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Investigating the Effect of Smoking on the Incidence of Internal Diseases (A Review Paper)

  • Al-Manara College for Medical Sciences


Background: According to World Health Organization (WHO) estimates, there are currently 1.1 billion tobacco smokers worldwide. This study follows the need for change in the increasing trend of lifestyle-related diseases and the lack of extensive studies on the pattern of smoking. Methods: In the current study, an electronic database search was conducted to identify studies that examined the impact of smoking on internal diseases from the beginning of February 2018 to the end of December 2021. After eliminating numerous articles based on their titles and abstracts, 273 articles pertinent to the study's objectives were selected. Due to the inadequacy of the target audience and the inclusion and exclusion criteria, 239 of the remaining articles were eliminated. The 44 remaining articles were examined more closely. Results: Each cigarette produces more than 7,000 chemicals. Many of these substances are toxic, and about 69 of them can cause cancer. For every 15 cigarettes you smoke, a mutation occurs in the body. Mutations are the cause of cancer. Studies have shown a clear relationship between dose and response, with a sharp increase in the risk of arterial disease in heavy smokers. In countries where approximately 30% of the population smokes, 50% of arterial disease can be attributed to smoking. Conclusion: Smoking increases the risk of cardiovascular disease (CVD) and lung disease, and leads to an increased risk of lung, throat, stomach, and bladder cancer, and many other cancers. One of the most important organs in the body that can be disrupted by smoking is the heart.
DOI: Published by Vesnu Publications
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The issue of tobacco use is discussed as one of the major and increasing risk factors
for diseases globally, especially in connection with non-communicable and chronic
diseases such as respiratory diseases, cancer, and stroke. Together, these diseases
account for 95% of about 60 million deaths and 44% of the total disease burden
worldwide as of 2005. Tobacco is the world's leading cause of controllable death. In
this regard, it is estimated that smoking causes 4.9 million deaths annually
worldwide (Akhu-Zaheya & Shiyab, 2017). The World Health Organization (WHO)
estimates that this number will rise to 10 million by 2030, and because half of the
mentioned deaths occur in productive and middle-aged individuals, it can decrease
the life expectancy of people aged 35-60 years by 20-30 years. Other estimates suggest
that of the 3.2 billion smokers, millions will die within the next 45 years if there is no
significant change in the current trend in tobacco use. Scientific evidence also
indicates that smoking makes a smoker sick and that people living around the
smoker are at risk. It is estimated that these people are 30% more likely to develop
lung cancer than others. A study conducted in the United Kingdom estimated the
death rate of people around smokers at more than 10 thousand a year (Mao, Huang,
Wang, Wang, Li, & Yang, 2021). Moreover, smoking is the most important risk factor
for preventable diseases and one of the important causes of premature death. It is
estimated that, currently, 87% of deaths due to lung cancer and 85% of deaths due to
obstructive pulmonary disease are caused by smoking. In addition to the lungs,
smoking also affects the cardiovascular system, and 56% of deaths due to coronary
artery disease (CAD) and 68% of deaths due to heart attack are also caused by
smoking. It is noteworthy that many previous researches worldwide have reported
that the prevalence of smoking is increasing in both sexes, especially among young
people, i.e., the age of smoking is decreasing (Pinto, Pichon-Riviere, & Bardach, 2015).
Snow et al. (2019) showed that tobacco and substance use disorders affect
high heart failure risk populations, including those of racial/ethnic minorities, lower
socioeconomic status, younger age, and male sex. Enhanced screening for tobacco
and substance use disorders in hospitalized heart failure patients may reveal
opportunities for treatment and secondary prevention. Grender et al. (2021) showed
that improving and expanding the implementation of evidence-based tobacco control
policies at the most comprehensive level could significantly reduce the future
incidence of lung cancer in Europe (Schwarz, Becker, Sahm, Horstkemper, Rousi, &
Becker, 2017).
The present study follows the need for change in the increasing prevalence of
lifestyle-related diseases, and the lack of extensive studies on the undesirable habit of
smoking and lack of adequate epidemiological knowledge about it, especially about
smoking patterns, because such studies help to identify the at-risk population, the
trend of smoking in different age groups, and its adverse effects and provide the
basis for targeted preventive planning at the level of primary health care.
