Why one Should QUIT Smoking? | Jindal Chest Clinic

Why one should Quit Smoking?

Dr. Surinder K. Jindal (Emeritus-Professor Pulm Med, PGIMER, Chandigarh) Medical Director, Jindal Clinics, Sec 20 D, Chandigarh www.jindalchest.com

Why did the issue of quitting arise?

• Recognition of health hazards – killing risks • Economic burden • Environmental risks Deforestation Loss of biodiversity Indoor pollution - ETS • Fire hazards

Tobacco is Bad – Any form or disguise I. Tobacco smoking Bidis , Cigarettes, Cigars Cheroots, Chutta Dhumti, Hookas, Hooklis Pipe, Chillums II. Non-smoking tobacco Gudhaku (Paste) Creamy snuff, Tobacco water, Paan masaala Mainpuri Mawa, Khaini, Snus, Mishri, Gul, Bajjar Betel quid

Active (First Hand) Smoking Direct Reverse (Chutta) Passive (Second Hand) Side-stream Fetus-in-utero (Smoking mother) Tertiary Smoking Husband/others’ smoking during pregnancy Delayed (Third Hand) Smoking From smoke-residue

What does tobacco contain?

• Tobacco smoke -mixture of over 4000 chemicals • Nicotine’, responsible for the habit-forming or addicting properties of tobacco • Many volatile - organic and inorganic compounds, heavy metals and trace elements: Cyanide, arsenic and strychnine-formaldehyde, methanol, acetylene, ammonia and acetone.

About 45 agents are carcinogens Over 400 of them are toxic and harmful agents.

The rest constitute ‘tar’ Several irritant and noxious gases including carbon monoxide, carbon dioxide, ozone and sulphur dioxide.

Non communicable diseases Four types of NCDs – *cardiovascular *cancers *chronic respiratory diseases *diabetes Account for almost twothirds of all deaths globally -80% g in lowand middle-income countries

Major risk factors • Smoking tobacco.

• Drinking too much alcohol.

• Nutritional choices.

• Physical inactivity.

Tobacco alone is responsible for at least 3 of the 4 common NCDs

Acute effects of smoking 1. Eye irritation: redness and watering 2. Headache, nasal irritation and cough 3. Worsening of allergies of eye, lungs and nose 4. Triggering of acute asthma attack 5. Increase in heart-rate and blood pressure 6. Acute respiratory symptoms – cough, phlegm, wheeze

Overall (all cause) Mortality due to Tobacco • Relative risk for death from tobacco (Rural India) – 40% to 80% higher for any type of tobacco use; – 50% - 60% higher for smoking; – 90% higher for reverse smoking; – 15% and 30% higher for tobacco chewing in men and women, – 40% higher for chewing and smoking combined • An urban cohort study in Mumbai found the relative risk of dying was more than 50% higher for smokers and about 15% higher for smokeless tobacco users.

• Overall, smoking currently causes about 700,000 deaths per year in India.

Smoking and Lung Diseases 1. Acute respiratory illnesses -pneumonias 2. Chronic obstructive pulmonary disease 3. Impaired lung growth during childhood and adolescence 4. Early onset lung function decline in children 5. Premature, age related decline in adults 6. Poor asthma control 7. Increased occurrence of interstitial lung diseases

Cancers Causal relationship of smoking with cancers Sufficient evidence Lung Larynx (voice box) Oral cavity and pharynx Esophagus (Food-pipe) Pancreas, Stomach Kidneys and bladder Uterine cervix (women) Acute myeloid leukaemia .

