(Tobacco damages and cure)

(Tobacco Damages and cure)Presentation

Dr. Anwr Alnahdi

GLOBAL SMOKING STATISTICS

•Smoking related-diseases kill one in 10 adults globally, or cause four million deaths. By 2030,

if current trends continue, smoking will kill one in six people.

•Every eight seconds, someone dies from tobacco use.

•About 15 billion cigarettes are sold daily - or 10 million every minute.

Statistics on Teen Smoking•Among young teens (aged 13 to 15), about one in five

smokes worldwide.•Between 80,000 and 100,000 children worldwide start

smoking every day - roughly half of whom live in Asia.•Evidence shows that around 50% of those who start

smoking in adolescent years go on to smoke for 15 to 20 years.

•Peer-reviewed studies show teenagers are heavily influenced by tobacco advertising.

•About a quarter of youth alive in the Western Pacific Region will die from smoking.

Approximately 80% of adult smokers started smoking before the age of 18.

Every day, nearly 3,000 young people under the age of 18 become regular smokers.

Nearly all first use of tobacco occurs before high school graduation .

The smoking epidemic

•75% of smokers live in low or middle income countries

World Health Organization. The Tobacco Atlas. http://www.who.int/tobacco/statistics/tobacco_atlas/en

Types of Tobacco•Chewing Tobacco•Snuff•Pipes•Cigars•Cigarettes

Type of Tobacco

Chemicals in Tobacco•A stimulant •Carcinogens are cancer causing

agents•More than 4000 chemicals•10% are carcinogens or poisonous•The 3 most poisonous chemicals

are: tar, nicotine, and carbon monoxide

Nicotine•Psychoactive substance-

causes a change in the person’s mood or behavior

•Very addictive- causes a physical dependence

Tar•Tiny pieces that when inhaled in to the

lungs, condense and form a sticky coating on the bronchial tubes

•Same substance used to pave roads!!!•Destroys cilia, waving hair-like

projections that work to keep the respiratory tract clear.

Carbon Monoxide•A colorless, odorless, poisonous

gas released by burning tobacco•Interferes with the blood’s

ability to carry oxygen•Same gas from car exhaust

–if inhaled directly-can be fatal

Smokeless Tobacco•Cracking and bleeding lips and gums•receding gums, which can eventually make

your teeth fall out•increased heart rate, high blood pressure, and

irregular heartbeats=leading to a greater risk of heart attacks and brain damage

•ORAL CANCER-lips, tongue, cheeks, gums, ANYWHERE IN MOUTH!

•CANCER-stomach, esophagus, bladder

Health Lung Vs. Smoker’s lung

Tobacco on the skin

Tobacco on the hands

Tobacco on the Mouth

About 90 percent of lung cancer deaths in men and almost 80

percent of lung cancer deaths in women are due to smoking.

People who smoke are 10 to 20 times more likely to get lung cancer or die from lung cancer than

people who do not smoke

Effects on the body•When you inhale a cigarette, the nicotine

travels to the bloodstream and then to the brain- this only take 8 seconds

•Heart will beat faster•Blood pressure will increase•Become more alert and energetic•Sense of smell and taste decrease•Yellow Teeth, Fingernails•Smelly clothes, hair, breath, house, car, etc.•“Smokers Voice”

LUNG CANCER •growth of malignant

cells that attack and replace healthy cells

•NO CURE!!•Now kills more

women than breast cancer!

•Many females believe smoking causes

weight loss-There is NO PROOF of this

being true!

Chronic Bronchitis–Inflammation of the bronchial tubes–Chronic coughing, excessive mucus

production–Cilia becomes useless-covered with tar

Pulmonary Emphysema•Pulmonary=LUNGS•Destruction of tiny air sacs in lungs which

absorb oxygen into the body•Tiny air sacs=ALVEOLI

•Instead of using only 5% of their energy to breathe, a person with

advanced emphysema uses 80% of their energy to breathe!!

How much money do you save by not smoking???LETS FIND OUT!!!

Let’s say someone smokes 1 pack a day…

Per PACK they will spend 5Per WEEK they will spend 35

Per MONTH they will spend 140Per YEAR they will spend 1680

5 YEARS= 840010 YEARS= 16,800

What would you buy with this much money??

Second Hand smoke•Mainstream smoking-

passes through the tobacco and filter when

the smoker inhales–what a smoker inhales

•Sidestream smoke- rises from the cigarette when the smoker is not

inhaling•This contains 2x more nicotine and tar,

and 5x more CO than mainstream

•Non-smokers who live with smokers have a 20-30% HIGHER risk of dying

from heart disorders than non-smokers who live with non-smokers!!!

