Smoking overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

Overview[edit | edit source]

Smoking is a recreational activity in which a substance, most commonly tobacco, is burnt and the smoke tasted or inhaled. This is primarily done as a form of recreational drug use, as combustion releases the active substances in drugs such as nicotine and makes them available for absorption through the lungs. It can also be done as a part of religious rituals, to induce trances and spiritual enlightenment. The most common method of smoking today is through cigarettes, either industrially manufactured or rolled with loose tobacco and a rolling paper. Other forms, though less common, are pipes, cigars, bongs, and hookahs. Smoking is one of the most common forms of recreational drug use.

Historical perspective[edit | edit source]

History of smoking can be dated to as early as 5000 BC. Tobacco first cultivated in the America in 3000 BC. Next important phase in smoking history returns to world exploration by sailors.

Classification[edit | edit source]

Smoking may be classified as heavy and non-heavy, depending on the number of cigarettes consumed per day. Smokers can also be classified with respect to duration as acute or chronic smokers.

Pathophysiology[edit | edit source]

Nicotine from the cigarette is rapidly absorbed form the lungs and diffuses readily into brain where it binds to nicotinic acetylcholine receptors. Stimulation of nicotinic acetyl choline receptor in the brain results in the release dopamine and other neurotransmitters which are responsible for the feeling of pleasure.

Causes[edit | edit source]

For details about the causes of smoking, view its risk factors.

Epidemiology and demographics[edit | edit source]

Tobacco use is the leading cause of preventable disease, disability, and death in the United States, accounting for more than 480,000 deaths every year, or 1 of every 5 deaths. In 2015, about 15 of every 100 U.S. adults aged 18 years or older (15.1%) currently smoked cigarettes, this means an estimated 36.5 million adults in the United States currently smoke cigarettes. It is more common among men than in women. Smoking is more common among adults aged 25-44. It is more common among non-Hispanic American Indians/Alaska Natives than other races.^[1][2][3]

Risk factors[edit | edit source]

The common risk factors for smoking are poor family ties, unemployment, alcohol addiction, using illicit drugs, anxiety disorders, and genetic susceptibility.^[4]

Screening[edit | edit source]

Screening for smoking is done on every visit to the physician by asking detailed questions related to smoking status and smoking history. The US Preventive Services Task Force guidelines recommend that clinicians ask all patients about tobacco use and provide tobacco cessation interventions for those who use tobacco.^[5]

Natural history, complications, and prognosis[edit | edit source]

Smoking may initially not cause any symptoms and is easy to give up. If not addressed smoking can lead to a vast variety of symptoms related to different organ systems. Smoking may cause carcinomas ultimately and lead to the death. Complications of smoking are not limited to a single organ system. Cardiovascular and respiratory systems are the most commonly involved. It increases the risk of coronary artery disease by 2 to 4 times. COPD is a common complication of smoking. Lung cancers are mostly attributed cigarette smoking. Cigarette smoking is the leading preventable cause of death in the United States. Smoking cessation has positive prognostic effect in lung cancer patients.^[6][7]

History and Symptoms[edit | edit source]

The primary method of diagnosing tobacco use is through the confidential interview or history. Symptoms of a chronic smokeer include fatigue, dyspnea on exertion, snoring and sleep apnea, retrosternal discomfort, heart burn, weight loss, breathlessness, sputum production and chest pain, leg pain, weight loss, loss of appetite and bloody sputum.

Physical Examination[edit | edit source]

The physical examination of a patient who smokes may show tachycardia, hypertension, tachypnea, smoke-odored clothing, stained teeth or fingernails, hoarse voice and wheezing.^{[6][8][9][10]}

Laboratory Findings[edit | edit source]

There are no diagnostic lab findings associated with smoking.

Chest Xray[edit | edit source]

There are no chest x ray findings associated with smoking. Chest x ray can be used to diagnose various complications of smoking like carcinomas, pulmonary fibrosis, and COPD.

Ultrasound[edit | edit source]

There are no ultrasound findings associated with smoking. Ultrasound can be used to diagnose various complications of smoking like carcinomas.

CT scan[edit | edit source]

There are no CT scan findings associated with smoking. CT scan can be used to confirm various complications of smoking like carcinomas, pulmonary fibrosis, COPD and stroke.

MRI[edit | edit source]

There are no MRI findings associated with smoking. MRI can be used to confirm various complications of smoking like carcinomas, pulmonary fibrosis, COPD and stroke.

Other Imaging Studies[edit | edit source]

There are no additional imaging findings for smoking.

Other Diagnostic Studies[edit | edit source]

Breath carbon monoxide can be used to assess the presence of smoking in the last 24 hours.

Medical Therapy[edit | edit source]

Some general principles including the 5 As (ask, Assess, Advise, Assist and Arrange follow-up), non-pahramcological strategies like nicotine gum and nicotine patch and pharmacological strategies including bupropion, varenicline, inhalers and nasal sprays can be used to help quit smoking.^{[1][2][3][11][12]}

Surgery[edit | edit source]

Surgical intervention is not recommended for the management of smoking. Various complications of smoking may benefit form surgery like carcinomas, stroke, coronary artery disease and ectopic pregnancy.

Primary Prevention[edit | edit source]

The primary prevention of smoking includes not selling cigarettes to individuals younger than 18, avoiding smoking near children, imposing taxes on cigarettes and campaigns to educate people regarding the risks and complications of smoking.^[13]

Secondary Prevention[edit | edit source]

The secondary prevention of smoking is similar to its primary prevention.

References[edit | edit source]