Smokers Just Keep Puffing

Smokers Just Keep Puffing

By Melissa Tennen, healthAtoZ writer

Doctors may not be doing enough to help the substantial number of smokers who continue to puff despite having chronic, life-threatening conditions, according to a report by the Agency of Healthcare Research and Quality.

Three out of five smokers with these chronic conditions who had a routine check-up in a previous 12-month period said their doctors advised them to stop smoking.

About 40 percent of people with emphysema, 25 percent with asthma, 20 percent with hypertension or cardiovascular problems and 19 percent with diabetes reported they still smoked.

“The information is discouraging. We need to do a better job,” says Gerald F. Fletcher, M.D., professor of medicine at the Mayo Clinic in Jacksonville, Fla. and spokesman for the American Heart Association.

Fletcher says that when coming from a doctor, the message to stop smoking can be a powerful wake-up call to smokers dealing with other conditions.

“Most of my patients eventually stop. But some just aren’t ready to quit and some never quit,” he says. “Some can’t find the motivation to do it while dealing with their other conditions…. If they have diabetes and high blood pressure, they are busy managing those things. Cigarettes are the last thing they consider.”

Another doctor says he was surprised by the high number of people with emphysema or asthma continuing to smoke.

Even though smoking may make management of their conditions tougher, smokers tend to develop an all-or-nothing attitude, says Charlie W. Shaeffer Jr., M.D., a cardiologist in private practice in Rancho Mirage, Calif. and spokesman with the American Heart Association. They also may not realize how much their habit contributes to their condition, which is where counselling by a health care professional could be useful.

“Once people are diagnosed with something, they think the damage is already done,” Shaeffer says. “But if someone quits, their health risks drop in just a few years. Sometimes it can take a fairly powerful event, like a heart attack, to make someone stop.”

Cheryl Healton, president of the American Legacy Foundation says, “The results are consistent with prior studies in that, among cardiovascular surgeries, as many as half continue to smoke. What is surprising is that only a little more than half are being advised.”

Healton stressed that quitting smoking is the single most effective way to increase life expectancy and to lessen complications from chronic illnesses.

Legacy is a national, independent public health foundation in Washington, D.C., which works with national, state and local organizations to help reduce tobacco use in the United States.

The inability to stop smoking may be a sign of depression, cautions Mark Ketterer, Ph.D., senior bioscientist staff member at the Henry Ford Hospital in Detroit and spokesman for the American Psychological Association.

“I see it all the time,” he says. “The problem is that they are not being appropriately treated. There is a 50 percent relapse for cardiac patients (and a 70 percent relapse rate for other smokers) who try to stop and aren’t taking an SSRI or another antidepressant.”

He estimates that only one-tenth of all cardiac patients get emotional counselling from a psychologist, therapist or other health care provider.

“Every cardiac patient should be screened for emotional distress, and they are not,” he says.

People with chronic conditions should see their primary doctor or psychiatrist to see if they should be taking an antidepressant, he says. A month later, and with a nicotine patch and cognitive behavioural therapy, they should try to stop smoking. Antidepressants may take four to six weeks to work. If people are depressed or angry, they are less likely to take their medications and less likely to keep from smoking.

He notes that many people become psychologically tied to smoking. It is part of their daily ritual and comforts them when they are upset. Smoking also helps people relax.

And of course, there’s the nicotine factor; the ingredient in cigarettes that causes the physical addiction and one of the most addictive of all substances, such as cocaine. A single cigarette could have as many as 4,000 chemicals with 40 of them potentially cancer-causing.

If they try to quit, smokers may give up trying because of withdrawal symptoms: irritability, sweating, headaches, diarrhoea or constipation, restlessness, tiredness or dizziness. Withdrawal is usually the worst on the second day after quitting, and it gradually lessens with time.

The body is always trying to repair damage from smoking. Within minutes of finishing a cigarette, the body begins a number of changes, according to the American Lung Association. If you quit, you will have more energy and breathe easier. At 24 hours your chance for heart attack decreases. At 48 hours your nerve endings start to improve and re-grow and the ability to taste and smell is enhanced.

