Transcript File - Dr. Abhay Nigam welcomes you

Why & How to Quit Smoking
Dr Abhay Nigam
MBBS MD (Medicine)
Specialist – Internal Medicine
Al Zahrawi Hospital
Ras Al Khaimah, UAE
SMOKING FACT SHEET
About 4.9 million die each year WW.
By 2020 – 10 million
Annually, smoking kills more people than a combined
mortality from AIDS, alcohol, drug abuse, car crashes,
murders, suicides, and fires
SMOKING FACT SHEET
•Globally, 1 person dies every 6
seconds from smoking related
diseases
•A smoker loses an average of
13.8 years of life
•One out of every five deaths is
caused by tobacco
Tobacco use costs the United States
billions of dollars each year.
• Cigarette smoking costs more than $193
billion (i.e., $97 billion in lost productivity
plus $96 billion in health care
expenditures).1
• Secondhand smoke costs more than
$10 billion (i.e., health care
expenditures, morbidity, and mortality).
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Thousands of young people begin
smoking every day
• Each day, more than 3,800 persons
younger than 18 years of age smoke
their first cigarette.
• Each day, about 1,000 persons younger
than 18 years of age begin smoking on
a daily basis.
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Many adult smokers want
to quit smoking
• Approximately 69% of smokers want to
quit completely.
• Approximately 52% of smokers
attempted to quit in 2010.
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Types of Tobacco – Smokeless Tobacco
Smokeless tobacco snuff:
Nicotine + Carcinogens +
other toxins
Gutkha is basically a
sweetened mixture of
tobacco, betel, lime and
catechu chewed together.
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Types of Tobacco – Smokeless Tobacco
• Khaini: is basically a
preparation made from
tobacco leaves when
they are mixed with
lime and ready to be
chewed.
• Zarda: Chewing
tobacco mostly added
to betel leaves
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Types of Tobacco Smoking
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CIGARETTES:
20th Century
phenomenon –
Epidemic after 2nd
world war
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CIGARS :A cigar is a tightly
rolled bundle of dried and
fermented tobacco. The wrapper
determines much of the cigar's
character and flavor.
Types of Tobacco Smoking - Pipes
A "Bulldog" style pipe made of
Briar wood
Meerschaum (hydrated magnesium
silicate), a mineral found mainly in
central Turkey
CALABASH GOURDS (usually with
meerschaum or porcelain bowls set
inside them) are quite expensive.
“CORNCOB" pipes made from maize
cobs are cheap
Egyptians call it Shisha, Lebanese refer to it as Nargile,
in English, it is Hookah or hubble-bubble
Types of Tobacco Smoking - BIDIS
• Bidis – common in south asia
• Concentrations of nicotine, tar and other toxic agents in
the smoke are much higher for bidi than for cigarettes.
• Since bidi is hand-rolled, workers employed in bidi
factories are at risk of developing cancerous conditions
due to exposure to tobacco dust and flakes
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Types of Tobacco Smoking
Kreteks:are cigarettes
made with a complex
blend of tobacco,
cloves and a flavoring
'sauce'.
Kreteks are by far the most widely-smoked form
of cigarettes in Indonesia.
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Passive Smoking
• Passive or involuntary
smoking occurs when the
exhaled and ambient smoke
from one person's cigarette is
inhaled by other people.
• Passive smoking involves
inhaling carcinogens, as well
as other toxic components,
that are present in
secondhand tobacco smoke.
If you have been. . .
it’s like you’ve smoked. .
 In a smoky bar for 2 hrs =
 In a nonsmoking section
for 2 hrs =
 In a car with someone,
windows closed for 1 hr =
source: breathe easy Springfield,
www.breatheeasymo.org
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• Passive Smoking
• Exposure to secondhand smoke occurs anywhere smoking
is permitted: homes, workplaces, and other public places.
• According to the WHO, some 200,000 workers die each
year due to exposure to smoke at work,
•
About 700 million children, around half the world's total,
breathe air polluted by tobacco smoke, particularly in the
home
• Based on the evidence of three recent comprehensive
reports on May 29, 2007, the WHO called for a global ban
on smoking at work and in enclosed public places.
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Passive Smoking
• Secondhand smoke is known to harm children, infants
and reproductive health
• Acute lower respiratory tract illness,
• Asthma induction and exacerbation,
• Chronic respiratory symptoms,
• Middle ear infection,
• Lower birth weight babies,
• Sudden Infant Death Syndrome, or SIDS.
• Low-level exposure to secondhand smoke has a
clinically important effect on susceptibility to
cardiovascular disease,
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What is third-hand smoke, and why is it a concern?
Definition:
A term used to describe the gases and small particles in
cigarette smoke that are deposited on every surface they
come in contact with. From the smoker's hair and
clothing, to the environment the cigarette was smoked in,
these toxic particles remain long after the cigarette has
been put out and any secondhand smoke has been
removed from the area.
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What is third-hand smoke, and why is it a concern?
• Residual nicotine and other toxic chemicals - indoor surfaces
• Potential health hazard to nonsmokers (especially children.)
• Third-hand smoke clings to hair, skin, clothes, furniture, drapes,
walls, bedding, carpets, dust, vehicles and other surfaces, even long
after smoking has stopped
• Third-hand smoke residue builds up on surfaces over time and
resists normal cleaning.
• Can't be eliminated by airing out rooms, opening windows, using fans
or air conditioners, or confining smoking to only certain areas of a
home.
• Third-hand smoke remains long after smoking has stopped
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Tobacco Addiction
•Motivated by the desire for nicotine.
•Smokers regulate their nicotine intake and blood levels by
adjusting the frequency and intensity of their smoking both
to obtain psychoactive effects and avoid withdrawal.
•Smokeless tobacco contains nicotine, carcinogens and
other toxins capable of causing gum and oral disease
mainly.
•When tobacco is burned resultant smoke contains
Nicotine, CO + 4000 other toxic compounds.
Effects of Smoking on Health

