, M.B.B.S[4]

Synonyms and keywords: Smoking, tobacco smoking, cigarette smoking

Overview

Overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

Overview

Smoking is a recreational activity in which a substance, most commonly tobacco, is burnt and the smoke tasted or inhaled. This is primarily done as a form of recreational drug use, as combustion releases the active substances in drugs such as nicotine and makes them available for absorption through the lungs. It can also be done as a part of religious rituals, to induce trances and spiritual enlightenment. The most common method of smoking today is through cigarettes, either industrially manufactured or rolled with loose tobacco and a rolling paper. Other forms, though less common, are pipes, cigars, bongs, and hookahs. Smoking is one of the most common forms of recreational drug use.

Historical perspective

History of smoking can be dated to as early as 5000 BC. Tobacco first cultivated in the America in 3000 BC. Next important phase in smoking history returns to world exploration by sailors.

Classification

Smoking may be classified as heavy and non-heavy, depending on the number of cigarettes consumed per day. Smokers can also be classified with respect to duration as acute or chronic smokers.

Pathophysiology

Nicotine from the cigarette is rapidly absorbed form the lungs and diffuses readily into brain where it binds to nicotinic acetylcholine receptors. Stimulation of nicotinic acetyl choline receptor in the brain results in the release dopamine and other neurotransmitters which are responsible for the feeling of pleasure.

Causes

For details about the causes of smoking, view its risk factors.

Epidemiology and demographics

Tobacco use is the leading cause of preventable disease, disability, and death in the United States, accounting for more than 480,000 deaths every year, or 1 of every 5 deaths. In 2015, about 15 of every 100 U.S. adults aged 18 years or older (15.1%) currently smoked cigarettes, this means an estimated 36.5 million adults in the United States currently smoke cigarettes. It is more common among men than in women. Smoking is more common among adults aged 25-44. It is more common among non-Hispanic American Indians/Alaska Natives than other races.[1][2][3]

Risk factors

The common risk factors for smoking are poor family ties, unemployment, alcohol addiction, using illicit drugs, anxiety disorders, and genetic susceptibility.[4]

Screening

Screening for smoking is done on every visit to the physician by asking detailed questions related to smoking status and smoking history. The US Preventive Services Task Force guidelines recommend that clinicians ask all patients about tobacco use and provide tobacco cessation interventions for those who use tobacco.[5]

Natural history, complications, and prognosis

Smoking may initially not cause any symptoms and is easy to give up. If not addressed smoking can lead to a vast variety of symptoms related to different organ systems. Smoking may cause carcinomas ultimately and lead to the death. Complications of smoking are not limited to a single organ system. Cardiovascular and respiratory systems are the most commonly involved. It increases the risk of coronary artery disease by 2 to 4 times. COPD is a common complication of smoking. Lung cancers are mostly attributed cigarette smoking. Cigarette smoking is the leading preventable cause of death in the United States. Smoking cessation has positive prognostic effect in lung cancer patients.[6][7]

History and Symptoms

The primary method of diagnosing tobacco use is through the confidential interview or history. Symptoms of a chronic smokeer include fatigue, dyspnea on exertion, snoring and sleep apnea, retrosternal discomfort, heart burn, weight loss, breathlessness, sputum production and chest pain, leg pain, weight loss, loss of appetite and bloody sputum.

Physical Examination

The physical examination of a patient who smokes may show tachycardia, hypertension, tachypnea, smoke-odored clothing, stained teeth or fingernails, hoarse voice and wheezing.[6][8][9][10]

Laboratory Findings

There are no diagnostic lab findings associated with smoking.

Chest Xray

There are no chest x ray findings associated with smoking. Chest x ray can be used to diagnose various complications of smoking like carcinomas, pulmonary fibrosis, and COPD.

Ultrasound

There are no ultrasound findings associated with smoking. Ultrasound can be used to diagnose various complications of smoking like carcinomas.

CT scan

There are no CT scan findings associated with smoking. CT scan can be used to confirm various complications of smoking like carcinomas, pulmonary fibrosis, COPD and stroke.

MRI

There are no MRI findings associated with smoking. MRI can be used to confirm various complications of smoking like carcinomas, pulmonary fibrosis, COPD and stroke.

