Medical Diagnoses

Promoting smoking cessation in those with medical diagnoses can help decrease disease symptoms and increase overall health.

Why is smoking cessation important?

      Tobacco smoke contains 250 known harmful chemicals and 29 of those chemicals are known to cause cancer¹. Studies have also found that smoking increases the risk of several types of heart diseases, lung diseases and other harmful health effects such as cancer². Furthermore, the Morbidity and Mortality Weekly Report of 2008 reported that 443,000 deaths took place each year during 2000-2004 due to adverse health effects produced by cigarette smoking³. Thus, based on the current cigarette smoking pattern, adults who smoke cigarettes are more likely to die 14 years earlier compared to nonsmokers.

      The CDC has also reported that smoking-related diseases could result in the premature death for roughly 25 million Americans overall; 5 million of whom could be below the age of 18 years⁴. However, studies have also found that smoking cessation not only helps to reduce the risk of heart diseases, lung diseases and cancer but it also results in several health benefits such as an improved blood count and metabolic profile^{2, 5}. As a result smoking cessation is important because it helps to reduce harmful health effects and also improves overall mortality rates².

Smoking related health concerns and possible preventions/recommendations
Studies have found numerous smoking related health concerns such as:

1. Cardiovascular diseases
   • Coronary artery disease- narrowing of blood vessels that supply blood and oxygen to the heart⁶
     • Smoking increases the risk of coronary artery disease. However, studies have found that quitting smoking can substantially reduce the risk of mortality in patients suffering with coronary artery disease^{7, 8}.
   • Myocardial infarction- blockage of blood flow to the heart for a prolonged period of time resulting in a heart attack⁹
     • Studies have found that fatal myocardial infarction is four times more likely in young male smokers compared to non-smokers².
   • Stroke- The discontinuation of blood flow to a part of the brain¹⁰
     • Studies have found that the risk for stroke increases by 3-fold with smoking².
   • Peripheral vascular disease- Obstruction of the large arteries in the arms and legs that can cause a range of problems from pain to tissue loss or gangrene¹¹
     • Cigarette smoking causes the blood vessels to narrow resulting in reduced circulation which increases smokers’ chances of developing a peripheral vascular disease¹¹.
   • Abdominal Aortic Aneurysm- swelling or weakening of the main artery of the body where it runs through the abdomen¹².
     • Based on the Surgeon General Report of 2004, there is a causal relationship between smoking and Abdominal Aortic Aneurysm¹².
   • Atherosclerosis- Hardening of arteries due to plaques formation due to buildup of fats, cholesterol and other substances¹³.
     • Studies have shown that smoking and Environmental Tobacco Smoking (ETS) is associated with cumulative and irreversible progression of Atherosclerosis¹⁴.
   • Prevention/Recommendation:
     • Studies have found that smokers who reported reducing their smoking habits had a decreased risk of hospitalization for myocardial infarction⁵.
     • Studies have found that smokers who reduced their smoking by 50% had a better cardiovascular system as indicated by their decreased white blood cell count (WBC), red blood cell count (RBC), fibrinogen, hemoglobin, hematocrit and low-density lipids (LDLs) and increased high-density lipids (HDLs)⁵.
     • Smokers who quit smoking reduce their risk for a heart attack within the first year and those who have had a heart attack before reduce their risk by ⅓ to ½ ¹⁵.
     • Smokers who quit for at least 2-5 years can also reduce their chances for a stroke¹⁵.   
     • The CDC reports that patients can substantially reduce their risk for a coronary heart disease within 1 to 2 years of smoking cessation¹⁶.
2. Type 2 diabetes mellitus-A chronic lifelong disease associated with high levels of blood sugar¹⁷.
   • Cigarette smoking is a known predictor of type 2 diabetes mellitus and studies have found that smoking cessation leads to fewer long term risks associated with diabetes¹⁸
   • Studies have also shown that diabetes can increase the risk of cardiovascular diseases¹⁸
3. Pulmonary diseases
   • Chronic Obstructive Pulmonary Disease (COPD)- A type of lung disease associated with breathing difficulty¹⁹
     • Studies have shown that volatile components contained in cigarette smoke such as acetaldehyde and acrolein create disruptions to the airway structure and functions resulting in COPD. Furthermore, death rates from COPD are higher among cigarette smokers^{7, 20}.
     • The two common types of COPD’s are chronic bronchitis and emphysema
       • The risk of smokers dying from chronic bronchitis and emphysema is 12 to 13 times more than a nonsmokers¹¹.
   • Asthma
     • Exposure to environmental tobacco smoke (ETS) in patients with asthma is associated with severe symptoms, reduced lung function and increased hospital administration. Furthermore, active smoking by individuals suffering from asthma results in longitudinal changes in lung function and asthma-related mortality^{7, 21}.
     • Smoking can trigger an asthma attack in smokers who have a preexisting condition of asthma²².
   • Smokers are also at an increased risk of contracting pneumonia and other respiratory infections²².
   • Prevention/Recommendation:
     • Studies have found that smoking cessation improves pulmonary function by 5% within the first several months of quitting and decreases the risk of developing COPD ².
4. Lung Cancer
   • The risk of lung cancer in men is about 20-fold in smokers compared to non-smokers².
   • Prevention: Smoking cessation can improve the survival rates in patients who have cancer, such that the risk for cancer decreases with increasing duration of smoking abstinence².
5. Smoking is also known to causes several other types of cancer such as²³:
   • Esophagus cancer
   • Larynx cancer
   • Mouth cancer
   • Throat cancer
   • Kidney caner
   • Bladder cancer
   • Pancreatic cancer
   • Stomach cancer
   • Cervical cancer, &
   • Myeloid Leukemia
   • Prevention: Smokers who quit smoking can reduce by half their chances of developing mouth, throat, esophagus and bladder cancer within 5 years and lung cancer within 10 years²⁴.  
6. Secondhand smoke
   • According to the CDC, ~88 million nonsmokers in the United States were exposed to secondhand smoke in 2007-2008²⁵.
   • The Morbidity and Mortality Weekly Report of 2008 stated that secondhand smoke exposure was the cause of 49,400 deaths per year in 2000-2004³.
   • Secondhand smoke exposure is also known to cause lung cancer and heart disease resulting in 3,400 annual deaths due to lung cancer and 46,000 annuals deaths due to some form of heart disease⁴.
   • Nonsmokers who are exposed to secondhand smoke at work/home can increase their risk of heart disease by 25%-30% and their risk for lung cancer by 20%-30% ²⁶.
   • Individuals with preexisting heart disease are at an even higher risk if exposed to secondhand smoke²⁶.