A search of electronic databases was conducted in this review study to identify
studies that examined the impact of smoking on internal diseases from the beginning
of February 2018 to the beginning of December 2021. After removing many articles
based on title and abstract, 273 articles were chosen that were relevant to the study's
objectives. Due to the inadequacy of the target group and the inclusion and exclusion
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criteria, 239 of the remaining articles were eliminated. Thus, 34 articles were
scrutinized in greater depth.
These articles were found using the keywords the effect of tobacco and smoking
on internal diseases and their exacerbation in the PubMed, ScienceDirect, and
BioMed Central databases. The following individuals were included in the study:
Interventional research Dissemination of electronic findings investigating the impact
of smoking on internal diseases. Articles that only considered cigarette smoking were
included in this study. The exclusion criteria included studies on the reduction of
smoking through interventions regarding health behaviors in consumers and
interventional studies on the reduction of smoking to prevent and reduce diseases
like diabetes, asthma, depression, and others. To determine the quality of the articles
in question, 2 researchers with no conflicts of interest and a common agreement and
consensus on the inclusion and exclusion criteria reviewed the articles and eliminated
those that did not meet these criteria.
When an individual's blood sugar level rises above normal, he/she develops
diabetes. The pancreas is an organ in the body that produces the hormone insulin,
which helps the body produce glucose to reach the body's cells (Kwon, Yang, & Lee,
2013). When a person has diabetes, their body cannot produce enough insulin or use
the insulin produced in the pancreas properly. Therefore, less glucose reaches the
cells, and instead, this glucose accumulates in the blood, which causes diabetes. There
are two types of diabetes, type 1 diabetes and type 2 diabetes (Grabowska,
Targowski, & Jahnz-Rozyk, 2006). Type 2 diabetes is the most common type of
diabetes in adults and is observed in 90% of people with diabetes (Kazemzadeh,
Manzari, & Pouresmail, 2017). Smoking is one of the causes of diabetes, and causes
type 2 diabetes. Smoking also increases the risk of diabetes itself. Smokers are about
30 to 40% more likely to develop type 2 diabetes (Huttunen, Heikkinen, & Syrjanen,
2011). Moreover, diabetics who smoke have more difficulty controlling their diabetes
and insulin intake, and no matter what type of diabetes a person has, smoking
exacerbates diabetes and makes it harder to control. Smoking in a diabetic causes
heart and kidney problems, slowing of blood flow in the legs that can lead to
infection and ulcers, and in turn, to amputation or amputation of the leg, retinopathy
(a type of eye disease that causes blindness), peripheral neuropathy (damage to the
nerves in the limbs that causes numbness, pain, weakness, etc.) (Morita, 2007).
Research has shown that one of the most dangerous harms of smoking for
diabetics is that diabetics who smoke are more likely to die, and this is a very
significant link between diabetes and smoking. The fact is that, in people with
diabetes, the toxic chemical compounds in cigarettes attack blood vessels more than
others. Smoking presents an extra risk for the development of vascular
complications in these patients, contributing to increased cardiovascular morbidity
and mortality. Studies show that diabetics find it difficult to quit smoking due to
the high social and psychological stress they experience. Little research has been
performed on the smoking of diabetics. In one part, the prevalence of smoking in
diabetic patients was studied by analyzing previous documents. The prevalence of
smoking in diabetics is significantly higher than the prevalence in the general
public. Unfortunately, smoking is also common among younger diabetics, while
this group contributes a great deal to their health by quitting smoking. Details are
presented in tables 1 and 2.