Suggestive Colorectal region Liver Prostate Breast High incidence of leukoplakia and oral cancers with reverse smoking

Smoking – Lung Ca in India 1. Type of smoking: Odds Ratio 95% CI Cigarettes 5.64 3.15 – 10.1 Bidi 5.76 3.42 – 9.7 Hookah 1.94 0.85 – 4.44 2. Duration < 25 yrs 2.91 1.50 – 5.63 > 45 yrs 7.38 3.93 – 13.83 There are more than 5.5 times odds of lung cancer with cigarette/ bidi smoking; The odds are higher with longer duration of smoking

Vascular (blood vessel) diseases: Causal relationship Subclinical atherosclerosis (narrowing of vessels) • Coronary heart disease & Heart-attacks • Stroke (Cerebro-vascular diseases) • Abdominal aortic aneurysm • Retinal artery involvement: Blindness • Peripheral vascular problems: Buerger’s disease Gangrenes

Smoking and heart disease • One out of every 5 smoking-related deaths is caused by heart disease.

• Women older than 35 who smoke are at much greater risk for heart disease or stroke.

• Cigarette smokers are 2 to 4 times more likely to get heart disease than non smokers.

• Disturb normal heart rhythms.

• Increase blood pressure and heart rate, making heart work harder than normal.

Reproductive effects Women Smokers at Added Risk A. Fertility 1. Sufficient evidence of reduced fertility in women 2. Impaired sperm motility in men B. Pregnancy 1. Suggestive evidence for a causal relationship with: Ectopic pregnancy and Spontaneous abortion 2. Sufficient evidence of causal relationship with: Premature rupture of membranes, placenta previa and abruption Preterm delivery and shortened gestation Fetal growth restriction and low birth weight

Children of smoking mothers The newborn baby 1. Low birth weight or small size babies at birth 2. Sudden infant death syndrome (SIDS) 3. Sufficient evidence of risk of oral clefts with smoking

Smoking during pregnancy is causally related to respiratory problems in children Increase in frequency of respiratory or lower respiratory tract illnesses during infancy Increased risk for impaired lung function in childhood and adulthood Reduction of lung function in infants

Other Health effects Smoking is causally related with: 1.

Diminished health status, increased absenteeism and increased use of medical care services 2. Increased risks for adverse surgical outcomes 3. Low bone density in post menopausal women and older men 4. Hip fractures 5. Periodontitis and caries of the teeth 6. Erectile dysfunction in men 7. Nuclear cataract in the eyes 8. Age related macular degeneration in the eyes 9. Peptic ulcer disease and its complications 10. Premature death: the leading preventable cause

Quick noticeable effects of quitting

• Food tastes better.

• Sense of smell returns to normal; breath, hair, and clothes smell better.

• Teeth and fingernails stop yellowing.

• Ordinary activities do not cause breathlessness.

• One can stay in smoke-free buildings without having to go outside to smoke.

• Quitting also helps stop the damaging effects of tobacco on the looks including premature wrinkling of skin, gum disease, and tooth loss

Effects of quitting on health Short term effects

Long term effects

• 20 minutes after HR & BP normalise • 12 hours: Carbon monoxide level to normal.

• 2 weeks to 3 months Circulation improves and lung function increases.

• 1 to 9 months: Coughing, breathlessness decrease.

• 1 year after quitting: Heart attack risk drops • 5 years after quitting: Risk of cancers falls; stroke risk can fall to that of a non-smoker • 10 years: Risk of lung cancer death, about half • 15 years: Risk of coronary heart disease is that of a non-smoker.

FEV1 (percent of value at age 25 years)

100

Not susceptible to smoke or never smoked Smoked regularly & susceptible to its effects

75

Stopped at 45

Onset of symptoms

50 Severe disability Stopped at 65

25 Death

0 25

35

45

55

65

75

Age (years)

Quitting is useful –at any age Fletcher & Peto. BMJ 1977

SUMMARY 1. Tobacco-use is the leading cause of preventable illness and death and therefore accounts for enormous health-care burden.

2. Tobacco-smoking is also injurious to nonsmokers and unborn babies exposed to 2nd and 3rd hand smoking.

3. Tobacco-use is a major cause of direct healthcare costs and indirect losses.

4. Quitting smoking improves health, reduces health hazards, reduces health-care costs as well as improves longevity and quality of life.