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The Effects of Tobacco Use

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This peer reviewed course is applicable for the following professions:
Advanced Practice Registered Nurse (APRN), Athletic Trainer (AT/AL), Certified Nurse Midwife, Certified Nurse Practitioner, Certified Registered Nurse Practitioner, Clinical Nurse Specialist (CNS), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN), Midwife (MW), Nursing Student, Occupational Therapist (OT), Occupational Therapist Assistant (OTA), Physical Therapist (PT), Physical Therapist Assistant (PTA), Registered Nurse (RN), Respiratory Therapist (RT)
This course will be updated or discontinued on or before Friday, August 15, 2025

Nationally Accredited

CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.

CEUFast, Inc. is an AOTA Provider of professional development, Course approval ID#08439. This distant learning-independent format is offered at 0.1 CEUs Intermediate, Categories: OT Foundational Knowledge AOTA does not endorse specific course content, products, or clinical procedures. AOTA provider number 9757.

CEUFast, Inc. (BOC AP#: P10067) is approved by the Board of Certification, Inc. to provide education to Athletic Trainers (ATs).

FPTA Approval: CE24-1092886 . Accreditation of this course does not necessarily imply the FPTA supports the views of the presenter or the sponsors.

≥ 92% of participants will know how to identify specific concerns related to tobacco smoke and e-cigarette use, long-term complications, and prevention and treatment methods.


Following the completion of this course, the participant will be able to accomplish the following objectives:

  1. Summarize the epidemiology of tobacco and electronic cigarette (e-cigarette) use.
  2. Identify long-term problems associated with cigarette smoking and e-cigarette use.
  3. Describe the dangers of e-cigarette use.
  4. Relate the changes that may occur in various body systems due to tobacco use.
  5. Apply strategies to help promote smoking cessation efforts.
CEUFast Inc. and the course planners for this educational activity do not have any relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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The Effects of Tobacco Use
To earn of certificate of completion you have one of two options:
  1. Take test and pass with a score of at least 80%
  2. Reflect on practice impact by completing self-reflection, self-assessment and course evaluation.
    (NOTE: Some approval agencies and organizations require you to take a test and self reflection is NOT an option.)
Author:    Krystle Maynard (DNP, RN, SANE-A)


Cigarette and tobacco use are among the most common preventable causes of death and disease in the United States (U.S.). More than 30 million Americans smoke cigarettes daily, with almost 2000 minors trying cigarettes for the first time (Centers for Disease Control and Prevention [CDC], 2021a). Over 80% of U.S. adults report having tried their first cigarette by age 18 (National Center for Chronic Disease Prevention and Health Promotion, 2012). In any form, tobacco use has short-term and long-term effects on our bodies.


The area where gas exchange occurs within the body extends from the nose, through the upper airway, and down into the alveoli within the lung bases; this is what makes up the respiratory system. We bring in oxygen and exhale carbon dioxide once that gas exchange has occurred. As people smoke, the chemicals included in the smoke are inhaled into the respiratory system and therefore get absorbed into the lung tissues. The longer someone smokes, the more chemicals and harmful substances get absorbed into the alveoli and other lung tissues (National Center for Chronic Disease Prevention and Health Promotion, 2012).

Pulmonary Defense

Housed within our pulmonary system is an innate immunological defense system. The system aims to identify foreign cells or organisms and produce an innate immune response. When smokers inhale tobacco smoke, this defense is compromised, making people more susceptible to injury and illness (CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010; National Center for Chronic Disease Prevention and Health Promotion, 2012).


The tobacco epidemic is one of the largest public health threats known to the world. The death toll for tobacco use is up to eight million, with more than one million being from second-hand smoke exposure. There is no safe tobacco version; cigarette smoking is the most commonly used form. Other tobacco forms include pipe tobacco, chewing tobacco, cigars, electronic cigarettes (e-cigarettes), and more. Economically, tobacco use is substantial, as is the cost of health conditions caused by smoking and second-hand smoke exposure (World Health Organization [WHO], 2022).

About 16 million people in the U.S. live with a chronic disease caused by smoking. Diseases known to be caused by smoking include cancer, diabetes, chronic obstructive pulmonary disease (COPD), stroke, heart disease, and more. Smoking may also increase the risk of autoimmune disorders, eye complications, and tuberculosis (CDC, 2020c).