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Table 1. Prevalence of smoking in various groups of diabetic patients
Number of patients
Number of smokers
Prevalence of smoking
IDDM And NIDDM patients
< 30 years
30 years
Men < 30 years
Men 30 years
Women < 30 years
Women 30 years
IDDM patients
IDDM: Insulin-dependent diabetes mellitus; NIDDM: Non-insulin-dependent diabetes mellitus
The assessment of the molecular and biochemical composition of saliva and the
study of structural and functional changes in its compounds due to various factors
such as cigarette smoke can be very important and can be used in the prevention,
diagnosis, and treatment of various oral diseases. Most of the biochemical
compounds in saliva in terms of weight are proteins, which are mainly present in the
form of glycoproteins. Alpha-amylase is one of the most important enzymatic
compounds in saliva. The chemical compounds in cigarette smoke, including
saturated and unsaturated aldehydes, can combine with enzymes and thiol-rich
compounds and cause structural changes and changes in the function of various
biochemical molecules in saliva. According to some studies, smoking and nicotine
may reduce the activity of several enzymes, including alpha-amylase, in saliva.
The response to treatment of oral diseases is somewhat different in smokers and
non-smokers and, in some cases, a significant difference has been observed in the
concentration of salivary biochemical compounds in these groups.
Side effects of smoking include damage to the heart and arteries. Smoking affects
the arteries that carry blood to the heart and other parts of the body. Smoking
reduces the amount of oxygen in the blood and causes damage to the walls of blood
vessels. Smoking contributes to the development of atherosclerosis. Atherosclerosis
occurs when blood vessels become narrowed and blocked. Finally, it reduces the
amount of blood and oxygen in the body. The chemicals in tobacco smoke damage
blood cells. Smoking can also damage heart function and the function and structure
of blood vessels. It is obvious that, this damage increases the risk of atherosclerosis.
Cardiovascular disease (CVD) occurs if plaque forms in the arteries of the heart. Over
time, this condition can lead to heart failure, heart attack, arrhythmia, or even death.
Smoking is a major risk factor for heart disease. The side effects of smoking and other
risk factors such as poor health, high blood pressure, and overweight or obesity
increase the risk of heart disease.
Smoking contains thousands of chemicals; the most important and harmful
substances are nicotine and carbon monoxide. Nicotine is an addictive drug that
affects brain and muscle activity and raises the blood pressure.
Table 2. Prevalence of smoking in the general population
Number of patients
Number of smokers
Prevalence of smoking
Both men and women
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Carbon monoxide is a toxic gas that replaces oxygen in the blood and reduces the
blood's ability to carry oxygen to the heart and other parts of the body (Smith &
Fenske, 1996).
Any amount of smoking can damage the arteries of the heart. Smoking poses a
greater risk to the heart and blood vessels in some people, such as women taking birth
control pills and people with diabetes. Exposure to secondhand smoke can also damage
the arteries of the heart. Cigarette smoke contains many harmful chemicals that greatly
increase the risk of heart attack and death (Lippi & Henry, 2020). Cigarette smoke
also increases the risk of heart disease in children and adolescents because it lowers
high-density lipoprotein cholesterol in the blood, increases blood pressure, damages the
tissues of the heart, and damages the lungs, especially in premature infants with
respiratory distress syndrome (RDS) and asthma (Sales et al., 2019).
No matter how much or how long you smoke, it is in your best interest to quit.
Quitting smoking reduces the risk of heart disease. Over time, the risk of developing
atherosclerosis and blood clots also decreases. If you smoke and already have heart
disease, quitting reduces the risk of sudden.
Some previous studies have investigated communities that have banned smoking
in workplaces and public places (Bunch, 2022; Ni, Shi, & Qu, 2020; Santos et al., 2018).
The results of these studies indicated that the number of heart attacks in these
communities is very low. The researchers believe that these results are due to
reduced smoking and reduced exposure to secondhand smoke. Among people with
CVD, smoking cessation greatly reduces the risk of cardiovascular attack and cardiac
death. In many researches, this risk reduction was 50% or more. The risk of
developing atherosclerosis and smoking-related blood clots decreases after quitting.
Quitting smoking can reduce your risk of heart disease by as much as or more than
using commonly used medications, including aspirin, statins, beta-blockers, and ACE
inhibitors (Lowe, Zein, Hatipoglu, & Attaway, 2021).
