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Study: Smoking cessation could benefit chronic wound patients


COLUMBUS, Ohio — While smokers are likely to hear dozens of reasons why they should quit, a new study is showing that there is a major health issue that healthcare providers may not be discussing: chronic wounds.


Affecting 6.5 million people in the United States, non-healing wounds such as pressure ulcers, venous leg ulcers and diabetic foot ulcers cost the healthcare system more than $25 billion dollars a year.


Yet according to a recently published study from Jodi McDaniel and Kristine Browning, researchers from The Ohio State University College of Nursing, the correlation between smoking and wound problems are rarely discussed during the often frequent doctor visits that chronic wound patients have.


“Despite the evidence that cigarette smoking negatively impacts wound healing on multiple levels, it’s just not something that is typically mentioned in a patient visit,” McDaniel said. “While evidence based guidelines for both chronic wound care and smoking cessation exist, they aren’t being implemented together. We think this could be having profound effects on clinical outcomes, and ultimately, patient’s quality of life.”


While chronic wounds vary in type, they share common characteristics of inflammation and reduced blood flow that make them particularly susceptible to the approximately 4,000 toxic chemicals found in cigarette smoke.


“The deep skin wrinkling associated with chronic smoking is caused by chemicals that impact the production of collagen, a protein that is also critical to the wound repair process,” McDaniel said. “Chemicals like carbon monoxide also reduce blood flow to the wound and prevent skin’s natural anti-inflammatory and anti-bacterial mechanisms – so it’s a perfect chemical storm which makes wounds more likely to get infected, and less likely to heal.”


One of the study authors, McDaniel — who received pilot funding from The Ohio State University Center for Clinical and Translational Science to conduct the research — says that it takes just one cigarette to reduce blood and oxygen flow to tissues, and that a pack a day habit results in significant and prolonged oxygen deprivation to tissues.


The nurse scientists point out that these data alone, coupled with the vast financial, social and clinical impact of chronic wounds, should make smoking cessation a priority topic during clinical visits.


“There are people with non-healing wounds living with chronic pain or needing amputations,” Browning said. “It’s stunning that more attention hasn’t been paid to this issue.”


While nicotine is one of the chemicals in cigarettes that has been connected with reduced blood flow, McDaniel noted that studies looking at the use of nicotine replacement drugs, used by millions to help kick the habit, don’t appear to have the same impact on tissue as when the chemical is inhaled through smoke.


“It’s possible that nicotine’s vasoconstrictive properties are amplified when it’s paired with substances in cigarette smoke like carbon monoxide and cyanide,” said McDaniel. “So we still think that nicotine replacement drug therapy has a vital role in cessation treatment.”


The study was also funded by a grant from the National Institute of Nursing Research.

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