Tobacco Dependence: Complications

The following are the most important diseases or complications that may be contributed to by tobacco dependence:

Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99).

  • Maldescensus testis (undescended testis).

Respiratory system (J00-J99)

  • Acute bronchitis
  • Bronchial asthma
  • Chronic bronchitis
  • Chronic obstructive pulmonary disease (COPD)
  • Interstitial lung disease (differential diagnosis to be considered in smokers with exertional dyspnea (shortness of breath on exertion) and/or nonproductive cough/(dry) cough without sputum)
    • Acute eosinophilic pneumonia (AEP).
    • Desquamative interstitial pneumonia (DIP).
    • Diffuse alveolar hemorrhage (DAH) in Goodpasture’s syndrome.
    • Idiopathic pulmonary fibrosis (IPF).
    • Collagenosis-associated interstitial lung disease – lung disease associated with conditions such as systemic lupus erythematosus or dermatomyositis
    • Combined pulmonary fibrosis and emphysema (CPFE).
    • Pulmonary alveolar proteinosis (PAP).
    • Pulmonary Langhans cell histiocytosis (PLCH).
    • Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD).
    • Rheumatoid arthritis-associated interstitial lung disease (RA-ILD).
  • Laryngitis (inflammation of the larynx).
  • Pulmonary emphysema (lung hyperinflation)
  • Pharyngitis (pharyngitis)
  • Pneumoconiosis – lung changes that can occur due to inhalation of dust.
  • Pneumonia (pneumonia)
  • Rhinitis (cold)
  • Sinusitis (sinusitis)
  • Tonsillitis (tonsillitis)

Eyes and eye appendages (H00-H59).

Blood, blood-forming organs – immune system (D50-D90).

Endocrine, nutritional, and metabolic diseases (E00-E90).

Factors influencing health status and leading to health care utilization (Z00-Z99).

  • Burnout syndrome

Skin and subcutaneous tissue (L00-L99)

  • Alopecia (hair loss)
  • Cellulite
  • Nail psoriasis (nail psoriasis)
  • Psoriasis (psoriasis)
  • Premature aging of the skin

Cardiovascular system (I00-I99)

  • Apoplexy (stroke)
  • Extrasystoles (heart palpitations; extra heartbeats).
  • Heart failure (cardiac insufficiency)
  • Hypertension (high blood pressure)
  • Coronary artery disease (diseases of the coronary arteries).
  • Pulmonary embolism (blockage of a blood vessel in the lungs usually with a blood clot (blood clot), the so-called thrombus).
  • Myocardial infarction (heart attack)
  • Peripheral arterial occlusive disease (pAVk) – progressive narrowing or occlusion of the arteries supplying the arms / (more often) legs, usually due to atherosclerosis (arteriosclerosis, arteriosclerosis).
  • Thrombangiitis obliterans (synonyms: endarteritis obliterans, Winiwarter-Buerger disease, Von Winiwarter-Buerger disease, thrombangitis obliterans) – vasculitis (vascular disease) associated with recurrent (recurring) arterial and venous thrombosis (blood clot (thrombus) in a blood vessel); symptoms: Exercise-induced pain, acrocyanosis (blue discoloration of the body appendages), and trophic disturbances (necrosis/tissue damage resulting from the death of cells and gangrene of the fingers and toes in advanced stages).
  • Thrombosis (vascular disease in which a blood clot (thrombus) forms in a vessel).
  • Atrial fibrillation (VHF)

Infectious and parasitic diseases (A00-B99).

  • HPV infection (human papilloma virus).
  • Infections of all kinds due to weakened defenses.
  • Influenza (flu)
  • Legionellosis (Legionnaires’ disease)
  • Pneumococcal infection
  • Tuberculosis (consumption)

Liver, gallbladder and bile ducts – pancreas (pancreas) (K70-K77; K80-K87).

Mouth, esophagus (esophagus), stomach, and intestines (K00-K67; K90-K93).

  • Acute mesenteric ischemia (AMI; intestinal infarction) – smokers 6-fold risk compared with nonsmokers.
  • Dysbiosis (imbalance of the intestinal flora).
  • Gastritis (inflammation of the gastric mucosa)
  • Gastroesophageal reflux disease (synonyms: GERD, gastroesophageal reflux disease; gastroesophageal reflux disease (GERD); gastroesophageal reflux disease (reflux disease); gastroesophageal reflux; reflux esophagitis; reflux disease; Reflux esophagitis; peptic esophagitis) – inflammatory disease of the esophagus (esophagitis) caused by the pathological reflux (reflux) of acid gastric juice and other gastric contents.
  • Gingivitis (inflammation of the gums)
  • Dental caries
  • Colon adenoma (colon polyps)
  • Gastric ulcers (stomach ulcers)
  • Crohn’s disease – chronic inflammatory bowel disease (IBD); usually progresses in relapses and can affect the entire digestive tract; characteristic is the segmental affection of the intestinal mucosa (intestinal mucosa), that is, several intestinal sections may be affected, which are separated from each other by healthy sections.
  • Periodontitis – inflammation of the periodontium.
  • Pulpitis (inflammation of the dental nerve)
  • Ulcus duodeni (duodenal ulcer)
  • Tooth loss – heavy smokers (> 15 cigarettes/d) must expect the loss of teeth before the age of 50 (because of caries and periodontitis/inflammation of the periodontium):
    • Men: 3.6-fold higher risk (odds ratio 3.6; 95% confidence interval 3.0 to 4.4).
    • Women: 2.5-fold higher risk odds ratio of 2.5; 95% confidence interval 2.1-2.9)

Musculoskeletal system and connective tissue (M00-M99).