      Overall, smoking is responsible for numerous harmful health effects; in particular, smoking increases the risk of developing cardiovascular diseases, pulmonary diseases and different forms of cancer ^{2, 7, 21}. In some cases, smoking can also increase the risk of harmful health effects among individuals who are already diagnosed with other health-related problems, as is the case in type 2 diabetes¹⁸. Even mere exposure to secondhand smoke can cause increases the risk of lung cancer and heart disease, which in turn can lead to a death ²⁶. However, numerous studies have also reported that individuals who reduce or stop smoking have an improved health outcome and a reduced risk of developing harmful health effects^{2, 5, 15}. As a result smoking cessation is important to not only prevent harmful health effects but to also continue enjoying a long and healthy lifestyle.

Source: Morbidity and Mortality Weekly Report, 2008³

1. The National Cancer Institute. (2011). Harms of Smoking and Health Benefits of Quitting; [last reviewed 2011 Jan 12; cited 2012 Jul 18].  Retrieved from http://www.cancer.gov/cancertopics/factsheet/Tobacco/cessation
2. Fagerström, K. (2002). The epidemiology of smoking: health consequences and benefits of cessation. Drugs, 62(11), 1-9.
3. Adhikari, B., Kahende, J., Malarcher, A., Pechacek, T., & Tong, V. (2008). Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses - United States, 2000-2004. Morbidity and Mortality Weekly Report, 57(45):1226-1228. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a3.htm
4. Center for Disease Control and Prevention. (2011). Tobacco-Related Mortality. Retrieved from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/to....
5. Pisinger, C., & Godtfredsen, N. S. (2007). Is there a health benefit of reduced tobacco consumption? A systematic review. Nicotine & Tobacco Research, 9(6), 631-646. doi:10.1080/14622200701365327
6. A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; c1997-2012. Coronary heart disease; [last reviewed 2011 May 23; cited 2012 Jul 18]. Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004449/
7. Das, S. (2003). Harmful health effects of cigarette smoking. Molecular And Cellular Biochemistry, 253(1-2), 159-165.