What is in Tobacco?

Tobacco products, such as cigarettes, pipe tobacco, and cigars, are formulated with tobacco leaves that have been dried, along with many additives and chemicals. The smoke from tobacco contains thousands of chemicals, 70 of which have been found to cause various cancers. Some of these chemicals include (American Cancer Society [ACS], 2020):

  • Nicotine
  • Formaldehyde
  • Lead
  • Arsenic
  • Hydrogen cyanide
  • Benzene
  • Ammonia
  • Carbon monoxide
  • Radioactive components
  • Polycyclic aromatic hydrocarbons
  • Tobacco-specific nitrosamines

In addition to causing cancer, many of these chemicals can cause other health conditions, such as lung and heart diseases (ACS, 2020).

graphic listing the ingredients in tobacco

Tobacco Ingredients

Cigar Smoke

Smoking cigars carries many of the same risks as smoking cigarettes. An aging process is used to make cigars, causing them to have higher concentrations of nitrates. Once smoked, these compounds produce some of the most potent carcinogenic substances known to experts (ACS, 2020).

Smokeless Tobacco

Smokeless tobacco products are nicotine-containing substances placed into the mouth or nose and, therefore, not burned like traditional tobacco products. Smokeless tobacco products are often called snuff or chewing tobacco. Like any tobacco product, these also cause many types of cancer, particularly oral and mouth cancers, as the chemicals are absorbed through the mouth during use (ACS, 2020).

Second-hand Smoke

Second-hand smoke has been a long-standing issue, as it has been responsible for more than 40,000 adult and 400 infant deaths per year. The same disease caused by smoking can also be caused by second-hand smoke exposure. Infants and children exposed have demonstrated a higher risk of developing asthma, ear conditions, recurrent respiratory illness, and sudden infant death syndrome, better known as SIDS (CDC, 2020c).

For decades, experts have warned of the dangers of second-hand smoke. Individuals who may have never smoked a day are being diagnosed with lung conditions seen in smokers, all because they were exposed to it (CDC, 2020d).

Second-hand smoke exposure can also cause heart attacks, strokes, and other forms of heart disease. Annually, more than 8,000 stroke deaths are caused by individuals exposed to second-hand smoke (CDC, 2020d).

Third-hand Smoke

Long before it had a name, experts hypothesized that cigarette smoke toxins lingered on car, home, and room surfaces long after the smoke dissipated. Studies have shown that nicotine has been found in the dust in the homes and cars of smokers, increasing the potential exposure to others. The term "third-hand smoke (THS)" was first heard in 2006, but it was not until 2009 that it was used by a Harvard professor stating they believed THS would be harmful to children, prompting home smoking bans (Burton, 2011).

Physiological Effects of Smoking

In addition to the numerous chemicals and harmful substances present in nicotine-containing products, the physical act of inhaling tobacco also causes damage to the body.

Respiratory System

The longer you inhale tobacco smoke, the lungs, trachea, and larynx become damaged and irritated. The process causes the lungs' ability to exhale harmful substances to diminish, resulting in poisonous substance buildup. Ultimately, the alveoli become permanently scarred, placing individuals at a higher risk for lung infections. Alveolar scarring is also the cause of increased sputum, coughing, and wheezing, often seen or heard in long-term smokers (Better Health Channel, 2019).

Circulatory System

The respiratory system is not the only system affected by smoking. Inhaling tobacco smoke causes the following issues in the circulatory system (Better Health Channel, 2019):

  • Decreased oxygen exchange during activity and exercise
  • Hypertension and tachycardia
  • Decreased skin temperature because of vascular constriction
  • Hypercoagulability
  • Atherosclerosis
  • Peripheral vascular constriction
  • Higher risks of myocardial infarction (MI) and cerebrovascular accident (CVA)

Immune System

Inhaling tobacco smoke causes the following problems with the immune system (Better Health Channel, 2019):

  • Diminished immunity; decreased antioxidants
  • Higher infection risks, especially pneumonia and flu
  • Longer lasting infections

Musculoskeletal System

Smoking can affect the musculoskeletal system, causing decreased bone density and muscle tightening (Better Health Channel, 2019).