Other Imaging Studies

There are no additional imaging findings for smoking.

Other Diagnostic Studies

Breath carbon monoxide can be used to assess the presence of smoking in the last 24 hours.

Medical Therapy

Some general principles including the 5 As (ask, Assess, Advise, Assist and Arrange follow-up), non-pahramcological strategies like nicotine gum and nicotine patch and pharmacological strategies including bupropion, varenicline, inhalers and nasal sprays can be used to help quit smoking.[1][2][3][11][12]

Surgery

Surgical intervention is not recommended for the management of smoking. Various complications of smoking may benefit form surgery like carcinomas, stroke, coronary artery disease and ectopic pregnancy.

Primary Prevention

The primary prevention of smoking includes not selling cigarettes to individuals younger than 18, avoiding smoking near children, imposing taxes on cigarettes and campaigns to educate people regarding the risks and complications of smoking.[13]

Secondary Prevention

The secondary prevention of smoking is similar to its primary prevention.

References

  1. ↑ 1.0 1.1 “CDC – 2010 Surgeon General’s Report – Consumer Booklet – Smoking & Tobacco Use”.
  2. ↑ 2.0 2.1 “QuickStats: Number of Deaths from 10 Leading Causes — National Vital Statistics System, United States, 2010”.
  3. ↑ 3.0 3.1 “CDC – 2014 Surgeon General’s Report – Smoking & Tobacco Use”.
  4. ↑ DOLL R, HILL AB (1950). “Smoking and carcinoma of the lung; preliminary report”. Br Med J. 2 (4682): 739–48. PMC 2038856. PMID 14772469.
  5. ↑ Siu AL, U.S. Preventive Services Task Force (2015). “Behavioral and Pharmacotherapy Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Women: U.S. Preventive Services Task Force Recommendation Statement”. Ann Intern Med. 163 (8): 622–34. doi:10.7326/M15-2023. PMID 26389730.
  6. ↑ 6.0 6.1 Parsons A, Daley A, Begh R, Aveyard P (2010). “Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: systematic review of observational studies with meta-analysis”. BMJ. 340: b5569. doi:10.1136/bmj.b5569. PMC 2809841. PMID 20093278.
  7. ↑ Pearl R (1938). “TOBACCO SMOKING AND LONGEVITY”. Science. 87 (2253): 216–7. doi:10.1126/science.87.2253.216. PMID 17813231.
  8. ↑ Iribarren C, Tekawa IS, Sidney S, Friedman GD (1999). “Effect of cigar smoking on the risk of cardiovascular disease, chronic obstructive pulmonary disease, and cancer in men”. N Engl J Med. 340 (23): 1773–80. doi:10.1056/NEJM199906103402301. PMID 10362820.
  9. ↑ Boffetta P, Pershagen G, Jöckel KH, Forastiere F, Gaborieau V, Heinrich J; et al. (1999). “Cigar and pipe smoking and lung cancer risk: a multicenter study from Europe”. J Natl Cancer Inst. 91 (8): 697–701. PMID 10218507.
  10. ↑ Henley SJ, Thun MJ, Chao A, Calle EE (2004). “Association between exclusive pipe smoking and mortality from cancer and other diseases”. J Natl Cancer Inst. 96 (11): 853–61. PMID 15173269.
  11. ↑ “CDC – Fact Sheet – Current Cigarette Smoking Among Adults in the United States – Smoking & Tobacco Use”.
  12. ↑ WYNDER EL, GRAHAM EA (1951). “Etiologic factors in bronchiogenic carcinoma with special reference to industrial exposures; report of eight hundred fifty-seven proved cases”. AMA Arch Ind Hyg Occup Med. 4 (3): 221–35. PMID 14867935.
  13. ↑ Tingen MS, Andrews JO, Stevenson AW (2009). “Primary and secondary tobacco prevention in youth”. Annu Rev Nurs Res. 27: 171–93. PMID 20192104​ Check |pmid= value (help). zero width space character in |pmid= at position 9 (help)
Historical Perspective

Historical Perspective

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

History of smoking can be dated to as early as 5000 BC. Tobacco first cultivated in the America in 3000 BC. Next important phase in smoking history returns to world exploration by sailors.

