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Table of Contents

Magill’s Medical Guide, 9th Edition

Smoking

by Trevor Prashad, , DO

Category: Disease/Disorder

Anatomy or system affected: Circulatory system, respiratory, throat, gastrointestinal, bladder

Specialties and related fields: Oncology, pulmonary medicine, vascular medicine, addiction medicine

Definition: The inhalation of tobacco in the form of cigarettes or cigars, which poses important health risks; those risks can be significantly decreased by smoking cessation, even in older age.

CAUSES AND EFFECTS

Cigarette smoking has long been known to have adverse effects. Smokers get more wrinkles than nonsmokers and brown/black discoloration of teeth so they tend to look older than their chronological age. They also are more likely to develop worsening of age-related problems such as gum disease, loss of teeth, and alteration in sense of smell and taste. Loss of teeth leads to difficulty chewing, which in turn leads to difficulties with digestion. Most people who lose teeth eventually develop loss of the bone that should support their teeth, making it increasingly difficult to fit dentures.

Smokers are ten times more likely to get lung cancer than nonsmokers. Lung cancer is now the number one cause of cancer deaths in women, as well as in men. In addition to lung cancer, smokers have a higher incidence of cancers of the head and neck, esophagus, colon, rectum, kidney, bladder, and cervix. Smokers are three to six times more likely to have a heart attack than are nonsmokers. In older people, the major risk factor for disease of the coronary arteries is hypertension, but smoking is still significant, especially when combined with other risk factors for heart disease, such as diabetes or high cholesterol. Smoking and diabetes are also the two most important risk factors for diseases of the veins and arteries of the lower leg. Those who continue to smoke once these diseases develop are much more likely to require limb amputation than those who quit. Smokers may develop chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis, and are eighteen times more likely than nonsmokers to die of diseases of the lungs other than cancer. Older smokers also show a decrease in muscle strength, agility, coordination, gait, and balance. The changes in these areas make them seem older than their actual age.

Information on Smoking

Causes: Addictive properties of drug

Symptoms: Increased incidence of lung cancer, pancreatic cancer, oral cancer, esophageal cancer, bladder cancer, emphysema, and chronic bronchitis; increased risk of gum disease; impaired sense of smell and taste; tooth loss; difficulty with digestion including acid reflux; decreased muscle strength, agility, coordination, gait, and balance; wrinkles

Duration: Often chronic

Treatments: Support groups, hypnosis, increased exercise; use of nicotine replacement systems (patches, gum), medications, electronic cigarettes

Smoking has long been thought to be associated with peptic ulcer disease. In addition, smoking makes the symptoms of many diseases worsen or increases the risk of complications in patients with allergies, diabetes, hypertension, and vascular disease. Male smokers are at greater risk of experiencing sexual impotence. Female smokers tend to experience an earlier menopause, bone loss called "osteoporosis" and are therefore at increased risk for hip fracture than nonsmokers. Smokers are more likely to develop glaucoma than nonsmokers. (Studies completed in 1996 indicated an increased risk with smoking for macular degeneration, the leading cause of blindness in older adults. The evidence is mixed on smoking and Alzheimer’s disease, but a 1998 study contradicted earlier work and found that the risk is greater in smokers than in nonsmokers.) Finally, smokers are at greater risk of death or injury caused by cigarette-related fires.

Cigarette smoking tends to speed up the processes in the liver for breaking down, using, and eliminating medications, both nonprescription and prescription. This means that medications may not perform as expected in the body. Smokers may need to take medications more frequently or in greater doses than nonsmokers, so it is important for health care providers to know that a person smokes. The drugs known to be affected by smoking include sedatives, narcotic and synthetic narcotic painkillers, certain antidepressants, anticoagulant medications, asthma medications, and certain blood pressure medications. These changes are of particular concern in the older population for a number of reasons. First, older people (whether smokers or nonsmokers) tend to need more medications than younger people. With each additional drug, the risk of serious drug interaction and other adverse effects increases. Second, changes in body composition and function that alter the metabolism of drugs come with age, making medication use somewhat riskier in older persons, in terms of adverse effects and complications. The additional changes associated with smoking increase these risks significantly.

Smoking is known to cause a variety of health problems.

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Photo via iStock/skynesher. [Used under license.]

The dangers of passive smoking are well-documented. More than fifty compounds in secondhand smoke are identified as carcinogens in humans. The effects seem to be more harmful in children than in adults, but adults who are affected are at increased risk for cancer, heart disease, cancerous lung diseases, and allergies.

TREATMENT AND THERAPY

Numerous studies have shown that smoking cessation has health benefits in as little as one year, such as reducing the risk of heart attack and coronary artery disease. Within two years of smoking cessation, the risks of stroke and diseases of the blood vessels in the lower leg are reduced as well. Even though chronic lung disease is not reversible, those who quit smoking slow the decline in lung function considerably. Risks for cancers also decrease significantly with smoking cessation and are similar to the cancer risk for nonsmokers in ten to thirteen years. These findings indicate that it is worthwhile even for older people to give up smoking. An average forty-year-old gains approximately nine additional years of life by quitting smoking, and a sixty-year-old gains approximately three additional years.

