SMOKING AND THE RISK
OF SYSTEMIC DISEASE
Dr. Mohamed Mostafa Kamel
MBBCh, MSc.,MD
Asst. professor of Pulmonology
Cairo university
 The combustion of tobacco produces a type of
smoke that contains more than 4000
substances and chemicals, which are made up
of particles and gases that can be inhaled and
absorbed into the body.
Many of these chemicals are extremely
dangerous, not only for the smoker but also for
those people nearby.
2005-2012helpwithsmoking.com
Three of the main components of environmental
tobacco smoke are:
 Nicotine - an addictive drug as powerful as cocaine or
heroin. It alters the brain as well as a person's
behaviour and mood. It is also used in insecticides.
 Tar - a cancer causing substance that damages the
lungs.
 Carbon monoxide - a gas that replaces some of the
oxygen in the body that is needed for the lungs to
function properly. Carbon monoxide is a poisonous gas,
which is also found in car exhaust fumes.
2005-2012 helpwithsmoking.com
Some of the carcinogenic substances found in tobacco smoke
are:
Tar - used to tarmac roads.
Arsenic - very potent deadly poison.
Cadmium and nickel - used in batteries.
Vinyl chloride - used to make vinyl products. Short-term exposure
causes dizziness, headaches and tiredness. Long-term exposure
can lead to cancer and liver damage.
 Creosote - a component of tar. If inhaled it can cause irritation of
the respiratory tract.
 Formaldehyde - a preservative substance used in forensic labs. It
causes cancer in humans and in animals.
 Polonium 210 - a radioactive substance that can cause cancer of
the liver and bladder, stomach ulcers & leukaemia




Other irritant toxins that are found in cigarette smoke are:






Ammonia - a pungent colourless gas
used in many cleaning products such as
window or glass cleaner.
Acetone - the main component of nail
varnish remover.
Acrolein - an extremely toxic substance
used to manufacture acrylic acid. It is
considered a possible human carcinogen
and it irritates the lungs and is the cause
of emphysema.
Hydrogen cyanide - deadly toxic poison
used to kill rats. If breathed in in small
doses, it can cause headaches, dizziness
and weakness.
Carbon monoxide - a deadly gas if
inhaled in enclosed spaces. Faulty and
leaking gas heaters, boilers, stoves and
tobacco smoke all produce this gas.
Toluene - used to manufacture paint,
paint thinners, nail varnish and
adhesives. Low - moderate levels can
provoke tiredness, weakness, loss of
appetite and memory loss.
2005-2012helpwithsmoking.com
 Systemic inflammation
 Systemic oxidative stress
 Effects of smoking on vasomotor and
endothelial function
Systemic inflammation
Decrease in Neutrophil deformability leading to increase in adherence and
migration and eventually to an increase in reactive oxygen species.
ERS research seminar2007
 Increase in abnormal forms of
Neutrophils from bone marrow
 Increase in cytokines such as IL-6
 Chronic smoking increases WBC
count which correlates with changes
in FEV1
 Decrease in number of CD 19 +ve B
cells
 Monocytes show increase
expression of CD 11b and CD 18
which increase their adhesion to
endothelial cells , together with an
increase in ICAM-1 which are
important in the pathogenesis of
atherosclerosis.
ERS research seminars 2007
Systemic oxidative stress

Cigarette smoke in the gas and tar
phases contains 1015-17 oxidant molecules
per puff. It is not surprising therefore
that inhalation of tobacco smoke results
in local lung, but also systemic oxidative
stress. Circulating neutrophils from
smokers release increased amounts of
reactive oxygen species whose release is
further enhanced in COPD patients.

Further evidence of increase systemic
oxidative stress induced by smoking is
shown by increase circulating products of
lipid peroxidation and a marked decrease
in plasma antioxidant capacity, which
may have profound effects on many
organs.

Cigarette smoking also affects systemic
lipid profiles increasing serum
cholesterol, triglyceride and low density
lipoproteins, but lowering high-density
lipoproteins and oxidising LDL.
ERS research seminars 2007
Vasomotor and Endothelial
Function.
Enhanced risk of Cardiovascular disease
 Decrease in NO and
increase in Peroxynitrite
which affect vasomotor
and endothelial
function.
 Decrease in sytemic
arterial wall compliance
and increase stiffness.
ERS research seminars 2007
 Decrease endogenous
fibrinolytic activity
demonstrated by
decrease t-PA release
and increase in PAI-1
 Increase in procoagulants such as
fibrinogen, D-dimer and
tissue factor
ERS research seminars 2007
CARDIOVASCULAR
 Increases Nephrotoxicity in old age
 Increase risk of End stage renal disease
 Damage to the renal transplant
 ?? Mechanisms include :
- Acute : increase in BP and Intraglomerular pressure
- Chronic: Endothelial cell dysfunction.
J.Am.soc.Nephrol.15,558-563-2004
INFLUENZA
 Smoking seems to cause a higher relative influenza-risk
in older populations than in younger populations.
 In a prospective study of community-dwelling people
60–90 years of age, during 1993, of unimmunized
people 23% of smokers had clinical influenza as
compared with 6% of non-smokers.
Nicholson, K. G.; Kent, J.; Hammersley, V. (1999). "Influenza A among community-dwelling elderly
persons in Leicestershire during winter 1993–4; cigarette smoking as a risk factor and the efficacy of influenza
vaccination". Epidemiology and Infection 123(1): 103–8.
ORAL EFFECTS
 ORAL CANCER
 LEUKOPLAKIA
 Smokers melanosis
 Hairy tongue
 Submucous fibrosis
 Leukoedema
 Tooth decay, abrasions
and erosions
 Halitosis
REPRODUCTIVE SYSTEM
 Impotence
Incidence of impotence is approximately 85 percent
higher in male smokers compared to non-smokers, and
it is a key cause of erectile dysfunction (ED). Smoking
causes impotence because it promotes arterial
narrowing.
 Female infertility
Smoking is harmful to the ovaries, potentially
causing female infertility, and the degree of damage is
dependent upon the amount and length of time a
woman smokes.

