Lung Disease - Smoking

Eighty-five million Americans smoke, and the vast majority of these people smoke cigarettes. This discussion will therefore center on cigarettes. The number of new smokers is increasing, which offsets the number of quitters, thereby producing a new gain in smokers each year. There was a temporary absolute decline in 1964 when the first U.S. Surgeon General's report on smoking outlined the many hazards, but that trend quickly reversed itself. The tobacco industry spends $280 million per year to promote smoking. The U.S. Public Health Service and several volunteer agencies spend $8 million in a contrary campaign to discourage smoking.

Dangers of Smoking

Scientists know much about the ways in which smoking produces health dangers. As they burn, cigarettes release more than 4,000 different substances into the atmosphere. Carried in the cigarette smoke, these substances enter the smoker's lungs or simply dissipate in the air. Three of the substances, carbon monoxide, “tar,” and nicotine, are the primary threats to health.

Smoking has “mainstream” effects on the smoker who inhales. But there are “sidestream” effects as well. For example, persons who habitually breathe the smoke from others’ cigarettes may be inhaling higher concentrations of possibly harmful chemicals than the smokers themselves. These nonsmokers may experience such unpleasant symptoms as watery eyes and headaches. If they have lung or heart diseases, suffer from asthma or some allergies, or wear contact lenses, the nonsmokers may find that their symptoms are worsening.

Some of the direct effects of breathing tobacco smoke suggest its capacity for producing disease in the smoker. Smoking lowers skin temperature, often by several degrees, principally through the constricting effect of nicotine on blood vessels. Carbon monoxide levels rise in the blood when a person is smoking. Even a single cigarette may impair somewhat the smoker's ability to expel air from the lungs. Adverse changes in the activity of several important chemicals in the body can be demonstrated after smoking.

Smoking has been strongly implicated in bronchitis and emphysema, lung and other cancers, heart disease, and peripheral vascular disease. Cigarette smoking causes more “preventable” deaths in the United States than any other single factor. Of the five leading causes of American deaths, smoking is related to four. According to verified statistics, a smoker faces a 70 percent greater risk of dying prematurely than a non-smoker of comparable age. Smoking-related diseases take six times as many American lives annually as automobile accidents.

A Cause of Cancer

Lung cancer takes more American lives annually than any other type of cancer. Some 80 percent of all lung cancer deaths, over 90,000 in a typical year, may be attributed to cigarette smoking. On average, 7 in 10 lung cancer patients die within a year of diagnosis.

The cigarette smoker's risks are not confined to lung cancer. Such serious and sometimes fatal diseases as cancers of the mouth, pharynx, larynx, and esophagus may also be smoking-related. Of all cancer deaths, 30 percent are related to smoking. Smoking leads to 10 times as many cancer deaths as all other reliably identified cancer causes combined.

Heart Disease

Heart disease caused by smoking cigarettes takes more American lives than does cancer. But smoking is implicated in about 30 percent of all deaths resulting from coronary heart disease, the most common cause of American deaths. In 1982, about 170,000 U.S. citizens died of heart disease resulting from smoking.

In the mid-1980s, statistics showed that one living American in every 10 would die prematurely as a result of smoking-related heart disease. The smoker who refused to give up smoking after a heart attack was inviting a second attack to a significant degree. But the person who quit smoking would after some 10 years face a heart-disease risk about equal to that of a nonsmoker.

Women and Smoking

Where women accounted for one lung cancer death in six in 1968, one-fourth of all such deaths occurred among women in 1979. Those figures suggest what later statistics have borne out: that lung cancer would soon replace breast cancer as the leading cause of cancer death among women.

Women were once thought to be less susceptible to smoking-related diseases than men. But later epidemiological studies have proved the opposite. When the earlier studies were conducted, women had simply not been smoking as long as men, or in such numbers. As the picture has changed, the statistics have changed. Like men, women smokers who experience other heart disease risk factors, including hypertension and high serum cholesterol levels, face a greatly increased risk of coronary heart disease.

The Dose-Response Relationship

The number of cigarettes an individual smokes is one of the determinants of eventual damage even though individual susceptibility is also important. Thus a definite dose-response relationship exists between smoking and disease. If a person smokes one pack a day for one year he has smoked one pack-year; if he smokes one pack a day for two years or two packs a day for one year, he has smoked two pack-years, and so on. Calculating by pack-years, it appears that 40 pack-years is a crucial time period above which the incidence of cancer of the lung, emphysema, and other serious consequences rises rapidly. Smoking three packs a day, it takes only about 13 years to reach this critical level.

Breaking the Smoking Habit

Obviously, the best way not to smoke is never to start. Unfortunately, young people are continuing to join the smoking ranks at a rapid rate. The teenager often is one of the hardest persons to convince of the hazards of smoking. He is healthy, suffers less from fatigue, headaches, breathlessness, and other immediate effects of smoking, and he often feels the need to smoke to keep up with his peers. Once he starts, it is not long before he becomes addicted. The addiction to cigarettes is very real. It is more psychological dependency than the physical addiction associated with narcotics, but there are definite physical addiction aspects to smoking that are mostly noted when one stops.

For most people it is quite a challenge to stop smoking. There are many avenues to travel and many sources now available to aid one on the way. They include smoking clinics that offer group support and medical guidance to those anxious to quit. The clinics vary in their format but basically depend on the support given the smoker by finding other individuals with the same problems and overcoming the problems as a group. The medical guidance helps people recognize and deal with withdrawal symptoms as well as helping them with weight control.

Withdrawal Symptoms

Withdrawal symptoms vary from person to person and include many symptoms other than just a craving for a cigarette. Many people who stop smoking become jittery and sleepless, start coughing more than usual, and often develop an increased appetite. This last withdrawal effect is especially disturbing to women, and the need to prevent weight gain is all too often used as a simple excuse to avoid stopping the cigarette habit or to start smoking again. The weight gained is usually not too great, and one generally stops gaining after a few weeks. Once the cigarette smoking problem is controlled, then efforts can be turned to weight reduction. Being overweight is also a threat to health, but ten extra pounds, even if maintained, do not represent nearly the threat that confirmed smoking does.

Despite all efforts, many individuals who would like to stop smoking fail in their attempts. The best advice for them is to keep trying. Continued effort will at least tend to decrease the amount of smoking and often leads to eventual abstinence, even after years of trying. If a three-pack-per-day smoker can decrease to one pack a day or less, he has helped himself even though he is still doing some damage. For prospective quitters it is important to remember that cigarette smoking is an acquired habit, and that the learning process can be reversed. The problem most people have is too little knowledge of the dangers and too much willingness to believe that disease and disability cannot strike them, just the other fellow.