Who is chronic smoker

It includes the categories of current smoker, former smoker, never smoked, and smoking status unknown. Bidis contain tobacco and can be flavored. When smoked, bidis have higher concentrations of nicotine, tar, and carbon monoxide than conventional cigarettes sold in the United States. Cigarette: A thin cylinder of ground or shredded tobacco that is wrapped in paper, lit, and smoked.

Other Tobacco Products that are Smoked Cigar: A tube of tobacco that is thicker than a cigarette, wrapped in tobacco leaf, lit, and smoked. Cigars include regular cigars, cigarillos, and little filtered cigars. Hookah: Hookahs are water pipes that are used to smoke specially made tobacco that comes in different flavors, such as apple, mint, cherry, chocolate, coconut, licorice, cappuccino, and watermelon.

Also called water pipes. Pipe: A tube with a small bowl at one end that is filled with tobacco, lit, and smoked. Affirmative answers to three questions defined altered olfaction olfactory problems in the past years; worse ability since age 25; phantom smells. Smoking never, former, current was self-reported by chronicity pack years, PY and dependency time to first cigarette upon waking and verified by serum cotinine. Estimated prevalence of altered olfaction was Olfactory-related pathologies sinonasal problems, serious head injury, tonsillectomy, xerostomia partially mediated the association between smoking and altered olfaction.

Chronic cigarette smoking was associated with increased odds of self-reported olfactory alterations, directly and indirectly via olfactory-related pathologies. Analysis of the US nationally representative data revealed significant positive associations between chronic smoking and alterations in the sense of smell.

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Smoking is the leading cause of chronic obstructive pulmonary disease COPD. No one knows exactly why some smokers develop COPD and others do not, although it is believed that there may be a certain genetic predisposition in this regard. It is notable that a large number of COPD patients smoke, even when they know that they have this condition and that it is adversely affecting the course of their disease. Several studies have shown that smokers with COPD have special characteristics in their smoking that make them a group with particular difficulties in quitting.

The following have been described among these characteristics: a they smoke more cigarettes daily than smokers without COPD and moreover, they have a specific smoking pattern: they inhale the cigarette smoke deeply and retain it for longer in their lungs. It is important to stress that the only measure that has been shown to be effective for arresting the progression of this disease is smoking cessation.

Few clinical trials have been conducted to study the efficacy and safety of the use of different pharmacological treatments for smoking in smokers with COPD.

These are reviewed briefly below. The Lung Health Study showed that using nicotine gum combined with intensive cognitive behavioural therapy CBT was effective and safe for helping these subjects to quit smoking.

Two clinical trials have analysed the efficacy and safety of the use of bupropion in the treatment of smokers with COPD. Two studies have analysed the efficacy and safety of the use of varenicline on the treatment of smoking in smokers with COPD.

One was conducted on a group of patients with mild or moderate COPD and was designed as a randomised, double-blind, placebo-controlled study. It was shown that varenicline was more efficacious than placebo for aiding smoking cessation in the third, sixth and twelfth month of follow-up. After one year the continuous abstinence rates were Patients were followed-up for 24 weeks. The mean continuous abstinence rate between week 9 and week 24 was Depending on the type of drug used, the rates were: Another study compared the efficacy of a high intensity smoking treatment programme in smokers with COPD with those who received usual care.

The high intensity programme consisted of a combination of pharmacological treatment plus hospitalisation for 2 weeks, where patients received intensive CBT; telephone calls and continuous follow-up were also scheduled for a period of one to 3 years. Probably one of the most informative studies was that by Hoogendoorn et al.

The various interventions were grouped into 4 categories: usual care, minimal intervention, intensive CBT and intensive CBT plus pharmacological treatment. The abstinence rates after one year of follow-up for each of the categories were 1. Compared with usual care, the cost per quality-adjusted life year for the minimal intervention was 16 Euros, for intensive CBT Euros and for intensive CBT plus pharmacological treatment, Euros.

This intervention should be performed differently depending on whether the patient has been recently diagnosed with COPD or if, on the contrary, the patient has been diagnosed with the disease for some time.

Occasionally, and if available, the determination of cotinine levels in body fluids, especially serum, may be useful.

Knowing this figure is helpful for assessing the prognosis. Analyse the motivation to quit smoking. In this respect, subjects can be classified into 2 groups: those who are willing to make a serious attempt to quit at the present time, and those to prefer to delay the attempt until later.

Study the degree of physical dependence on nicotine. Table 1 shows this test. Reward test. This test has also been shown to be quite useful for the assessment of smoking. Analysis of previous attempts to quit smoking. This study is very helpful for determining the subject's smoking characteristics.

It should be noted that for performing this analysis, only attempts that led to the subject not smoking for at least 24 h should be considered. The following variables should be determined: number of attempts made, time without smoking at each attempt, symptoms suffered, treatments used and their effects, and finally, the reasons for relapse.

