Cigarette Smoking

Cigarette smoking is a leading cause of death and health problems among Americans, such as lung cancer, chronic bronchitis, and emphysema.

Cigarette smoking is a leading contributor to death and illness among Americans.

Significantly fewer than half of all American adults smoke. Slightly more men smoke than women. Hispanics and Asian Americans smoke less than whites or African Americans. Fewer than one-third of people ages 25 to 44 are current smokers.

Since 1964, when the Surgeon General issued the first report outlining the health dangers of smoking, the prevalence of smoking has dropped among adults. The incidence of lung cancer, chronic bronchitis, and emphysema would become significantly less common if people would stop smoking.

How dangerous is smoking, really?

Compared to a non-smoker, a smoker faces these risks:

• fourteen times greater risk of dying from cancer of the lung, throat, or mouth;
• four times greater risk of dying from cancer of the esophagus;
• two times greater risk of dying from a heart attack; and
• two times greater risk of dying from cancer of the bladder.

Use of other tobacco products such as pipes, cigars, and snuff is less common; 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 non-smoking Americans are exposed to secondhand smoke and 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.

What is the effect of smoking?

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

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, the legality regarding their age and the purchase of cigarettes or their parents forbid 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 those listed here are simply examples.)

• Shortness of breath may be a sign of emphysema or heart disease.
• Chest pain may signal angina pectoris 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

If you are interested in quitting smoking, call your doctor.

• It is never too early to think about quitting.
• Every encounter with a doctor, whether in the office, the hospital, the emergency department, or clinic, is a good time to talk about smoking and the possibility of quitting.

Anyone, especially smokers, with unexplained or sudden onset chest pain or difficulty breathing should go to the nearest hospital's emergency department, probably by ambulance. These conditions may be symptoms of a heart attack or other serious health problems, which can be life-threatening if not recognized and treated promptly. Tobacco use may cause problems (for example, hypertension, vascular alterations) that lead to shortness of breath or chest pain that may be life-threatening.

Tobacco use may lead or contribute to one of the following causes of dyspnea or chest pain:

• pneumonia,
• acute attack of emphysema,
• pulmonary embolism (blood clot in the lung),
• aortic aneurysm (a widening of the main artery leaving the heart, caused by a weakening in the wall of the artery), and
• aortic dissection (a tearing of the wall of the aorta, which, if it ruptures, bleeds profusely).

Smoking is recognized as a medical diagnosis called Tobacco Use Disorder.

Doctors should ask people about tobacco use at every visit and provide counseling about quitting.

Most people who smoke admit doing so, in part because smoking carries less social stigma than the use of other substances, such as alcohol or illicit drugs. Smokers should not underestimate how much they smoke and for what length of time (for example, a pack a day since age 16), as this information helps the doctor understand the risk for tobacco-related disease.

Upon a physical exam, a doctor may find various conditions associated with chronic tobacco use.

• Nicotine causes a characteristic brown staining of the hard palate, teeth, fingers, and fingernails.
• A smoker's skin may wrinkle prematurely.
• Smokers have a typical odor to their hair and clothing.
• People with emphysema may have a large, barrel-shaped chest and a chronic cough that produces thick green sputum.

Occasionally, a smoker may have pulmonary function tests performed to help determine the amount of damage done to the lungs by smoking. For young teens, it may be best for physicians to ask the teen about his or her cigarette smoking history with the parents or caregivers out of the room.

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 is not easy. Many smokers try to quit, but only a few succeed.

Treatment consists of two broad areas.

• The medical conditions caused by smoking - respiratory illness, heart disease, circulatory disease, cancer, ulcers - need to be treated. In addition to stopping smoking, any associated medical condition, if one is present, needs to be addressed by the patient's doctor. Smokers need to discuss treatments for their individual diagnosis with their doctor.
• 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.

Other Treatments

Treatment of the many diseases and conditions associated with smoking is dependent upon the extent and severity of the condition. Treatments are numerous, varied and are best done in consultation with the individual's primary care physician and associated caregivers (for example, cardiologist, oncologist). Smoking cessation products are available (see medical treatment previously) for home use for people interested in quitting smoking.

Prevention can be easy; simply do not start to smoke cigarettes or use any other tobacco products. Unfortunately, quitting is often very difficult. Most smokers begin to smoke as teenagers.

Parents still have the biggest impact on their children's decision whether to smoke. The best way to prevent a youngster from taking up smoking is to have parents who don't smoke. Children from smoking households are more likely to begin smoking than children from nonsmoking households.

• Much attention has been focused on the influence of tobacco company advertising on encouraging young people to smoke.
• Although cigarette commercials have been banned from television for over 30 years, tobacco products remain among the most heavily marketed products. According to the American Lung Association, the tobacco industry spent an estimated $8.24 billion on advertising in 2015. Some states place restrictions on the type and locations of tobacco advertising, and legislation enacted in 2009 gave the U.S. FDA strong authority to regulate tobacco products. The FDA requires prominent health warnings on all cigarette packaging and advertisements in the United States.
  • Studies have shown that youth are particularly susceptible to tobacco marketing campaigns.
  • In the past, cigarette use by actors in popular films was a means to portray smoking as sophisticated and glamorous.
  • Although denied by tobacco companies, the use of cartoon animals and the like in advertising campaigns appeals to youngsters.
  • Counter-advertising by various antismoking advocacy groups may provide some balance, but their advertising budgets pale beside those of tobacco companies.
  • Schools generally provide education on the use of tobacco, alcohol, and other substances, but their impact is unclear.
  • Increasing the taxes on cigarettes, and hence their price, has been shown to reduce tobacco consumption, especially among adolescents.

For smokers, quality and length of life depend on the number and severity of smoking-associated illnesses they may develop and if they have other medical conditions such as diabetes or high blood pressure. Other lifestyle factors, for example, use of alcohol or other drugs, also make a difference in long-term outcomes for smokers. For smokers who quit, projected health and life expectancy improve markedly at any age of life.

• Smokers who quit before age 50 years have half the risk of dying in the next 15 years compared with those who continue to smoke.
• Quitting smoking substantially decreases the risk of lung, larynx, esophageal, oral, pancreatic, bladder, and cervical cancers. For example, 10 years after quitting, an ex-smoker has a lower risk of lung cancer compared to a continuing smoker. Continued smoking abstinence continues to lower the risk.
• Quitting lowers the risk for other major diseases including coronary heart disease and cardiovascular disease. The increased risk of coronary heart disease halves after 1 year of abstinence. After 15 years, the risk of coronary heart disease approximates that of someone who never smoked.
• Women who stop smoking before pregnancy, or during the first 3 or 4 months of pregnancy, reduce their risk of having a low birth weight baby to that of women who never smoked.
• The health benefits of quitting far exceed any risks from the average 5-pound weight gain that may follow quitting.