DR SUSHIL SHARMA
Each year, the World Health Organization (WHO) holds World No Tobacco Day on May 31. The goal is to spread awareness about the risks of tobacco use and how we can make the world tobacco free. The tobacco epidemic is one of the biggest public health threats the world has ever faced, killing more than 8 million people a year around the world. More than 7 million of those deaths are the result of direct tobacco use while around 1.2 million are the result of non-smokers being exposed to second-hand smoke. There are 1.3 billion tobacco users worldwide. That number would be even larger if tobacco didn’t kill half of its users. Every four seconds, tobacco takes another life. Decades of the tobacco industry’s deception and devious tactics have hooked generations of users to nicotine and tobacco, driving this global epidemic. The multi-billion-dollar industry recruits new tobacco and nicotine users to reward investors with as much profit as possible and keep its business alive. Tobacco and related industries have increasingly preyed on children and adolescents, employing advertising tactics and targeting them directly with a new portfolio of products that threaten their health. These industries are moving at a rapid speed to launch existing and new products and use every means to expand their market share before regulations can catch up with them. Tobacco and related industries continue to oppose evidence-based measures, such as increases in excise taxes and comprehensive bans on tobacco advertising, promotion and sponsorship, and have threatened legal actions against governments that try to protect the health of their citizens.All forms of tobacco are harmful, and there is no safe level of exposure to tobacco. Cigarette smoking is the most common form of tobacco use worldwide. Other tobacco products include waterpipe tobacco, various smokeless tobacco products, cigars, cigarillos, roll-your-own tobacco, pipe tobacco, bidis and kreteks.
BackgroundTobacco is a product of the fresh leaves of nicotiana plants. It is used as an aid in spiritual ceremonies and a recreational drug. It originated in the Americas, but was introduced to Europe by Jean Nicot, the French ambassador to Portugal in 1559. It quickly became popular and an important trade crop.Medical research made it clear during the 1900s that tobacco use increased the likelihood of many illnesses including heart attacks, strokes, Chronic Obstructive Pulmonary Disease (COPD), emphysema and many forms of cancer. This is true for all ways in which tobacco is used, including:¢ Cigarettes and cigars.¢ Hand rolling tobacco.¢ Bidis and kreteks (cigarettes containing tobacco with herbs or spices).¢ Pipes and water pipes.¢ Chewing tobacco.¢ Snuff.¢ Snus (a moist version of snuff popular in some countries such as Sweden).¢ Creamy snuff (a paste consisting of tobacco, clove oil, glycerin, spearmint, menthol, and camphor sold in a toothpaste tube popular in India).¢ Gutkha (a version of chewing tobacco mixed with areca nut, catechu, slaked lime and other condiments popular in India and South-East Asia).¢ o E-Cigarette ( new alternative devised for quitting smoking).
Tobacco was first brought to Britain from America in the 16th century by Sir Walter Raleigh. Cigarettes as we know them were introduced in the late 19th century, and by the turn of the 20th century largely replaced other forms of tobacco use such as snuff, chewing tobacco and cigars. There are more than 4000 chemicals in tobacco smoke, of which at least 250 are known to be harmful and more than 60 of these substances are known or suspected carcinogens.The Three main poisons in tobacco smoke are:1) Tar – A solid irritant, tar coats the lungs, blocks the airways and causes emphysema and lung cancer.2) Nicotine – Nicotine is a highly addictive toxic substance which diffuses into the blood stream very quickly, providing a quick fix for the smoker .One Cigarette contains about 1mg of nicotine, which if taken intravenously could be fatal. Nicotine has a variety of adverse effects, many of which contribute to the development of CHD.3) Carbon Monoxide (CO) – Carbon Monoxide is absorbed via the lungs into the blood stream where it binds to haemoglobin, replacing oxygen. The level of CO in the smoker’s body depends on the number of Cigarettes smoked and how they are smoked. Carbon Monoxide causes heart and arterial diseases.Other Poisons in Tobacco smoke include formaldehyde, ammonia and benzene.Tobacco use is a threat to any person, regardless of gender, age, race, cultural or educational background. It brings suffering, disease, and death, impoverishing families and national economies.The growing