20th February 2024

Smoking and health impacts

Epidemiology 

Approximately 14-15% of the UK population smokes and has declined over the decades. The incidence of smoking continues to increase in the developing world. 

Smoking behaviour occurs due to a mix of genetic, behavioural, social and environmental factors. Risk factors for increased smoking include social deprivation, mental illness, and previous/current substance use. Nicotine stimulates nicotinic acetylcholine receptors, and its action within the mesolimbic dopaminergic system results in addiction. Nicotine withdrawal occurs after smoking cessation and presents with depressed mood, irritability, anxiety, restlessness, cravings and increased appetite. 

Smoking results in the inhalation of many carcinogens and mutagens. The substances also stimulate immune system activation and enzyme release within the alveolar tissues, leading to elastin destruction. 

Co-morbidities related to smoking

Smoking is the leading cause of cancer in the UK, with up to 15% of cancers caused by smoking. It is also the leading cause of premature and preventable deaths in the UK. 

Lung cancer, peripheral vascular disease and COPD are responsible for up to 70% of all deaths attributed towards smoking. It is also associated with pregnancy complications and foetal complications. Vascular complications from smoking have been attributed towards an increased rate of cardiovascular disease, decreased wound healing and subsequently wound infection and prolonged hospital stays.

Second-hand smoking is associated with asthma and a small risk of cancer.

References

• Rahaghi, F., & Hernandez, F. (2018 Oct 30). Smoking cessation. Accessed on 2022 Mar 25. Available from: https://bestpractice.bmj.com/topics/en-gb/411/epidemiology. 
• Rigotti, N. (2021 Nov 29). Overview of smoking cessation management in adults. Accessed on 2022 Mar 25. Available from: https://www.uptodate.com/contents/overview-of-smoking-cessation-management-in-adults. 
• National Institute for Health and Care Excellence. (2018). Tobacco: preventing uptake, promoting quitting and treating dependence. Accessed on 2022 Mar 25. Available from: https://www.nice.org.uk/guidance/ng209/resources/tobacco-preventing-uptake-promoting-quitting-and-treating-dependence-pdf-66143723132869. 
• National Institute for Health and Care Excellence Clinical Knowledge Summary. (2021 ). Smoking Cessation. Accessed on 2022 Mar 25. Available from: https://cks.nice.org.uk/topics/smoking-cessation/. 
• Frew, A., & Doffman, A. (2012). Respiratory disease. In P. Kumar & M. Clark (Eds.), Kumar & Clark’s Clinical Medicine (12 ed.). Spain: Elsevier.