Cachar Cancer Hospital and Research Centre


Polycyclic aromatic hydrocarbon, N-nitrosamines, Naphthylamine, 1,3-Butadiene, Benzene, Aldehydes, and Ethylene oxide. What seems like a throwback to our elementary chemistry lessons, are actually what you inhale, with every puff of cigarette smoke. And these are only a few honourable mentions, out of over 70 known carcinogens in tobacco smoke. Let us further delve into this flurry of smoke.

Tobacco smoking is a known precursor to some of the most devastating diseases in the world. There are over 1.3 billion smokers worldwide. These figures correspond to a number that is larger than the second-most populous country in the world! With such alarming statistics, it is no wonder that tobacco smoking is associated with over 17 classes of cancer and innumerable systemic diseases.

For the reasons above, it goes without saying that identifying the deleterious effects of smoking and ending this vicious habit is pertinent in reducing the mortality and morbidity that eventually ensues.

Psychopharmacology of cigarette smoking and addiction

A cigarette contains tobacco, which when burnt generates smoke particles carrying Nicotine. These make their way into the blood and subsequently the brain in just a matter of seconds. In the brain, complex reactions ensue, leading to the release of a neurotransmitter called Dopamine. Dopamine is the incriminating substance that makes smoking a pleasurable and addictive experience, often called a “Feel good hormone”. As a result, the brain associates this act of smoking with a euphoric feeling and plays it on loop. This explains why it is so hard for daily smokers and non-daily smokers alike to quit smoking.

Understanding the behaviour of smoking

This feeling of elation has paved the way to a high frequency of cigarette use among smokers. With these insurmountable amounts of nicotine, the neural circuitry gets acclimatised and perceives it as “the new normal”, causing the smoker to lapse into an addictive pattern.
In the event of abstinence for a few hours, nicotine concentrations fall in the blood. The smoker then goes into a frenzy of agitation and unease called ‘’Nicotine hunger’’. This is his body’s cue to restore the elevated levels of nicotine to which he had newly become accustomed. Now we understand the need for early initiation of smoking among chronic users as soon as one awakens in the morning. In fact, studies show that the time between waking up and taking the first drag of a cigarette is a good predictor to assess one’s chance at overcoming Nicotine addiction. This way, ‘’Nicotine Hunger’’ and ‘’Cue-driven smoking’’ are the propelling mechanisms behind smoking addiction.

Foremost outcomes of tobacco smoking

The effects of tobacco smoke are directly proportional to the duration of smoking. The cocktail of carcinogens and free radicals in tobacco smoke results in DNA damage, oxidative stress and inflammatory reactions. These pathogenic processes are the segue to conditions such as:

  • Cancer of the upper airways, lungs, bladder and kidneys
  • Coronary artery disease like Angina (Chest pain) and Myocardial infarction (heart attack)
  • Respiratory diseases such as COPD (Chronic Obstructive Pulmonary Disease) leads to remodelling of the lung tissue along with structural changes causing breathing difficulty, productive cough and wheezing
  • Peripheral arterial diseases (PAD) like Buerger’s disease are primarily caused by smoking. It presents with tingling of the feet and arms, pain, eventual discolouration, infection and gangrene of the affected area
  • Alzheimer’s disease and vascular dementia
  • Reproductive health- It is known to cause decreased sperm count and impotence in men. In women, smoking disrupts the normal menstrual cycle and poses a deleterious threat to their ovarian reserve. It is also associated with miscarriage in pregnant women
  • Teratogenic effects- Smoking in pregnant women can lead to undescended testis in the newborn, low birth weight, and respiratory diseases. It is also known to cause sudden death of the infant (known as Sudden Infant Death Syndrome SIDS)
  • Other diseases like osteoporosis in postmenopausal women, peptic ulcer disease, Rheumatoid arthritis.

Factors responsible for Smoking initiation

Unfortunately, low socioeconomic status is the encouraging factor behind the early initiation of smoking. It is most prevalent in lower and lower-middle-income countries. Lack of awareness has further propagated this issue.
Research has shown that individuals having friends, family or counterparts who smoke, exponentially increases their chances of smoking initiation due to the close-knit social structure and peer pressure. In actuality, smoking initiation and addiction has a heritable nature that can be passed onto future generations which can have huge ramifications on their journey towards smoking cessation. Other stand-alone mentions are consumption of alcohol, weak orientation towards academics and vulnerable mental health.
The only question that should daunt a smoker is, how many puffs are too many? Well, the answer is even one puff is too many. They say that awareness is the first step towards change. Having empowered you with scientific and evidence-based medicinal facts, we hope you agree that with every drag, you are smoking your life away.

Authored by:

Dr Shivakumar A


Dr Pranathi G


West R. Tobacco smoking: Health impact, prevalence, correlates and interventions. Psychol Health. 2017;32(8):1018-1036. doi:10.1080/08870446.2017.1325890

Adams TN, Morris J. Smoking. [Updated 2021 Feb 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from:

Benowitz NL. Pharmacology of nicotine: addiction, smoking-induced disease, and therapeutics. Annu Rev Pharmacol Toxicol. 2009;49:57-71. doi:10.1146/annurev.pharmtox.48.113006.094742

Onor IO, Stirling DL, Williams SR, et al. Clinical Effects of Cigarette Smoking: Epidemiologic Impact and Review of Pharmacotherapy Options. Int J Environ Res Public Health. 2017;14(10):1147. Published 2017 Sep 28. doi:10.3390/ijerph14101147