Cath Lab Digest

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  According to the Centers for Disease Control and Prevention (CDC),¹ smoking is the leading preventable cause of death in the United States, where every year it is the reason for one out of five deaths.

  What is it about smoking that causes such negative health outcomes? The byproducts of smoking — carbon monoxide and nicotine — pose a double threat to the body. Once inhaled, they increase heart rate, blood pressure, and the body’s demand for oxygen. It doesn’t take long to feel the effect; just 10 seconds after inhaling smoke, the brain is bathed in nicotine and carbon monoxide hinders red blood cells from carrying adequate amounts of oxygen. The lungs cannot work to full capacity because smoking narrows the small airways of the lungs, making smokers more prone to lung collapse, infection, chronic coughing, and breathing complications. Despite efforts to squelch smoking with mandatory smoke-free public buildings and clean-air laws, an estimated 46 million adults 18 years and older still choose to light up.¹

  Smoking is cause for concern in the healthcare arena because it can lead to poor surgical outcomes and increased length of time in intensive care, in recovery from surgery, and in hospital.² The economic and psychological costs of increased hospitalization, medical care, and lost productivity are enormous: $3,000.00 annually per smoker, according to CDC statistics.¹ The US Surgeon General’s Report,³ The Health Consequences of Smoking, states, “The evidence is sufficient to infer a causal relationship between smoking and increased risks for adverse surgical outcomes related to wound healing and respiratory complications.”

  Wound healing progresses more slowly in smokers and renders patients more susceptible to infections. Smoking has been found to block immune responses and increase production of free radicals, the main culprits in oxidative stress. This is damaging to every body cell, including skin cells, the active players in wound healing. Thus, maintaining optimal levels of antioxidants (eg, vitamins A, C, E and selenium and carotenoids), as well as other vitamin and minerals, is vital for wound healing. However, smoking depletes nutrients. According to Vardavas et al,⁴ smokers have lower levels of wound healing nutrients, such as vitamin C, carotenoids (eg, a-carotene, betacarotene, and cryptoxanthin), and B vitamins (such as folic acid) than nonsmokers. Plus, the poor eating habits of the average smoker (ie, a diet high in red meat and alcohol and lower in nutrient-rich fruits, vegetables, whole grains, beans, and lean protein) may add to lower serum levels of vital nutrients.⁴ Malnourished or nutrient-deficient patients are susceptible to chronic wounds (regarded as skin defects that last longer than 6 weeks or frequently reoccur). Chronic wounds are in a constant inflammatory state that is further compounded by smoking, which releases inflammatory cells that, over time, can damage healthy cells in the body. Thus, first and foremost, patients who smoke need to be educated as to the benefits of smoking cessation and the tools available to help them quit. In addition, medical nutrition therapy must be a vital component of their on-going healthcare.

Benefits of Smoking Cessation on Wound Healing

  The obvious way to improve wound healing outcomes among smokers is for them to quit. One of the major conclusions of the US Surgeon General’s report is that quitting smoking, regardless of age, has immediate as well as long-term effects. Smoking cessation before and after surgery is ideal for adequate recovery and speedy wound healing.