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36. What are some of the less publicized health risks of smoking?


This article is from the Stop Smoking FAQ, by 70424.57@compuserve.com with numerous contributions by others.

36. What are some of the less publicized health risks of smoking?

We all know that smoking greatly increases the risk of developing
emphysema, stroke, heart attack, lung cancer, etc. In addition, there are
several less publicized health conditions which are linked to smoking:

a. Blindness

In October 1996, results of separate long-term studies linking smoking
to an incurable form of blindness called age-related macular
degeneration were published in the Journal of the American Medical
Association (JAMA). In this form of blindness, a person's field of
vision becomes increasingly limited. The research found that smoking
more than doubled the risk of macular degeneration in women over 50,
with similar findings in men over 40. While researchers couldn't
pinpoint the exact reason for the increased risk, they theorized that
smoking either affects the blood flow to the eye, or causes retinal
damage through oxidation.

(source: JAMA. 1996; 276:1141-1146 [study of women]; 1147-1151 [study of
men]) Thanks to Evan Herberg for calling this study to AS3's attention.


From The Lung Association Home Page:

"COPD (Chronic Obstructive Pulmonary Disease) is a term that refers to a
variety of chronic lung disorders, the most common being a mixture of
chronic bronchitis and emphysema.

"COPD is the result of damage that has been done to lungs over many years.
The diagnosis is made when the symptoms become apparent to you and your

"COPD results in chronic airflow obstruction, the main symptom of which is
dyspnea, or shortness of breath, often occurring with cough and wheeze.
COPD affects both men and women. The average Canadian with COPD is 65 years
of age and has a long history of smoking. However, COPD can first be
diagnosed in patients as young as 40.

"COPD progresses slowly and worsens over time. Symptoms can range from
being barely noticeable to incapacitating. The rate of progression and
extent of disability vary from person to person.

"While there is no cure for COPD, the progression of the disease can be
controlled first and foremost by quitting smoking. Appropriate medication,
exercise rehabilitation and prevention of infection are also important
factors in the rate of deterioration and symptom control."

c. Depression

This is a biggie, and comes up for discussion frequently. The excellent
discussion below was posted to AS3 on 30 Sept. 1996:

Darcy Binder <DBinder@ifc.org> wrote:

"Does anyone know the connection between smoking (or quitting smoking) and
depression? I have quit three times in my life, and each time I have been
getting seriously depressed. Is there a chemical connection? Is it the lack
of stimulant? I don't want to start again -- its been SIX weeks -- but I
also would like to stop crying!"

Bob Christofferson <rechris1@facstaff.wisc.edu> followed-up:

"Hi! There definitely *is* a chemical connection between nicotine and
depression, but as with most matters of brain chemistry, it's less than
perfectly understood. What is quite certain is that people who are
depressive find nicotine an especially effective drug, and consequently
find it especially hard to quit.

"That doesn't mean that *you* are depressive, however. It's a normal
response to nicotine withdrawal to have some feelings of depression. If you
read the posts to this group, you'll notice that many people go through
periods of depression while completing the process of smoking cessation.
Different people have the experience at different times after they quit,
and some people don't seem to have it at all. But, for most people, it's a
withdrawal symptom which isn't too severe and doesn't last too long, and
they recover from it and feel 'like themselves' again.

"In some people, though, smoking cessation does trigger serious episodes of
clinical depression which require medical treatment, and which, in the
extreme, can be life threatening. In recent years, new medication and
therapies have been developed which can help most people with depression,
and which often produce dramatic improvement quickly. Many people who could
benefit from these treatments, though, are reluctant to get help because
they feel embarrassed or ashamed, because they think they should be able to
'snap out of it' or somehow make their illness go away by themselves. Of
course, there's no reason for anyone to think that, but symptoms of
depression typically include feelings of guilt and hopelessness, which make
it hard for the person to see the situation objectively.

"So, how does anyone decide if their symptoms are more than the normal
consequence of smoking cessation? My advice is that anyone who has any
doubt should be evaluated *really soon* by a medical professional qualified
to determine whether medical attention is needed. I say that in part
because I'm convinced people hardly ever exaggerate the seriousness of
their own situation but often will *understate* it, even to themselves --
for perfectly sensible reasons, really. No one I know has ever been eager
to get mental health treatment (but quite a few people I know have
benefited by getting it).

"So, my point of view is that if someone feels they may be more depressed
than 'normal' nicotine withdrawal would explain, then there's a good chance
that they are -- at least, a good enough chance that they should talk it
over with someone who can tell."

d. Gastro-Esophageal Reflux Disorder (GERD)

Again, I'll let the information come from our impressively well informed
members. This was posted 22 Oct. 1996:

Luci wrote:

"Hi! I need an info buddy... After years of smoking and sinus problems,
etc., I've been diagnosed with a new disorder - gastro esophageal reflux
disorder. Does anybody out there share my problems??? Any advice???"

Ed replied:

"I've had GERD for years ...

"GERD, according to my doctor, is often caused by cigarette smoke
irritating the valve that separates the esophagus from the stomach. It
seems that the smoke also goes down the esophagus when we inhale. For some
not completely understood reason, the smoke irritation causes a loose
closure of this valve and at times stomach acid can rise into the
esophagus. The tissue of the esophagus, unlike the stomach, reacts with
pain when in contact with stomach acid. A prescription drug - PRILOSEC, has
really helped me. It is time-released and I take one each day. On rare
occasions, usually at night, I also use liquid GAVISCON and within 20
minutes the discomfort is gone. PRILOSEC is prescription. GAVISCON is
over-the-counter. Both are not cheap but they work for me.

