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 millionAnnually, 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

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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

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 - PipesA "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

Types of Tobacco Smoking

Egyptians call it Shisha, Lebanese refer to it as Nargile, in English, it is Hookah or hubble-bubble

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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.

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.

How Many Cigarettes Have You Smoked Without Knowing It?

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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

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.

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

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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 HealthORAL

• 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 HealthNON MALIGNANT

Gastrointestinal

Respiratory

Cardiovascular

Ocular

Sexual Dysfunction & Infertility

Pregnancy related

Skin wrinkling

Osteoporosis

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• SMOKING HAZARDS – PEPTIC ULCER

SMOKING HAZARDS - COPD

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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

SMOKER’S LUNG

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SMOKING HAZARDS - LARYNX

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Anterior Left Vocal Cord Polyp

Larynx – Supraglottic Squamous Cell carcinoma

SMOKING HAZARDS - VASCULAR

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• CVA• CARDIAC - CAD & MI• OCULAR• HYPERTENSION• THROMBOANGITIS

OBLITERENS

(BURGER’S DISEASE)

SMOKING HAZARDS - VASCULAR

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SMOKING HAZARDS - EYE

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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

SMOKING HAZARDS - SEXUAL

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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 

Smoking and Pregnancy

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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)

After: After quitting and a thorough cleaning, this smoker's teeth were restored to their originalwhiteness. Failure to remain tobacco-free will cause the staining to recur in weeks

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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

Relatively common tobacco related white lesion seen in the palate of a pipe, cigar or a cigarette smoker. Unless the habit is particularly intense or the patient is a reverse smoker, risk for malignancy is quite low. The combination of tobacco smoke and heat combustion is believed to be important for this tissue change.

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Smoker’s Palate

Cigarette smoking in particular may lead to melanin pigmentation of the gums and other mucosal sites in the oral cavity. The process is reversible and improves when the patient quits smoking. It is a harmless condition but needs to be separated from other more serious pigmental disorders 41

Smoker’s Melanosis

Smoking Stains

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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.

Snuff Dipper’s lesions

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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.

New developments

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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)

Non Party StatesCountries those have signed but not yet ratified 1. U.S.A2. 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

Monitor tobacco use and prevention polices.

Protect people from tobacco smoke.

Offer help to quit tobacco use

Warn about the dangers of tobacco.

Enforce bans on tobacco advertising, promotion and sponsorship.

Raise taxes on tobacco.

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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!

Benefits of Quitting 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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Benefits of Quitting1 year after quitting: Your added risk of coronary heart disease is half

that of a smoker’s5 -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 smoker15 years after quitting: Your risk of coronary heart disease is back to that of

a nonsmoker’ssource: US Department of Health & Human Services http://www.hhs.gov/ and

www.gasp.org.uk

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Live longer and healthier

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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 healthier2 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 healthier10 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 healthier15 years after quitting:• Your risk of coronary heart disease is

back to that of a nonsmoker’s

Approach to Quitting

1. Counseling 2. Peer support 3. A Word about Cold Turkey4. Nicotine Replacement Therapy (Patches,

chewing gums, Lozenges, Micro-tabs, E cigarettes, Nasal sprays, Mouth sprays)

5. The Downside of NRTs6. Nicotine-Free Quit Aids

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Designing your personal goalsSetting your personal goals can be a big help. List the reasons Keep copies of the list in the places - jacket, purse, or car.

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• 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?“

Steps to quitting

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1. Get ready

2. Get support

3. Learn new skills and behaviors

4. Get medication – if recommended by your doctor – and use it correctly

5. Be prepared for cravings and withdrawal symptoms

Steps to quitting

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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

Steps to quitting

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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

Steps to quitting

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Step 3: Learn New Skills & BehaviorsDistract yourself from urges to smoke o Talk to someoneo Go for a walko Get busy with a tasko 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 booko Plan something enjoyable to do every dayo Drink a lot of water and other fluids

Steps to quitting

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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

Steps to quitting

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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

Managing withdrawal

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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

Managing withdrawal

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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

Managing withdrawal

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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

Managing withdrawal

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If your appetite has increased• Eat healthy snacks• Don’t delay regular meals• Drink more water• Exercise regularly

Managing withdrawal

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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

Renew your dedication

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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!

Resources

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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/

StayAwayfromTobacco/GuidetoQuittingSmoking/index

Website: www.abhaynigam.com

E Mail: dr@abhaynigam.com

The Fork on Tobacco Road

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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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