Determination of expired air CO levels. This is a simple examination. Table 4 shows how it should be performed and its assessment. After it has been performed, the healthcare professional should explain to the patient why he has high CO levels and how these high CO levels are causing the disease in his body. He should also be informed that once he has quit smoking, the CO levels will return to normal.

Taking into account all the data obtained on analysing the different variables, the diagnosis of smoking in the patient can be made according to 4 aspects: a extent of smoking; b motivation for smoking cessation; c degree of physical dependence on smoking; and d type of reward. With respect to the motivation, 2 patient groups can be distinguished: one group made up of subjects who are willing to make a serious attempt to quit at the present time this group corresponds to smokers in the preparation stage of the Prochaszka classification and another made up of subjects who do not want to make a serious attempt to quit smoking at the present time, and who prefer to delay the decision-making this group corresponds to smokers in the pre-contemplation or contemplation phase of the Prochaszka classification.

Depending on the degree of dependence, smokers can be classified into 3 types: light, moderate or heavy. Tables 1 and 2 explain each of these. With respect to the type of reward, the keys are discussed in Table 3. Algorithm for diagnosing smoking in smokers with recently diagnosed COPD. In this patient group, the diagnosis of smoking has specific characteristics and should be made with empathy, respect and understanding by the doctor towards their patient.

The most important aspects that must be addressed in this subject group are the following: identification of tobacco smoking; co-oximetry; determination of cotinine levels in body fluids, especially serum; analysis of degree of physical dependence on nicotine; analysis of degree of motivation to quit smoking; self-efficacy analysis; assessment of mood status, and analysis of previous attempts at smoking cessation.

The identification of tobacco smoking in these patients is a task that should be approached with empathy. Taking into account that on many occasions the subject may be reluctant to provide the real information, it is advisable to identify how many cigarettes he smokes per day and for how long he has smoked, despite knowing that it had been advised against.

The use of co-oximetry and even the determination of cotinine levels are very useful for making, not only the tobacco consumption, but also the amount consumed objectively clear.

In this respect, it is highly recommended that after having asked the subject about their smoking and the number of cigarettes smoked per day, the expired air CO levels are determined.

Although CO levels less than 10 ppm are traditionally considered to define non-smoking, various studies have found that the figure that marks the cut-off point is around 4—5 ppm.

The determination of cotinine levels in serum, urine and saliva can also be very helpful for the reliable identification of smoking. Therefore, the answer that the subjects give to the question regarding the time between getting up until they smoke their first cigarette of the day is much more valuable than the answer that they give to the question regarding the number of cigarettes that they smoke daily. Analysis of the degree of motivation to quit smoking in these patients should be performed using a visual analogue scale Fig.

It is advisable to proceed as follows: show the patient the figure and explain that this is a scale on which 0 corresponds to the total absence of motivation for quitting smoking and 10 to the maximum degree of motivation for doing so. Ask the patient to point with their finger to the point on the scale that best defines their degree of motivation, taking into account the rating explained above. Unfortunately, there are no scales that can accurately measure the self-efficacy of the subject for quitting smoking.

It is recommendable to use the same visual analogue scale as used in measuring the motivation for this purpose, and to do so in a similar way to that used to determine the motivation. Assessing the mood is essential in these patients. Many studies have shown that depression is a very common comorbidity in subjects with COPD, and even those with more severe COPD suffer this condition more frequently. Therefore, it is recommendable to ask the subject 2 questions: a during the past month, have you often been bothered by feeling down, depressed or hopeless?

When the answer to both questions is yes, the likelihood that the subject has depression is very high. Analysis of previous attempts at smoking cessation in these subjects does not vary with respect to the analysis performed in the group of smokers with recently diagnosed COPD.

Taking into account the different results obtained after the assessment carried out in this subject group, we can diagnose patients according to the following criteria: a extent of smoking; b degree of physical dependence on nicotine; c degree of motivation and self-efficacy; and d assessment of mood. For this, it is advisable to analyse the number of cigarettes smoked per day, the expired air CO levels and, if available, blood cotinine levels.

In this subject group, there is little relation between the number of cigarettes smoked per day and the CO or blood cotinine levels. It is often observed that although they smoke a small number of cigarettes per day, the figures for expired air CO, or even blood cotinine levels, are higher than they should be. This is because these smokers smoke with a specific pattern: although they smoke fewer cigarettes, they take many puffs of the cigarette, inhale them deeply and retain the smoke inside their lungs for a long time.

Assessment of the degree of physical dependence on nicotine. In this aspect, assessing the time between getting up and smoking the first cigarette of the day is the determining factor Table 2. In general, it can be considered that smoking the first cigarette within the first 30 min is a sign of a high degree of dependence. If the subject wakens in the middle of the night in order to smoke, it is an unmistakeable sign of a high degree of dependence. Assessment of the degree of motivation and self-efficacy.