8. Critchley, J., & Capewell, S. (2003). Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA: The Journal Of The American Medical Association, 290(1), 86-97.
9. A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; c1997-2012. Heart attack; [last reviewed 2011 May 23; cited 2012 Jul 18]. Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001246/
10. A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; c1997-2012. Stroke; [last reviewed 2011 Jun 24; cited 2012 Jul 18]. Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001740/
11. Center for Disease Control and Prevention. (2011). Health Effects of Cigarette Smoking. Retrieved from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/ef...
12. U.S. Department of Health and Human Services. (2004). The Health Consequences of Smoking:Executive Summary. A Report of the Surgeon General. Retrieved from July 17, 2012, from U.S. Department of Health and Human Services, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Centers for Disease Control and Prevention website: http://www.cdc.gov/tobacco/data_statistics/sgr/2004/pdfs/executivesummar...
13. A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; c1997-2012. Hardening of the arteries; [last reviewed 2011 May 20; cited 2012 Jul 18]. Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001224/
14. Howard, G., Wagenknecht, L., Burke, G., Diez-Roux, A., Evans, G., McGovern, P., & ... Tell, G. (1998). Cigarette smoking and progression of atherosclerosis: The Atherosclerosis Risk in Communities (ARIC) Study. JAMA: The Journal Of The American Medical Association, 279(2), 119-124.
15. Center for Disease Control and Prevention. (2012). 2010 Surgeon General's Report: Overview of Findings Regarding Cardiovascular Disease. Retrieved from http://www.cdc.gov/tobacco/data_statistics/sgr/2010/highlight_sheets/pdf...
16. Center for Disease Control and Prevention. (2012). Facts sheets: Smoking cessation. Retrieved from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/cessation/quittin...
17. MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2012 Jun 28]. Type 2 diabetes; [updated 2011 Jul 28; cited 2012 Jul 18]; Available from: http://www.nlm.nih.gov/medlineplus/ency/article/000313.htm
18. Yeh, H., Duncan, B., Schmidt, M., Wang, N., & Brancati, F. (2010). Smoking, smoking cessation, and risk for type 2 diabetes mellitus: a cohort study. Annals Of Internal Medicine, 152(1), 10-17. doi:10.1059/0003-4819-152-1-201001050-00005
19. A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; c1997-2012. Chronic obstructive pulmonary disease; [last reviewed 2011 May 1; cited 2012 Jul 18]. Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001153/
20. Carter, R., Tiep, B., & Tiep, R. (2008). The emerging chronic obstructive pulmonary disease epidemic: clinical impact, economic burden, and opportunities for disease management. Disease Management & Health Outcomes, 16(5), 275-284.

21. Kjærgaard, T., Cvancarova, M., & Steinsvåg, S. K. (2011). Cigarette smoking and self-assessed upper airway health. European Archives Of Oto-Rhino-Laryngology, 268(2), 219-226. doi:10.1007/s00405-010-1287-y
22. Center for Disease Control and Prevention. (2012). 2010 Surgeon General's Report: Overview of Findings Regarding Respiratory Diseases. Retrieved from http://www.cdc.gov/tobacco/data_statistics/sgr/2010/highlight_sheets/pdf...
23. The National Cancer Institute. (2011). Harms of Smoking and Health Benefits of Quitting; [last reviewed 2011 Jan 12; cited 2012 Jul 18].  Retrieved from http://www.cancer.gov/cancertopics/factsheet/Tobacco/cessation
24. Center for Disease Control and Prevention. (2012). 2010 Surgeon General's Report: Overview of Findings Regarding Cancer. Retrieved from http://www.cdc.gov/tobacco/data_statistics/sgr/2010/highlight_sheets/pdf...
25. Kaufmann, R. B., Babb, S., O'Halloran, A., Asman, K., Bishop, E., Tynan, M., Caraballo, R. S., Pechacek, T. F., Bernert, J. T., & Blount, B. (2010).Vital Signs: Nonsmokers' Exposure to Secondhand Smoke - United States, 1999-2008. Morbidity and Mortality Weekly Report 2010; 59(35):1141-1146. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5935a4.htm?s_cid=mm5935a4_w
26. Center for Disease Control and Prevention. (2011). Secondhand Smoke (SHS) Facts. Retrieved from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/...