Some of the effects of smoking on divers are, like most other consequences, chronic the result from long-term use. Various chemicals primarily tar from inhaled smoke cause chronic irritation of the bronchi, resulting in chronic bronchitis. The tar also destroys tiny hairlike structures called cilia that line much of the respiratory tract. Cilia are important because they conduct mucus from the lungs up and out of the airway. When they no longer function, the effect is retention of mucus and partial clogging of the airway, causing the classic symptom of smokers cough. But theres a far greater effect on divers than an irritating cough.
Various poisons in the smoke also eventually destroy alveolar walls, which produces cavities in the lungs. The result of this process, excluding death, is a condition called emphysema. This form of emphysema, however, is unrelated to the disorder divers get from lung overexpansion injury. But noted diving medical authority Dr. Ernest Campbell said Obstruction in the terminal airways and the emphysema thats caused can and does produce air-filled dilations that can markedly increase your chances of pulmonary barotrauma and arterial gas embolism.
Perhaps the most significant effect of smoking occurs long before any sign of emphysema, and it involves the restriction of air flow in the lungs. Smoking causes mucus retention and reduced alveolar flexibility that can easily cause air trapping deep within the lungs. Or, as Campbell puts it, Smoking also causes an increase in bronchial mucous production with a concomitant paralysis of the cilia. Mucous plugs then become dangerous to the diver, setting the stage for air-filled sacs that lead to rupture upon ascent. The result could be, and has been, pulmonary barotrauma in smoking divers who were breathing normally. So, assurance of safety from the first rule of scuba diving always breathe normally doesnt necessarily apply to smokers.
Some of the chemicals in inhaled smoke do not remain in the lungs, but pass into the bloodstream. Their effect is to cause spasm and otherwise damage the walls of blood vessels. Damage is noted particularly in vessels supplying the heart, and thus is one of the reasons smokers are so prone to heart attacks. Other effects include stroke and various forms of peripheral circulatory disorders.