Take a Long Drag

Is it really worth it …

Smoking kills, or so they say on the packs – so then how come so many people with spinal cord injury and other disabilities do smoke. I’m told that for some, a good smoke can be a rare and simple pleasure – after all so few pleasures are still possible after spinal cord injury – and, they say, it can also help to relieve stress, but at what price to health. There are in fact at least 3 very strong reasons for all people with spinal cord injury not to smoke – and to avoid secondary smoking whenever possible. Firstly, there is now no doubt that smoking causes a build-up of secretions in the chest and destroys the airways, resulting in congestion and making it difficult to exhale and to cough the mucus out of the chest.

Of course able-bodied people can, with a good cough or two, simply clear their chest and get on with life. Unfortunately in people with spinal cord injury the muscles responsible for coughing are weakened or paralyzed and there is already an impaired ability to cough and exhale. This impaired ability to cough can lead to lung collapse, causing secretions to become trapped in the lungs. These secretions can build up and may lead to pneumonia, one of the common causes of sickness and death in people with SCI. Smoking dramatically increases the production of this mucus and accelerates the development of congestion.

So, while people with spinal cord injury are already at a high risk of congestion and infection due to their injury, smoking further increases the danger and places you at even higher risk!

And then you should remember that when we age, both breathing capacity and lung volume also tend to decrease. This is due to a loss of elasticity of the lungs and muscles of the chest wall. These changes decrease the ability to fight off infections. In people with SCI there are additional problems like:

  • A tendency to gain weight easily, leading to breathing difficulties.
  • An inability to engage in much significant exercise that leads to decreased breathing capacity.
  • The development of problems related to poor posture with contractures in the shoulder and a slouched sitting position – which decrease lung volume.
  • The presence of spasticity – which prevents easy movement of the chest and hampers breathing.

All these changes already leave people with spinal cord injury at higher risk for respiratory problems as they age – and smoking not only multiplies the problems but also increases the risks. Poor lung function and an increase in chest infections are not the only smoking related problems that are even worse in spinal cord injury. There is clear evidence that smoking increases the risk of pressure ulcers and delays healing once they do develop – often making surgery necessary, where it previously was not. If you want to maintain healthy skin, you will need to ensure that you have a constant supply of highly oxygenated blood to carry nutrients to the skin and remove waste products from it. Smoking decreases blood flow to the extremities and to the skin by closing up blood vessels and in addition, pollutes the blood stream with carbon monoxide, which severely impairs oxygen from even entering the blood.

This means that not only does smoking cause less blood to get to the skin, but the blood that does get there has far less oxygen. This decrease in the supply of oxygenated blood and nutrients to the skin, as well as the ineffective removal of waste products are a sure fire recipe for pressure ulcers. So, by smoking, even if you are doing excellent pressure care, you may end up dramatically increasing you risk of pressure ulcers. And then once you have developed that pressure ulcer the same poor circulation of inadequately oxygenated blood goes on to slow down healing – and poses one of the most greatest threats to wound healing.

And lastly – smoking is also very clearly associated with an increased risk of bladder cancer. While there already a higher rate of bladder cancer in people with spinal cord injury (3/100 in SCI compared to 1/1000 in the general population), a person with SCI then more than doubles this risk again. So, what is there to take home this time? I am truly sorry if I sound like a Killjoy, but there is absolutely no doubt that while smoking is never a good thing, is spinal cord injury it invariably will undermine you quality of life! If you are a smoker and have a spinal cord injury, take a long good drag and decide if it is really worth it – and then speak to your doctor about giving up today!

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