Historical Perspective

  • The history of smoking can be dated to as early as 5000 BC, and has been recorded in many different cultures across the world.
  • Tobacco has been cultivated and smoked in the Americas for at least 5000 years, originating in the Peruvian and Ecuadorian Andes.
  • The smoking of cannabis in India has been practiced for over 4000 years.
  • The first report of a smoking Englishman is of a sailor in Bristol in 1556, seen “emitting smoke from his nostrils”.
  • There is reference to tobacco in Persian poem dating from before 1536.
  • A Frenchman named Jean Nicot (from whose name the word nicotine is derived) introduced tobacco to France in 1560.
  • After the European exploration and subsequent colonization of the Americas in the 16th century, the smoking, cultivation and trading of tobacco quickly spread to all corners of the globe.
  • Sailors spread the tobacco during 16th century along the sea routes by their discoveries.
  • Soon after its introduction to the Old World, tobacco came under frequent criticism from state and religious leaders. Murad IV, sultan of the Ottoman Empire 1623-40 was among the first to attempt a smoking ban by claiming it was a threat to public moral and health.
  • In Europe, it introduced a new type of social activity and a form of drug intake which previously had been unknown.

References

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Classification

Classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

Smoking may be classified as heavy and non-heavy, depending on the number of cigarettes consumed per day. Smokers can also be classified with respect to duration as acute or chronic smokers.

Classification

Smoking and smokers can be classified with respect to quantity and the duration of smoking.

Quantity

Smoking may be classified based on the number of cigarettes per day multiplied by the duration of smoking as years (pack per year) to:

  • Heavy smokers
    • More than 20 packs per year (p/y)
  • Non-heavy smokers
    • Less than 20 p/y

Duration

With respect to the duration of smoking, smokers can be classified as:

References

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Pathophysiology

Pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]

Overview

Nicotine from the cigarette is rapidly absorbed form the lungs and diffuses readily into brain where it binds to nicotinic acetylcholine receptors. Stimulation of nicotinic acetyl choline receptor in the brain results in the release dopamine and other neurotransmitters which are responsible for the feeling of pleasure.

Pathophysiology

Pathogenesis

  • Nicotine is the primary addictive substance in tobacco.
  • Nicotine from the cigarette is rapidly absorbed form the lungs and diffuses readily into brain where it binds to nicotinic acetylcholine receptors.[1]
  • Nicotine exists in charged and uncharged forms in the blood stream. The uncharged form diffuses directly into the lipid membranes and the charged form attaches to the nicotine receptors.[2]
  • The nicotinic acetyl choline receptor is a ligand gated channel complex composed of five subunits which are present in abundance in the brain. These receptors subtypes are believed play a role in mediating nicotine dependence.
  • Stimulation of nicotinic acetyl choline receptor in the brain results in the release dopamine and other neurotransmitters which are responsible for the feeling of pleasure.[3]
  • Chronic exposure of the brain to nicotine results in adaptation and needing increased demands of nicotine for the brain to function normally. Therefore, cessation of smoking abruptly causes withdrawal symptoms of irritability, anxiety, problems getting along with others, difficulty concentrating, hunger, and weight gain.[4]
  • Nicotine addiction is sustained by positive effects of pleasure and arousal and to avoid the adverse effects of nicotine withdrawal.

Genetics

  • CYP2A6 gene codes for the enzymes metabolizing nicotine. Polymorphisms in the gene can result in the variability in individual smoking response and addictive behavior by influencing the nicotine metabolism in the body .[5]