Reproductive System

Tobacco use can also affect both the male and female reproductive systems. Males may experience decreased sperm count, sperm damage, or lead to a high percentage of deformities. Impotence is also a potential effect. Females may experience irregular menstrual cycles, decreased fertility, earlier menopause, and increased cervical cancer risk. In females older than 35, if they are on oral contraceptives and a smoker, the risk of stroke or heart attack is substantially higher (Better Health Channel, 2019).

Smoking and Babies

Women who are pregnant or are thinking of becoming pregnant may experience difficulty if they are active smokers. For those already pregnant, evidence has suggested for years that a strong correlation exists between smoking during pregnancy and damage to the unborn baby. Smoking is known to damage the tissue in the brain and lungs during fetal development. Congenital disabilities and miscarriages are also linked to smoking during pregnancy (CDC, 2020f).

When mothers smoke during pregnancy, there is a higher risk of preterm delivery, which comes with complications. Experts state that one in every five babies born to mothers who smoked during pregnancy experience a low birth weight. Several health concerns relate to babies being born too early and too small. Babies born with low birth weight due to smoking are at higher risk for hypertension, diabetes, and heart disease in adulthood. Babies born to mothers who smoked during pregnancy are also at higher risk of being born with a cleft lip or palate and attention deficit hyperactivity disorder (ADHD) as they get older (Better Health Channel, 2019).

SIDS has been linked to maternal smoking over the years; studies show the risk of SIDS increases three-fold when the mother smoked during pregnancy (CDC, 2020f). Once born, a baby exposed to second-hand smoke during their first year is at a much higher risk of ear infections, respiratory infections, and meningitis (Better Health Channel, 2019).

Experts have discouraged smoking during pregnancy or around babies for quite a while. Some of the harmful effects experienced by babies due to smoking are relatively common knowledge, and others may not be well understood.

Chronic Bronchitis

Chronic bronchitis has been linked to long-term smoking and is described as a chronic cough and sputum production. To receive an official diagnosis of chronic bronchitis, one must have experienced these symptoms for at least three months (most days each month) in two consecutive years without any other identifiable cause (National Center for Chronic Disease Prevention and Health Promotion, 2012).

Chronic Obstructive Pulmonary Disease

A collective of conditions affecting the respiratory system is how COPD is identified. COPD affects people differently and at different points in life, ultimately causing issues with airflow and breathing. Emphysema, asthma, and bronchitis make up the diagnosis of COPD(CDC, 2020b).

In the beginning stages of COPD, people may not exhibit any signs or symptoms; or they may be so mild they are difficult to identify. Symptoms may include (CDC, 2020b):

  • Wheezing
  • Chest tightness
  • Shortness of breath (this worsens with exertion)
  • Frequent cough (may be referred to as a "smokers cough")

As the disease progresses, symptoms last longer and may become worse. What initially begins as shortness of breath with exertion may progress into difficulty talking or moving due to the inability to catch their breath. Other later symptoms include the following (CDC, 2020b)

  • Blue-gray discoloration to the lips and nails
  • Weight loss (individuals may become so short of breath that even eating is difficult)
  • Tachycardia
  • Mental status changes

The overall type, amount, and progression of symptoms will vary from person to person. These factors will also be determined by an individual's willingness to quit smoking. According to the CDC, 39% of Americans with COPD continue to smoke cigarettes (CDC, 2020b).


Emphysema is one of the diseases that make up COPD and results from gradual lung tissue damage. Alveoli are often described as "tiny air sacs" and often rupture in emphysema, creating a larger air pocket. The process reduces surface area within lung tissues and diminishes the ability for oxygen to flow through the bloodstream as expected. More than three million people have an emphysema diagnosis in the United States. Smoking is the primary cause of emphysema, making it a highly preventable respiratory disease (American Lung Association [ALA], n.d.).

Heart Disease

Smoking is one of the number one causes of stroke and heart disease in America, resulting in one in four deaths. Smoking is known to cause the following (CDC, 2020d):

  • High cholesterol
  • Increases atherosclerosis
  • Damage to the lining of blood vessels
  • Decreases the "good" cholesterol
  • Smoking makes blood more susceptible to clotting

Individuals are at an increased risk of developing coronary artery disease and having a stroke if any combination of these occurs (CDC, 2020d).

