Smoking
Smoking
You already know that a spinal cord injury causes an impairment
of the muscles involved in breathing the higher the injury,
the greater the impairment. That’s strike one. The fact that smoking
is harmful to your lungs is hardly news. Still, that’s strike
two. How smoking affects your lungs just what happens when you
smoke and what this means when you have a spinal cord injury
and an already compromised respiratory system is what’s important
to know.
You’ve Heard it All Before…
You most likely have heard all the reasons to stop smoking lung
cancer, heart disease, emphysema, shorter life expectancy yet,
it’s a pleasure, a stress reliever or an old friend you are unwilling
to give up following your spinal cord injury. Or, you simply may
be willing to take your chances despite all the evidence of how
harmful smoking is. Besides, quitting can be pretty difficult.
For SCI survivors who smoke, however, there’s even more bad news
and more ill health effects than those cited for the general population.
Specifically, there is an increased incidence of skin sores, a
decreased ability to heal following skin surgeries, and a greater
likelihood of atelectasis (collapsed lung).1,2 Additionally, smoking further reduces the total lung capacity
already decreased by SCI and diminishes the amount of oxygen in
the bloodstream used to nourish tissues and power muscles. Finally
smoking can further increase an already heightened risk for bladder
cancer.
It’s Not Just Breathing In…
When we think of breathing, we usually think about getting air
in. Often times with SCI, and especially with SCI and cigarette
smoking, getting air out can be even more important. Why? Because a buildup of mucus and
various secretions in the lungs which are increased by smoking
can lead to problems.1,2 Normally, this buildup is coughed out. However, the muscles responsible
for coughing are affected with cervical injuries, and to a varying
degree with thoracic injuries as well. An impaired ability to
cough can frequently lead to atelectasis, which is a collapse
of the honeycomb-like air sacs that often causes secretions to
become trapped in the lungs. The secretions build up and may lead
to pneumonia, one of the more common causes of both sickness and
death with SCI. Smoking increases the production of this mucus
and contributes to congestion.
…But Breathing Out, too
What’s more, smoking further impairs the ability to cough or expel
these secretions. A study of 165 SCI survivors found that smokers
tested significantly lower in both the amount of air they were able to cough out, as well as the force with which they were able to expel it. Survivors are already
at risk of congestion and infection due to their injury; smoking
raises the stakes, placing them at even higher risk.1,2
SCI: New Risks
As people age, both breathing capacity and lung volume decrease.
This is due to a loss of elasticity of the lungs and muscles of
the chest wall. These changes decrease the ability to fight off
infections. With SCI comes other potential concerns, such as:
- increased weight can make breathing more difficult
- general decrease in exercise can lead to decreased breathing capacity
- posture problems: rounded shoulders or slouching can lead to smaller
lung capacity
- a change in the type or severity of spasticity can affect the
chest or breathing muscles
- increased number and severity of respiratory infections due to
diminished ability to cough
All these changes place SCI survivors at higher risk for respiratory
problems as they age. Smoking not only multiplies the problems
but also increases the risks.
My Skin Can Be Affected, Too
Congestion and lung infection aren't the only problems associated
with smoking. Studies have also linked smoking to an increased incidence of pressure sores as well as longer healing time for both sores
and the skin surgery which is sometimes necessary to repair them.
Specifically, a study of 38 SCI survivors found smokers to have
both a higher incidence
and more extensive pressure sores than nonsmokers.4 After ruling out various other factors which might contribute
to skin problems – diabetes, type of cushion, completeness of
injury, spasticity, body weight and the availability of help with
skin care the conclusion was that smoking contributed to the
development of pressure sores more than any of the above mentioned
factors. Why? Read on....
Healthy skin depends on the good circulation of highly oxygenated
blood to carry nutrients to the skin and remove waste products
from it. Smoking in general, and nicotine in particular, cause
a decreased blood flow to the extremities. In addition, smoking
produces carbon monoxide, which severely impairs oxygen from even
entering the blood. In other words, not only does smoking
cause less blood to get to the skin, but the blood that does get
there has far less oxygen. A decrease of oxygenated blood and
nutrients to the skin, as well as insufficient removal of waste
products from it are good ways to develop pressure sores. Actually,
that’s exactly what happens when you don’t do weight shifts, use
a bad cushion or wear shoes that are too tight.
Once skin sores develop, this same impaired circulation of less
oxygenated blood slows down healing. In fact, this decreased concentration
of oxygen in the blood is the greatest threat to wound healing.5 The relationship between smoking and poor healing has been noted
by many surgeons, and several studies have shown the increased
risk of skin flap necrosis the death of skin tissue following
surgery due to smoking. It appears that smoking not only helps
you get pressure sores, it also seems to help you keep them.
The risk of skin problems for the survivor increases with both
age and number of years post injury.6 The skin become's thinner, less elastic and more susceptible
to shearing and tearing, which increases the possibility of skin
breakdown during transfers. Sitting and turning tolerances may
also diminish. As circulation decreases, the body ages and the
skin is less able to clear waste products. These factors result
in the increased susceptibility to skin infections and slower
healing of wounds. Just as with respiratory complications, smoking
raises the risks and increases the odds of serious skin problems.
Then, There’s the Bladder…
The links between smoking and various health problems seem to
grow stronger every day. If all you’ve read so far isn’t enough,
the risk of bladder cancer is also higher among those with SCI:
about 3% compared to less than 1/10% for the general population.
Indwelling catheters have been found to increase the risk of bladder
cancer 3.8 times, compared to SCI survivors who do not use an
indwelling catheter. And of course, the risk of that problem also goes up with smoking, as cancer-causing agents may
be carried in the urine. See our brochure on bladder cancer for
more information.
Parting Thoughts:
Living with a spinal cord injury is risky business. The chances
of developing skin or respiratory problems are quite high far
greater than before injury. Combining SCI and smoking is like
playing against a stacked deck the chances of losing are very
high.
1Spungen AM, Lesser M, Almenoff PL, Bauman WA. 1995. Prevalence
of cigarette smoking in a group of male veterans with chronic
spinal cord injury. Military Medicine; 160:6, 308-311.
2Almenoff PL, Spungen AM, Lesser M, Bauman WA. Pulmonary function
survey in spinal cord injury: influences of smoking and level
and completeness of injury. Lung; 173:5, 297-306.
3Wilmot CB, Hall KM. “The Respiratory System” in Aging with Spinal
Cord Injury, Whiteneck GG, et al., editors. Demos Publications,
New York, 1993.
4Lamid S, El Ghatit AZ. 1983. Smoking, spasticity and pressure
sores in spinal cord injured patients. American Journal of Physical
Medicine. 62:6; 300-306.
5Vienbeck M, McGlynn J, Harris S. 1995. Pressure ulcers and wound
healing: educating the spinal cord injured individual on the effects
of cigarette smoking. SCI Nursing; 12: 3, 73-76.
6Yarkony GM. “Aging Skin, Pressure Ulcerations, and Spinal Cord
Injury” in Aging with Spinal Cord Injury, Whiteneck GG, et al.,
editors. Demos Publications, New York, 1993.
This is one of more than 20 educational brochures developed by
Craig Hospital while it was a federally-funded Rehabilitation
Research & Training Center on Aging with Spinal Cord Injury. The
opinions expressed here are not necessarily those of the funding
agency, the National Institute on Disability and Rehabilitation
Research of the US Department of Education.
For a hard copy of a METS brochure, click on your selection above
and hit the "print" button on your browser. If you'd like to ask for one directly from Craig Hospital, you can contact us by telephone at 303-789-8202, or you can e-mail us at HealthResources@craighospital.org.
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