References

  1. ↑ Prochaska JJ, Benowitz NL (2016). “The Past, Present, and Future of Nicotine Addiction Therapy”. Annu Rev Med. 67: 467–86. doi:10.1146/annurev-med-111314-033712. PMC 5117107. PMID 26332005.
  2. ↑ Benowitz NL, Hukkanen J, Jacob P (2009). “Nicotine chemistry, metabolism, kinetics and biomarkers”. Handb Exp Pharmacol (192): 29–60. doi:10.1007/978-3-540-69248-5_2. PMC 2953858. PMID 19184645.
  3. ↑ Subramaniyan M, Dani JA (2015). “Dopaminergic and cholinergic learning mechanisms in nicotine addiction”. Ann N Y Acad Sci. 1349: 46–63. doi:10.1111/nyas.12871. PMC 4564314. PMID 26301866.
  4. ↑ Benowitz NL (2010). “Nicotine addiction”. N Engl J Med. 362 (24): 2295–303. doi:10.1056/NEJMra0809890. PMC 2928221. PMID 20554984.
  5. ↑ López-Flores LA, Pérez-Rubio G, Falfán-Valencia R (2017). “Distribution of polymorphic variants of CYP2A6 and their involvement in nicotine addiction”. EXCLI J. 16: 174–196. doi:10.17179/excli2016-847. PMC 5427481. PMID 28507465.

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Causes

Causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]

Overview

The common risk factors for smoking are, poor family ties, unemployment, alcohol addiction, using illicit drugs, anxiety disorders, and genetic susceptibility.[1]

Risk Factors

The risk factors for the smoking and the failure of smoking cessation attempts include:

  • Poor parent-adolescent relationship quality[2]
  • Unemployment[3]
  • Alcohol addiction
  • Anxiety disorders
  • Genetic susceptibility
  • Patients with addictive disorders[4]
  • Smoking under the age of 18 years is considered as a risk factor for chronic smoking.
  • Illicit drug abuse[5]
  • Access and exposure to substances of abuse and neighborhood disadvantage[6]

References

  1. ↑ DOLL R, HILL AB (1950). “Smoking and carcinoma of the lung; preliminary report”. Br Med J. 2 (4682): 739–48. PMC 2038856. PMID 14772469.
  2. ↑ Hummel A, Shelton KH, Heron J, Moore L, van den Bree MB (2013). “A systematic review of the relationships between family functioning, pubertal timing and adolescent substance use”. Addiction. 108 (3): 487–96. doi:10.1111/add.12055. PMID 23163243.
  3. ↑ Henkel D (2011). “Unemployment and substance use: a review of the literature (1990-2010)”. Curr Drug Abuse Rev. 4 (1): 4–27. PMID 21466502.
  4. ↑ Morisano D, Bacher I, Audrain-McGovern J, George TP (2009). “Mechanisms underlying the comorbidity of tobacco use in mental health and addictive disorders”. Can J Psychiatry. 54 (6): 356–67. doi:10.1177/070674370905400603. PMID 19527556.
  5. ↑ Camenga DR, Klein JD (2016). “Tobacco Use Disorders”. Child Adolesc Psychiatr Clin N Am. 25 (3): 445–60. doi:10.1016/j.chc.2016.02.003. PMC 4920978. PMID 27338966.
  6. ↑ Mennis J, Stahler GJ, Mason MJ (2016). “Risky Substance Use Environments and Addiction: A New Frontier for Environmental Justice Research”. Int J Environ Res Public Health. 13 (6). doi:10.3390/ijerph13060607. PMC 4924064. PMID 27322303.

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Differentiating Any Disease from other Diseases

Differentiating Any Disease from other Diseases

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

Overview

Differential diagnosis is not applicable to smoking.

Differentiating Smoking from other Diseases

Differential diagnosis is not applicable to smoking.

References

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Epidemiology and Demographics

Epidemiology and Demographics

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

Overview

Tobacco use is the leading cause of preventable disease, disability, and death in the United States, accounting for more than 480,000 deaths every year, or 1 of every 5 deaths. In 2015, about 15 of every 100 U.S. adults aged 18 years or older (15.1%) currently smoked cigarettes, this means an estimated 36.5 million adults in the United States currently smoke cigarettes. It is more common among men than in women. Smoking is more common among adults aged 25-44. It is more common among non-Hispanic American Indians/Alaska Natives than other races.[1][2][3]

Epidemiology and Demographics

The epidemiology and demographics of smoking can be explained as follows:[1][2][3][4][5]