Smoke from cigarettes, hookahs, pipes, or any other type of tobacco can damage the
body, but the damages to the lungs are much greater in people with asthma. Tobacco
smoke is a strong stimulant for asthma symptoms. Smoking is an independent risk
factor for pulmonary tuberculosis. Most studies have shown the effect of smoking on
the weakening of the body's defenses. Smoking disrupts the function of alveolar
macrophages and stimulates them to trigger a local inflammatory response. Nicotine
suppresses the supply of antigens which produce a specific immune response. As a
result, specific defenses of the body are disrupted (Gaur, Kasliwal, & Gupta, 2012).
When a person inhales cigarette smoke in any way, irritants are absorbed through
the moist airway. These substances can lead to an asthma attack in people with
asthma. In addition, cigarette smoke damages small tissues that look like hair and are
called eyelashes. Typically, cilia expel dust and mucus from the airways. Tobacco
smoke damages these lashes and reduces their efficiency, thus causing dust and
mucus to accumulate in the airways. Smoke also causes the lungs to produce more
mucus than usual. As a result, the accumulation of this mucus in the airways can
trigger an asthma attack.
A person who does not smoke, but inhales environmental tobacco smoke (ETS)
takes two types of smoke into their lungs, the smoke from burning smoking and the
smoke emitted by the smoker. Inhaling secondhand smoke, commonly referred to as
"passive smoke," may be more dangerous than smoking. This is because the smoke
from the burning end of a cigarette contains substances such as tar, carbon monoxide,
and nicotine, and is more dangerous than the smoke that the smoker himself inhales.
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Cigarette smoke is especially dangerous for people with asthma. A person with
asthma who is exposed to secondhand smoke is more likely to experience symptoms
such as wheezing, coughing, and shortness of breath.
One of the reasons for the increase in cancer is smoking. Smoking cigarettes and
hookahs causes various cancers in the body that are often irreversible. Not smoking is
the greatest factor in the prevention of various cancers. The chemicals in cigarette
smoke enter the bloodstream and can then affect the whole body, which is why
smoking causes a variety of cancers (Takase et al., 2021).
Research shows that for every 15 smokers who smoke, a change in a person's DNA
can cause a cancer cell to grow in the body (Sarthak, 2020). The best way to reduce your
risk of cancer is to quit smoking altogether. The link between smoking and cancer is
well known, and research suggests that smoking can cause at least 15 types of cancer.
Cancers caused by smoking in the body are very sensitive and dangerous. Lung cancer
is one of the cancers that can be caused by smoking and can affect a person (Miyazaki et
al., 2022). Smoking causes other cancers in the body, including oral cancer, throat
cancer, upper throat cancer, cancer of the nose and sinuses, throat cancer, cancer of the
esophagus, and liver, pancreas, stomach, kidney, bowel, ovarian, bladder, and cervical
cancer, and some blood cancers (Girkantaite & Andrejevaite, 2019).
Some of the harmful chemicals in tobacco smoke damage DNA. DNA is present
in all cells of the body and controls how cells behave. If DNA is damaged, it can
adversely affect cells and cause overgrowth as well as excessive division of the
damaged cells. The chromium in tobacco smoke can attach harmful chemicals to
DNA. This makes it easier for damaged cells to turn into cancer cells (Arpacioglu,
Unubol, Erzincan, & Bilici, 2019). Moreover, the chemicals in tobacco smoke damage
the immune system, which is responsible for eliminating toxins, which is why
smokers are less able to eliminate toxic chemicals than other people. Toxins in
cigarette smoke can weaken a person's immune system and make it harder to kill
cancer cells (Palmer et al., 2018). When this happens, cancer cells grow without
stopping. It is generally reported that 9 out of 10 lung cancers are caused by smoking
or exposure to secondhand smoke. Although there are various treatments for lung
cancer, it can be said that this type of cancer is the most important cause of death due
to cancer (Wang, Ji, & Rahman, 2021).
Cigarette smoke contains harmful chemicals that can be harmful to both smokers
and non-smokers. Breathing even a small amount of tobacco smoke can be very
dangerous. There are more than 7,000 chemicals in tobacco smoke, at least 250 of
which are harmful, including hydrogen cyanide, carbon monoxide, and ammonia.
Smoking is a very important factor in the incidence and acceleration of
osteoporosis in smokers and non-smokers exposed to secondhand smoke.
Osteoporosis is a disease that weakens bones and increases the risk of bone fractures.