Other Effects

Aside from specific system damage, there are other generalized effects caused by smoking. Smokers may experience:

  • Higher rates of gastritis
  • Premature skin aging
  • Increased rate of periodontitis
  • Increased rate of vision problems and blindness
  • Decreased sense of taste and smell
  • Increased risk of stomach ulcers

Smoking and Cancer

Smoking has long been connected to cancer, but some may not realize that smoking can prevent your body from fighting off tissues and cells invaded by abnormal cells (i.e., cancer). Though lung cancer is the most common cancer caused by smoking, smokers can develop cancer anywhere in the body (CDC, 2021b). For example, chewing tobacco is a common cancer offender, especially with mouth, esophagus, and pancreatic cancer (CDC, 2021b).

Luckily, research and science have evolved, creating more options for cancer treatment, but the numbers are still grim. Men are more likely to succumb to their diagnoses as smokers than women.

Cancer is a generalized term that describes many diseases caused by the overgrowth of abnormal and irregular cells multiplying and invading various tissues and structures within the human body. There are more than 100 known types of cancer; most are named based on the organ or cells in which they originate. Cancer symptoms can differ from person to person based on the type of cancer present. As a generalized rule, some common red flags to pay attention to may include the following:

  • Changes in bowel or bladder habits (without a known reason for the change)
  • Weight loss or gain without trying
  • Sores that do not heal
  • Any type of mass, thickened area, or lump
  • A persistent cough or hoarseness
  • Pain or discomfort after eating
  • Difficulty swallowing
  • Persistent weakness or fatigue
  • Any form of unusual discharge or bleeding

Just because you may have any of these symptoms does not mean you have cancer. These symptoms are just a precautionary reason to follow up with your primary care provider for further assessment and diagnostic testing, if necessary (CDC, 2021b).

Prevention: The most significant factor in cancer prevention is smoking cessation. Once the decision is made to quit smoking, cancer risk drops by 50% within the first five years. Within ten years, the dying risk also drops by 50%. Experts say that if everyone quit smoking, one out of every three cancer-related deaths would be prevented (CDC, 2021b).

Treatment: Cancer treatment will depend greatly on the type of cancer, its diagnosis stage, and other contributing factors. For some people, the primary goal may be to cure cancer. For other people, their goal may be symptom management. Everyone is different; therefore, their care plans will differ (CDC, 2021b). Cancer treatment options often include chemotherapy, radiation, and surgery when indicated. Cancer is often hard to pinpoint; one may respond well to one form of treatment, whereas another may require a combination of treatment options (CDC, 2021b).

Lung Cancer

Cancer occurs when cells begin to multiply uncontrollably. When this process begins in the lungs, it is termed lung cancer. The location within the body where cancer originates is known as primary cancer; if it migrates to other organs, it is best known as metastases. A lung cancer diagnosis can be further broken down into small-cell or non-small-cell (CDC, 2022b).

Risk factors: The number one risk factor for lung cancer is cigarette smoking. Up to 90% of all lung cancer deaths are attributed to smoking. Of the 7,000 chemicals in tobacco smoke, most are poisonous, and many are known to cause cancer.

Symptoms: Not everyone with lung cancer will exhibit the same symptoms. Symptoms may begin as respiratory, or if the cancer has spread to other organs, symptoms may be based on the affected organs. Some more common symptoms include the following:

  • Chest pain
  • Worsening cough
  • Hemoptysis
  • Wheezing
  • Weight loss without trying
  • Fatigue
  • Shortness of breath or difficulty breathing
  • Lymphadenopathy
  • Recurrent pneumonia

Lung cancer types: The non-small cell is the more common of the two types. Once an official diagnosis is given, further diagnostics are performed to determine which stage the cancer has progressed to. The process allows medical professionals to identify which treatment regimen would work best.

Treatment: Treatment selection will depend upon the cancer's location and staging. Treatment could include a combination of the following (CDC, 2022a):

  • Surgery
  • Chemotherapy
  • Radiation
  • Targeted therapy

Electronic Cigarettes

Electronic nicotine delivery systems (ENDS) are also known as "vapes," "mods," "vape pens," and more. E-cigarettes have a nicotine-containing liquid that produces an aerosol to be inhaled by the person using them but can also be inhaled by bystanders (similar to second-hand smoke). These products may or may not contain nicotine, but they all contain various chemical substances. In addition to nicotine, some may use vapes to inhale marijuana or other substances (CDC, 2023).

