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Ask the Doctor: Smoking and Spinal Cord Injury

By Sam Ho, MD, Spinal Cord Injury Program Medical Director

Why is it important to stop smoking after I have a spinal cord injury?

After a spinal cord injury, your body is doing all it can to heal. If you smoke, you’re not giving yourself every possible opportunity for optimal recovery. Surgeons have documented that smoking interferes with your body’s healing efforts. Smoking produces carbon monoxide, which diminishes the amount of oxygen in the bloodstream used to nourish tissues and power muscles. This decreased concentration of oxygen in the blood is the greatest threat to healing.

Depending on the level of your spinal cord injury, your respiratory system may be gravely compromised. Muscle function that helps with breathing and coughing is sometimes impaired, or it might be absent altogether. Individuals with spinal cord injury, and especially those with higher-level injuries, are at greater risk for increased congestion and respiratory infections. If you add smoking to that risk, spinal cord injury survivors significantly increase their odds of acquiring a serious upper respiratory infection.

Why are smokers with spinal cord injuries at higher risk for heart disease, cancer, and other health problems?

Research that links smoking and various health problems grows stronger by the day. People with spinal cord injury have many factors working against them as it is. Immobility and inactivity associated with spinal cord injury contributes to loss of muscle mass due to atrophy below the level of spinal cord injury, increased fat to muscle ratio, weight gain, poor circulation, and difficulty maintaining cardiovascular, or aerobic fitness. Smoking, and all the health problems resulting from it, puts the health of individuals with spinal cord injury in greater jeopardy.

Specifically, studies show those with spinal cord injury who are less fit on cardiovascular tests are more likely to be insulin resistant. The condition affects the body’s ability to use blood sugar normally, and can lead to metabolic and blood pressure abnormalities. Smoking further constricts blood vessels, making it harder for blood, oxygen, and nutrients to flow to the body’s organs and tissues, causing infections and diseases and increasing the likelihood of developing pressure sores.

Additionally, the risk for bladder cancer is higher among spinal cord injury survivors who use indwelling catheters. This risk also increases with smoking because cancer-causing agents may be carried in the urine.

Besides smoking, what other factors contribute to breathing and respiratory problems among those with spinal cord injury?

As we age, we all lose elasticity in our lungs and in the muscles of the chest wall. These changes decrease both breathing capacity and lung volume, making it harder for the body to fight off infections. With spinal cord injury there are other potential concerns:

  • Increased weight, which usually makes breathing more difficult
  • General decrease in exercise leading to decreased breathing capacity
  • Smaller lung capacity due to posture problems, such as rounded shoulders or slouching
  • A change in the type, or severity of spasticity that affects the chest or breathing muscles
  • Increased number and severity of respiratory infections due to diminished ability to cough

All these changes place spinal cord injury survivors at a higher risk for respiratory problems as they age. Smoking not only multiplies the problems, but also increases the risks.

How does smoking affect the respiratory system of a spinal cord injured person?

With spinal cord injury, and especially those with spinal cord injury who smoke, getting air out of the lungs can sometimes be even more important than getting air in. A build up of mucus, and various secretions in the lungs can lead to problems. Smoking increases the production of mucus, and contributes to congestion. Normally, these secretions are coughed out. However, the muscles responsible for coughing are affected by cervical injuries and, to a varying degree, by thoracic injuries.

An impaired ability to cough frequently leads to atelectasis, a collapse of the honeycomb-like air sacs that often causes secretions to become trapped in the lungs. These secretions build up and may lead to pneumonia, one the most common causes of both sickness and death in those with spinal cord injury.

How does smoking contribute to the development of pressure sores?

According to the Spinal Injury Resource Center, studies link smoking to an increased incidence of pressure sores, as well as longer healing time for both sores and the skin surgery that is sometimes necessary to repair them.

Research shows that healthy skin needs good circulation of highly-oxygenated blood to carry nutrients and remove waste products. Smoking and nicotine cause decreased blood flow to the extremities. Smoking also produces carbon monoxide which severely impairs oxygen from even entering the blood. In other words, not only does smoking cause less blood to get to skin cells, but the blood that does get there has far less oxygen.

A decrease of oxygenated blood and nutrients to the skin, as well as insufficient removal of waste products, leads to skin breakdown and the development of pressure sores. Once skin sores develop, this same impaired circulation with less oxygenated blood slows the healing process. In fact, this decreased concentration of oxygen in blood is the greatest threat to wound healing.

Other than not smoking or using tobacco, what are some strategies to stay healthy?

Health strategies for people with spinal cord injuries are the same as for those without an injury: eat a sensible diet, avoid excessive alcohol use, maintain a healthy weight, and exercise regularly. If you’d like to stop smoking, but need help, be sure to talk to your health care provider or call Amy Arends, our Spinal Cord Injury Program Nurse Care Coordinator, at 616.242.9216 or 800.528.8989.

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