By Dr Sandeepa, Consultant Transplant Pulmonologist, BGS Gleneagles Global Hospitals, Bengaluru
New Delhi, July 23, 2018: Tobacco addiction is a global epidemic that is ravaging the countries and regions that can least afford its toll of disability, disease, lost productivity and death. There are more than 1 billion smokers worldwide, the majority of whom live in low- and middle-income countries. Cigarette smoking and exposure to secondhand smoke together are responsible for about 6.3 million annual deaths worldwide and 6.3% of the global burden of disease. A lifelong smoker has about a one in three chance of dying prematurely from a complication of smoking. Life expectancy is shortened by more than 10 years among current smokers. Cigarettes, bidis, pipes and cigars are the various forms of inhaled tobacco, whereas tobacco is also used as snuffs and in chewing form.
Tobacco smoke is an aerosol of droplets containing water, nicotine and other alkaloids, and tar. Cigarette smoke is composed of 4,000 substances, including nicotine, chemical poisons, toxic gases, small particles and carcinogens. The nicotine present in tobacco leaves is highly addictive but has little toxicity on the respiratory tract. Thus, people smoke for the psychoactive effects of nicotine, but die from the high toxicity of the other components present in smoke.
Tobacco use is a major cause of morbidity and death from cancer (Lung, Larynx, Oral cavity, Pharynx, Esophagus, Pancreas, Nasal cavity, Stomach), Cardiovascular disease (Acute myocardial infarction, Unstable angina, Stroke, Peripheral arterial occlusive disease, Aortic aneurysm) and pulmonary disease (Lung cancer, Chronic bronchitis, Emphysema, Asthma). Smoking is also a major risk factor for Peptic ulcer, esophageal reflux, oral diseases, osteoporosis, reproductive disorders, and fire-related and trauma-related injuries. Smoking, the largest preventable cause of cancer is responsible for about 30% of cancer deaths. Many chemicals in tobacco smoke may contribute to carcinogenesis. The risk for lung and other cancers is proportional to the number of cigarettes smoked per day and the duration of smoking. Pulmonary disease from smoking includes chronic bronchitis (cough and mucus secretion), emphysema, and airway obstruction. Smoking also increases the risk for respiratory infections. Cigarette smoking has been associated with multiple non-neoplastic pulmonary disorders other than emphysema and chronic bronchitis like RB-ILD, DIP, and LCH etc.
Secondhand smoke, also known as environmental tobacco smoke, consists of side stream smoke that is generated while the cigarette is smouldering and mainstream smoke that has been exhaled by the smoker. An appreciation of the hazards of secondhand smoke is important to the physician because it provides a basis for advising parents not to smoke when children are in the home, for insisting that child care facilities be smoke-free, and for recommending smoking restrictions in work sites and other public places.
Tobacco use is motivated primarily by the desire for nicotine. Nicotine is absorbed rapidly from tobacco smoke into the pulmonary circulation; it then moves quickly to the brain, where it acts on nicotinic cholinergic receptors to produce its gratifying effects within 10 to 15 seconds after a puff. Addiction to tobacco is multifactorial, including a desire for the direct pharmacologic actions of nicotine, relief of withdrawal symptoms, and learned associations.
Of cigarette smokers, 70% state they would like to quit and approximately 50% try to quit each year. The benefits of quitting smoking are substantial for smokers of any age. A person who quits smoking before age 50 has half the risk of dying in the next 15 years compared with a continuing smoker.
The main strategies for cessation are behavioural counselling, pharmacologic intervention, or a combination of the two. Counselling smokers about the dangerous effects of tobacco should be routine medical practice and has been shown to be an effective method of improving cessation rates.
All smokers trying to quit should be offered pharmacotherapy. In brief, three types of medications have been approved for smoking cessation—nicotine, bupropion and varenicline. Other drugs such as nortriptyline and clonidine have been shown in clinical trials to be effective in aiding smoking cessation. Nicotine replacement medications include nicotine polacrilex gum, transdermal nicotine patches, nicotine nasal spray, nicotine inhaler and nicotine lozenges. A smoker should be instructed to quit smoking entirely before beginning nicotine replacement therapies. Combined medications for smoking cessation are more effective than individual therapies, particularly when combining long-acting medications such as nicotine patch or bupropion with short-acting nicotine replacement therapy used at times of intense urges or cravings to smoke.
Strict legislator rules should be formulated in order to restrict cigarette and smokeless tobacco sales, advertising, and marketing to youth, to prohibit “reduced harm” claims such as “light” or “mild” and require bigger and more prominent warning labels; electronic cigarettes that deliver a nicotine aerosol without tobacco combustion products are being marketed with claims to reduce smoking, to aid quitting, and to use where conventional smoking is banned.
Since current treatments of lung cancer and COPD are poorly efficient, it is obvious that preventing tobacco use through tobacco control and treating tobacco addiction are by far the most efficient means to prevent and ‘‘cure’’ these respiratory diseases. The treatment of tobacco dependence benefits from knowledge, experience and training. “Quit Smoking before smoking quits you”
Corporate Comm India(CCI Newswire)
