🚭 Smoking itself is not a disease, but it is a leading cause of preventable morbidity and mortality.
Helping motivated patients quit is one of the most effective interventions in medicine.
⚠️ Markers of severe nicotine dependence: smoking within 30 min of waking + >25 cigarettes/day.
🩸 Pathology Caused or Worsened by Smoking
- 🧬 Cancers: Lung, stomach, oral cavity, larynx, colon, bladder, oesophagus, pancreas.
- 🫀 Vascular: Malignant hypertension, subarachnoid haemorrhage (ruptured Berry aneurysm), Buerger’s disease, AAA, ↑ VTE risk (esp. on OCP), atherosclerotic PVD.
- 🍽 Gastrointestinal: Thrombosis, dyspepsia, peptic ulcer disease.
- 🌬 Pulmonary: Worsens COPD, asthma control, Goodpasture’s alveolar haemorrhage, ↑ lung cancer risk, severe varicella pneumonia.
- 🦋 Endocrine: Exacerbates thyroid eye disease in Graves’ disease.
- 🤰 Pregnancy: IUGR, perinatal morbidity & mortality.
- 🧠 Neurology: May worsen multiple sclerosis severity.
📉 Conditions Less Common / Less Severe in Smokers
- Osteoporosis
- Parkinson’s disease
- Ulcerative colitis
- COVID-19 pneumonia (controversial; not a reason to smoke)
💊 Therapies for Smoking Cessation
- 🌱 Complementary: Hypnotherapy, acupuncture (variable evidence).
- 🩹 Nicotine Replacement Therapy (NRT): Gum, inhalers, sprays, patches, lozenges. Widely available on the NHS. Avoid immediately post-MI, stroke, or in severe arrhythmias.
- 💊 Bupropion SR (Zyban): NA/DA reuptake inhibitor. Contraindicated in epilepsy, bipolar disorder, pregnancy, breastfeeding. Start 1 week pre-quit, continue 2–3 months. Can combine with patch.
- Other options (not listed above): Varenicline (Champix) – partial nicotinic agonist, effective but watch mood changes. Often 1st-line alongside NRT in UK practice.
😖 Nicotine Withdrawal
- Cravings, irritability, restlessness, anxiety.
- ↑ appetite, poor concentration.
- Most symptoms resolve by ~30 days.
- Weight gain: ~2–4 kg is common.
🩺 General Approach (UK Context)
- Stopping smoking at any age reduces risk → “never too late.”
- Encourage smoke-free homes 🚭🏠 and involve family/partners.
- NRT and cessation support available via the NHS; refer to local stop-smoking services.
- Use caution with NRT in arrhythmias/AF patients – tailor therapy.
- Follow NICE + local protocols: behavioural + pharmacological support is most effective.
📚 References
💡 Teaching Pearl: Always ask about smoking status at every consultation – brief advice (“Very Brief Advice” model: Ask, Advise, Act) is proven to increase quit rates.