Nicotine is absorbed into pulmonary circulation,
brain
nicotinic
cholinergic receptors

Smokeless tobacco is absorbed more slowly and
results in less intense pharmacologic effects.

With long term use of tobacco, physical dependence
develops as a result of an increased number of
nicotinic cholinergic receptors in the brain.
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Effects of Smoking on Health
• The acidic pH of smoke generated by cigarettes
dramatically reduces nicotine absorption in oral
mucosa, necessitating inhalation of smoke deep into
lungs.
• Alkaline pH of smoke from tobacco utilized in cigars,
pipes and smokeless tobacco allows absorption from
oral mucosa to satisfy the smokers need for this drug.
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Effects of Smoking on Health
ORAL
• Staining and shifting of
teeth
• Oral cancers
• Mouth sores
• Root caries (cavities)
• Sinusitis
• Hairy tongue
• Smoker’s lip
• Leukoplakia
• Snuff Dipper’s lesions
• Smoker’ palate
• Periodontal diseases which
includes bone and tooth
loss, if unchecked, it can
lead to complete
destruction of the tooth’s
supporting tissues,
abscesses and, ultimately,
loss of the tooth.
• Dangerous gum diseases
• Loss of taste sensation
• Halitosis (Bad breath)
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Effects of Smoking on Health
NON MALIGNANT
Gastrointestinal
Respiratory
Cardiovascular
Ocular
Sexual Dysfunction & Infertility
Pregnancy related
Skin wrinkling
Osteoporosis
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• SMOKING HAZARDS – PEPTIC ULCER
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Increased incidence
of Asthma
Chronic obstructive pulmonary disease (COPD) is a
permanent, incurable reduction of pulmonary capacity
characterized by shortness of breath, wheezing,
persistent cough with sputum, and damage to the lungs,
including emphysema and chronic bronchitis
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Anterior Left
Vocal Cord Polyp
Larynx – Supraglottic
Squamous Cell
carcinoma
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•
•
•
•
•
CVA
CARDIAC - CAD & MI
OCULAR
HYPERTENSION
THROMBOANGITIS
OBLITERENS
(BURGER’S DISEASE)
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• Smoking doubles the risk of nuclear
cataract. cataracts are more serious in heavy
smokers than in light smokers.
• Age related macular degeneration (AMD) risk
among smokers is 2 to 3 times higher.
• Smoking may accelerate the development of, or
worsen diabetic retinopathy,
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• Anterior ischaemic optic
neuropathy is an eye
disease that results in a
sudden, painless loss of
vision, often leading to
permanent
blindness. Smokers are
at a 16-fold increased
risk
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• Smoking increases the risk of erectile
dysfunction because blood flow into the penis
is blocked by atherosclerosis.
• Smoking also causes
–
–
–
–
–
Abnormal sperm shape,
Impaired sperm motility
Damaged sperms,
Oligospermia
Reduced ejaculate volume
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• Smoking causes delivery complications,
(Fetal tobacco syndrome)
• Increases risk of pre-term delivery (premature rupture of
membrane)
• Abortions : 2 - 3 times
• Abruptio placentae & Placenta previa
• Giving birth to low-birth weight baby : 4 times
• Slows fetal growth
• Smoking also increases risk of serious health problems to
the newborn such as:
• Cerebral palsy
• Mental retardation : 1.5 times
• Learning disabilities
• Sudden Infant Death Syndrome (SIDS)
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Smoking and Oral Hygiene
•
Before: 37-year-old heavy
smoker with a heavy build up
of dental calculus, stains,
and severely offensive
tobacco breath.
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Smoking and Oral Hygiene
Smokers can develop a condition called
black hairy tongue
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Smoking and Periodontitis
Roughly half of periodontitis cases are attributed to current
or former smoking.
Smokers experience widespread periodontal destruction and
have significantly greater loss of bone height
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Smoker’s Palate
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Smoker’s Melanosis
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Smoking wrinkles
“For smokers, middle-age starts in their early 30’s as
the tell-tale wrinkles around the mouth and eyes
begin to appear. Young female smokers are likely to
be wasting their money on anti-aging face creams if
they continue to smoke.”
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SMOKING & ORAL CANCER
A large cancer (Squamous CC) is shown growing out of
neck of this patient’s neck. The cancer was due to
smoking and started in patient’s mouth. The cancer
eventually eroded into Carotid Artery causing massive
bleeding & death.
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A white or discolored lesion of the oral mucosa
occurring at the site at which the powdered tobacco is
retained. Malignant transformations are not common but
do occur, usually as low-grade VERRUCOUS
CARCINOMAS.
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Global Treaty 2004
WHO Framework Convention for Tobacco Control
(FCTC)

