What Does Smoking-Related Vascular Disease Refer To?
Smoking-related vascular disease refers to the range of vascular changes caused by long-term exposure to the constituents of tobacco smoke.
Nicotine, carbon monoxide and the hundreds of toxic substances inhaled by smokers affect the vascular endothelium through multiple mechanisms. They cause vasoconstriction, accelerate the atherosclerotic process, increase the tendency towards thrombosis and impair microcirculation.
Buerger’s disease, also known as thromboangiitis obliterans, is the most characteristic form of smoking-related vascular disease. It is an inflammatory thrombotic disorder affecting the small and medium-sized blood vessels of the limbs, primarily in younger smokers.
It typically presents with intermittent claudication, ischaemic ulcers of the fingers or toes and, in advanced cases, gangrene. Patients commonly report severe pain, cold extremities and numbness, symptoms that worsen considerably if smoking continues.
Characteristics of Smoking-Related Vascular Disease
The defining characteristic of smoking-related vascular disease is its direct and, at least to some extent, reversible association with continued smoking or smoking cessation.
Unlike atherosclerotic vascular disease, Buerger’s disease may stabilize and, in many cases, improve following complete smoking cessation. However, tissue changes that have already occurred still require effective treatment.
At the level of the microcirculation, chronic exposure to carbon monoxide is particularly harmful. Carbon monoxide binds to haemoglobin with a much greater affinity than oxygen, substantially reducing the blood’s oxygen-carrying capacity. As a result, smokers experience chronic systemic hypoxia even when they appear to be in otherwise good clinical condition.
Scientific Literature on the Use of Hyperbaric Oxygen Therapy
The scientific literature on the use of hyperbaric oxygen therapy in smoking-related vascular disease focuses primarily on Buerger’s disease and its ischaemic complications.
Studies have reported improvements in transcutaneous oxygen pressure (TcPO₂), reductions in ischaemic pain and healing of digital ulcers in patients who received hyperbaric oxygen therapy alongside conventional treatment and smoking cessation.
Of particular importance is the ability of hyperbaric oxygen therapy to reverse the binding of carbon monoxide to haemoglobin. Under hyperbaric conditions, the elimination of carbon monoxide is markedly accelerated, helping to restore normal oxygen transport in the blood.
The Role of Hyperbaric Oxygen Therapy
In smoking-related vascular disease, hyperbaric oxygen therapy is always used as an adjunctive treatment. Smoking cessation remains the fundamental and irreplaceable intervention. Without it, the effectiveness of any treatment is substantially limited.
Once smoking has ceased, hyperbaric oxygen therapy may provide valuable biological support. It helps correct local hypoxia in ischaemic limbs, stimulates neovascularisation to improve the microcirculation, exerts an anti-inflammatory effect on the affected vessels and supports the healing of ischaemic ulcers.
In patients with Buerger’s disease who are at risk of amputation, the combination of smoking cessation and hyperbaric oxygen therapy may play a decisive role in limb preservation.
A typical treatment course consists of 20 to 40 sessions.