For this purpose, it is useful to distinguish between those who indicate 8 or higher on the visual analogue scale and those who indicate lower scores. Depending on the score that the subject awards each of these variables, the intervention of the healthcare professional will be different.

Thus, smokers with a high degree of motivation and self-efficacy will be prepared to receive treatment in order to quit smoking for good. In smokers with a low degree of motivation and high degree of self-efficacy, it will be necessary to intervene to improve their knowledge of the relationship between smoking and their disease.

In smokers with high motivation and low self-efficacy, the offer of pharmacological treatment and psychological support is sufficient. Finally, in those with low motivation and low self-efficacy, the motivational interview is the treatment of choice. Assessment of mood.

This is very important information due to the impact that it could have on the therapeutic intervention. In subjects who answer yes to the questions stated above, the use of antidepressants will be necessary and consultation with a psychiatrist should be assessed; in those who respond negatively but who show a depressed mood, intense psychological support and continuous follow-up will be very useful. Those who do not have depression issues or depressed mood will find it easier to quit smoking.

Algorithm for diagnosing smoking in smokers with previously diagnosed COPD. The decisions stated below on this topic are based on the strength of evidence graded according to the GRADE system. The use of this type of combined treatment is a consistent recommendation with high quality evidence. Level of recommendation: strong. As in the case of the diagnosis, the characteristics of the CBT offered to these smokers should differ depending on whether they are smokers recently diagnosed or previously diagnosed with COPD Fig.

Algorithm for therapeutic intervention in smokers with COPD. This therapy consists of the following aspects: a Explanation of the close relationship between smoking and COPD. Subjects should be informed that smoking is the direct cause of their disease.

They should also be warned about the following aspects: 1 that smoking cessation is the only therapeutic measure that has been shown to be effective for improving their disease; 2 that the use of pharmacological treatments for their disease will have very little effectiveness if they continue smoking; and 3 that, on the contrary, smoking cessation will be followed by a marked improvement in the course of their disease and the response of the COPD to treatment.

The lung age and spirometry results may be used for increasing the motivation to quit smoking in these patients. Some studies have found an increase in the motivation for cessation using both results. In normal conditions, there is a correlation between the lung age and chronological age of the subject. When the individual has COPD, their spirometric results correspond to a lung age much higher than their chronological age. Showing these results to patients and explaining their significance helps to increase their motivation to quit smoking.

In smokers who are willing to make a serious attempt at smoking cessation, the intervention will be devoted to choosing the day to quit D-day , the identification of high risk situations, development of alternative behaviours, explanation of the symptoms of withdrawal syndrome and its evolution, and the issue of leaflets with health information on smoking and COPD and self-help leaflets to quit smoking.

In this group of smokers, scheduling follow-up visits with the sole objective of assessing the progress of the cessation process and monitoring the use of the different pharmacological treatments that have been prescribed for smoking cessation is a requirement that must be met in all cases.

A follow-up schedule that is recommended in this patient group is as follows: first, second, fourth, eighth, twelfth, sixteenth, and twenty-fourth week after D-day. It is important that the patient feels supported by the entire healthcare team during their smoking cessation process. It is crucial that they understand the importance of this for their health through the interest that the healthcare professionals who treat them place in their quitting.

Telephone calls, sending personalised letters or even using new technologies SMS messages, email messages, chats, etc. In smokers who are not willing to make a serious attempt to quit at the present time, the need to quit smoking must be stressed at each of the visits that the subject makes to their doctor or nurse. The insistence should be made with empathy, cordiality and understanding, but with firmness and accompanied by offering all types of help.

The components of the CBT offered to these patients should be the same as those stated in the previous section. Nevertheless, it is important to take into account that the vast majority of these patients have already been warned by various healthcare professionals about the need for smoking cessation.

The correct health intervention on these patients requires not only that we change our message, but that we also change the way of presenting it. Therefore, the intervention in these patients should be carried out with empathy, respect and understanding, trying to increase the patient's motivation, self-efficacy and self-esteem. It causes serious long-term disability and early death.

COPD starts by making it hard to be active, such as playing with a grandchild, then usually gets worse, until climbing a short set of stairs or even walking to get the mail is exhausting or impossible. It can leave people stuck in their homes, unable to do the things they want or see friends. Smoking harms nearly every organ in your body, including your heart. Smoking can cause blockages and narrowing in your arteries, which means less blood and oxygen flow to your heart.

When cigarette consumption in the U. Yet, heart disease remains the number one cause of death in the U. Because smoking affects your arteries, it can trigger stroke. A stroke happens when the blood supply to your brain is temporarily blocked. Brain cells are deprived of oxygen and start to die. A stroke can cause paralysis, slurred speech, altered brain function and death.

Stroke is the fifth leading cause of death in the United States and a leading cause of adult disability. Asthma is a chronic lung disease that makes it harder to move air in and out of your lungs—otherwise known as "breathing.