Maryland's Tobacco Resource Center - Linking Professionals to Best Practices

Medical Diagnoses

Promoting smoking cessation in those with medical diagnoses can help decrease disease symptoms and increase overall health.

Why is smoking cessation important?

      Tobacco smoke contains 7,000 chemicals with over 250 harmful chemicals and 69 of those known to cause cancer1. Studies have also found that smoking increases the risk of several types of heart diseases, lung diseases and other harmful health effects2. Furthermore, the 2014 Surgeon General Report stated that 483,000 deaths take place annually due to adverse health effects produced by cigarette smoking3. Based on the current cigarette smoking prevalence in the United States, adults who currently smoke cigarettes die 14 years earlier on average than nonsmokers. The CDC has also reported that smoking-related diseases could result in the premature death for roughly 25 million Americans overall; 5.6 million of whom could be below the age of 18 years4.

      However, studies have also found that smoking cessation not only helps to reduce the risk of heart disease, lung disease and cancer but also results in several health benefits such as an improved blood count and metabolic profile2, 5. Cessation also results in greater lung functioning and  decreased negative respiratory symtpoms. Therefore smoking cessation is important because it helps to reduce harmful health effects and also improves overall mortality rates2.

The harmful effects of smoking and possible preventions/recommendations
Studies have found numerous smoking-related health concerns such as:

Disease What is it? Research Findings Prevention / Recommendations
Cardiovascular diseases
Coronary Heart Disease Narrowing of blood vessels that supply blood and oxygen to the heart6. Smoking increases the risk of coronary artery disease. However, studies have found that quitting smoking can substantially reduce the risk of mortality in patients suffering with coronary artery disease7, 8. Smokers who quit smoking reduce their risk for a first heart attack within one year after quitting, and those who have had a heart attack before reduce their risk by ⅓ to ½ in that time15.
Myocardial Infarction Blockage of blood flow to the heart for a prolonged period of time resulting in a heart attack9. Studies have found that fatal myocardial infarction is four times more likely in young male smokers compared to non-smokers2 Studies have found that smokers who reported reducing their smoking habits had a decreased risk of hospitalization for myocardial infarction5.
Stroke The discontinuation of blood flow to a part of the brain10. Studies have found that the risk for stroke increases by 3-fold with smoking2 Smokers who quit for at least 2-5 years can also reduce their chances for a stroke15.   
Peripheral Vascular Disease Obstruction of the large arteries in the arms and legs that can cause a range of problems from pain to tissue loss or gangrene11. Cigarette smoking causes the blood vessels to narrow resulting in reduced circulation which increases smokers’ chances of developing a peripheral vascular disease11. The CDC reports that patients can substantially reduce their risk for a coronary heart disease within 1 to 2 years of smoking cessation16.
Abdominal Aortic Aneurysm Swelling or weakening of the main artery of the body where it runs through the abdomen12. Based on the Surgeon General Report of 2004, there is a causal relationship between smoking and Abdominal Aortic Aneurysm12. Studies have found that smokers who reduced their smoking by 50% had a healthier cardiovascular system as indicated by their decreased white blood cell count (WBC), red blood cell count (RBC), fibrinogen, hemoglobin, hematocrit and low-density lipids (LDLs) and increased high-density lipids (HDLs) 5.
Atherosclerosis Hardening of arteries due to plaques formation due to buildup of fats, cholesterol and other substances13. Studies have shown that smoking and Environmental Tobacco Smoke (ETS) is associated with cumulative and irreversible progression of Atherosclerosis14.  
Pulmonary Diseases
COPD A type of lung disease associated with breathing difficulty19. Studies have shown that volatile components contained in cigarette smoke such as acetaldehyde and acrolein create disruptions to the airway structure and functions resulting in COPD. Furthermore, death rates from COPD are higher among cigarette smokers7, 20. A smoker’s risk of dying from chronic bronchitis and emphysema is 12 to 13 times more than a nonsmoker’s11.
Asthma, Pneumonia, Emphysemia Lung disease that inflames and narrows the airways. Exposure to environmental tobacco smoke (ETS) in patients with asthma is associated with more severe symptoms, reduced lung function and increased hospital admission. Furthermore, active smoking by individuals suffering from asthma results in longitudinal changes in lung function and asthma-related mortality7, 21.  
Type II Diabetes Mellitus A chronic lifelong disease associated with high levels of blood sugar17.   Cigarette smoking is a known predictor of type 2 diabetes mellitus and studies have found that smoking cessation leads to fewer long term risks associated with diabetes18.
Cancers of the body
Lung, Trachea, Bronchus   The risk of lung cancer in men is about 20-fold in smokers compared to non-smokers2. Smoking cessation can improve the survival rates in patients who have cancer, such that the risk for cancer decreases with increasing duration of smoking abstinence2.