The severity of this disease is directly related to aging and is more common in
women than men. There are several reasons why smoking is bad for your bones.
Smoking increases the concentration of blood calcium in the body, and changes its
absorption and storage in the bones by altering the permeability of cell membranes.
Older people who smoke are 40-30% more likely to have a pelvic fracture than their
non-smoking peers. Smoking reduces blood flow to the bones (Guo, 2020). Cigarette
nicotine reduces the activity of bone marrow cells. Smoking reduces the absorption of
calcium from food. Smoking lowers estrogen in women (estrogen causes strong
bones in women). The rupture of the rotator cuff in the shoulder of smokers is almost
twice as large as that of non-smokers. This is because tendons in smokers lose their
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quality. Smokers are one and a half times more likely than non-smokers to have
bursitis and tendonitis around the joints (Gallus, Lugo, & Gorini, 2020).
Smoking can lead to infertility in both men and women. Erectile dysfunction in men
and pregnancy complications also increase with smoking. Chemicals (such as
nicotine, cyanide, and carbon monoxide) in cigarette smoke accelerate the destruction
of eggs. Unfortunately, once the eggs are destroyed, they cannot be reproduced or
replaced. This means that menopause occurs 1 to 4 years earlier in women smokers
compared to non-smokers. In men who smoke, smoking is associated with a decrease
in sperm count, low sperm motility, and an increase in abnormal sperm count,
reduced sperm quality.
The fertility of women smokers is lower than that of non-smokers, so that the
infertility rate of women and men smokers is almost twice that of non-smokers. The
risk of fertility problems increases with the number of daily smoking sessions.
Assisted reproductive therapies such as IVF may be effective in reducing the effects
of smoking on fertility (Zheng, Ji, Dong, & Chang, 2018). Women who smoke need
more ovarian stimulants during IVF, but they still have fewer eggs during ovulation
and are 30% less likely to become pregnant than IVF patients who do not smoke
(Mazıcan & Yarar, 2018). As smoking damages eggs and sperm, abortions and birth
defects are more common in the fetuses of smokers. Even smokeless tobacco can
increase the rate of miscarriage. The prevalence of chromosomal abnormalities such
as Down syndrome is higher in women who smoke than in non-smoking mothers. In
women smokers, the rate of ectopic pregnancy and preterm delivery is also higher
(Ramotowski, Gurbel, Tantry, & Budaj, 2019).
Studies have shown that men whose mothers smoked half a pack (or more) a day
had lower sperm counts. In addition, smoking during pregnancy can lead to fetal
growth retardation and being underweight before birth. These children are at greater
risk of lifelong medical problems (such as diabetes, obesity, and CVD). Children
whose parents smoke are at higher risk of sudden infant death syndrome and asthma
(Krzyścin, Napierała, Bręborowicz, Florek, & Sowińska-Przepiera, 2022).
The toxins in nicotine smoke cause the breakdown of auditory hair cells and
disrupt the blood supply to the inner ear, resulting in hearing loss and hearing loss.
Furthermore, due to the reduction in blood oxygen due to nicotine and carbon
dioxide, the function of the auditory system is impaired. Researchers have found that
the risk of hearing loss among smokers is about 70% higher than other people.
Studies also show that exposure to secondhand smoke increases the risk of ear
infections. Exposure to secondhand smoke causes fluid buildup in the middle ear,
recurrent infections, and hearing loss (Russo et al., 2022).
Currently, smoking is thought to pose a separate risk called Epstein-Barr virus
(EBV), which interacts with this factor, almost doubling the risk of developing non-
steroidal anti-inflammatory drugs (NSAIDs). There is a direct relationship between
consumption and the incidence of inflammation; people who have smoked for 25
years or more are at a higher risk of developing MS than people who have never
smoked (Ahmed et al., 2021). In addition to setting the stage for these cancers,
smoking causes a more severe secondary progression of MS by altering the relapsing -
remitting period (Babinets & Kvasnitska, 2019).
The more a person smokes, the greater is the brain damage seen on magnetic
resonance imaging (MRI) in patients with inflammatory bowel disease (IBD). Disability
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is also more common in smokers, but may be prevented, at least in part, by quitting.
