Smoking

Cigarette smoking remains a leading contributor to death and illness among Americans. Every year, roughly 440,000 Americans die from illnesses caused by tobacco use, accounting for nearly one-fifth of all deaths. Smoking cigarettes kills more people in the U.S. than alcohol, car accidents, suicide, AIDS, homicide, and illegal drugs combined.

About 20% of all American adults (45.3 million people) smoke. Slightly more men (21.5%) smoke than women (17.3%). Hispanics (12.5%) and Asian Americans (9.2%) smoke less than whites (21.0%) or African Americans (20.6%). Almost 22% of those 25-44 years of age are current smokers. About 20% of all high school students are smokers.

Nevertheless, significant progress has been made since 1964, when the Surgeon General issued the first report outlining the health dangers of smoking. Since that time, the prevalence of smoking has dropped from 42.4% among adults to 19.3%. Lung cancer, chronic bronchitis and emphysema would become infrequently diagnosed diseases if people would stop smoking.

cigaretteCompared to a nonsmoker, a smoker faces these risks:

  • 14 times greater risk of dying from Lung, Throat, Mouth Cancer
  • 4 times greater risk of dying from cancer of the esophagus
  • 2 times greater risk of dying from a heart attack

Use of other tobacco products such as pipes, cigars, and snuff is less common, comprising less than 10% of use of all tobacco products; however, the health effects of these products are similar to those of cigarettes – particularly their association with cancers of the mouth, throat, and esophagus.

Increasing attention has been devoted to publicizing the dangers of second-hand (environmental) smoke, the association between tobacco marketing and initiation of smoking among youth, and the development of strategies and medications to help smokers quit. According to the CDC, about 126 million people are exposed to secondhand smoke and are put at risk for tobacco-related problems such as lung cancer, heart disease and respiratory infections. In addition, a new problem termed “third-hand smoke” has been recently investigated; cigarette smoke generated carcinogens lodge in clothing, carpets, drapes and other materials and can be absorbed through human skin, especially that of children and infants. These carcinogens can also be ingested and inhaled in dust.

Cigarette smoking has been linked strongly to the following illnesses:

  • heart disease
  • stroke
  • hypertension (high blood pressure)
  • other diseases of blood vessels (such as poor circulation in the legs) and aortic aneurysms (potentially life-threatening disruptions in the wall of the aorta)
  • respiratory illness, including the following:
  • lung cancer
  • emphysema
  • bronchitis
  • pneumonia
  • cancers, including:
  • lip or mouth
  • pharynx or larynx (voice box)
  • esophagus (food pipe)
  • stomach
  • pancreas
  • kidney
  • urinary bladder
  • cervix
  • ovary
  • peptic ulcer disease
  • burns

Cigarette Smoking Symptoms
Signs and symptoms of cigarette smoking are frequently obvious even to a casual observer. Besides the confirmatory evidence (a person actually smoking a cigarette in public view), nicotine-stained fingers and teeth, the characteristic smell of smoke impregnated clothing and household items, the chronic “smokers cough,” the gravelly voice, and often the visible pack of cigarettes and lighter in a person’s pocket or purse are signs and symptoms that a person smokes. However, new (teenage) smokers or “infrequent” smokers may exhibit few or none of these signs and symptoms. In addition, many teens will try to “cover up” any evidence of cigarette use for any number of reasons (for example, their parents forbid any smoking).

Signs and symptoms of tobacco related diseases often depend on the specific illnesses they cause. (There are many other symptoms of tobacco-related diseases, and these listed here are simply examples.)