popularity of tobacco smoking appears to defy rational explanation. Tobacco users generally acknowledge the harm they are doing to themselves and many report that they do not enjoy it – yet they continue to use tobacco in one form or another. Progress is being made in many countries in reducing tobacco prevalence but it remains one of the main causes of ill health and premature death worldwide. In order to raise awareness on the negative impact that tobacco has on people’s health, every year, on 31 May, the World Health Organization (WHO) and global partners celebrate World No Tobacco Day (WNTD). The campaign also serves as a call to action, advocating for effective policies to reduce tobacco consumption and engaging stakeholders across multiple sectors in the fight for tobacco control. Each year, the WHO selects a theme for the day in order to create a more unified global message for WNTD. This theme then becomes the central component of the WHO’s tobacco-related agenda for the following year. The WHO oversees the creation and distribution of publicity materials related to the theme, including brochures, fliers, posters, websites, and press releases. Gauging the global implications caused by the tobacco use on sustainable development, encompassing the health and economic well-being of citizens in all countries, this year WNTD theme is “Commit to Quit.” Commit to Quit will help create healthier environments that are conducive to quitting tobacco by advocating for strong tobacco cessation policies; increasing access to cessation services; raising awareness of tobacco industry tactics, and empowering tobacco users to make successful quit attempts through “quit & win” initiatives.
SMOKING HARMS THE CARDIOVASCULAR SYSTEMChemicals in cigarette smoke cause the cells that line blood vessels to become swollen and inflamed. This can narrow the blood vessels and can lead to many cardiovascular conditions.Atherosclerosis, in which arteries narrow and become less flexible, occurs when fat, cholesterol, and other substances in the blood form plaque that builds up in the walls of arteries. The opening inside the arteries narrows as plaque builds up, and blood can no longer flow properly to various parts of the body. Smoking increases the formation of plaque in blood vessels.Coronary Heart Disease occurs when arteries that carry blood to the heart muscle are narrowed by plaque or blocked by clots. Chemicals in cigarette smoke cause the blood to thicken and form clots inside veins and arteries. Blockage from a clot can lead to a heart attack and sudden death.Stroke is a loss of brain function caused when blood flow within the brain is interrupted. Strokes can cause permanent brain damage and death. Smoking increases the risk for strokes. Deaths from strokes are more likely among smokers than among former smokers or people who have never smoked.Peripheral Arterial Disease (PAD) and peripheral vascular disease occur when blood vessels become narrower and the flow of blood to arms, legs, hands and feet is reduced. Cells and tissue are deprived of needed oxygen when blood flow is reduced. In extreme cases, an infected limb must be removed. Smoking is the most common preventable cause of PAD.Abdominal Aortic Aneurysm is a bulge or weakened area that occurs in the portion of the aorta that is in the abdomen. The aorta is the main artery that carries oxygen-rich blood throughout the body. Smoking is a known cause of early damage to the abdominal aorta, which can lead to an aneurysm. A ruptured abdominal aortic aneurysm is life-threatening; almost all deaths from abdominal aortic aneurysms are caused by smoking. Women smokers have a higher risk of dying from an aortic aneurysm than men who smoke. Autopsies have shown early narrowing of the abdominal aorta in young adults who smoked as adolescents.Cancer is not the only disease caused by smoking. Smoking also causes chronic bronchitis and emphysema, and worsens asthma. Cigarette smoking substantially increases the risk of coronary heart disease, including stroke, heart attack, aneurysm and vascular disease. It also contributes to peptic ulcers, varicose veins, osteoporosis, periodontal disease, Alzheimer’s disease, atherosclerosis, high blood pressure, allergies, and impotence. The bottom line is that continuing to smoke puts you at risk of contracting a serious, life-threatening illness. If you contract any one of the diseases listed above, your quality of life will deteriorate and you will shorten your life span. In addition, smoking is a leading cause of cancers of the mouth, tongue, throat, larynx (voice box), esophagus, stomach, pancreas, cervix, kidney, ureter, and bladder.
