One-third of smokers develop a smoking-related disease

This Thursday, Nov. 15, eastern Mainers join the nation in the Great American Smokeout, sponsored by the American Cancer Society. The Smokeout is a light-hearted, supportive approach to taking a break from nicotine — possibly the first step to breaking the habit.

This week also marks the one-year anniversary of Bangor’s hospitals going smoke-free under Maine law. Health Talk features A. Marshall Smith, M.D., head of pulmonary medicine at EMMC.

Why do people smoke?

People smoke because of peer pressure in the schools — they want to join the in group; if the in-group smokes, then they start smoking to be part of the group. People smoke because of cigarette advertising showing healthy athletic, attractive young people smoking, and they smoke because of addiction. They have been given cigarettes at various times. During the Second World War, the military handed out free cigarettes to everyone and helped create a whole generation of smokers.

One interesting factor is the “idol effect.” U.S.Olympic diver Greg Louganis said that he once came out from a diving meet and saw a 12-year-old boy smoking in the parking lot. Louganis asked why he was smoking, and the youth said, “Because you are my idol and I want to be just like you — and I know that you smoke.” Louganis said that at that moment he quit smoking because he realized he was a role model.

Do people smoke because they are nervous?

The only time that people smoke because they are nervous is when they are addicted to smoking. If they aren’t able to stop smoking because they are addicted, they get nervous in their withdrawal. Then they start smoking again to relieve that nervousness.

But that’s not why they started smoking in the first place. It’s a physical addiction to nicotine. Nicotine is the addicting substance and it is as addicting, or even more so, than other major substances, such as cocaine and heroin.

Many of my smoking patients have said they’ve known that cigarettes are addicting since they started smoking 30 years ago. I came across a monograph recently in a collection of old medical books talking about the addicting characteristics of cigarette smoking. The book was published in 1922.

Do people gain weight when they quit smoking?

About a third of the people who stop smoking will gain weight because food tastes better, so they eat more. Also, they are used to having something in their mouth, so they substitute food for the cigarette.

Another third may lose weight because they can breathe better and are able to exercise more or feel better; and another third don’t change weight at all. Remember that to do the same damage to your body that you do with one pack of cigarettes a day, you would have to gain 100 pounds. I have never seen an ex-smoker gain that much.

Does everyone who smokes develop smoking-related diseases such as cancer?

One-third of smokers will develop — and die of — a smoking-related disease.

I think it’s like playing Russian roulette with a six-shooter — with two shells in the chambers instead of the usual one for Russian roulette, so you’ve got one chance in three of blowing your brains out. You’re doing the same thing with smoking cigarettes.

Is lung cancer the biggest problem associated with smoking?

The biggest problems caused from cigarette smoking are chronic bronchitis and emphysema. Patients become increasingly short of breath, unable to do things and find they have to quit work early.

It’s a very debilitating and serious disease that we see in a high percentage of smokers.

Other smoking-related diseases are coronary artery disease, early heart attacks, problems of peripheral vascular disease, ulcers, other gastrointestinal disorders related to smoking, and other cancers besides lung cancer. Bladder cancer, for instance, has a direct relationship to smoking.

How much does cigarette smoking really cost?

The average smoker in this state smokes a pack-and-a-half to 2 1/2 packs a day. I have seen people who smoke up to five packs a day, but let’s take the average of two packs a day at $1.45 a pack. That comes out to more than $1,000 a year for cigarettes. Think of what you could do with $1,000 if you weren’t burning it up in tobacco.

I had a patient come in because of a cough. She smoked three packs of cigarettes a day and her husband smoked five packs a day. I pointed out to her that if both she and her husband stopped smoking, she would get rid of her cough, and they could afford a trip to Hawaii. She never came back.

Smoking-related medical costs are extremely high. Not only do we have a lot of hospital admissions because of smoking, but our whole coronary artery surgery program is closely related to smoking, and many patients who are in the hospital with pulmonary diseases are smoking-related.

Not only do you have the immediate cost of treating the illness that the patient has, but you have the long-term cost. These people have to retire early on disability — so you have the lost wages, the cost to society for paying their disability cost, and the cost of long-term home care.

Then you have the indirect costs such as lost time from work. Even before they become severely ill, smokers have a much higher incidence of general illness. They get colds and pneumonia more often. They miss more days from work. Smokers account for a high proportion of missed days of work. That costs industry, which then costs the public because the products cost more.

Is it ever too late to stop smoking?

With age, the smoker loses lung function much more rapidly than the non-smoker. The smoker reaches a stage of disability quite early and progresses rather rapidly to death.

If the smoker stops smoking, the lungs don’t return to where the non-smoker would be at that stage. Deterioration of the lung from that point on, instead of being the rapid deterioration of the smoker, becomes the more slow loss of lung function of the non-smoker, starting at a lower level. It is never too late to stop smoking.

Are people more aware of the dangers of smoking?

There is certainly more information and talk about the effects of smoking today. Non-smokers are becoming more militant. Laws have been passed for non-smoking sections in restaurants and in public buildings. Oregon has proposed a law which effectively would ban smoking in almost all public areas in the workplace. If the law is passed, it will be the most extensive non-smoking law in the country. The rights of the non-smoker are being observed a lot more closely. And the number of new smokers is dropping off.