  • Tobacco use is the leading cause of preventable disease, disability, and death in the United States, accounting for more than 480,000 deaths every year, or 1 of every 5 deaths.
  • In 2015, about 15 of every 100 U.S. adults aged 18 years or older (15.1%) currently smoked cigarettes, this means an estimated 36.5 million adults in the United States currently smoke cigarettes.
  • Current smoking has declined from nearly 21 of every 100 adults (20.9%) in 2005 to about 15 of every 100 adults (15.1%) in 2015.
  • Nearly 40 million US adults still smoke cigarettes, and about 4.7 million middle and high school students use at least one tobacco product, including e-cigarettes.
  • Every day, more than 3,800 youth younger than 18 years smoke their first cigarette.
  • Each year, nearly half a million Americans die prematurely of smoking or exposure to secondhand smoke and more than 16 million Americans live with a smoking-related disease.
  • Each year, the United States spends nearly $170 billion on medical care to treat smoking-related disease in adults.

The epidemiology of the current smoking status based on different descriptive characteristics is as follows:

Gender

  • Nearly 17 of every 100 adult men (16.7%).
  • More than 13 of every 100 adult women (13.6%).

Age

  • 13 of every 100 adults aged 18–24 years (13.0%).
  • Nearly 18 of every 100 adults aged 25–44 years (17.7%)
  • 17 of every 100 adults aged 45–64 years (17.0%).
  • More than 8 of every 100 adults aged 65 years and older (8.4%).

Race

  • Nearly 22 of every 100 non-Hispanic American Indians/Alaska Natives (21.9%).
  • More than 20 of every 100 non-Hispanic multiple race individuals (20.2%).
  • Nearly 17 of every 100 non-Hispanic Blacks (16.7%).
  • More than 16 of every 100 non-Hispanic Whites (16.6%).
  • More than 10 of every 100 Hispanics (10.1%).
  • 7 of every 100 non-Hispanic Asians* (7.0%).

Education

  • More than 24 of every 100 adults with 12 or fewer years of education (no diploma) (24.2%).
  • About 34 of every 100 adults with a GED certificate (34.1%).
  • Nearly 20 of every 100 adults with a high school diploma (19.8%).
  • More than 18 of every 100 adults with some college (no degree) (18.5%).
  • More than 16 of every 100 adults with an associate’s degree (16.6%).
  • More than 7 of every 100 adults with an undergraduate college degree (7.4%).
  • More than 3 of every 100 adults with a graduate degree (3.6%).

Socio-economic status

  • About 26 of every 100 adults who live below the poverty level (26.1%).
  • Nearly 14 of every 100 adults who live at or above the poverty level (13.9%).

Geographical Area

  • Nearly 19 of every 100 adults who live in the Midwest (18.7%).
  • More than 15 of every 100 adults who live in the South (15.3%).
  • More than 13 of every 100 adults who live in the Northeast (13.5%).
  • More than 12 of every 100 adults who live in the West (12.4%).

Disability

  • More than 21 of every 100 adults who reported having a disability/limitation (21.5%)
  • Nearly 14 of every 100 adults who reported having no disability/limitation (13.8%)

Sexual Orientation

  • More than 20 of every 100 lesbian/gay/bisexual adults (20.6%)
  • Nearly 15 of every 100 straight adults (14.9%)

Adult Smokers Distribution

The distribution of smokers in the US can be depicted by this picture.[6]

Distribution of smokers in the US
Distribution of smokers in the US


References

  1. ↑ 1.0 1.1 “CDC – 2010 Surgeon General’s Report – Consumer Booklet – Smoking & Tobacco Use”.
  2. ↑ 2.0 2.1 “QuickStats: Number of Deaths from 10 Leading Causes — National Vital Statistics System, United States, 2010”.
  3. ↑ 3.0 3.1 “CDC – 2014 Surgeon General’s Report – Smoking & Tobacco Use”.
  4. ↑ “CDC – Fact Sheet – Current Cigarette Smoking Among Adults in the United States – Smoking & Tobacco Use”.
  5. ↑ WYNDER EL, GRAHAM EA (1951). “Etiologic factors in bronchiogenic carcinoma with special reference to industrial exposures; report of eight hundred fifty-seven proved cases”. AMA Arch Ind Hyg Occup Med. 4 (3): 221–35. PMID 14867935.
  6. ↑ “Map of Cigarette Use Among Adults | STATE System | CDC”.