Though they come in various shapes and sizes, these popular devices cause more harm than good. Despite the initial belief that e-cigarettes could help people quit smoking, experts have found that they are just as harmful (if not more so) than cigarettes. In short, e-cigarettes contain chemicals, organic compounds, and even heavy metals linked to various lung-related injuries by those who use them (CDC, 2023).

Nicotine is known to be an addictive substance, placing adolescents at a higher risk for issues when using e-cigarettes. Evidence has shown that brain development continues until the mid-twenties, placing them at risk for negative health consequences. Like regular cigarette use, e-cigarette use is linked to higher risks for lung and heart conditions and fetal growth damage when used by pregnant women (WHO, 2022).

Currently, e-cigarette use is the most popular among adolescents. Over 2 million middle and high school students used e-cigarettes in 2022 (CDC, 2023). With smoking at its current rate, experts state that one in 13 children today will eventually die from a smoking-related disease prematurely (CDC, 2022c).

Health Effects and Dangers of Electronic Cigarettes

Experts are still studying the long-term effects of e-cigarette use, though the harmful effects of nicotine are not new. E-cigarettes contain multiple chemicals, metals, and other dangerous particles that have been shown to cause unintended lung and other injuries.

There have been reports of defective e-cigarettes that cause explosions and fires, which can cause various amounts of injury. Lung injuries have also been linked to e-cigarettes (CDC, 2023).

No tobacco products are considered safe because they pose multiple health-related risks. The Food and Drug Administration [FDA] has also had to warn the general population about other safety concerns related to e-cigarettes, including:

  • Vape-induced lung injuries
  • Explosions and fires
  • Neurological symptoms, such as seizures

Healthcare providers and regulatory agencies, such as the FDA and CDC, have noticed many respiratory illnesses linked to e-cigarettes (vapes). Despite medical providers educating teens and young adults against using e-cigarettes, respiratory illnesses continue to occur, though they seem to have been on the decline. According to the CDC, 2800 hospitalizations or deaths have been reported in the U.S. The total death count in 2020 was reported at 68 within 29 U.S. states (CDC, 2020e).

There are specific e-cigarette contents that have been found harmful. Vitamin E acetate is a well-known vitamin found in many foods and supplements. Vitamin E supplements are in pill or capsule form and can be found in most pharmacies, drug stores, and major grocery stores. Vitamin E is also found in many cosmetic products, particularly skin creams. Food high in vitamin E content includes fruits, vegetables, meats, and oils. However, many THC-containing e-cigarette products contain vitamin E acetate as an additive. Evidence supports that when vitamin E acetate is inhaled into the lungs, our lung function may be impacted, placing us at risk for respiratory illness and other complications (CDC, 2020e).

Researchers have enough evidence to support a likely link between tetrahydrocannabinol (THC)-containing e-cigarettes and chemicals containing vitamin E as potential contributors to adverse health effects. Data from state public health departments and emergency rooms showed a shift in cases of vape-induced lung injuries after a rapid increase in e-cigarette use in 2019. Since then, there have been multiple interventions that have promoted a decrease in severity, such as:

  • Vitamin E has been removed from some chemicals used in e-cigarettes
  • Law enforcement has increased their response related to e-cigarette usage
  • Public health officials have enhanced educational and awareness efforts in the community

Food and Drug Administration Lab Analysis

Laboratory analyses have occurred over the years on patients, vaping devices, packaging, and other products containing cartridge liquor or packaging. More than 1300 samples were submitted from more than half of U.S. states containing varied amounts of liquid for sampling ability. Findings demonstrated that although not one chemical was found in each sample, THC was present in most submitted samples. Half of the samples containing THC also contained vitamin E acetate. Persistent research and identifying chemical compounds found in e-cigarettes are vital to determine the root cause of vape-induced lung injuries and associated respiratory illnesses (FDA, 2020).

CDC Recommendations

Though it is unlikely to end all e-cigarette usage, the CDC and FDA have developed recommendations (CDC, 2020e).

