Maryland's Tobacco Resource Center - Linking Professionals to Best Practices

Chronic Health Conditions

"Smoking plays a causal role in several long-term health conditions and worsens their outcomes."  ...  Professor Kamran Siddiqi, University of York 

Smoking cessation for those with a chronic health condition

  • Smoking prevalence is higher among patients with long-term health conditions compared to the general public. 
  • Continued smoking in these patients:  1)  accelerates disease progression, 2) worsens outcomes, and 3) is associated with poorer treatment compliance.1
  • However, there is strong evidence for the effectiveness of cessation interventions in achieving smoking abstinence, even among those with chronic health conditions.1
  • Unfortunately, only a small percentage of patients receive these interventions.




             There is hope! 

             Interventions work...  




Key Facts

  • Cigarette smoking causes more than 480,000 deaths each year in the U.S., or about 1 in 5.2
  • Smoking increases risk of death from all causes in men and women.
  • The top 3 causes of death related to smoking are 1) Cardiovascular Disease, 2)  Pulmonary Disease, and 3) Cancer.3
  • Life expectancy is on average 10 years lower for smokers compared to non-smokers.4   
  • All smokers regardless of the intensity and duration of smoking, can benefit from quitting. No one is too old to not see the benefits of quitting.5

We summarize how smoking is related to the top 3 causes of death:  

Cardiovascular Disease (CVD):

  • Smoking causes Stroke and Coronary Heart Disease…among the leading causes of death. 
  • An estimated 6 million deaths each year are attributable to tobacco use.5
  • The risk for another heart attack drops sharply after 1 year of cessation. 6
  • However, smoking cessation for people diagnosed with CVD can be quite challenging. 
    • In one recent study, about 1/2 returned to smoking within 20 days of leaving the hospital, and 2/3 returned to smoking within the first year.7
  • Smoking cessation for those with CVD should be considered using a chronic disease model.
    • Interventions need to be ongoing, and should consider holistic needs.7
    • Many with CVD who smoke also have co-occurring issues, including mental health, alcohol use, and sedentary lifestyle.
  • Continued focus on smoking cessation, initiated at the hospital, is making a difference.
    • A recent analysis found that smoking cessation counseling, performed after hospitalization for heart attack, significantly increased life expectancy, compared to non-counseled smokers.8  
    • Results held up 17 years after discharge.8

​​Pulmonary Disease

  • Smoking leads to many lung diseases, including COPD (includes emphysema/chronic bronchitis), lung cancer, and makes asthma conditions worse.1
  • COPD causes premature death, and according to the World Health Organization, is expected to become the third leading cause of death by 2030.2
  • Only sustained smoking abstinence will slow the progression of COPD; however, few patients with COPD stop smoking abruptly.9
    • People with COPD who smoke say they know the consequences of smoking.10
    • They want help and support, but only after they have made the choice to quit.9
    • Concerned loved ones, and providers, are encouraged to continue offering support, and initiate conversations about smoking behaviors, but without instilling guilt, while respecting one’s autonomy to make the decision to quit.11
  • Despite challenges, people with COPD can and do quit smoking    
    • Persistence and committing to a comprehensive plan is key. 
    • Important to address both physical dependence and behavioral habit.
    • Clinical trials have shown success treating people with COPD with meds like Chantix:12   


  • Cigarette smoking causes cancer almost anywhere in the body. 
  • With lung cancer, smokers have approximately 20 times the risk of being diagnosed compared to non-smokers. 13,14
  • In one large study, 39% of patients with lung cancer were smoking at time of diagnosis, and 14% were smoking 5 months after diagnosis.15  
  • Quitting smoking at any age reduces the risk of lung cancer.
    • For people already diagnosed with early-stage lung cancer, smoking cessation is associated with a substantial reduction in the risk of death and improvement in quality of life.14
    • Predictors of relapse, or continuation of smoking after diagnosis, include:   1) low household income, 2) other smokers in home, and 3)  symptoms of depression.16

Health Care Response to Chronic Health Conditions and Smoking

  • People with a chronic health condition reported that a health professional spoke to them about their smoking a majority of the time, ranging from 68% (CVD) to 77% (Cancer).17
  • This is higher compared to people without a chronic health condition (about 50%).17
  • “Providers are key to assisting patients who smoke to quit. They should ask all patients about tobacco use, advise smokers to quit, assess a smoker's readiness to quit, and assist smokers to quit. Hospitals are recommended to assess smoking status in all admitted patients, offer treatment to hospitalized smokers, and provide treatment at time of discharge.”5