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Risk Factors

Risk Factors

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]

Overview

The common risk factors for smoking are, poor family ties, unemployment, alcohol addiction, using illicit drugs, anxiety disorders, and genetic susceptibility.[1]

Risk Factors

The risk factors for the smoking and the failure of smoking cessation attempts include:

  • Poor parent-adolescent relationship quality[2]
  • Unemployment[3]
  • Alcohol addiction
  • Anxiety disorders
  • Genetic susceptibility
  • Patients with addictive disorders[4]
  • Smoking under the age of 18 years is considered as a risk factor for chronic smoking.
  • Illicit drug abuse[5]
  • Access and exposure to substances of abuse and neighborhood disadvantage[6]

References

  1. ↑ DOLL R, HILL AB (1950). “Smoking and carcinoma of the lung; preliminary report”. Br Med J. 2 (4682): 739–48. PMC 2038856. PMID 14772469.
  2. ↑ Hummel A, Shelton KH, Heron J, Moore L, van den Bree MB (2013). “A systematic review of the relationships between family functioning, pubertal timing and adolescent substance use”. Addiction. 108 (3): 487–96. doi:10.1111/add.12055. PMID 23163243.
  3. ↑ Henkel D (2011). “Unemployment and substance use: a review of the literature (1990-2010)”. Curr Drug Abuse Rev. 4 (1): 4–27. PMID 21466502.
  4. ↑ Morisano D, Bacher I, Audrain-McGovern J, George TP (2009). “Mechanisms underlying the comorbidity of tobacco use in mental health and addictive disorders”. Can J Psychiatry. 54 (6): 356–67. doi:10.1177/070674370905400603. PMID 19527556.
  5. ↑ Camenga DR, Klein JD (2016). “Tobacco Use Disorders”. Child Adolesc Psychiatr Clin N Am. 25 (3): 445–60. doi:10.1016/j.chc.2016.02.003. PMC 4920978. PMID 27338966.
  6. ↑ Mennis J, Stahler GJ, Mason MJ (2016). “Risky Substance Use Environments and Addiction: A New Frontier for Environmental Justice Research”. Int J Environ Res Public Health. 13 (6). doi:10.3390/ijerph13060607. PMC 4924064. PMID 27322303.

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Screening

Screening

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

Overview

Screening for smoking should be done on every visit to the physician by asking detailed questions related to smoking status and smoking history.The US Preventive Services Task Force guidelines recommend that clinicians ask all patients about tobacco use and provide tobacco cessation interventions for those who use tobacco.[1]

Screening

Screening for smoking is done on every visit to the physician by asking detailed questions related to smoking status and smoking history. The US Preventive Services Task Force guidelines recommend that clinicians ask all patients about tobacco use and provide tobacco cessation interventions for those who use tobacco.[1]

References

  1. ↑ 1.0 1.1 Siu AL, U.S. Preventive Services Task Force (2015). “Behavioral and Pharmacotherapy Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Women: U.S. Preventive Services Task Force Recommendation Statement”. Ann Intern Med. 163 (8): 622–34. doi:10.7326/M15-2023. PMID 26389730.

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Natural History, Complications and Prognosis

Natural History, Complications and Prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

Overview

Smoking may initially not cause any symptoms and is easy to give up. If not addressed smoking can lead to a vast variety of symptoms related to different organ systems. Smoking may cause carcinomas ultimately and lead to the death. Complications of smoking are not limited to a single organ system. Cardiovascular and respiratory systems are the most commonly involved. It increases the risk of coronary artery disease by 2 to 4 times. COPD is a common complication of smoking. Lung cancers are mostly attributed cigarette smoking. Cigarette smoking is the leading preventable cause of death in the United States. Smoking cessation has positive prognostic effect in lung cancer patients.[1][2]

Natural History

Smoking may initially not cause any symptoms and is easy to give up. If not addressed smoking can lead to a vast variety of symptoms related to different organ systems including staining of teeth, cough, sputum production and shortness of breath. Smoking may cause carcinomas ultimately and lead to the death. [3][4]

Complications

Some complications of smoking include:[3][5][6]

Death due to Smoking

  • Cigarette smoking is the leading preventable cause of death in the United States.
  • It causes more than 480,000 deaths each year in the United States. This is nearly one in five deaths.
  • Cigarette smoking increases risk for death from all causes in men and women.
  • The risk of dying from cigarette smoking has increased over the last 50 years in the U.S.
  • 80% of all the deaths as a result of chronic obstructive pulmonary disease (COPD) are due to smoking.