  • Shortness of breath may be a sign of emphysema or heart disease.
  • Chest pain may signal coronary artery disease caused by insufficient blood flow to the heart or a heart attack.
  • Difficulty swallowing, or persistent hoarseness, may signal a cancer in the mouth or larynx.
  • Painless bloody urination may signal bladder cancer.
  • The presence of any of the following common symptoms associated with tobacco use should prompt a visit to the doctor or hospital’s emergency department:
    • chest pain
    • shortness of breath
    • persistent cough
    • coughing up blood
    • frequent colds and upper respiratory infections
    • persistent hoarseness
    • difficulty or pain on swallowing
    • change in exercise capacity
    • sudden weakness on one side of the face or body; or difficulty speaking
    • leg pain while walking that goes away when at rest
    • unexplained weight loss
    • persistent abdominal pain
    • blood in the urine

Effects of Smoking on the Ear, Nose Throat Head and Neck
Smoking has a direct local and distant effect on many body organs. The most immediate effect of smoking however is on the tissues it reaches first, namely the skin of the face, the lips and mouth, the nose and sinuses, the Eustachian tube (drainage pathway of the middle ear), the throat, voice box, esophagus, trachea (wind pipe) bronchi and lungs.

If smoking didn’t cause cancer, it still causes accelerated aging of the skin and an obvious change that is seen in most all smokers is the early onset of wrinkles on the skin of the face, hands and around the mouth. The appearance of lines around the lips is so stereotypical for smokers in fact, that we call those lines “smoker’s lines”. Sagging of the facial skin and accelerated aging is a result of the exposure of our skin to the numerous toxins found within the cigarette smoke.

The connection between the ear, nose and throat opens a dark doorway to multiple pathways for injury from smoking. The tar and toxins in cigarette smoke damages the microscopic hairs lining our upper and lower respiratory tract. These hairs, better known as cilia, function to clear microorganisms and debris out of our airways. Scattered throughout the cilia are goblet cells that secrete mucous that helps to protect the lining of our airway and trap bacteria. Damage to these mechanisms can result in chronic infections of our respiratory tract, chronic cough and phlegm and finally the reactive release of certain enzymes can lead to the development of irreversible emphysema of the lungs.

Smoking also leads to the removal of certain essential proteins that protect our DNA from damage that leads to the development of a variety of cancers of the skin, lips, mouth, tongue, throat, trachea, esophagus, stomach, lungs, bronchi and bladder.

How to Quit Smoking?
Treating tobacco involves helping the individual successfully stop smoking. This often requires integrated steps.

Smokers must partner with their doctors, families, spouses, friends, even employers, to make quitting successful.

Quitting smoking may seem easy but not going back to old habits is easier said than done. Every year, 34% of all smokers try to quit, but only about 2.5% succeed. Nonetheless, 1 million Americans quit smoking each year.

The medical conditions caused by smoking – respiratory illness, heart disease, circulatory disease, cancer, ulcers – need to be treated. In addition to stopping smoking, the individual’s medical condition, if one is present, needs to be addressed by the patient’s doctor; unfortunately there are too many conditions and treatments to be covered in this article. Smokers need to discuss individual treatments for their individual diagnosis with their primary caregiver.

The nicotine addiction also must be addressed and generally consists of a combination of the following:
Nicotine replacement therapy (gum, patch, lozenges, inhaler, or nasal spray): Some nicotine replacement products (gum, patches, and lozenges) are available over the counter, under several brand names, but are best used in conjunction with a doctor. Others (nasal sprays and inhalers) require a prescription. The non-prescription products are less expensive and work as well as the prescription products.

Varenicline (Chantix) is a prescription drug approved by the U.S. FDA to help adults quit smoking. Chantix acts on the nicotine receptors in the brain, stimulating these receptors and blocking the ability of nicotine to attach to these receptors. Chantix is taken seven days prior to the date an individual desires to quit smoking, and most people will keep taking Chantix for up to 12 weeks.

Group or behavioral counseling. The most successful quitting programs use combinations of drug treatment and counseling and have success rates of 5% after 1 year.

The prescription antidepressant bupropion (Zyban, Wellbutrin) has also been shown to help some people quit smoking.

Smokers trying to quit need lots of support and encouragement to help handle the inevitable urges to light up.

Doctors, although trained in the diagnosis and treatment of smoking-related illnesses, may be less comfortable in providing the counseling and drug treatment smokers need to quit.

Call your local chapter of the American Lung Association for further advice about smoking cessation programs.