Because smoking is an addiction, it may be difficult to quit, particularly after years of cigarette use. Most smokers have to stop several times before quitting permanently. Setting a quit date, attending support group meetings, taking it one day at a time, undergoing hypnosis, making a contract with a friend or a health care provider, substituting carrot sticks for cigarettes, increasing exercise (particularly swimming), and breathing deeply all seem to be helpful techniques. Nicotine replacement systems are available in the United States on a nonprescription basis, but it is important for older people, particularly those with health problems or who are taking multiple medications, to consult a health care professional prior to using them. Some forms of nicotine replacement include lozenges, patches, gum. It is also important that anyone using these aids stop smoking completely. Continuing to smoke while using nicotine replacement could potentially cause toxicity, and it decreases the success of cessation attempts, since the behavior of smoking is still present. Two non-nicotine-containing medications are available by prescription for smoking cessation: the antidepressant bupropion SR (Wellbutrin, Zyban) and varenicline (Chantix). Both medications significantly increase the success rates at the end of treatment and one year later. The mechanism of action is by stimulating chemical messengers in the brain that are affected by nicotine. The use of nicotine replacement in conjunction with these two non-nicotine-containing medications may increase the likelihood of smoking cessation. Wellbutrin may work better in patients who have depression-like symptoms.

Electronic cigarettes are used as a tool for smoking cessation. A battery-powered device that can deliver nicotine without the combustion or smoke. Use and awareness of e-cigarettes has dramatically increased over the past few years. Studies have suggested that physical and behavioral stimuli, such as holding a cigarette, can reduce the craving to smoke. Recent findings suggest that individuals who used e-cigarettes reduced the number of tobacco cigarettes they smoked. These findings suggest that e-cigarettes may be an important tool for reducing the harm that tobacco cigarettes can cause. Unfortunately, the benefits and risks of electronic cigarettes as of 2013 are still uncertain. More studies are needed for further investigation of their safety and efficacy.

PERSPECTIVE AND PROSPECTS

Smoking is the main avoidable cause of death in the United States and many other developed nations. More than 10 percent of North Americans over the age of sixty-five smoke cigarettes. This put them, and those with whom they live, at risk for significant health problems. These risks appear to increase both with age and with the number of years of smoking. After World War II, more women began smoking. Because the diseases related to smoking usually take years to develop, it was only in the last part of the twentieth century that rates of smoking-related disease among women began to approach those of men. Research indicates that smoking cessation appears to be beneficial, even in a person who has smoked for many years.

See also: Addiction; Amputation; Bronchitis; Caffeine; Cancer; Carcinogens; Chronic obstructive pulmonary disease (COPD); Dental diseases; Diabetes mellitus; Emphysema; Eyes; Fracture and dislocation; Gingivitis; Glaucoma; Heart attack; Lung cancer; Lungs; Macular degeneration; Nicotine; Osteoporosis; Pulmonary diseases; Pulmonary medicine; Respiration; Sexual dysfunction; Skin disorders; Strokes; Substance abuse; Teeth; Vision disorders; Wrinkles.

For Further Information:

1 

Britton, John. ABC of Smoking Cessation. Blackwell, 2004. This guide provides practical information for smoking cessation and discusses the public health and individual health problems associated with smoking.

2 

Hales, Dianne. An Invitation to Health Brief. Updated editor. Wadsworth/Cengage Learning, 2010. This updated, helpful resource covers many aspects of health, including mental health, physical fitness, stress management, and preventive medicine.

3 

Jameson, J. L., A. S. Fauci, D. L. Kasper, et al., editors. Harrison’s Principles of Internal Medicine. 20th ed., McGraw Hill, 2018. Accessed 19 Apr. 2020.

4 

Jorenby, Douglas E., et al. “Efficacy of Varenicline, an a4ß2 Nicotinic Acetylcholine Receptor Partial Agonist, versus Placebo or Sustained-Release Bupropion for Smoking Cessation.” Journal of the American Medical Association, vol. 296, no. 1, 5 July 2006, pp. 56-63. This article compares two non-nicotine smoking-cessation products to a placebo in a smoking-cessation study with evaluation at the end of treatment and at fifty-two weeks. Varenicline was found to be significantly more effective than bupropion. Both agents were more effective than a placebo.

5 

Marcus, Bess H., Jeffrey S. Hampl, and Edwin B. Fisher. How to Quit Smoking without Gaining Weight. Simon & Schuster, 2004. This paperback book from the American Lung Association provides expert advice on quitting smoking without gaining substantial weight. It provides motivation and discusses physical activity and many strategies to help with cravings. Includes recipes and meal plans.

6 

Parles, Karen, and J. H. Schiller. One Hundred Questions and Answers about Lung Cancer. 2nd ed., Jones and Bartlett, 2010. A patient-oriented guide that covers a range of topics related to lung cancer, including risk factors and causes; methods of prevention, screening, and diagnosis; available treatments and how to choose among them; and ways of coping with common emotional and physical difficulties associated with the diagnosis and treatment.

7 

Pirozynski, Michael. “One Hundred Years of Lung Cancer.” Respiratory Medicine, vol. 100, no. 12, Dec. 2006, pp. 2073-84. Lung cancer is the most common cause of cancer death in the world, and cigarette smoking remains the major risk factor. Discusses treatment and prognosis.

8 

Sloan, Frank A., et al. The Price of Smoking. MIT Press, 2006. This book contains a thorough analysis of the costs of smoking, which have often been ignored. These costs are carefully and comprehensively discussed by a group of economists.

Citation Types

Type
Format
MLA 9th
Prashad, Trevor. "Smoking." Magill’s Medical Guide, 9th Edition, edited by Anubhav Agarwal,, Salem Press, 2022. Salem Online, online.salempress.com/articleDetails.do?articleName=MMG2022_1257.
APA 7th
Prashad, T. (2022). Smoking. In A. Agarwal, (Ed.), Magill’s Medical Guide, 9th Edition. Salem Press. online.salempress.com.
CMOS 17th
Prashad, Trevor. "Smoking." Edited by Anubhav Agarwal,. Magill’s Medical Guide, 9th Edition. Hackensack: Salem Press, 2022. Accessed October 22, 2025. online.salempress.com.