Good news! Cigarette smoking among US adults has dropped steadily over the last 50 years. And yet—you are likely to know someone who still smokes. About one in five people between ages 45 and 64 still use some form of tobacco. That’s the same as a decade ago and higher than the national average of 14%. Even worse, many people who smoke don’t acknowledge the toll it is taking on their bodies. Despite the evidence, research shows that adults age 65 and older are less likely to label cigarettes as very or extremely harmful than adults ages 18 to 24.

Fact: Tobacco is the number-one cause of preventable illness and death in the US, and it ends up killing half of its users.

Equal Opportunity Organ Destroyer

While the lungs are the most significantly affected, no organ or system in the body can escape the destruction that smoking causes, including…

Heart: Smoking causes blood vessels to narrow and thicken, increasing blood pressure, quickening your heart rate and predisposing you to blood clots that can cause a heart attack, a blood clot to the lung (called a pulmonary embolism) or a stroke. Smokers face two to four times the heart disease risk of nonsmokers. Not even casual smokers are safe—smoking just one cigarette a day elevates heart disease and stroke risk to nearly half that of pack-a-day smokers.

Brain: Smoking impairs day-to-day cognitive functioning, including memory, focus and the ability to process information. Dementia, including Alzheimer’s disease, strikes smokers at a higher-than-average rate. Much of this increased risk is linked with smoking’s detrimental effects on the heart—when blood flow is compromised, all the organs in the body are starved for oxygen, including the brain—but chemicals in tobacco smoke also accelerate the brain’s natural aging process.

Bones and joints: System-wide inflammation triggered by smoking hastens bone loss, predisposing smokers to low bone density and osteoporosis, including hip fractures. It also raises the risk for rheumatoid arthritis, which tends to strike smokers earlier and with greater severity.

Vision and hearing: Smokers lose their hearing faster and earlier than nonsmokers…and they are more prone to cataracts, dry eye syndrome, glaucoma and macular degeneration, the number-one cause of blindness in adults over 65.

Gums and mouth: Bad breath and stained teeth are the least of smokers’ oral health troubles. They develop more bacterial plaque on their teeth, a root cause of gum infections, often leading to gum disease, jaw deterioration and tooth loss. Smoking also boosts the risk for complications after oral surgery and raises risk for oral cancer, including cancer of the throat and lips.

And more: The fallout from smoking also includes, among other things, type 2 diabetes (along with an increased risk for complications such as limb loss)…erectile dysfunction…a compromised immune system…and slower wound healing.

And Then There’s the Lungs

Interestingly, when it comes to ­smoking-induced lung damage, nicotine is not the culprit—the highly addictive chemical primarily just gets people hooked. It’s a one-two punch of airway inflammation (caused by inhaling a cocktail of thousands of chemicals, of which nearly 100 are cancer-causing) and tar, a sticky black goo created by the combustion of those chemicals that occurs when a person lights up. When inhaled, tar coats the interior of the lungs with a poisonous film similar to the tar used to pave roads.

Smoke slowly obliterates the hundreds of millions of tiny air sacs in your lungs that help you breathe. It also toughens lung tissue, impeding its ability to expand. And it doesn’t matter if you’re smoking cigarettes, cigars, e-cigarettes or marijuana…when you inhale something that doesn’t belong in your lungs, your body is not happy.

Toxins in smoke damage cellular DNA, paving the way for tumors—so much so that smokers have a 20-fold increased risk for lung cancer versus nonsmokers. (Smokers also have higher rates of cancer of the nasal cavity, mouth, throat, voice box, breast, kidney, bladder, liver, pancreas, colon/rectum and more.)

Smokers’ lungs suffer in several other potentially life-threatening ways…

Chronic obstructive pulmonary disease (COPD): A leading cause of death in the US, COPD is an umbrella term for two lung diseases—emphysema and chronic bronchitis—that often hit people who have smoked for decades.

With emphysema, lung damage reduces the amount of oxygen entering the blood, causing coughing and breathlessness that can render even bathing and dressing difficult. It usually affects people in their 50s, 60s and 70s, many of whom end up needing supplemental oxygen.

With chronic bronchitis, lung damage causes excess mucus production, triggering shortness of breath, frequent coughing and, eventually, scar tissue buildup and pneumonia. This tends to hit smokers a bit earlier than emphysema…usually in their 40s, 50s and 60s.

