Smoking tobacco is the number one preventable cause of death in the world. If no one in the United States smoked, one out of three cancer deaths would not happen. Nicotine is the second-leading cause of death globally. The best component of treatment is education about the benefits of smoking cessation and the cessation process.

Most patients – over 90% – attempt to stop smoking by stopping cold turkey. However, there are a myriad of other cessation methods including counseling, nicotine replacement therapy, antidepressant medications, behavioral training, group therapy, hypnosis, and others.

What damage does smoking do?

Smoking is associated with acute and long-term structural changes in the airways and pulmonary parenchyma, including upper airway mucosal gland hypertrophy and hyperplasia. In other words, smoking damages the lungs no matter how you look at it.

Smoking irritates the lining in the lung tissue, particularly the tiny hair cells or cilia that are responsible for clearing mucus. Those cilia stop working, causing mucus production to increase, which causes inflammation. The cycle continues and the person becomes short of breath and develops a chronic cough.

Smoking causes chronic obstructive pulmonary disorder (COPD), which includes emphysema and chronic bronchitis. It also causes the majority of lung cancer. It can trigger asthma attacks in those who are susceptible. It also leads to cardiovascular and kidney disease.

Smokers are 12 to 13 times more likely to cause death from COPD than non-smokers.

Smoking can also cause cancer in other places in the body:

  • Bladder.
  • Blood (acute myeloid leukemia).
  • Cervix.
  • Colon and rectum (colorectal).
  • Esophagus.
  • Kidney and ureter.
  • Larynx.
  • Liver.
  • Oropharynx (includes parts of the throat, tongue, soft palate, and the tonsils).
  • Pancreas.
  • Stomach.
  • Trachea, bronchus, and lung.

Can a doctor tell if I smoke?

In my own clinical practice, I saw plenty of patients with cancer from smoking. The distinction was that even in those patients who did not have cancer, their airways, particularly their lungs always had changes.

I could easily tell if a person smoked based on not just their cough. It was their voice. Smoking causes a constant irritation to the lining of the upper airways. Many patients who smoke have a distinctive raspy voice which means there is swelling in the vocal cords just like when a person has an upper respiratory infection.

Those who had stopped smoking usually had regained most of their lung function, but not always. We were taught in medical school that after ten years of total abstinence from smoking, the lungs would return back to their own normal state, meaning functioning as if the person had never smoked. I am not completely convinced that is completely true.

Your lungs start to heal immediately after you stop smoking. That is why quitting today is so important. However, the time for healing in the airways and lungs varies dramatically, depending on the person.

Signs of lung damage from smoking

Smoking causes minor and major swelling and scarring in the airways. The minor scarring in the lungs may not cause too much damage right away.

Long-term smoking does cause major scarring in the lungs, particularly damaging the alveoli, the small sacs in the lungs that are responsible for exchange of oxygen and carbon dioxide.

Our lungs only have so many alveoli (about five hundred million in most people). Once the alveoli are destroyed by smoking, they are gone for good. Once there are too many alveoli missing, we develop pulmonary emphysema, even if the person stops smoking.

Pulmonary emphysema is incurable. It leads to chronic cough, excess sputum production, poor oxygen exchange, fatigue, exhaustion, anxiety, trouble sleeping, weight loss, and even heart problems. Emphysema is one type of chronic lung disorders, which includes COPD.

COPD means there is a slow, progressive obstruction of the airflow in or out of the lungs. It is associated with an abnormal inflammatory response of the lungs to the inhaled noxious gases in smokers.

The diagnosis of COPD and emphysema can be made by your doctor based on your breathing history, exposure to irritants and smoking, and breathing tests such as PFTs or pulmonary function tests (spirometry). The stage of lung disease is determined by what is called the forced expiratory volume (FEV) level.

What are the stages of lung disease?

FEV refers to the volume of air that you can exhale during a forced breath. The ‘1’ subscript means the forced expiratory volume in one second.

The ratio of different results on these pulmonary function tests determines if you have obstructive or restrictive lung disease from smoking.

What can I do besides stopping smoking?

Prevention means lowering your risks. This includes stopping smoking, but also taking care to protect the lungs from infections. This means taking vaccines for illnesses such as the flu, COVID, or the pneumococcal vaccine.

Depending on the stage of chronic obstructive lung disease from smoking, your doctor may recommend further evaluation by specialists such as pulmonologists, lung surgeons, and those respiratory professionals who offer pulmonary rehabilitation.

A final word

Some doctors advocate using home remedies. These include vitamins, antioxidants, and omega-3 fatty acids.

Surgery is usually the last resort for those who have lung damage from smoking. Options include partial removal of the lungs or in the worst cases, a lung transplant.

The average life expectancy for a person who has COPD and undergoes a lung transplant is about five years.

Again, the best treatment is always to stop smoking as soon as possible. And, as I tell my patients, do not start again.


Johns Hopkins. Smoking and Respiratory Diseases.

MD Anderson Cancer Center. What Happens to Your Lungs From Smoking: 3 Things to Know.

University of Rochester. Smoking and Respiratory Diseases.

U.S. Department of Health and Human Services. (2014). The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

U.S. Department of Health and Human Services. (2010). How Tobacco Smoke Causes Disease: What It Means to You. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health

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