There are many risks one faces when smoking. They include pulmonary, cardiovascular, peripheral vascular, and neoplastic(cancer) risks to point out a few. I want to underscore the pulmonary risk of smoking because it is the hardest to live with, IMMHO. We have a few friends on this board working hard to stop, and a few more that are planning to stop; perhaps this will bring food for thought. I should declare that I am an ex-smoker, and I know the level of difficulty I faced when I stopped. First a quick review of the anatomy of the respiratory system(RS). The functional end of the RS is the little air sac, alveolus, at the end of all the breathing tubes. All the breathing tubes and alveoli together are the lungs. An alveolus is a very tiny, thin walled structure, about one micron thick, through which gas exchanges take place. The surface area of both lung fields is roughly the size of a tennis court. The alveoli is a delicate, well protected structure. Part of the protection for the alveolus is a filtration system of tiny hairlike projections called cilia. The cilia are further enhanced with a thin film of sticky mucous. This forms a very effective filtration system that is enhanced by ciliary action. The cilia move filtered debris, and any waste within the lung, upward into the larger tubes, bronchi, where they can be coughed out or expectorated as may be needed. It is this filtration system that is heavily impacted by smoking. Smoking takes a heavy toll on the cilia, and the mucous that is produced by the RS. Initially, the cilia stop moving; and secondly, the mucous produced becomes thicker. The cilia still filter, it is just much more difficult to move the filtered, or other debris, upward and out of the RS. With continued exposure to the products of smoking, the cilia become fewer, and less functional. This results in an increase of little sub-clinical infections within the lungs. Coughing becomes the only means for the lungs to clean themselves; thus the "smoker's cough". Over time, a chronic bronchitis becomes the norm, as does an increase in widespread damage to the tiny, fragile little alveoli, their protection is now gone. As the damage heals within the lung, it replaces functioning alveoli with scar tissue. The scar tissue just holds things together, it is nonfunctional tissue. As the damage continues, larger areas of the lungs become fibrous, and the pressure generated to cough, the only defense now, pinches off, or obstructs the small bronchi ( the breathing tubes), and traps the debris within the lung fields.The debris remains in the lungs and adds to the ongoing infections. This is Chronic Obstructive Pulmonary Disease (COPD), or also known as emphysema. It can not be cured, only managed. Two severe cases of COPD have stuck with me. The first was when I was doing summer work in a local hospital. A pharmacist was admitted with severe COPD. He looked about 70 y/o, and was unable to breathe unless sitting bolt upright, with oxygen running in his nose. It took him an hour to eat a meal, and could not lay down at all. His shortness of breath was so severe, he had trouble even speaking, and he still smoked; he was 52 y/o. The second case was at base X in California. Patients admitted to ICU, on a ventilator became one of my patients, in consultation as the norm. I generally wrote the ventilator and sedation orders for such patients. A gent was admitted who was in his 60's with moderate/severe COPD. He was fishing when he developed a severe attack of severe shortness of breath. This had happened to him several times in the past; but this one was different for him. His shortness of breath was very severe at best. As I was getting things together for his intubation and ventilation, he reached out grabbed me and pulled me closer to him....he asked me to give him enough medicine to "put me to sleep forever". This struggle had been so difficult for so many years, he simply could no longer live with it. We did get him around the corner, and later discharged him, but his message never changed. He took every opportunity to plead with me to end the struggle for him, his eyes spoke volumes. Nearly all who smoke will develop COPD. It is a most debilitating disease. Normal life with advanced COPD, is a constant worry about your next breath. Breathing meds , Oxygen concentrators and tanks are a constant need. The dyspnea is so severe that you will run out of breath just eating. Normal conversations are impossible, you will only be able to sleep sitting up, or in a lounge chair that can elevate the head to help breathing. There will be no end to the misery, and it will only get worse. This does not happen quickly, symptoms come on very gradually. You make little adjustments in your daily routines without noticing it. One day, it will hit you; you will discover you are a pulmonary cripple, wheelchair and all. It will not go away, and life will become a struggle. You may find yourself in the same postion as the man that begged me to," put me to sleep forever". There is good news for those looking to stop smoking. Smoking cessation can arrest the progression of COPD. Treatment will not repair the damaged areas of the lung, only a lung transplant can do that. What will happen is stopping the progression of the disease. The cilia will regrow. The mucus will return to normal; and the cilia will resume normal function. Stopping will make a difference. It is not unusual for coughing to increase once you stop smoking; that is a sign that the cilia are back to work. The decision to stopping is the key IMMHO. There is a lot of support now for folks looking to stop smoking. There are prescribed meds, OTC aids, like nicotine patches and chewing gum, support groups with phone help lines. It may take several attempts before it finally works, it will be worth it. The real key is the desire to stop. If you do not have the proper motivation, the above aids will be worthless. It may take several attempts to finally succeed. If the attempt fails, look at your motivation, that really is key, then regroup and go at it again. Failed attempts are chances to look at what works and what does not. The only time you truly loose, is if you stop trying. The above information about COPD is something to mull over if you are thinking about smoking cessation. I have said nothing about cancer, vascular, and cardiovascular risks; perhaps in another thread. Best of luck with the struggle; and it is a struggle; BTDT. RF 1
From the description, I think COPD might be what my paternal grandfather died from. He smoked very heavily and it destroyed his body. He had to get wheeled around while permanently attached to an oxygen tank. Eventually he ended up in the hospital, where he lived... sorry that's not a good description, "lingered" in great pain, trying to breathe, until he finally succumbed. Along the way the family savings were wiped out to help pay for medical bills. All utterly preventable. Even complete tobacco addicts like my grandfather can quit; I know because after he was given the "you're going to die soon" diagnosis, he completely gave up smoking. If only he would have quit earlier...
For the last couple of months my Mom was on 10 liters of O2 per min. That is not a typo. 10. Most people you see out and about on small Helios type systems are on 2-4 liters per min. 10 still wasnt enough. Her sats would drop with activity and when I say activity I mean getting up off the chair and walking across the room. Also when you are on that high of a liter flow you touch on the area of CO2 retention, which Im quite sure was the case for my Mom. You can Google it but CO2 retention = not good. Stick to it Deathy. Stay off the cigs.