Pulmonary fibrosis: This progressive scarring disease causes a gradual loss of lung function and several of the same symptoms as COPD. In fact, it often is misdiagnosed as COPD or even as heart disease. But doctors can differentiate pulmonary fibrosis from other diseases if they hear a crackling noise, almost like Velcro tearing apart, when they listen to the base of the lungs. The average patient develops pulmonary fibrosis in his/her 60s, 70s or 80s.

Both pulmonary fibrosis and COPD are irreversible, but quitting smoking may slow the worsening of symptoms by adding less fuel to the fire.

The Challenge: How to Quit

There’s no way to sugarcoat it—quitting smoking is difficult. Nicotine physically changes the way your brain cells work—within 10 seconds of inhalation, it reaches the brain, where it stimulates the release of dopamine and other feel-good chemicals. When you stop smoking, your brain feels deprived and prompts you to light up again to get that neurochemical hit. This not only drives smoking throughout the day but also is responsible for the intense cravings and withdrawal symptoms (irritability, insomnia, anxiousness, trouble concentrating and hunger) that make quitting so difficult. But there are tools to help you stop smoking…

Don’t quit cold turkey. Research from Mayo Clinic shows that if 100 smokers try to quit this way, only three to five of them will make it past six months—meaning that 95% or more fail. Your doctor can prescribe medication to help ease the withdrawal symptoms and wean your brain off nicotine, including…

Nicotine replacement therapy (NRT). Prescription nasal sprays and inhalers, as well as over-the-counter skin patches, lozenges and gums, deliver small amounts of nicotine without the chemicals and toxins found in smoke. The amount of nicotine is reduced week by week, helping you slowly wean off smoking.

Bupropion (Zyban or Wellbutrin). Started one to two weeks before your quit date, this medicine works by curbing nicotine cravings. It does not contain nicotine and usually is taken for about 12 weeks. Bupropion and NRT may be used simultaneously.

Change your habits. Medicine combined with a personalized ­behavior-modification program (avoiding places and situations where you used to smoke…being aware of the emotions that trigger you to reach for a cigarette…chewing sugarless gum or snacking on crunchy vegetables to satisfy the hand-to-mouth urge…using relaxation techniques) offers the best chance of success. Ask your doctor for help or…

Call 1-800-LUNGUSA (1-800-586-4872, and press 2) to reach the American Lung Association Lung HelpLine and Tobacco QuitLine. You’ll connect with certified tobacco treatment specialists, nurses and respiratory therapists who can help you craft an evidence-based personalized cessation plan.

Text QUIT to 47848 (or if you’re a Veteran enrolled in VA health care, text VET to 47848) to receive daily motivational text messages from the National Cancer Institute’s Vets also can call the US Department of Veterans Affairs tobacco quitline at 1-855-QUIT-VET (1-855-784-8838).

Can e-cigarettes help you quit? The short answer is no. These battery-­operated devices deliver nicotine, chemicals and flavors without creating smoke. They have been marketed as a way to avoid the perils of smoking and even facilitate quitting. But using e-cigarettes (known as “vaping”) has not been shown to help smokers quit and still contributes to lung diseases such as COPD and lung cancer, heart disease and more.

The Reward

Even if you’ve been smoking for decades, it’s never too late to stop. Here are the benefits if you do…

Two weeks to three months after quitting…

  • Heart attack risk begins to drop.
  • Lung function begins to improve.

One year after quitting…

  • Added risk for coronary heart disease is half that of a current smoker.

Five to 15 years after quitting…

  • Stroke risk is reduced to that of a nonsmoker.
  • Risk of getting cancer of the mouth, throat or esophagus is half that of a current smoker.

10 years after quitting…

  • Risk of dying from lung cancer is about half that of a current smoker.
  • Risk for bladder, kidney, pancreatic and cervical cancer drops.

15 years after quitting…

  • Risk for coronary heart disease is the same as that of a nonsmoker.

Sources: American Lung Association and University of Southern California’s Keck Medicine.

Cannabis Concerns

Marijuana smoke contains many of the same cancer-causing agents as tobacco smoke. And because marijuana users tend to inhale deeply and hold the smoke in their lungs, smoking pot results in four times the amount of tar deposition versus cigarette smoke. Regular users have an elevated risk for emphysema, chronic bronchitis, heart attack and stroke.

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