Topics

Intro
Cigarette Smoke
Nicotine
Carbon Monoxide
Other Substances
Smoke and Bone
Bone Healing
Wound Healing
Osteonecrosis
Lower Back Pain
Arthritis
Dupuytrens
RSD (CRPS)
Summary
Bibliography

Carbon Monoxide

Incomplete combustion of paper and tobacco results in the production of carbon monoxide. This toxic gas has an affinity for hemoglobin which is 200 times greater than oxygen and binds preferentially with the hemoglobin molecule to form carboxyhemoglobin. The creation of carboxyhemoglobin instead of oxyhemoglobin has two major effects. First, the amount of oxyhemoglobin available for oxygen transport is reduced. Second, the oxygen dissociation curve shifts leftward, so that available oxygen is less able to dissociate from hemoglobin. The end result is tissue hypoxia.77 82

Cigarette smoke contains 2 to 6 percent carbon monoxide. During active smoking, as much as 2 to 15 percent of hemoglobin is converted to carboxyhemoglobin with an average of 5 percent among smokers.44 This results in chronic tissue hypoxia which is entirely unrelated to the presence or absence of nicotine in the cigarette.

Chronic exposure to carbon monoxide also results in polycythemia which contributes to the increase in blood viscosity caused by nicotine.9 Like nicotine, carbon monoxide increases platelet aggregation22 74 and further elevates fibrinogen levels.70 These qualities also contribute to increased blood viscosity and eventually to microvascular clotting.38 70

Jensen and Goodson have demonstrated that smoking for 10 minutes results in a reduction of tissue oxygen tension for 1 hour. An individual who smokes one pack of cigarettes per day is tissue hypoxic for 15 to 20 hours each day.52