"Hope this helps you. GERD is not uncommon. Just another reason for me to
stop the cigs."

e. "Smoker's Face" and Other Dermatological Ailments

This phrase seems to have been coined in 1985 by Dr. Douglas Model of
Eastbourne, England, who found, in empirical evidence, that nearly half of
the smokers he studied looked far older than they were. Similar research
was conducted by Dr. Jeffrey Smith, a senior resident in dermatology at the
University of South Florida in Tampa. He found these conditions to be
directly related to smoking:

(From The St. Paul (Minnesota) Pioneer Press, 23 June 96. Originally posted
to AS3 by <selmar@concentric.net>)

"Wrinkles: 'For some patients the threat of wrinkles may be a more powerful
motivator to help them stop smoking than the more deadly consequences of
smoking,' Smith wrote. He explained that, as with skin that is overexposed
to sunlight, smoking causes thickening and fragmentation of elastin, the
elastic fibers that are long and smooth in healthy skin. Smoking also
depletes the skin's oxygen supply by reducing circulation. It decreases the
formation of collagen, the skin's main structural component, and may reduce
the water content of the skin, all of which increase wrinkling.

"Smoking also interferes with the skin's ability to protect itself against
damage by free radicals, highly reactive substances that are omnipresent in
tobacco smoke. In women, smoking diminishes the level of circulating
estrogen, which in turn fosters dryness and disintegration of skin tissues.

"Skin Cancers: Two kinds of skin cancers, the more curable squamous cell
carcinomas and the often lethal melanomas, are influenced by smoking. Smith
said that although smoking did not cause melanoma, smokers with melanoma
were more likely to die of their disease. They are twice as likely to have
advanced disease at the time of diagnosis and are more likely to have their
cancers spread within two years of diagnosis, probably because smoking
impairs the immune system. As for squamous cell carcinoma, even when
exposure to sunlight was taken into account, smokers were found to be at
greater risk of developing this cancer. In a study of more than 107,000
nurses, for example, the risk of developing squamous cell carcinoma was 50
per cent greater in smokers than in those who had never smoked. Smokers
also tend to get particularly 'large, bad' skin cancers, Smith said.

"Other Cancers: Cancers of the lip, mouth, penis, anus and vulva are also
more common in smokers than nonsmokers. For example, in one study of 903
female cancer patients, 60 percent of those with vulvar and anal cancers
and 42 percent of those with cervical and vaginal cancers were smokers as
against only 27 percent of comparable women without cancer. Smoking more
than 10 cigarettes a day more than doubles a man's risk of developing
penile cancer.

"Delayed Wound Healing: The problem of slow or incomplete healing of wounds
associated with exposure to cigarette smoke was clearly demonstrated in
laboratory animals in the 1970s. Then surgeons began reporting on similar
problems in patients who smoked: larger scars in women undergoing
exploratory abdominal surgery, more complications and skin sloughing after
facelifts and a much higher failure rate of skin grafts, for example. The
more and the longer patients had smoked, the greater the likelihood of
impaired wound healing. Even resuming smoking during an uneventful recovery
could lead to adverse effects. Smith linked the slow healing of wounds to
known effects of cigarette smoking, which constricts surface blood vessels,
reduces the oxygen level in the blood, thickens the blood and impedes the
laying down of collagen needed for healing.

"Psoriasis and related disease: Studies of both men and women with this
unsightly and discomforting skin condition have shown that smokers are
about two to three times as likely to develop it as nonsmokers. And the
more cigarettes smoked, the greater the risk. Palmoplantar pustulosis, a
difficult-to-treat skin condition that resembles psoriasis, occurs only on
the palms of the hands and soles of the feet. The skin blisters, then forms
a scaly rash. It occurs almost exclusively in smokers and it does not
necessarily go away when the patient quits smoking.

"Oral lesions: In addition to smoker's face, there is also smoker's palate
and smoker's tongue. The tars and heat of tobacco smoke can cause tiny red
pimples in the mouth that result from an inflammation of the openings of
salivary glands. Smokers also often develop depressions on the surface of
the tongue. Potentially more serious, however, are lesions called
leucoplakia, which are about six times more common in smokers than in
nonsmokers. Although benign, these white patches in the mouth can become

"Buerger's disease: This blood vessel disease results in poor circulation
in the lower legs, causing skin problems like burning, tingling and
ulcerations. 'It usually occurs in young men who smoke, men in their 30s,'
Smith said. 'But now that women are smoking a lot more, we're seeing it in
women too.'

"Other Skin conditions: Many skin diseases are associated with diabetes,
which impairs circulation to the outer reaches of the body. A study of more
than 112,000 female nurses followed for 12 years showed that current
smokers faced an increased risk of developing noninsulin-dependent
diabetes, and that the risk rose with the number of cigarettes smoked each
day. Another study of nearly 43,000 male health professionals showed that
smoking 25 or more cigarettes a day doubled a man's risk of developing

"People who smoke are much more likely to develop the bowel disorder
Crohn's disease, which can cause 'big, ugly-looking ulcerations, most often
on the legs, and painful red nodules, usually on the lower legs,' Smith
said. Another condition more common in smokers is systemic lupus
erythematosus, an autoimmune disease that can cause rashes on the face,
scalp, hands and elsewhere, ulcerations in the mouth and hair loss."


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