Are there immediate and long-term health benefits of quitting for all smokers?Beneficial health changes that take place:¢ Within 20 minutes, your heart rate and blood pressure drop.¢ 12 hours, the carbon monoxide level in your blood drops to normal.¢ 2-12 weeks, your circulation improves and your lung function increases.¢ 1-9 months, coughing and shortness of breath decrease.¢ 1 year, your risk of coronary heart disease is about half that of a smoker’s.¢ 5 years, your stroke risk is reduced to that of a nonsmoker 5 to 15 years after quitting.¢ 10 years, your risk of lung cancer falls to about half that of a smoker and your risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas decreases.¢ 15 years, the risk of coronary heart disease is that of a nonsmoker’s.The understandable attention to current pandemic should not overshadow the world’s ongoing fight against smoking and related diseases. In fact, we must attend to the points at which these deadly crises intersect. Surveys of individuals under various conditions of lock-down show that smokers are experiencing high levels of stress, and that tobacco is often their primary coping mechanism for managing this stress. While many of those surveyed reported that they would like to quit, they often lacked access to the information, support, and nicotine alternatives that might enable this transition.Tobacco use and COVID-19Tobacco smoking is a known risk factor for many respiratory infections and increases the severity of respiratory diseases. A review of studies by public health experts convened by WHO on 29 April 2020 found that smokers are more likely to develop severe disease with COVID-19, compared to non-smokers.COVID-19 is an infectious disease that primarily attacks the lungs. Smoking impairs lung function making it harder for the body to fight off coronaviruses and other diseases. Tobacco is also a major risk factor for non communicable diseases like cardiovascular disease, cancer, respiratory disease and diabetes which put people with these conditions at higher risk for developing severe illness when affected by COVID-19. Available research suggests that smokers are at higher risk of developing severe disease and death.Benefits of Smoking CessationThe aim of a stop smoking intervention with patients from any group is to encourage and enable the patients to make health enhancing behaviour changes for themselves. This may involve work on motivation, skill building and confidence building it will certainly demand the best of communication skills.The short-term benefits of quitting smoking include the following:¢ 20 minutes after quitting, heart rate and blood pressure drop.¢ 2 hours after quitting, the amount of nicotine in the bloodstream will drop by half.
¢ 8 hours after quitting, there will be more oxygen in the blood.¢ 12 hours after quitting, the carbon monoxide level in the blood drops to normal.¢ 72 hours after quitting, breathing becomes easier and bronchial tubes begin to relax.¢ 2 to 12 weeks after quitting, circulation improves and lung function increases.¢ 1 to 9 months after quitting, coughing and shortness of breath decrease. Cilia (tiny hair-like structures that move mucus out of the lungs) start to regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection.The long -term benefits of quitting smoking include the following:At one year, you have halved your risk of coronary heart disease. By two to five years, your risk of stroke is now the same as a non-smoker, and at five years you have halved your risk of mouth, throat, oesophageal and bladder cancer.By 10 years, your risk of dying from lung cancer is half that of a current smoker, and your risk of developing kidney and pancreatic cancers decreases.Key Message: Save your heart and avoid the Smoke.Quitting smoking is one of the best things you can do for yourself. You’ll feel better, you’ll look better, and your health will be better Smoking damages the heart and blood vessels very quickly, but the damage is repaired quickly for most smokers who stop smoking. Even long-time smokers can see rapid health improvements when they quit. Within a year, heart attack risk drops dramatically. Within five years, most smokers cut their risk of stroke to nearly that of a nonsmoker. So, the only proven strategy to keep your heart safe from the effects of smoking is to Quit. As the world grapples with a new and terrifying virus, WNTD reminds us that smoking, too, is a pandemic. Relief from its devastation will come not from a vaccine, but from innovative solutions that consider the needs of smokers themselves.(The writer is Head of Department Cardiology GMC & SSH Jammu)
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