  1. People should be cautious about where they purchase e-cigarette products and who they get them from. Just like medication, purchasing products online, from unknown sources, or using products belonging to others is discouraged.
  2. There are already enough harmful chemicals in nicotine-containing products, and people should avoid additional additives, especially vitamin E acetate.
  3. Adolescents, young adults, and pregnant women should avoid using nicotine-containing products, including e-cigarettes.
  4. It is not a good time to start if you are an adult who does not currently use nicotine-containing products.
  5. If you have used e-cigarettes to quit smoking, do not go back to smoking. Speak to your healthcare provider about safer smoking cessation options available.
  6. Concerns about using THC-containing products and their potential health effects have been raised. Side effects and complications have been linked to prolonged use of these products.
  7. If you or someone you know is or becomes addicted to substances, consider seeking help from a trusted source who can provide safe and evidence-based treatment options.

Since many individuals use e-cigarettes to help them quit smoking, researchers decided to perform a literature review to evaluate the numbers and get to the bottom of the e-cigarette debate on using e-cigarettes in cigarette smoking cessation. Researchers reviewed 78 randomized controlled trials that studied more than 22,000 smokers. All studies compared the use of e-cigarettes with other smoking cessation modalities, such as nicotine replacement therapy, medication, therapy, and no support (Hartmann-Boyce et al., 2021).

Findings from the literature reviews included the following:

  • E-cigarettes containing nicotine were more successful at helping people to stop smoking than nicotine replacement therapy.
  • E-cigarettes helped more people to stop smoking than behavioral-based supportive measures.

Smoking Cessation

There are many benefits to quitting smoking.

Time after quittingBenefits
MinutesDecrease in heart rate
1 DayNicotine blood level decreases
Several DaysCarbon monoxide level drops to non-smoker levels
Up to 1 yearShortness of breath/coughing decreases
1-2 yearsDecreased risk of heart attack
3-6 yearsRisk of coronary heart disease drops by 50%
5-10 yearsRisk of oral cancer drops by 50%
Stroke risk decreases
10 yearsRisk of esophageal/kidney cancer drops by 50%
15 yearsRisk of coronary heart disease drops to near non-smoker levels
20 yearsCervical cancer risk drops by 50%
Risk of pancreatic and oral cancer drops to near non-smoker levels
(CDC, 2020a)

Why Quit?

All evidence supports that quitting smoking significantly decreases the risk of cancer, heart disease, other smoking-related lung diseases, and other health conditions. Smoking cessation also helps prevent potentially damaging effects on loved ones caused by second-hand smoke exposure (Carabello et al., 2017).

The overall health benefits gained when a person quits smoking are numerous; they include the following (CDC, 2020a):

  • It can give you up to 10 years back on your average life expectancy
  • Improves the overall quality of life
  • Diminishes reproductive risks
  • Lowers your risk of developing chronic diseases, such as heart disease, COPD, and cancer
  • Can reduce any financial burden felt by a smoking habit
  • Improves cholesterol
  • Reduces the risk of stroke

Smoking is a massive contributor to various types of cancers. By quitting smoking, individuals reduce their chances of getting the following twelve types of cancer (CDC, 2020a):

  • Leukemia
  • Lung cancer
  • Bladder cancer
  • Cervical cancer
  • Colon cancer
  • Esophageal cancer
  • Hepatocellular carcinoma
  • Renal cancer
  • Oral and throat cancer
  • Pancreatic cancer
  • Stomach cancer
  • Laryngeal cancer

Though e-cigarettes have been largely marketed as a smoking cessation aid, the FDA has not approved them for that purpose. To find an approved smoking cessation method, speak with your primary care provider or a specially trained representative.

Nicotine Replacement Therapy

Smoking is an addiction because nicotine has addictive properties; like anything else, it is not advised to quit an addictive substance abruptly. Nicotine replacement therapy (NRT) is an approved smoking cessation method. Though various forms can be used, the primary mechanism of action is to give individuals lower levels of nicotine without some harmful chemicals. Quitting an addiction abruptly can lead to unpleasant withdrawal symptoms. These symptoms may vary depending on the substance being withdrawn from.

NRT options can be bought at most grocery stores and pharmacies, in addition to some requiring a prescription from a medical provider. Some NRT therapies may include the following (National Health Service [NHS], 2022):

  • Nicotine patches
  • Nicotine gum
  • Nicotine lozenges
  • Oral or nasal spray
  • Inhalators

Nicotine patches vary in strength and length of time to be worn. They allow for a slow release of nicotine. Gum, inhalators, and sprays are more rapid-acting and help reduce immediate cravings. Successful NRT treatment may last 8-12 weeks, with the goal being a slow, gradual decrease in use/dose over time (NHS, 2022).

