Smoking and vaping are still widely seen in Malaysia as a lung problem, the cause of a nagging cough or perhaps cancer decades later. Doctors on the frontline of respiratory and emergency medicine say the damage runs far deeper, reaching the heart, brain and kidneys long before symptoms appear.
According to the Ministry of Health’s National Health and Morbidity Survey (NHMS) 2023, about one in five Malaysian adults (19%) uses tobacco products, while e-cigarette use is climbing sharply among those aged 15 to 24. Smoking and vaping both fuel a growing burden of non-communicable diseases, from heart attacks and strokes to kidney failure and chronic lung disease.
Why Smoking and Vaping Are a Whole-Body Problem
Dr Syed Ajmal Bin Syed Ali, Consultant Physician, Respiratory Physician and Interventional Pulmonologist at Sunway Medical Centre, Sunway City (SMC), calls smoking a systemic disease, not a single-organ problem.
“When you inhale a cigarette or a vape, more than 7,000 chemicals can enter the bloodstream and travel throughout the entire body. The lungs are just where the story begins,” he says.
The chemicals from smoking and vaping damage the lining of blood vessels and trigger atherosclerosis, the hardening of arteries that raises the risk of heart attack and stroke. Smoking makes blood clot more easily, while carbon monoxide displaces oxygen, starving the heart and brain.
It also speeds up kidney damage, weakens immunity and drives chronic inflammation, according to the US National Heart, Lung, and Blood Institute.
Chronic Obstructive Pulmonary Disease (COPD), a progressive and irreversible lung condition, was once seen as a disease of the elderly. Not anymore.
“If you start at 15 or 16, by the time you are 35, you have nearly two decades of cumulative damage. The harm is there, it just has not yet shown up on a scan. That is not reassurance, that is a warning,” Dr Syed Ajmal says.
From Clinic to Crisis in the Emergency Room
Dr Ian Tey Zhe Yuan, Emergency Medicine Physician at SMC, sees the consequences first-hand. In patients arriving with heart disease or stroke, smoking often sits in the history alongside diabetes, hypertension and family history.
“It is one of the biggest risk factors in the room. And unlike age or genetics, smoking habits are the only factor a patient can change,” he says.
He most often links smoking to heart attacks, severe COPD episodes, acute asthma, pneumonia and acute limb ischaemia, and these patients are getting younger.
“Being young no longer gives you a free pass,” Dr Ian says. National Cardiovascular Disease Database (NCVD) figures show acute coronary syndrome rates among patients under 45 are rising, with smoking a key independent risk factor.
The Vaping Illusion
Many young Malaysians have turned to vapes or heated tobacco products, believing them to be safer. Both doctors say they are not.
“With heated tobacco, you are still inhaling carcinogens, the amount may be lower, but it accumulates. With vaping, we may not understand the full damage for another 10 to 20 years,” says Dr Syed Ajmal.
Vape liquids contain chemicals that can turn carcinogenic when heated, and nicotine levels may exceed those in cigarettes, deepening dependency among young users.
“There is no safe amount of smoking and vaping. The body does not make that distinction,” says Dr Ian.
Quitting Smoking and Vaping: It Is Never Too Late
Quitting smoking and vaping pays off, however long the habit has lasted. Within 24 hours, carbon monoxide clears and oxygen delivery improves. Within weeks, circulation strengthens. Within a year, heart attack risk falls by about 50%, and within five years, stroke risk drops significantly.
Willpower alone is rarely enough to give up smoking and vaping, as nicotine creates real physical dependency. Nicotine replacement therapy, prescription medication and structured quit programmes improve success rates, with support available from the Ministry of Health, clinics and some pharmacies.
For those over 50 with a significant smoking history, Dr Syed Ajmal recommends annual low-dose CT (LDCT) lung cancer screening. “Even if you quit years ago, screening matters,” he says, as catching lung cancer early may change the outlook. Readers can also check which free health screening programmes in Malaysia they qualify for.
Dr Ian sums it up: “Smoking is not just a lung habit. It is a whole-body risk. The good news is that stopping, today and not someday, is one of the most powerful things a person can do for their health.”
