What is it?

Cigarette smoking is the leading contributor to preventable deaths in the United States. According to the U.S. Centers for Disease Control and Prevention (CDC), more than 442,000 deaths in the United States are due to tobacco use each year (about 20 percent of the total mortality throughout the country). More than 179,000 of these deaths are from cardiovascular diseases, including stroke. Smokers also face very high risks of developing respiratory diseases that have no cure, such as chronic obstructive pulmonary disease, lung cancer and other smoking related diseases.

On average, adults who smoke die 13 to 14 years earlier than nonsmokers. Also at risk are individuals exposed to secondhand smoke. Such “involuntary” smoking is responsible for approximately 3,000 lung cancer deaths annually among non-smokers and 300,000 respiratory tract infections among children. Based on current cigarette smoking patterns, an estimated 6.4 million people younger than 18 will die prematurely of smoking-related diseases, according to the CDC. The direct medical cost of tobacco use in the United States is estimated at more than $75 billion annually.

The CDC estimates that in recent years, the number of Americans who smoke has consistently dropped, down from a high of more than 50 percent in the 1960s to less than 25 percent of Americans today. Much of this progress may be due to extensive public education campaigns that seek to educate people about the dangerous toxins in tobacco smoke and prevent young people from becoming smokers.

Tobacco smoke contains more than 4,000 chemical compounds, including:

• Nicotine. A highly addictive chemical that goes straight to the brain in as little as 10 seconds and has effects throughout the rest of the body. This is the chemical largely responsible for “hooking” people on cigarettes (a smoking addiction).
• Tar. A term used to describe the 20 (or more) carcinogens (cancer-causing substances) found in tobacco smoke that form a sticky, tar-like substance within the lungs.
• Carbon monoxide. Replaces some of the essential oxygen in the bloodstream. With less oxygen, the major organs of the body and linings of the blood vessels are damaged over time, directly contributing to conditions such as hardened arteries (atherosclerosis).

Smoking can have devastating effects on many systems of the body, especially the cardiovascular system. It is a major cause of high blood pressure (hypertension) as well as heart failure, coronary artery disease, heart attack, stroke and other cardiovascular conditions.

Smoking is also the “great equalizer” for heart disease in women. Among non-smokers, men overall have a much greater risk of acquiring heart disease than women who have not yet gone through menopause. However, female smokers' risk of heart disease can be as much as six times greater than female non-smokers. This risk is exponentially increased in women receiving contraceptive pills. Pregnant and breast-feeding smokers also risk the health of the child, both before the birth and afterward, due to the effects of second-hand (passive) smoke.

Specifically, smoking affects the cardiovascular system in the following ways:

• Stimulates the formation of a blood clot, which can quickly and suddenly obstruct a blood vessel.
• Damages areas on the walls of the arteries. These become attractive spots for plaque to form, which could lead to hardened arteries (atherosclerosis).
• Higher levels of fatty materials triglycerides and “bad” low-density lipoproteins, (LDL) cholesterol – two dangerous elements in the development of hardened arteries (atherosclerosis). Smokers also have lower levels of “good” high-density lipoproteins (HDL) cholesterol.
• Has been linked to sudden cardiac death of all types in both men and women.

Other tobacco or smoking products such as chewing tobacco and snuff are harmful as well. Furthermore, people who smoke other products (e.g., “light” cigarettes or clove cigarettes) are also facing serious health risks. The risk for cancers of the mouth, esophagus, larynx and bladder are also increased in pipe and cigar smokers. Because of the many dangers of smoking, people are encouraged to speak with their physician about strategies that are available to help them quit.

How is it diagnosed?

According to the DSM-IV, dependence is established by the presence of three or more of the following symptoms during a twelve month period:

• tolerance (more of the drug is required to achieve the same effect),
• withdrawal (unpleasant physical or psychological effects when use is reduced),
• use is in greater amounts or over a longer period than intended,
• a persistent desire to quit or unsuccessful efforts made at control of the amount used,
• much time spent in using or obtaining substance (chain smoking),
• work, social, or leisure activities reduced because of use,
• continued use despite knowledge of or having experienced related health problems.

Physical exam is not necessary to make the diagnosis, but because of the large number of associated serious medical complications, it is recommended. Physical signs such as stained fingers or evidence of lung disease may be present.

How is it treated?

Treatment approaches include hypnosis, acupuncture, aversive conditioning, psychotherapy, medications, and tobacco substitutes, to name a few.

The key to quitting is preparation. Unless fully prepared, many people are unable to stay smoke-free. Preparation begins with a firm commitment to quit smoking. People usually make this decision because they fear the deadly effects of smoking. Once they have made this decision, they should pick a date to quit and then talk with their physician about smoking cessation strategies and aids, such as nicotine replacement therapy. Smokers should not get discouraged if their first attempt at quitting is unsuccessful. It often takes more than one try. Above all, people are urged to quit for good.

Studies have shown that the transdermal (skin) patches appear to be an effective aid, at least in the short-term. Recent research with antidepressants has been promising, but, at this time, there are no quick or easy fixes for this addiction.

Medications

Revia (Naltrexone)

What might complicate it?

Cancer, lung, and heart disease are some of the major illnesses resulting from exposure to tobacco products. Smokers are also believed to be more susceptible to minor respiratory illness such as viral infection. Both asthma and allergies are exacerbated by exposure to smoke.

Predicted outcome

Today, in addition to lung cancer, heart disease, chronic obstructive pulmonary disorder and stroke, chronic bronchitis and emphysema, smoking has been linked to:

• Abdominal aortic aneurysm
• Leukemia
• Cataract
• Cancer of the cervix, kidney, pancreas, stomach, bladder, esophagus, larynx and throat
• Pneumonia
• Gum disease
• Sudden infant death syndrome (SIDS)

Researchers have estimated that smoking cuts an average of 10 years off a person's life expectancy, even with advances in prevention and treatment of the various diseases associated with smoking. However, by quitting early these “lost” years can be regained. A person who quits at age 35 can live as long as nonsmokers, according to recent studies.

Alternatives

The diagnosis is made by history and is usually obvious.

Appropriate specialists

Psychiatrist, psychologist, and internist.

Last updated 12 July 2015