woman smoking

Up in smoke…

Smoking. A word, an action and a habit that has in recent years become the pariah of modern society, although smoking tobacco has not always been seen that way.

From the millennia-old cultural custom of the sharing of a peace pipe, to the modern-day bleary-eyed, worse-for-wear sharing of a cigarette outside a club or bar, smoking was perceived as an acceptable and sometimes essential social behaviour.

A panacea for calming the nerves, weight loss, and even treating asthma, tobacco and cigarette manufacturers even used doctors to advertise the benefits of smoking their brand. “…More doctors smoke CAMELS than any other cigarette! …”

Tobacco plants (genus Nicotiana) are part of the nightshade family (same as tomatoes and aubergines) and contain an active alkaloid named nicotine.

Nicotine, in its purest form, has had several medicinal uses. The ancient civilizations of the Americas made teas from tobacco leaves for the treatment of intestinal worms, gastro-intestinal complaints and as a cure for dizziness and headaches.

Other medical applications included a cure for toothache by the Iroquois, a cure for earache by the Indians of central Mexico, as a painkiller by the Cherokee, and tobacco leaves were also applied to cuts and wounds as an antiseptic and to stop bleeding.

Camel advert

Part of the chemical structure of nicotine looks very similar to acetylcholine, a natural cellular messenger in our bodies, which plays an important role in alertness, attention, learning and memory. This structural element gives nicotine both a stimulant as well as a depressant effect on the central nervous system.

The nicotine-mediated release of the hormone epinephrine, a central nervous system stimulant, is partly responsible for the “kick” one gets from nicotine ingestion, inhalation, or absorption.

Nicotine also promotes the release of the hormone beta-endorphin, which inhibits pain and stimulates an overall lift in mood and fatigue. Unfortunately, this effect wears off quickly and the user then seeks out the next “kick”, making nicotine such an addictive substance.

Animal studies have shown that much higher nicotine doses create an overstimulation of the dopamine receptors in the brain (the “feel good” neurotransmitter), to which the brain response is to eliminate these receptors, thus diminishing all other responses to pleasurable stimuli.

But the addictive properties apart, why has smoking been banned in so many places if nicotine, in fact, has several other potentially therapeutic indications?

A tobacco plant, Nicotiana tabacum, its flowers and seeds, bordered by six scenes illustrating its use by man

This is where a clear separation must be made between the pure nicotine extracted from natural tobacco leaves … and the mass-produced smoking tobacco, especially in the form of cigarettes.

Cigarettes, and in particular cigarette smoke, contains more than 4,000 potentially carcinogenic or tissue damaging substances, leading to many health problems, including:

  • Chronic bronchitis
  • Emphysema
  • Lung and other cancers, such as: mouth, larynx, esophagus, bladder, kidney, pancreas, stomach and cervix
  • Vascular disease, in particular arterial and Coronary (heart) disease
  • Increased risk for Thrombosis causing Stroke, DVT’s or Pulmonary Emboli

It has taken the medical fraternity several decades to understand the severe risks cigarette smoking can pose to our health and well-being, and it makes me wonder how much longer it is going to take for us to fully understand what the new trend of vaping is going to do to our lungs in the future. Touted as the “safer” alternative to smoking, the popularity of e-cigarettes and vaping has been rising exponentially.

Chesterfield advert

The first patent for a “vape”-type device was actually filed in the 1920s, but it was only in the 1960s that another patented device by Herbert A. Gilbert has been generally credited as the one most closely resembling the modern e-cigarette. Neither device used nicotine to create the smoke.

2003 saw the creation of the first commercially successful e-cigarette. After the death of his father from smoking-related lung cancer, a Beijing pharmacist, Hon Lik, created a device to replicate the sensation of smoking a cigarette … using nicotine and propylene glycol with vegetable glycerin.

However, in 2019, the media exploded with reports of over 3,000 hospitalisations for a new syndrome, now called EVALI (e-cigarette, or vaping, product use-associated lung injury). EVALI reached epidemic status, with a worryingly high percentage of sufferers being adolescents under 18 years old. A 2022 study by the CDC showed that 14.1% of high school students were regular vapers.

The vape liquids being used can vary in their content, and arguably do not contain the thousands of potential toxins like cigarette smoke does, however, they can still have serious adverse effects from the heated chemicals such as:

  • Diacetyl: This food additive, used to deepen e-cigarette flavours, is known to damage small passageways in the lungs.
  • Formaldehyde: This toxic chemical can cause lung disease and contribute to heart disease.
  • Acrolein: Most often used as a weed killer, this chemical can also damage lungs.
  • Vitamin E: used as a thickening agent of e-liquids, has been found in lung tissue of patients with severe vaping-related damage.
  • THC: the cannabinoid at the heart of the EVALI controversy, the heated oil being responsible for the inflammatory reaction deep in the lung tissue.

Doctors are still not sure if the vaping-related lung damage is completely or permanently reversible. Evidence so far suggests that the worse the acute damage, the less chance of recovery and even less so without supportive treatments and therapy.

So, the advice still remains the same: do not smoke or vape, as the puff at the end of the day may not bring you any magic … but rather a nightmare.

By Dr Jo

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Dr Joanna Karamon is a General Practitioner with over 20 years’ experience. She is Clinical Director of Luzdoc International Medical Services Network