Then, between two weeks to three months circulation improves, walking becomes easier and lung function increases. Between one month and nine months coughing, sinus congestion, fatigue and shortness of breath decreases. One to five years later, the excess risk for coronary heart disease is decreased to half that of a non-smoker and stroke risk is reduced to that of people who have never smoked. At the 10-year mark the risk of lung cancer drops to as little as one-half that of continuing smokers. The risk of cancer of the mouth, throat, oesophagus, bladder, kidney and pancreas decreases. And the risk of ulcers also decreases.

Smoking can cause or aggravate chronic conditions.

Asthma and smoking can be a deadly mix because smoking is extremely harmful to the respiratory system. Asthma is a potentially life-threatening disease of the bronchial tubes, the airways that branch into the lungs. This chronic disease, in which airflow in and out of the lungs, may be blocked by muscle squeezing, swelling and excess mucus. The airways of a person with asthma are sensitive and can be triggered by allergens and smoke. When a person inhales tobacco smoke, irritating substances settle in the lining of the airways and can set off asthma attacks.

Diabetes type 2 is caused by the body’s decreased ability to make sufficient, or properly use, insulin. About 90 percent to 95 percent of the 16 million diabetics have type 2 diabetes. Smoking damages and constricts the blood vessels, and this damage can worsen foot ulcers and lead to blood vessel disease and leg and foot infections. Smokers with diabetes are more likely to get nerve damage and kidney disease.

Because emphysema destroys air sacs, the lungs transfer less oxygen to the bloodstream, causing shortness of breath. The lungs also lose their elasticity, so patients experience great difficulty exhaling. Early symptoms include shortness of breath and cough. Emphysema is a chronic lung disease that is almost always caused by years of smoking.

Hypertension (or high blood pressure). Blood pressure is the force in the arteries when the heart beats (systolic pressure) and when the heart is at rest (diastolic pressure). It’s measured in millimetres of mercury (mm Hg). High blood pressure (hypertension) is defined in an adult as a blood pressure greater than or equal to 140 mm Hg systolic pressure or greater than or equal to 90 mm Hg diastolic pressure. High blood pressure directly increases the risk of coronary heart disease, heart attack, and stroke, especially when combined with other risk factors.

Heart attack (myocardial infarction). A smoker’s risk of heart attack is more than twice that of non-smokers’, according to the American Heart Association. Cigarette smoking is the biggest risk factor for sudden cardiac death. Smokers have two to four times the risk of non-smokers. Smokers who have a heart attack also are more likely to die and die suddenly, within an hour of the attack. Cigarette smoking also acts with other factors to greatly increase the risk for coronary heart disease. People who smoke cigars or pipes seem to have a higher risk of death from coronary heart disease (and possibly stroke) but their risk isn’t as great as cigarette smokers’. Constant exposure to other people’s smoke increases the risk of heart disease even for non-smokers.

Some of the potential health hazards of smoking:

Smoking cuts the amount of oxygen reaching tissues. The decrease in oxygen can lead to a heart attack or stroke. If you are pregnant, smoking may cause miscarriage or stillbirth.

Smoking damages and constricts the blood vessels. This damage can worsen diabetic foot ulcers and lead to blood vessel disease and leg and foot infections.

Smokers with diabetes are more likely to get nerve damage and kidney disease.

Smokers get colds and respiratory infections more easily.

Smoking increases the risk of limited joint mobility.

Smoking can cause cancer of the mouth, throat, lung and bladder.

People with diabetes who smoke are three times more likely to die of cardiovascular disease than non-smokers with diabetes.

Smoking increases blood pressure.

Smoking raises blood sugar levels, making it harder to control diabetes.

Smoking can cause impotence.

Sources and resources:

The American Legacy Foundation

The American Lung Association

The American Heart Association

The American Diabetes Association

American Academy of Allergy, Asthma and Immunology

This article was published on 01/14/2003

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