Source: Surgeon General Report,2014and MMWR, 200830

Secondhand Smoke

  • According to the CDC, ~88 million nonsmokers in the United States were exposed to secondhand smoke in 2007-200825.
  • A 2014 CDC report stated that secondhand smoke exposure was the cause of 42,000 deaths in the United States3.
  • Secondhand smoke exposure is also known to cause lung cancer and heart disease resulting in 7,333 annual deaths due to lung cancer and 33,951 annual deaths due to some form of heart disease3.
  • Nonsmokers who are exposed to secondhand smoke at work/home can increase their risk of heart disease by 25%-30% and their risk for lung cancer by 20%-30% 26.
  • Individuals with preexisting heart disease are at an even higher risk if exposed to secondhand smoke26.

      Providing cessation assistance to those with chronic or terminal illnesses is important, yet overlooked and underestimated for its efficacy. 

  • For example, people with COPD who received counselling and NRT therapy had higher abstinence rates compared to those who did not receive either treatment27
  • Self-help interventions, as well as pharmacological treatments, increase the likelihood that chronically ill people will remain smoke-free28
  • Smoking cessation prevents the progression of smoking-related diseases as well as reduces the rate of decline in lung and heart function29.
  • Those who have diabetes and quit smoking can increase their overall mortality rates and decrease the risk for heart disease, while heart disease sufferers can reduce all-cause mortality29.

       Health care professionals can use motivational interviewing and brief intervention as helpful tools to assist smokers in quitting. Although time may be a barrier to using these tools, individuals with chronic diseases may still have reasons for quitting smoking. Assessing the patient's readiness and willingness to quit, devising a quit plan, and regular check-ups can be extrememly beneficial to those with tobacco-related illnesses who are smoking.

        Smoking is responsible for numerous harmful health effects; in particular, smoking increases the risk of developing cardiovascular diseases, pulmonary diseases and different forms of cancer 2, 7, 21. In some cases, like those with type II diabetes, smoking can also increase the risk of harmful health effects among individuals who are already diagnosed with other health-related problems18. Even mere exposure to secondhand smoke can cause increases in the risk of lung cancer and heart disease, which in turn can lead to death 26. However, numerous studies have also reported that individuals who reduce or stop smoking have an improved health outcome and a reduced risk of developing harmful health effects2, 5, 15. As a result, smoking cessation is important to not only prevent harmful health effects but to also perpetuate enjoyment of a healthy lifestyle.