Nicotine and other harmful chemicals in cigarettes interfere with
the body’s ability to create estrogen, a hormone that
regulates folliculogenesis and ovulation.

Some damage is irreversible, but stopping smoking can prevent
further damage. Smokers are 60% more likely to be infertile than
non-smokers.
Kendirci M, Nowfar S, Hellstrom WJ. (2005). "The impact of vascular risk factors on erectile function". Drugs Today (Barc) 41(1): 65–74.
D echanet, C.; Anahory, T.; Mathieu Daude, J. C.; Quantin, X.; Reyftmann, L.; Hamamah, S.; Hedon, B.; Dechaud, H. (2010). "Effects of cigarette
smoking on reproduction". Human Reproduction Update 17 (1): 76
By the American Society for Reproductive Medicine (ASRM). Retrieved on Jan 4, 2009
Psychological

Immediate effect:
Users report feelings of relaxation, sharpness, calmness,
and alertness.Those new to smoking may experience nausea, dizziness,
and rapid heart beat. Generally, the unpleasant symptoms will eventually
vanish over time, with repeated use, as the body builds a tolerance to the
chemicals in the cigarettes, such as nicotine.

Stress :
Smokers report higher levels of everyday stress. Several studies have
monitored feelings of stress over time and found reduced stress after
quitting.
The apparent relaxant effect of smoking only reflects the reversal of the
tension and irritability that develop during nicotine depletion. Dependent
smokers need nicotine to remain feeling normal.
Gilbert Lagrue, François Lebargy, Anne Cormier, "From nicotinic receptors to smoking dependence: therapeutic
prospects"Alcoologie et Addictologie Vol. : 23, N° : 2S, juin 2001, pages 39S - 42
Parrott, Andrew C. (1998). "REVIEW Nesbitt's Paradox resolved? Stress and arousal modulation during cigarette
smoking". Addiction 93 (1): 27–39.
• Cognitive function :
-
Alzheimer’s disease : conflicting results..
-
Increase in incidence of dementia and cognitive
decline, cerebral atrophy, anxiety disorders
-
Increase in mental concentration similar to
caffeine
Anstey, K.; Von Sanden, C.; Salim, A.; O'Kearney, R. (2007). "Smoking as a risk factor for dementia and cognitive decline: a metaanalysis of prospective studies". American journal of epidemiology 166 (4): 367–378.
Jacobsen, L.; Krystal, J.; Mencl, W.; Westerveld, M.; Frost, S.; Pugh, K. (2005). "Effects of smoking and smoking abstinence on
cognition in adolescent tobacco smokers". Biological Psychiatry 57(1): 56–66.

Former and current smokers have a
lower incidence of Parkinson's
disease compared to people who
have never smoked.

Possible role of nicotine in reducing
Parkinson's risk: nicotine stimulates
the dopaminergic system of the
brain, which is damaged in
Parkinson's disease.

Other compounds in tobacco smoke
inhibit MAO-B, an enzyme which
produces oxidative radicals by
breaking down dopamine.
Quik, M. (2004). "Smoking, nicotine and Parkinson's
disease".Trends in Neurosciences 27 (9): 561–568.
SKIN DISEASE
OTHER EFFECTS
 Decreases appetite
 Increases expression of AZGP1 gene that increases
lipolysis
 Increases symptoms associated with crohn’s disease
 Increase risk of abdominal aortic aneurysm formation
Vanni, H.; Kazeros, A.; Wang, R.; Harvey, B.; Ferris, B.; De, B.; Carolan, B.; Hübner, R. et al (2009). "Cigarette smoking induces
overexpression of a fat-depleting gene AZGP1 in the human".Chest 135 (5): 1197–1208.
Cosnes J et al., (1999). "Effects of current and former cigarette smoking on the clinical course of Crohn's disease". Aliment Pharmacol.
Ther. 13 (11): 1403–11
Lung Transplantation
Diagnosis
N
1 month
1 Year
5 Years
COPD
AAT
215
85
97%
94%
89%
83%
52%
59%
CF
86
95%
63%
46%
IPF
57
95%
60%
44%
PPH
39
85%
77%
60%
THANK YOU