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Yes, smoking is harmful

Proton pump inhibitors (PPIs), like omeprazole, block acid more effectively, allowing esophageal healing

Aside from inactivity, smoking causes muscle fatiguability on its own by reducing: blood flow to the muscle (reducing transport of oxygen and nutrients) oxygen binding to hemoglobin/ mitochondrial entry (due to carbon monoxide build up) adenosine triphosphate production by muscle mitochondria muscle mitochondrial structural integrity (increasing production of harmful reactive oxygen species within muscle) Maximal muscle strength : In contrast to muscle fatiguability, the effects of smoking on muscle strength are less clear

That said, the research available strongly suggests that tobacco free nicotine pouches carry a much lower risk profile than smoking

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