Smoking may also prevent the treatment of IBD because it increases the production of
antibodies against the beta-interferon molecules used to treat the disease. Therefore,
many epidemiological studies suggest that smoking is one of the main environmental
factors in the development of IBD. The average interval between the onset of
smoking and clinical IBD development is about 15 years (Wieczorek et al., 2022).
Nicotine is known to be an immunosuppressive agent and stimulates the
glycoprotein in tobacco's immune system, which may explain the increase in
autoimmune phenomena in smokers, such as rheumatoid arthritis, systemic lupus
erythematosus (SLE), and Crohn's disease. Microcirculation is defined as the flow of
blood that carries blood to smaller vessels within the body's tissues. Nicotine increases
this flow in the brain and increases the likelihood of permeable solutions entering the
blood-brain barrier. According to research, leakage in the blood-brain barrier is thought
to be an important factor in the onset of inflammation (R. Wang et al., 2019).
Smoking is one of the most important modifiable health risk factors worldwide,
causing significant mortality due to cardiovascular accidents and lung problems. A
new US Department of Health report on smoking states that new research shows that
smoking, in addition to what is thought to be the cause of more diseases, second, the
risk of lung cancer due to the prevalence of smoking and other diseases such as type
2 diabetes, muscle wasting in old age, male sexual dysfunction, arthritis, and
osteoarthritis play an important role. Smoking, while weakening the immune system,
can exacerbate respiratory illnesses such as asthma, and in some cases, the fetus is
affected by smoking. Today, the role of cigarettes in diseases such as lung cancer and
heart failure has increased compared to the previous 50 years. According to experts,
the reason for this is the change in the way of making cigarettes and materials in
cigarettes. In the 50 years since the first reports on the dangers of smoking were
published, awareness of its implications for public health and its detrimental effects
on the human body has increased, but unfortunately, the necessary measures to
reduce smoking have not been taken worldwide.
Authors have no conflict of interests.
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Background: We conducted a systematic review to assess the effectiveness of smoking cessation, physical activity (PA), diet, and alcohol reduction interventions delivered by mobile technology to prevent non-communicable diseases (NCDs). Methods: We searched for randomised controlled trials (RCTs) of mobile-based NCD prevention interventions using MEDLINE, EMBASE, Global Health, CINAHL (Jan 1990-Jan 2016). Two authors extracted data. Findings: 71 trials were included: smoking cessation (n = 18); PA (n = 15), diet (n = 3), PA and diet (n = 25); PA, diet, and smoking cessation (n = 2); and harmful alcohol consumption (n = 8). 4 trials had low risk of bias. The effect of SMS-based smoking cessation support on biochemically verified continuous abstinence was pooled relative risk [RR] 2.19 [95% CI 1.80-2.68], I2 = 0%) and on verified 7 day point prevalence of smoking cessation was pooled RR 1.51 [95% CI 1.06-2.15], I2 = 0%, with no reported adverse events. There was no difference in peak oxygen intake at 3 months in a trial of an SMS-based PA intervention. The effect of SMS-based diet and PA interventions on: incidence of diabetes was pooled RR 0.67 [95% CI 0.49, 0.90], I2 = 0.0%; end-point weight was pooled MD -0.99Kg [95% CI -3.63, 1.64] I2 = 29.4%; % change in weight was pooled MD -3.1 [95%CI -4.86- -1.3] I2 0.3%; and on triglyceride levels was pooled MD -0.19 mmol/L [95% CI -0.29, -0.08], I2 = 0.0%. The results of other pooled analyses of the effect of SMS-based diet and PA interventions were heterogenous (I2 59-90%). The effects of alcohol reduction interventions were inconclusive. Conclusions: Smoking cessation support delivered by SMS increases quitting rates. Trials of PA interventions reporting outcomes ≥3 months showed no benefits. There were at best modest benefits of diet and PA interventions. The effects of the most promising SMS-based smoking, diet and PA interventions on morbidity and mortality in high-risk groups should be established in adequately powered RCTs.
This cohort study assesses the association of cumulative smoking exposure, as measured by pack-years, with outcomes of patients with coronavirus disease 2019.