Other Health Risks

Smoking has shown to increases the risk of:

Smoking causes diminished overall health, increased absenteeism from work, and increased health care utilization and cost

Smoking and Cardiovascular Disease

  • Smoking causes stroke and coronary heart disease, which are among the leading causes of death in the United States.
  • Even people who smoke fewer than five cigarettes a day can have early signs of cardiovascular disease.
  • Smoking damages blood vessels and can make them thicker and grow narrower.
  • A stroke may result when:
    • A clot blocks the blood flow to part of your brain
    • A blood vessel in or around your brain bursts
  • Blockages caused by smoking can also diminish the blood flow to the legs and the skin.

Smoking and Respiratory Disease

Smoking can cause lung disease by damaging your airways and the small air sacs (alveoli) found in your lungs.[2][4]

  • Lung diseases caused by smoking include COPD, which includes emphysema and chronic bronchitis.
  • Cigarette smoking causes most cases of lung cancer.
  • If you have asthma, tobacco smoke can trigger an attack or make an attack worse.
  • Smokers are 12 to 13 times more likely to die from COPD than nonsmokers.

Smoking and Cancer

Smoking can cause cancer almost anywhere in your body:

Other Health Risks due to Smoking

Smoking harms nearly every organ of the body and affects a person’s overall health.Smoking can make it harder for a woman to become pregnant. It can also affect her baby’s health before and after birth. Smoking increases risks for:

  • Preterm (early) delivery
  • Stillbirth (death of the baby before birth)
  • Low birth weight
  • Sudden infant death syndrome (known as SIDS or crib death)
  • Ectopic pregnancy
  • Orofacial clefts in infants
  • Smoking can also affect men’s sperm, which can reduce fertility and also increase risks for birth defects and miscarriage.
  • Smoking can affect bone health.
  • Women past childbearing years who smoke have weaker bones than women who never smoked. They are also at greater risk for broken bones.
  • Smoking affects the health of your teeth and gums and can cause tooth loss.
  • Smoking can increase your risk for cataracts (clouding of the eye’s lens that makes it hard for you to see). It can also cause age-related macular degeneration (AMD). AMD is damage to a small spot near the center of the retina, the part of the eye needed for central vision.
  • Smoking is a cause of type 2 diabetes mellitus and can make it harder to control. The risk of developing diabetes is 30–40% higher for active smokers than nonsmokers.
  • Smoking causes general adverse effects on the body, including inflammation and decreased immune function.
  • Smoking is a cause of rheumatoid arthritis.

Prognosis

Continued smoking adversely effects the prognosis of all malignancies associated with smoking. Studies have shown that smoking cessation improves the prognosis in early stages of lung cancer.[1][2][4]

References

  1. ↑ 1.0 1.1 Parsons A, Daley A, Begh R, Aveyard P (2010). “Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: systematic review of observational studies with meta-analysis”. BMJ. 340: b5569. doi:10.1136/bmj.b5569. PMC 2809841. PMID 20093278.
  2. ↑ 2.0 2.1 2.2 Pearl R (1938). “TOBACCO SMOKING AND LONGEVITY”. Science. 87 (2253): 216–7. doi:10.1126/science.87.2253.216. PMID 17813231.
  3. ↑ 3.0 3.1 “CDC – 2010 Surgeon General’s Report – Consumer Booklet – Smoking & Tobacco Use”.
  4. ↑ 4.0 4.1 4.2 DOLL R, HILL AB (1950). “Smoking and carcinoma of the lung; preliminary report”. Br Med J. 2 (4682): 739–48. PMC 2038856. PMID 14772469.
  5. ↑ “QuickStats: Number of Deaths from 10 Leading Causes — National Vital Statistics System, United States, 2010”.
  6. ↑ “CDC – 2014 Surgeon General’s Report – Smoking & Tobacco Use”.

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