Most people are good candidates for NRT, even pregnant and breastfeeding women. Speaking with a medical provider before using any treatment is always advised to ensure it is safe for their specific use. Side effects of NRT may include nausea, skin irritation, nasal or throat irritation, headaches, or dizziness (NHS, 2022).

photo of smoking cessation gum

Smoking Cessation

Prescriptions for Smoking Cessation

Recently, two popular medications were used as prescription options for smoking cessation. Varenicline (Chantix) and bupropion (Zyban) have since been withdrawn from their manufacturers as smoking cessation treatments (NHS, 2022).

Community Response

Local and state communities can lend a hand in a variety of ways to help reduce the risk of cancer and other illnesses caused by smoking. As one of the biggest concerns in society, community partners can help reduce access to e-cigarettes and tobacco products for minors. Other ways people can help include:

  • Promote the avoidance of second-hand smoke
  • Help people with smoking cessation endeavors
  • Promote regular cancer screenings

Heart Disease and Stroke Prevention

The damaging effects of smoking and second-hand smoke place people at risk for death and disability; luckily, many can be prevented. The federal government has initiated increasing heart disease and stroke prevention efforts. The first step is to identify those at risk, starting with heart health ABCs (CDC, 2020d):

  • Aspirin has been shown in prevention measures to decrease MIs and strokes
  • Blood pressure control
  • Cholesterol management
  • Smoking cessation and prevention

There is a long list of lifestyle modifications that individuals can participate in to help further reduce their risk. Modifications include (CDC, 2020d):

  • Avoid smoking (or second-hand exposure) or quit smoking
  • Limit the use of alcohol
  • Regular physical activity
  • Eat a healthy, well-balanced diet
  • Maintain a healthy weight status
  • Identify and manage other health conditions (such as diabetes, etc.)

Case Study

Jane Smith is a 22-year-old college student who reportedly used an e-cigarette regularly for the past three years. Jane presents to the local emergency department with complaints of worsening cough, shortness of breath, and chest pain for the past week. She has had a persistent cough, fever, vomiting, and fatigue. Jane denies any past medical history, takes no medications, and has no known allergies.

Jane is a college student and lives on campus. She denies using illicit drugs and reports drinking alcohol occasionally (usually in social situations).

On examination, Jane appears to be very anxious, fatigued and has a visual increased work of breathing. Her vital signs are as follows:

  • Oxygen saturation: 90% on room air
  • Blood pressure: 135/86
  • Heart rate: 110
  • Respiratory rate: 40

Upon chest auscultation, diminished breath sounds in both lungs were appreciated. There were no crackles or wheezes. The rest of her physical exam was unremarkable.

Diagnostic findings included:

  • Chest X-ray: Diffuse bilateral opacities
  • Arterial blood gas (ABG): pH 7.37, PaO2 62 mmHg, PaCO2 43 mmHg, HCO3 25 mEq/L
  • Complete blood count (CBC): Unremarkable
  • Pulmonary function studies: Deferred due to acute respiratory difficulty
  • CT of the chest (pulmonary embolism protocol): No pulmonary embolism, but diffuse bilateral opacities, suggestive of aspiration pneumonia with a potential vaping-related lung injury, also known as electronic-cigarette or vaping product use-associated lung injury (EVALI).

Diagnosis: Based on clinical presentation, Jane is most likely experiencing bacterial pneumonia caused by potential aspiration. The e-cigarette history allows for concern for a vape-induced lung injury as well, further complicating the case.

Clinical management includes the following:

  • Oxygen therapy: Supplemental oxygen to maintain an oxygen saturation of > 94%
  • Intravenous fluids: Fluid resuscitation is indicated, given the weeklong history of vomiting and diarrhea
  • Antimicrobial therapy: Will attempt a sputum culture; in the meantime, will start broad-spectrum antibiotics
  • Sepsis protocol: Draw blood, urine, and sputum cultures to assess for potential bacterial culprits
  • Follow up on reasons for aspiration
  • Supportive care: Jane will be monitored closely in the intensive care unit due to the risk of decompensation

Prognosis: Jane is admitted to the intensive care unit for closer monitoring. She transitioned from a nasal cannula to a non-rebreather mask for oxygen delivery due to higher respiratory demands. Jane was found to become more hypoxic with any exertion, and her oxygen saturation would drop into the 70s and 80s with ambulation. The first 48 hours were guarded, as she initially presented weak, tachypneic, and tachycardic.