Need now to legislate and fund campaigns in
accordance with it

The Convention entered into force on 27
February 2005 -- 90 days after it had been
acceded to, ratified, accepted, or approved by
40 States. ( now 172 countries have ratified –
covering 87% world population)
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Countries those have
signed but not yet ratified
1. U.S.A
2. Argentina,
3. Cuba,
4. Czech Republic,
5. El Salvador,
6. Ethiopia,
7. Haiti,
8. Morocco,
9. Mozambique,
10.Switzerland
Countries that have not signed
1. Andorra
2. Dominican Republic,
3. Eritrea,
4. Indonesia,
5. Liechtenstein*,
6. Malawi,
7. Monaco,
8. Somalia,
9. Tajikistan,
10.Uzbekistan,
11.Zimbabwe
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When it comes to stemming the flow of death and
destruction that tobacco use leaves in its wake, it
takes a village to effect change -- a global village.
If adopted by governments around the world,
these simple, yet powerful MPOWER policies
could be a life preserver that will save millions
and millions of lives.
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From WHO:
"To sell a product that kills up
to half of all its users requires
some extraordinary marketing
savvy."
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Quitting Smoking
• How to stop smoking … for
good!
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20 min. – blood pressure and pulse return to normal,
circulation improves to make hands & feet warmer
 24 hours – carbon monoxide is eliminated from the
body and the lungs start to clear out mucus
 72 hours – breathing becomes easier and energy levels
increase
 2-12 weeks – circulation improves through the body,
Your heart attack risk begins to drop, exercise is easier,
Your lung function begins to improve
 1 to 9 months after quitting:
 Your coughing and shortness of breath decrease

