A chronic wound is not an isolated problem, but is often a symptom of chronic diseases that occur due to genetics and lifestyle choices. Although genetic makeup is not a modifiable factor, lifestyle choices are. Specifically, tobacco use is a choice that can significantly impair wound healing. However, there is good news for those patients who use tobacco products and suffer from chronic wounds. By giving up tobacco use, one can significantly improve wound healing and reduce overall wound care expenses.
American culture tends to emphasize smoking cessation and the dangers of tobacco use in public school education and medical practices, yet according to the CDC (2022) about 30.8 million American adults still pursue habitual tobacco use. Furthermore, smoke exposure through second-hand smoke reaches a broader range of Americans with 41,000 deaths annually among non-smoking adults (CDC, 2022).
Smoking increases overall mortality risk and negative health outcomes. Specifically, with wound care, the effects can be detrimental to wound healing. Smoking negatively impacts wound healing by impairing the immune system and reducing blood flow in the skin required for healing. Blood circulation delivers oxygen and nutrients to the cells, promoting the closure of wounds. Nicotine causes vasoconstriction which is the narrowing of blood vessels. Vasoconstriction reduces the perfusion of the wound bed and can delay tissue growth, thus delaying healing.
The immune system is also impaired with nicotine use because white blood cells depend on normal oxygen levels in order to kill bacteria. By lowering tissue oxygen levels increasing risk of infection, which can lead to abscess formation, wound treatment failure, limb amputation, and even premature mortality. Delivery of nutrients to the wound bed is also decreased with tobacco. Nutrients like Vitamin C are a vital component needed in wound healing along with Vitamins A, D, and zinc.
Through nicotine exposure, whether from cigarette smoking, vaping, smokeless tobacco, or even nicotine gum, the overall process of wound healing is hindered, thus increasing the physical and financial demands on the patient. Delayed wound healing can increase doctor visit frequency, loss of wages, use of wound care products, prescriptions, and financial burden needed to address the open wound. The risk of continuing tobacco use can be detrimental to overall health.
The great news is that a 2016 study showed patients who stopped smoking for eight hours had oxygen levels normalize in the bloodstream. The same study showed that after 24 hours of smoking cessation, nerve endings started to recover. After two weeks, blood flow improved and helped increase mobility. The dangers of smoking to wound healing and overall health far outweigh the challenges of smoking cessation. Resources are available to assist with smoking cessation. Chronic wounds are challenging to heal, but smoking cessation can expedite the healing process.