After 48 hours of antibiotics and intravenous fluids, Jane started to show some improvements. Her respiratory status, though improved, was still a cause for concern. She required 2-4 liters on a nasal cannula and would still drop with exertion. Due to the improvements overall, Jane was downgraded to a progressive level of care to continue antibiotics and to watch her respiratory status closely. At the one-week mark of her inpatient stay, the primary reason Jane was still in the hospital was her oxygen requirement. It was also determined that Jane had acid reflux issues, which were believed to have contributed to her aspiration. After a discussion with the medical provider, it was determined that Jane could be discharged home with supplemental oxygen.

Discharge education: During Jane's hospital stay, she was provided extensive education surrounding the dangers of vaping, including her recent experience with a vape-induced lung injury. Jane was recommended to begin a proton pump inhibitor for her reflux, as well as instructions on her oxygen delivery and discharge instructions.


Tobacco can be very harmful to our bodies. Here are some of the important highlights from this course:

  • Tobacco use is one of the most common preventable causes of death in the U.S. A large majority of adults have reported trying their first cigarette as a teenager.
  • When cigarette smoke is inhaled into the lungs, lung tissue becomes damaged. The respiratory system contains an innate defense mechanism to help prevent foreign cells from entering. As the lung tissue becomes damaged by smoking, that defense system becomes compromised. As a result, smokers may become more at risk for infection.
  • More than eight million people worldwide have died due to complications from smoking cigarettes. More than 1 million deaths occur as a result of second-hand smoke exposure.
  • Multiple chronic disease processes are believed to be caused by smoking. Examples include COPD, heart disease, stroke, cancer, and more.
  • Tobacco smoke contains thousands of chemicals, with 70 being known to cause cancer.
  • Cigar use carries the same risks as smoking cigarettes. Due to the aging process used to make cigars, there is a higher rate of nitrates being inhaled.
  • Smokeless tobacco products carry a high risk of developing various cancers, especially cancers of the mouth and neck region.
  • Smoking produces various harmful effects on the different body systems.
  • The respiratory system becomes damaged and irritated, leading to increased poisonous substance buildup, causing scarring.
  • Smoking causes decreased oxygen exchange, hypertension, tachycardia, and various other vascular conditions that can harm smokers.
  • Smoking harms the immune system, making smokers more susceptible to infection.
  • Smoking causes diminished bone density and muscle tightening.
  • Both male and female reproductive systems can be harmed by smoking.
  • Smoking around infants and children puts them at risk for second-hand smoke exposure.
  • Smoking during pregnancy increases the risk of premature birth, low birth weight, poor lung development, and congenital disabilities.
  • E-cigarettes started by being marketed as a smoking cessation adjunct, though the FDA has not approved this.
  • Tobacco is still being inhaled when using e-cigarettes, along with an unknown amount of other chemicals.
  • Medical professionals are seeing an increase in vape-induced lung injuries.
  • E-cigarettes have been defective, causing fires and explosions if not careful.
  • THC-containing e-cigarette cartridges containing vitamin E acetate are linked to many complications.
  • E-cigarette use is very popular among adolescents.
  • The CDC has released its recommendations to reduce the number of adolescents accessing and using e-cigarettes.
  • Smoking cessation is incredibly difficult but not impossible. When deciding to stop smoking, the risk of developing various health conditions decreases tremendously.
  • Using nicotine replacement is an approved smoking cessation method.
  • The most common products for smoking cessation are nicotine gum, patches, and lozenges.
  • Previously approved prescription medications for smoking cessation have been placed on hold.
  • The FDA does not approve e-cigarettes as a smoking cessation option.
  • The biggest factor in cancer prevention is smoking cessation.
  • Smoking puts people at risk for developing COPD, bronchitis, emphysema, and cancer.
  • Heart disease and stroke are also significant conditions associated with smoking.
  • Despite e-cigarettes still being on the newer side, nicotine and cigarettes are not, and nicotine's health effects have been studied for years. Repetitive evidence supports that nicotine is an addictive substance, dangerous to developing fetuses, harmful to brain development, and can cause cancer (CDC, 2023).

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Implicit Bias Statement

CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.


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