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1 year after quitting:
Your added risk of coronary heart disease is half that of a
smoker’s
5 -15 years after quitting:
Your stroke risk is reduced to that of a nonsmoker
10 years – risk of lung cancer falls to about half that of
a smoker
15 years after quitting:
Your risk of coronary heart disease is back to that of a
nonsmoker’s
source: US Department of Health & Human Services http://www.hhs.gov/ and
www.gasp.org.uk
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20 minutes after quitting:
• Your heart rate drops
12 hours after quitting:
• Carbon monoxide levels in your blood
drop to normal
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Live longer and healthier
2 weeks to 3 months after quitting:
• Your heart attack risk begins
to drop
• Your lung function begins to improve
1 to 9 months after quitting:
• Your coughing and shortness of breath
decrease
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Live longer and healthier
1 year after quitting:
• Your added risk of coronary heart
disease is half that of a smoker’s
5 -15 years after quitting:
• Your stroke risk is reduced to that of a
nonsmoker
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Live longer and healthier
10 years after quitting:
• Your lung cancer death rate is about
half that of a smoker’s
• Your risk of cancers of the mouth,
throat, esophagus, bladder, kidney and
pancreas decreases
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Live longer and healthier
15 years after quitting:
• Your risk of coronary heart disease is
back to that of a nonsmoker’s
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1.
2.
3.
4.
Counseling
Peer support
A Word about Cold Turkey
Nicotine Replacement Therapy (Patches,
chewing gums, Lozenges, Micro-tabs, E
cigarettes, Nasal sprays, Mouth sprays)
5. The Downside of NRTs
6. Nicotine-Free Quit Aids
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Setting your personal goals can be a big help.
List the reasons
Keep copies of the list in the places - jacket, purse, or car.
• I will feel healthier and have more energy, whiter teeth, and
fresher breath.
• I will lower my risk for cancer, heart attacks, strokes, early death,
cataracts, and skin wrinkling.
• I will make myself and my partner, friends, and family proud of
me.
• I will no longer expose my children and others to the dangers of
my second-hand smoke.
• I will have a healthier baby (If you or your partner is pregnant).
• I will have more money to spend.
• I won't have to worry: "When will I get to smoke next?“
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1.
2.
3.
4.
Get ready
Get support
Learn new skills and behaviors
Get medication – if recommended by
your doctor – and use it correctly
5. Be prepared for cravings and
withdrawal symptoms
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Step 1: Get Ready
• Set a quit date
• Get rid of all cigarettes and ashtrays at
home, work, and in your car
• Keep a diary of when and why you smoke
• Call 1-800-QUIT-NOW for free materials
• Tell friends and family you’re going to stop
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Step 2: Get Support
• Your chances of success increase if you have a
support network
• Ask friends, family, and coworkers for their support in
helping you quit
• Ask others not to smoke around you or leave
cigarettes out in the open
• Talk to your family physician about tobacco’s effects
on the body, choosing a quit plan, and dealing with
withdrawal
• Get individual, group, or telephone counseling
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Step 3: Learn New Skills & Behaviors
Distract yourself from urges to smoke
o Talk to someone
o Go for a walk
o Get busy with a task
o Go somewhere you’re not allowed to smoke
o Change your routine
 Take a different route to work
 Drink tea instead of coffee
 Eat breakfast in a different place
o Reduce stress – take a hot bath, exercise, or read a book
o Plan something enjoyable to do every day
o Drink a lot of water and other fluids
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Step 4: Get Medication
• Your family physician may recommend one of these
to help you quit:
– Bupropion SR
– Nicotine gum
– Nicotine inhaler
– Nicotine nasal spray
– Nicotine patch
– Varenicline
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Step 5: Avoid Relapse
• Most relapses occur within the first three months
• Avoid drinking alcohol – drinking lowers your chances of success
• Avoid being around other smokers – can make you want to
smoke
• Expect a small weight gain
(usually less than 10 pounds)
• Eat a healthy diet
• Stay active
• Look for ways to improve your mood other than smoking
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Symptoms
• Most intense during the first three to
seven days
• May continue for several weeks but will
get less severe
• Triggers or cues associated with
smoking can cause cravings
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•
•
•
•
•
•
•
Exercise
Reduce or avoid caffeine or other stimulants
Relax before going to bed
Make your bedroom quiet
Keep a bedtime routine
Drink plenty of water
Use cough drops to relieve
throat irritation
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If you’re having trouble concentrating
• Adjust your schedule to a lighter
workload
• Lower your expectations on the amount
of work you can do
• Understand the amount of energy and
time it takes to stop smoking
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If your appetite has increased
• Eat healthy snacks
• Don’t delay regular meals
• Drink more water
• Exercise regularly
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If you crave a cigarette
• Wait out the craving (usually less than
five minutes)
• Try deep breathing
• Use distractions
• Call someone in your support network
• Chew gum
• Brush your teeth
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• Reward yourself for resisting urges to
smoke
• Review your reasons for stopping
• Remind yourself often how well you’re
doing
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You can do it!
• Tobacco addiction is a chronic disease –
seek advice, support, and care from your
family physician to increase your chance
of success
• Quitting smoking can reduce illness,
prevent death, and increase your quality
of life
• Quitting can be difficult – remember to ask
for help
• You can do it!
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Web Sites with helpful information:
• familydoctor.org
• www.smokefree.gov
• www.surgeongeneral.gov/tobacco
• http://www.cdc.gov/tobacco/quit_smoking
• http://www.cancer.org/Healthy/StayAwayfro
mTobacco/GuidetoQuittingSmoking/index
Website:
www.abhaynigam.com
E Mail:
[email protected]
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If we act now
Result of improved funding can
cut smoking rates from present
20% to 10% OR even LESS by
2015
If we do nothing on present global
trends, it’s estimated ONE
BILLION people will die from
smoking this century
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