Makindo Medical Notes

While smoking itself is not classified as a disease, it is a major cause of numerous life-threatening conditions. Helping motivated patients quit smoking is one of the most impactful interventions in healthcare. Indicators of severe nicotine dependence include smoking within 30 minutes of waking and consuming more than 25 cigarettes per day.

Pathology Caused or Worsened by Smoking

• Cancers:
  • Lung
  • Stomach
  • Oral cavity
  • Larynx
  • Colon
  • Bladder
  • Oesophagus
  • Pancreas
• Vascular Disease:
  • Malignant hypertension
  • Subarachnoid haemorrhage (SAH) from Berry aneurysm rupture
  • Buerger’s disease
  • Abdominal aortic aneurysm
  • Increased risk of venous thromboembolism (VTE), especially in those on oral contraceptives
  • Atherosclerotic peripheral vascular disease
• Gastrointestinal:
  • Increased risk of thrombosis
  • Dyspepsia
  • Peptic ulcer disease
• Pulmonary Disease:
  • More severe alveolar haemorrhage in Goodpasture’s syndrome
  • Increased risk of lung cancer
  • Chronic Obstructive Pulmonary Disease (COPD) and worsened asthma control
  • Severe chickenpox pneumonia
• Endocrine:
  • Worsening eye complications in Graves’ disease
• Pregnancy:
  • Perinatal morbidity and mortality
  • Intrauterine growth restriction
• Neurology:
  • Possible association with multiple sclerosis severity

Pathology Potentially Less Common or Less Severe in Smokers

• Osteoporosis
• Parkinson’s disease
• Ulcerative colitis
• COVID-19 pneumonia (controversial and not a recommended reason to smoke)

Therapies for Smoking Cessation

• Complementary Therapies: Hypnotherapy, acupuncture (may help some individuals)
• Nicotine Replacement Therapy (NRT): Gum, inhalers, nasal sprays, patches, lozenges. Available on the NHS. Generally avoided immediately post-MI, stroke, or significant arrhythmias.
• Bupropion SR (Zyban): Noradrenaline/dopamine reuptake inhibitor. Can be combined with a patch. Contraindicated in epilepsy, bipolar disorder, pregnancy, and breastfeeding. Typically started a week before the quit date and continued for 2–3 months.

Nicotine Withdrawal Symptoms

• Cravings, irritability, anger, restlessness, anxiety
• Increased appetite, poor concentration
• Most withdrawal symptoms resolve by 30 days
• Weight gain of 2–4 kg is common

General Approach

• Encouraging patients to stop smoking—regardless of age—is one of the most valuable healthcare interventions. It’s rarely too late.
• Discuss and support the idea of a smoke-free home environment. Involve partners or family members.
• Emphasize the availability of nicotine replacement therapy on the NHS.
• For patients with atrial fibrillation or arrhythmias, use caution with NRT.
• Follow NICE guidelines and local protocols for comprehensive support, including psychological and pharmacological interventions.

References

• NICE guidelines on COPD