Ask The Experts by Alfonso O'Neill, MD
Q: "I see other kids in my high school class smoking, and I have been to their homes, and I have seen their parents smoking, and they all look very healthy to me. How bad can cigarette smoking be?"
A: Although there are no obvious outward effects when you see your friends and their parents smoking cigarettes, you should pay closer attention to the subtle signs, which often include cough, either for short or long periods of time. The longer you smoke, the more short of breath you become. Some of the other early signs of smoking include: chronic sinus conditions, watery nose, runny eyes, and other allergic-like symptoms. You will also notice that the smokers have a very deep, almost hoarse voice. These are all irritant effects of cigarette smoke that might be seen in very early smokers. So, just because you do not hear that your friends and/or their parents have developed lung cancer or emphysema, these very subtle irritant effects of cigarette smoke can be seen if you pay closer attention.
Q: "I smoke socially and so I do not think that smoking is causing me any harm."
A: Usually, even if you are smoking socially, you are smoking in an area where there are other smokers. Smoke then begets more smoke, so not only do you get the ill effects of your own inhalation, but you are also inhaling the smoke of other smokers around you and you are inhaling unfiltered smoke, which after several hours of "enjoyment", can cause a tremendous amount of harm, not only immediately, but over the long term. So, if one were to smoke every weekend, once or twice a night, the days begin to add up very quickly, and so this type of exposure can certainly lead to chronic smoking-related diseases, such as chronic bronchitis and emphysema. There is good evidence that children that grow up in homes where there are smokers have a much higher incidence of asthma and chronic bronchitis later in life.
Q: "I can quit smoking anytime I want and that time is just not now, so why do I need to quit now?"
A: Nicotine has been well documented to be a more highly addictive substance than cocaine. Once you develop a nicotine addiction, it is extremely difficult to quit. Even with the best programs and best ancillary help, the 1-year smoking cessation rate is only about 1 out of 6 people. Once you become addicted to nicotine, it is extremely difficult to quit, so the best answer to that problem is just not to start smoking.
Q: Why can't I just wait for symptoms to begin and then stop smoking, and hope that everything will be alright?"
A: It can take years for the ill effects of cigarette smoke to finally cause symptoms. The problem with waiting is that once the symptoms begin, they are invariably irreversible. If you were to smoke long enough to develop emphysema, which is a destruction of lung tissue, there is no return; the lung will not regenerate. Once you have lost that lung function, it will not return. In fact, the inflammatory process will continue, and the lung function can continue to deteriorate at a rapid rate, such that even if you quit smoking cigarettes, your symptoms will worsen. Again, the best answer to that problem is to just never start smoking.
Q: "I have seen a lot of old people smoking cigarettes, and except for a little bit of cough and shortness of breath, they look fine to me."
A: It is true that not everyone that smokes, even for prolonged periods of time, develops cancer, emphysema, chronic bronchitis, or other illnesses. Unfortunately, there are so many American smokers, so that even when that small percentage develops disease, the cost to society is dramatic: in the billions of dollars per year. The other problem is that genetics play a large role in whether you develop these diseases or not. When you start smoking in your teens, you just don't know. There is no way to tell whether you have the genetics that will be "good" or "bad" regarding cigarette smoke. So again, the best solution is simply to just never start smoking cigarettes. That way you never have to face the dilemma of lung cancer, or other kinds of cancer such as bladder and bowel cancer, the ill effects of heart disease, and/or the ill effects of emphysema or chronic bronchitis - which are all related to cigarette smoking.
Alfonso O'Neill, MD is board certified in Pulmonary Medicine and board eligible in Critical Care Medicine. He has been in private practice for over 20 years and is the senior physician in the practice of O'Neill, Greenberger, Wu & Dunn, PLLC, with offices in St. Clair Shores, Huntington Woods and Troy. Dr. O'Neill may be reached at 586.774.0399.
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