Conclusions:  ​

  • Quitting smoking, and then staying quit, is a big challenge for any smoker, particularly if they struggle with a chronic health condition. 
  • Health Care Providers can take advantage of "teachable moments", times when their patients are in the hospital, or even at a follow-up outpatient appointments, to prioritize smoking cessation and seek patient readiness. 
  • Consider the graph below showing the advantages of using Chantix, compared to placebo, for smoking abstinence rates among people recently hospitalized with acute CVD problems.  This graph illustrates that while the road may be rocky, and many go back to smoking, people who struggle with a chronic health condition, such as CVD, are capable of experiencing abstinence. 16
  • Current evidence suggests the combination of behavioral interventions, like motivational interviewing, and pharmacotherapy, like Chantix or Bupropion, are most effective for smoking cessation.5  

  1.  U.S. Department of Health and Human Services.The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2015 Oct 5].
  3.  Jha, P., Ramasundarahettige, C., Landsman, V., Rostron, B., Thun, M., Anderson, R. N., ... & Peto, R. (2013). 21st-century hazards of smoking and benefits of cessation in the United States. New England Journal of Medicine, 368(4), 341-350.
  4.  Siddiqi, K., Dogar, O. F., & Siddiqi, N. (2013). Smoking Cessation in Long-Term Conditions: Is There “An Opportunity in Every Difficulty”?. International Journal of Population Research, 2013. 
  5. Colivicchi, F., Mocini, D., Tubaro, M., Aiello, A., Clavario, P., & Santini, M. (2011). Effect of smoking relapse on outcome after acute coronary syndromes. The American Journal Of Cardiology, 108(6), 804-808.
  6. Center for Disease Control and Prevention. (2012). 2010 Surgeon General's Report: Overview of Findings Regarding Cardiovascular Disease. Retrieved from
  7. Bucholz, E. M., Beckman, A. L., Kiefe, C. I., & Krumholz, H. M. (2016). Life Years Gained From Smoking-Cessation Counseling After Myocardial Infarction. American Journal of Preventive Medicine.
  8. Eklund, B. M., Nilsson, S., Hedman, L., & Lindberg, I. (2012). Why do smokers diagnosed with COPD not quit smoking?-a qualitative study. Tobacco induced diseases, 10(1), 1.
  9. Klinke, M. E., & Jónsdóttir, H. (2014). Smoking addiction in chronic obstructive pulmonary disease Integrating neurobiology and phenomenology through a review of the literature. Chronic respiratory disease, 1479972314546764.
  10. Wilson, J. S., Fitzsimons, D., Bradbury, I., & Elborn, J. S. (2008). Does additional support by nurses enhance the effect of a brief smoking cessation intervention in people with moderate to severe chronic obstructive pulmonary disease? A randomised controlled trial. International journal of nursing studies, 45(4), 508-517.
  11. Tashkin, D. P., Rennard, S., Hays, J. T., Ma, W., Lawrence, D., & Lee, T. C. (2011). Effects of varenicline on smoking cessation in patients with mild to moderate COPD: a randomized controlled trial. Chest Journal, 139(3), 591-599.
  13. Parsons, A., Daley, A., Begh, R., & Aveyard, P. (2010). Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: systematic review of observational studies with meta-analysis. Bmj, 340, b5569.
  14. Park, E. R., Japuntich, S. J., Rigotti, N. A., Traeger, L., He, Y., Wallace, R. B., ... & Keating, N. L. (2012). A snapshot of smokers after lung and colorectal cancer diagnosis. Cancer, 118(12), 3153-3164.
  15. Nugent, C. N., Schoenborn, C. A., & Vahratian, A. (2014). Discussions Between Health Care Providers and Their Patients Who Smoke Cigarettes. Women, 18(24), 25-44.
  16. Hopenhayn, C., Christian, W. J., Christian, A., Studts, J., & Mullet, T. (2013). Factors associated with smoking abstinence after diagnosis of early stage lung cancer. Lung Cancer, 80(1), 55-61.
  17. Windle, S. B., Dehghani, P., Roy, N., Old, W., Grondin, F. R., Bata, I., ... & Cassavar, D. (2018). Smoking abstinence 1 year after acute coronary syndrome: follow-up from a randomized controlled trial of varenicline in patients admitted to hospital. Canadian Medical Association Journal190(12), E347-E354.