Respiratory Therapy: The Truth about Smoking

As a Respiratory Therapist, I want to tell you the truth about smoking.

  It is bad for you.

  Ten years of working with end stage lung disease caused by smoking has proven that to me.

  For reasons we don’t completely understand, cigarette smoke affects people differently. Its affects almost certainly include a genetic component, but it is largely about how your body responds to the irritation caused by the smoke.

  When you burn a cigarette, or burn anything for that matter, the chemical processes that release all that heat also create unstable, reactive chemicals that literally burn the tissue.  

  Picture hot acid steam with your arm in it – that’s what your lungs are dealing with.

  Now if your arm just brushes past the steam, you might not get burned. But if you keep sticking it in there, it’s going to get hot.  

  Now think about 20 cigarettes a day for 20 years. The tissue in your lungs is 1/100 the width of a single hair, never mind the full thickness of the skin of your arm!

  It is a single cell membrane that separates the smoke you breathe in from the blood in your arteries. And from there it goes straight to the heart. People think about lung disease, but the chemicals in smoke also burn your heart.

  How differently the smoke affects you is as different as the burn on your arm. Did it get infected? Did you burn it again before it completely healed? Did it form a thick scar?

  Only lung tissue is so extremely thin, it doesn’t usually scar.  

  Instead, the inflammation results in the lung tissue being consumed by the fire. By the time the inflammation settles down, the enzymes used to fight the infection wind up killing lung cells.

  The lung tries to defend itself by producing mucous. If you have classic smokers cough, that is undoubtedly a symptom of this process.

  But you already knew smoking was bad for you. Let me tell you something you probably didn’t know.  

  You can quit smoking.  

  I know, because I’ve been talking to patients who’ve already quit. Over 500 in the last two months and thousands in the last 10 years.

  95% of them tell me they quit Cold Turkey.  They tell me that one day they made a decision to quit, and they did. They may have tried a thousand times in the past, but one time it finally stuck. And when it did, it was for good.

  Now the Drug Company studies say that using Nicotine Replacement Therapy (NRT) doubles your chances of quitting, so I wholly recommend trying it if you’ve been unsuccessful at cold turkey. 

  The patch, inhaler, lozenge or gum can go a long way to helping with the withdrawl from the Nicotine. Plus, if we double your chances of 95%, you’ve got a 180% chance of success!

  But I want you to start by cutting down. As low as possible. Zero is the goal.

  If you want to quit, start by only smoking the cigarettes you need to. You can use NRT to reduce the number of cigarettes you smoke. Contrary to popular belief, it is safe to smoke on the patch.

  Or at least as safe as you can consider smoking to be…

  So, if you can’t quit, I want you to cut down. Although medicine cannot predict how many cigarettes a day are safe for you, we do know that less is better for your lungs.

  So, for your lungs, I want you to at least start thinking about cutting down. It’s not a very big request. At least think about it.

  I’d also like to ask you to start adding deep breathing exercises into your daily schedule.

  Two deep breaths three times an hour. It only takes 10 seconds and can be done in any situation.  

  The trick is remembering to do them.

  When I first learned about these exercises, I had to set the timer on my watch. I had it go off every 23 minutes, so my brain could not predict when it was going to happen. This speeds the training process: eventually, you want to spontaneously do your deep breathing exercises throughout the day without needing the reminder.

  Now, I couldn’t have my watch beeping all day at the hospital, so I only do this on the weekends. Maybe only evenings will work for you. Or maybe you’ll use the ringing phone as your reminder – but how will you remember when the phone rings?

  Like everything in life, doing is the key. If you don’t do it, you won’t get the benefits.

  The benefits of this exercise are stronger lungs and a more focussed mind.

  The second key to deep breathing exercises is focussing the mind. What we are doing is creating a neural “anchor” in the brain – an anchor to a pathway that will lead to the pattern of behaviour we wish. In this case, a deep breath.

  If you’ve never read the Power of Now, it is about taking control of the present moment. We cannot affect the past, and the future is not here yet. All we have is the now.

  Simple concept, but difficult to do anything with.  


  Now what?

  That’s where the deep breathing exercises come in.

  Start with your diaphragm, the big muscle stretching across your lower ribcage to your back. It is the powerhouse of breathing. As it pulls the lungs down, it pushes the belly out. Start your breath by making your belly go out as far as you can and then finish by filling up the top of your lungs.

  Then with a quiet sigh, breathe out to empty, seeing how far you can comfortably force the air out, this time contracting your belly muscles in tight.

  Wherever you are, try this several times. Slow deep breath in to full, then feel the breath empty from your lungs.  

  If you have Chronic Obstructive Pulmonary Disease (COPD), the breath out is especially important as the “obstruction” is because the damaged airways have trouble letting the air out.

  Now that you’ve got the feel for it (don’t worry, it gets more natural with time), I want you to add in the mental component. The Here and Now, so to speak.

  With the breath in, hear yourself saying in your mind “Breathing in”.  With the breath out, “Breathing Out”.  This overrides the mental chatter in our mind and helps the us to focus on the breath.  

  If you don’t involve your mind, you are wasting your time.

  Breathing in. Breathing out. Breathing in. Breathing out. Slow. Controlled. Focussed, but relaxed. There is nothing stressful about this, use this as an anchor in your mind to calmness.

  The trick is to practice. Do the exact same thing each and every time, only next time, do it even better and with more focus. Thousands of repetitions are required before the anchor is set – likely several weeks of practice. The idea is to do the exercise so many times that we create a chain from the anchor to our destination.

  With the brain, the more times you do something, the stronger those pathways become. We want to strengthen the pathways to a healthy mind, because only then can we have a healthy body.

  Next article, I will give you the second half of the breathing exercise. I hope you will have practised, because it will make adding the second half much more powerful.

Chris Semrick, B.Sc, RRT, CRE is a Registered Respiratory Therapist, Certified Respiratory Educator and a Smoking Cessation Counselor.