  1. The National Cancer Institute. (2014). Harms of Smoking and Health Benefits of Quitting. Retrieved from
  2. Fagerström, K. (2002). The epidemiology of smoking: health consequences and benefits of cessation. Drugs62(11), 1-9.
  3. Surgeon General’s Report. (2014).Retrieved from
  4. Center for Disease Control and Prevention. (2014). Surgeon General Report :Tobacco-Related Mortality. Retrieved from
  5. Pisinger, C., & Godtfredsen, N. S. (2007). Is there a health benefit of reduced tobacco consumption? A systematic review. Nicotine & Tobacco Research9(6), 631-646. doi:10.1080/14622200701365327
  6. A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; c1997-2012. Coronary heart disease; [last reviewed 2011 May 23; cited 2012 Jul 18]. Available from:
  7. Das, S. (2003). Harmful health effects of cigarette smoking. Molecular And Cellular Biochemistry253(1-2), 159-165.
  8. Tolstrup, J; Hvidtfeldt, U; Flachs, E; (2014). Smoking and Risk of Coronary Heart Disease in Younger, Middle-Aged, and Older Adults. American Journal of Public Health104(1), 96-102.
  9. A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; c1997-2012. Heart attack; [last reviewed 2011 May 23; cited 2012 Jul 18]. Available from
  10. A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; c1997-2012. Stroke; [last reviewed 2011 Jun 24; cited 2012 Jul 18]. Available from:
  11. Center for Disease Control and Prevention. (2011). Health Effects of Cigarette Smoking. Retrieved from
  12. U.S. Department of Health and Human Services. (2004). The Health Consequences of Smoking:Executive Summary. A Report of the Surgeon General. Retrieved from July 17, 2012, from U.S. Department of Health and Human Services, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Centers for Disease Control and Prevention website
  13. A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; c1997-2012. Hardening of the arteries; [last reviewed 2011 May 20; cited 2012 Jul 18]. Available from
  14. Howard, G., Wagenknecht, L., Burke, G., Diez-Roux, A., Evans, G., McGovern, P., & ... Tell, G. (1998). Cigarette smoking and progression of atherosclerosis: The Atherosclerosis Risk in Communities (ARIC) Study. JAMA: The Journal Of The American Medical Association279(2), 119-124.
  15. Center for Disease Control and Prevention. (2012). 2010 Surgeon General's Report: Overview of Findings Regarding Cardiovascular Disease. Retrieved from
  16. Center for Disease Control and Prevention. (2012). Facts sheets: Smoking cessation. Retrieved from
  17. MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2012 Jun 28]. Type 2 diabetes; [updated 2011 Jul 28; cited 2012 Jul 18]; Available from
  18. Yeh, H., Duncan, B., Schmidt, M., Wang, N., & Brancati, F. (2010). Smoking, smoking cessation, and risk for type 2 diabetes mellitus: a cohort study. Annals Of Internal Medicine,152(1), 10-17. doi:10.1059/0003-4819-152-1-201001050-00005
  19. A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; c1997-2012. Chronic obstructive pulmonary disease; [last reviewed 2011 May 1; cited 2012 Jul 18]. Available from:
  20. Carter, R., Tiep, B., & Tiep, R. (2008). The emerging chronic obstructive pulmonary disease epidemic: clinical impact, economic burden, and opportunities for disease management.Disease Management & Health Outcomes16(5), 275-284.
  21. Kjærgaard, T., Cvancarova, M., & Steinsvåg, S. K. (2011). Cigarette smoking and self-assessed upper airway health. European Archives Of Oto-Rhino-Laryngology268(2), 219-226. doi:10.1007/s00405-010-1287-y
  22. Center for Disease Control and Prevention. (2012). 2010 Surgeon General's Report: Overview of Findings Regarding Respiratory Diseases. Retrieved from
  23. The National Cancer Institute. (2011). Harms of Smoking and Health Benefits of Quitting; [last reviewed 2011 Jan 12; cited 2012 Jul 18].  Retrieved from
  24. Center for Disease Control and Prevention. (2012). 2010 Surgeon General's Report: Overview of Findings Regarding Cancer. Retrieved from
  25. Kaufmann, R. B., Babb, S., O'Halloran, A., Asman, K., Bishop, E., Tynan, M., Caraballo, R. S., Pechacek, T. F., Bernert, J. T., & Blount, B. (2010).Vital Signs: Nonsmokers' Exposure to Secondhand Smoke - United States,1999-2008. Morbidity and Mortality Weekly Report 2010;59(35):1141-1146.Retrieved from
  26. Center for Disease Control and Prevention. (2011). Secondhand Smoke (SHS) Facts.Retrieved from
  27. Thabane, M. (2012). The Health Quality Ontario. Smoking Cessation for Patients with Chronic Obstructive Pulmonary Disease (COPD): An Evidence Based Analysis. 12(4). 1-50.Available from
  28. Wagena,E., Van der Meer,R .(2004. Respiratory Medicine.The efficacy of smoking cessation strategies in people with chronic obstructive pulmonary disease: results from a systematic review.98(9).805-815.Available from:
  29. Nagrebetsky, A., Brettell, R., Farmer, A. (2014). Smoking Cessation in Adults With Diabetes: A Systematic Review and Meta-Analysis of Data from Randomized Controlled Trials. 4(3). 1-7.Available from
  30. Adhikari, B., Kahende, J., Malarcher, A., Pechacek, T., & Tong, V. (2008). Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses - United States, 2000-2004.Morbidity and Mortality Weekly Report, 57(45):1226-1228.Retrieved from