  • Anti-GBM (glomerular basement membrane) disease (synonym: Goodpasture’s syndrome) – hemorrhagic pneumonia with concomitant glomerulonephritis – hemorrhagic (associated with bleeding) pneumonia with concomitant glomerulonephritis (inflammation of the renal corpuscles).
  • Osteoarthritis
  • Osteoporosis (bone loss)
  • Rheumatoid arthritis

Neoplasms – tumor diseases (C00-D48)

  • Bronchial carcinoma (lung cancer)
  • Cervical carcinoma (cancer of the cervix)
  • Cholangiocellular carcinoma (CCC, cholangiocarcinoma, bile duct carcinoma, bile duct cancer).
  • Urinary bladder carcinoma (urinary bladder cancer)
  • Histiocytosis/Langerhans cell histiocytosis (abbreviation: LCH; formerly: histiocytosis X; Engl.histiocytosis X, langerhans-cell histiocytosis) – systemic disease with proliferation of Langerhans cells in different tissues (skeleton 80% of cases; skin 35%, pituitary gland 25%, lungs and liver 15-20%); in rare cases neurodegenerative signs may also occur; in 5-50 % of cases, diabetes insipidus (hormone deficiency-related disturbance in hydrogen metabolism, leading to extremely high urine excretion) occurs when the pituitary gland is affected; the disease occurs disseminated (“distributed over the whole body or certain regions of the body”) frequently in children between 1-15 years of age, less frequently in adults, here predominantly with an isolated pulmonary affection (lung affection); prevalence (disease frequency) approx. 1-2 per 100,000 inhabitants
  • Hypernephroma (renal cell carcinoma).
  • Carcinoma of the oral cavity
  • Carcinoma of the paranasal sinuses
  • Carcinoma of the trachea (windpipe)
  • Colon carcinoma (cancer of the large intestine)
  • Laryngeal carcinoma (cancer of the larynx)
  • Hepatocellular carcinoma (heptocellular carcinoma, HCC; liver cancer).
  • Leukemia – acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML).
  • Gastric carcinoma (stomach cancer)
  • Mammary carcinoma (breast cancer)
  • Esophageal carcinoma (cancer of the esophagus)
  • Pancreatic carcinoma (cancer of the pancreas)
  • Squamous cell carcinoma of the skin

Ears – mastoid process (H60-H95)

  • Dysacusis (hearing disorder)
  • Hearing loss
  • Meniere’s disease (disease of the inner ear)
  • Otitis media (inflammation of the middle ear)

Perinatal period (P00-P96)

  • Low birth weight
  • Stillbirth

Psyche – nervous system (F00-F99; G00-G99)

  • Dependence
  • Attention-deficit/hyperactivity disorder (ADHD) (smoking in adolescence).
  • Dementia
  • Diabetic polyneuropathy – secondary disease of diabetes mellitus (diabetes), which leads to chronic disorders of peripheral nerves or parts of nerves. This results in sensory disturbances in the affected regions of the body.
  • Erectile dysfunction (ED; erectile dysfunction).
  • Insomnia (sleep disorders)
  • Migraine
  • Alzheimer’s disease
  • Transient ischemic attack (TIA) – sudden onset of circulatory disturbance in the brain leading to neurological dysfunction, which resolves within 24 hours.

Pregnancy, childbirth and puerperium (O00-O99).

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

  • Dysgeusia (taste disorder/tasting disorder).
  • Halitosis (bad breath)
  • Sore throat
  • Sudden infant death syndrome
  • Pyrosis (heartburn)
  • Sinus tachycardia (cardiac arrhythmia; stimulus formation disorder).
  • Vertigo (dizziness)

Genitourinary system (kidneys, urinary tract – sex organs) (N00-N99).

  • Chronic renal insufficiency (kidney weakness)/kidney failure (double risk for smokers compared with nonsmokers).
  • Genital prolapse – partial or complete prolapse of the vagina (descensus vaginae) and/or uterus (descensus uteri) from the pubic symphysis (rima pudendi).
  • Sterility (male; female)

Injuries, poisonings, and other consequences of external causes (S00-T98).

  • Food allergies (immunological reaction)

Further

  • DNA methylation; this could have lasting effects on gene activity; one study demonstrated that DNA methylation in smokers differed from nonsmokers in a total of 1,405 genes. These affected genes that influence lung function, inflammatory diseases, carcinogens and heart disease. Some changes were still detectable after 30 years.
    • Gene encoding G protein-coupled receptor 15 (GPR15) (involved in inflammation and new blood vessel formation): gene activity ↑ (with the number of cigarettes smoked per year); in ex-smokers, there was a decrease in GPR15 activity with years since cigarette cessation and fell off most sharply in the early years.
  • Higher risk (+32%) of major bleeding when smokers receive vitamin K antagonists (VKA).
  • Delayed wound healing

Prognostic factors

  • Mortality risk in lifetime smokers compared with nonsmokers:
    • <1 cigarette/which lifetime: 64% increased mortality (death rate).
    • 1-10 cigarettes/die: 87% increased mortality.

    Conclusion: there is no risk-free level of tobacco smoke exposure.