The problem most commonly associated with smoking is lung cancer, but tobacco is hugely damaging to health in many other, and often surprising ways, from the very first puff.

Immediately upon inhaling cigarette smoke, carbon monoxide binds to haemoglobin in the bloodstream instead of oxygen. This means that the body’s cells are starved of the oxygen they require and is part of the reason why smokers get more breathless when they exercise. During pregnancy, smoking can deprive a baby of oxygen, so if a woman smokes while she is pregnant, her baby may be born below its expected birthweight.

To compensate for the lack of oxygen, the heart rate increases, as does blood pressure. However, blood flow to the extremities (the hands and feet) is reduced, making the person feel cold. At the same time, the brain and the nervous system are stimulated, which can create a jittery feeling.

Smoking also affects the cilia – tiny hair-like structures in the trachea and bronchi – making them unable to perform their usual function of moving mucus and other particles up and away from the lungs. This puts the smoker at a higher than usual risk of respiratory infections and can cause a cough to develop as the body tries to clear the chest of unwanted substances by an alternative mechanism.

Other immediate effects of smoking include:

• A reduction in the sense of taste and smell
• A detrimental impact on the complexion
• Yellow staining of the fingers and teeth
• Bad breath.