One Puff, Many Scars: A Journey Inside Smoker's Lungs

India Today

6 days ago

(This article has been critically reviewed by medical experts - Dr. Radhika Banka, Consultant, Respiratory Physician, P. D. Hinduja Hospital & Medical Research Centre, and Dr Vibhu Kawatra, Pulmonologist Paediatrician and Allergy Specialist, New Delhi) Take a deep breath. Now imagine that same breath filled with invisible toxins — chemicals you can't see, but ones that start damaging your lungs from the very first inhale. One breath at a time, the harm begins. India is now home to over 100 million adult smokers — one of the highest in the world. And the consequences are catching up with us. Lung cancer, which is directly linked to tobacco use, has emerged as the leading cause of cancer-related deaths globally — and India is no exception.
From quick chai breaks and shared suttas (cigarettes) outside college canteens and office buildings to the deeply rooted social habit of smoking beedis in rural corners of the country, tobacco use has long been woven into the everyday fabric of Indian life.
But behind this casual culture of smoking lies a health crisis we've largely ignored.
Despite the growing awareness of risks associated with tobacco, smoking is still socially accepted and alarmingly common across age groups and geographies.
From the affordable beedi in the village to premium cigarettes in metro cities, access to tobacco is easy, and quitting remains difficult.
This chai-sutta culture might seem harmless, even nostalgic to some. But beneath the smoke lies a deadly truth — one that India can no longer afford to ignore. THE FIRST SMOKE
Credit: Generative AI
The moment you take a puff or are exposed to passive smoking — you're drawing in more than just smoke. You're inhaling a toxic cocktail of chemicals such as tar, carbon monoxide, ammonia, and formaldehyde.
These particles enter your airways and irritate the lining of your lungs, setting off a chain reaction of inflammation and tissue stress.
Even a single inhalation can cause airways to swell and produce excess mucus. With regular exposure, this becomes a chronic condition, paving the way for long-term and irreversible respiratory damage. HEALTHY LUNGS VS. SMOKERS' LUNGS
Healthy lungs are pink, spongy, and elastic. They expand freely, drawing in oxygen and releasing carbon dioxide efficiently. Cilia and alveoli work together to keep the lungs clean and functioning.
In contrast, smokers' lungs are darkened, stiff, and scarred. Tar and chemicals blacken the tissue, and the lungs gradually lose their flexibility. This reduces their ability to absorb oxygen, making every breath less effective over time.
When one smokes, these alveolar sacs are damaged, and instead of remaining a grape-like structure, they change to the form of a balloon. This impairs gas exchange and leads to increased breathlessness. DISEASES LINKED TO SMOKING
Smoking significantly increases the risk of over 60 serious illnesses. Key among them are:
Chronic Obstructive Pulmonary Disease (COPD): Lungs lose elasticity, trapping air and making exhalation difficult. Studies show that smoking is often responsible for 9 out of 10 cases of COPD. It pertains to the lining of the lungs and the airways. It swells the air tubes and destroys the air sacs.
Lung cancer: Caused by DNA mutations in lung cells from prolonged exposure to toxic chemicals.
What's more concerning is that lung cancer often goes undetected until it's too late. By the time symptoms like chronic cough or chest pain appear, the disease is often in an advanced stage, leaving limited treatment options.
And while there are public campaigns and warnings, they are no match for the addictive nature of nicotine and the cultural normalisation of the chai-sutta ritual.
Heart disease: Smoke narrows blood vessels, increases blood pressure, and reduces oxygen supply to the heart.
Stroke and vascular issues: Smoking thickens the blood and promotes artery blockages, raising the risk of brain and circulatory damage. IMPACT ON LUNG CELLS (MICROSCOPIC DAMAGE)
Your lungs are lined with millions of alveoli, these are tiny air sacs that enable oxygen to enter the bloodstream and carbon dioxide to be expelled.
Cigarette smoke destroys these alveoli, causing inflammation, rupture, and scarring. Once damaged, alveoli do not regenerate.
The cilia, tiny hair-like structures responsible for sweeping out dust and microbes, are also paralysed or destroyed, leaving the lungs vulnerable to infection and buildup of harmful substances.
Lung function tests or spirometry objectively measure lung capacity. Smoking can cause limitations on spirometry, known as airflow obstruction, which can be easily picked up. WHAT YEARS OF SMOKING LOOKS LIKE
Smoking damage is not always immediate — but it is cumulative. After 1 year: Chronic cough and noticeable shortness of breath may develop. Regular smokers are also at the risk of COPD depending on the frequency of smoking as well as the kind of smoke. Experts warn that Beedi is more lethal than cigarettes. Hookah without a filter is the worst for your lung health.
After 5 years: Risk of stroke and heart attack rises significantly.
After 10–20 years: The risk of lung cancer and COPD is dramatically higher. Lung capacity may be less than 50% of its original function.
Even if symptoms aren't felt early on, the internal damage builds with every puff.
As smoking-related diseases rise, India seems to be staring at a mounting public health burden. And data paints a grim picture.
In India, the incidence of cancer cases is likely to increase from 1.46 million in 2022 to 1.57 million in 2025, according to the Indian Council of Medical Research (ICMR). CAN LUNGS RECOVER?
The good news: Yes, your lungs can recover — to a point.
Within days of quitting, oxygen levels in the blood begin to improve.
After a few weeks, cilia start to repair themselves, helping to clear mucus and reduce infections.
Over months and years, lung function improves, and the risk of cancer and cardiovascular disease declines.
Statistically, smoking can cut your life short by 10 to 15 years. But if you stop smoking by age 30, you can get back almost all of those years.
Just one year after quitting, your chance of having a heart attack drops by half. After four years, your heart health becomes as good as someone who never smoked.
If you stay away from smoking for five years, your risk of getting smoking-related cancer drops by 50%, according to the US Centers for Disease Control and Prevention (CDC). After 15 years of quitting, your cancer risk becomes the same as that of a person who has never smoked.
However, scar tissue and destroyed alveoli do not regenerate.
Lifestyle improvement will result in instantaneous improvement in symptoms of cough and breathlessness.
A sustained improvement in lifestyle may eventually show improvement in lung function, but typically damage to the lung secondary to smoking is usually irreversible.
In short, the longer you smoke, the harder it is for your lungs to heal completely.
Early intervention is key.
Photo credits: Adobe Stock, Getty Images, Generative AI
Glossary of Terms
Spirometer: It is a medical device used to measure how well your lungs are working.
COPD: Short for chronic obstructive pulmonary disease. It is a progressive long-term lung disorder.
Alveoli: These are tiny balloon-like air sacs in our lungs where the exchange of oxygen and carbon dioxide take place.
Cilia: Tiny hair-like structures responsible for sweeping out dust and microbes.