•Passive smoker- a person who inhales the

sidestream smoke–smoke inhaled by non-

smokers•Passive smoke can cause:•Heart disease*Asthma•Eye irritation*Cancer •Ear infections•Emphysema

The benefits of quitting

Action on Smoking and Health (ASH) Factsheet Number 11: Stopping Smoking. http://www.ash.org.uk

8 hoursNicotine and carbon monoxide levels halved,Blood oxygen levels return to normal

24 hoursCarbon monoxide eliminated from the body

48 hoursNicotine eliminated from the body,Taste buds start to recover

Within hours.......



1 monthAppearance improves – skin loses greyish pallor, less wrinkled Regeneration of respiratory cilia startsWithdrawal symptoms have stopped

3-9 monthsCoughing and wheezing decline

Within months .......



5 yearsThe excess risk of a heart attack reduces by half

10 yearsThe risk of lung cancer halved

Within years .......

Withdrawal SymptomsTrouble sleeping.

Fatigue.Hunger.

Tenseness.Irritability.

Women who quit in the second half of their menstrual cycle may be

more irritable.Coughing.

Sense of time distortions.

Sore throat.Sore gums.

Sore tongue.Mouth ulcers.

Dry mouth.Yucky taste in your mouth.

Irregularity.Gas/ bloating/ diarrhea (eat

active culture yogurt & avoid gas producing foods).

Headaches.

DDDDNicotine withdrawal: Duration


1 weekSleep disturbance

2 weeksPoor concentrationCraving for nicotine

4 weeksIrritability or aggressionDepressionRestlessness

2 days Lightheadedness

10 weeksIncreased appetite

DDDDNicotine withdrawal: the 4 ‘D’s


Delay acting on the urge to smoke

Drink water slowly

Deep breathe.

Do something else (eg exercise)

Pharmacotherapy

Pharmacotherapy + behavioural counselling improves long-term quit rates

Aveyard P, West R. Managing smoking cessation. BMJ 2007;335;37-41

Smokers of 10 or more cigarettes a day who are ready to stop should be

encouraged to use pharmacologial support as a cessation aid

Social Support•Does everyone have social support to quit?•Make sure that those who support you really are

supportive, that they don’t nag you when you get cranky.

•Stay away from other tobacco users when on break or socializing as this may tempt you to smoke or dip.

•Don’t let people use tobacco in your home or car.

Physical Therapy •Silver Spike Point Therapy•Acupuncture is an ancient Chinese medical practice

which uses needles placed at specific spots in the skin to treat pain or disease. It is used today to treat

addiction to nicotine.•S.S.P. therapy, also known as Needle Free

Acupuncture and The S.S.P. electrodes used in S.S.P therapy are uniquely designed to enable medical practitioners to achieve results comparable with

needle electro-acupuncture while eliminating the many disadvantages associated with needle usage

Silver Spike Point Therapy

Bio-Resonance •Biolaz–Oberon/Dianel developed on the basis of the

knowledge of that the cells, tissues and organs are the structures having definite bioelectrical characteristics.

• The device makes it possible to select medicinal products (food additives, pharmaceutical products, phytopreparations or homeopathic remedies) most

fitting purposes of treatment or preventive treatment of an actual on an individual basis.

•Nonlinear Diagnosis SystemIn 1980 Theodore Van Hoven developed the theory of

quantum entropy logic that underlies the method

Ranking of nicotine in relation to other drugs in terms of addiction

Dependence among users

nicotine>heroin>cocaine>alcohol>caffeine

Difficulty achieving abstinence

(alcohol=cocaine=heroin=nicotine)>caffeine

Tolerance (alcohol=heroin=nicotine)>cocaine>caffeine

Physical withdrawal severity

alcohol>heroin>nicotine>cocaine>caffeine

Deaths nicotine>alcohol>(cocaine=heroin)>caffeine

Importance in user's daily life

(alcohol=cocaine=heroin=nicotine)>caffeine

Prevalence caffeine>nicotine>alcohol>(cocaine=heroin)

42

•Nicotine Replacement Therapy (NRT)- Patch (OTC)- Gum (OTC)- Lozenge (OTC)- Oral Inhaler (Rx)- Nasal Spray (Rx)•Non-Nicotine Medications

- Varenicline (Champix, Rx)- Bupropion Hydrochloride (Rx)

First-Line Medications

NRT: Nicotine patches

Adapted from : Henningfield JE. Nicotine medications for smoking cessation. N Engl J Med 1995;333:1196-203

NRT increases the odds of quitting about 1.5 to 2 fold

Nicotine patch (15mg nicotine)

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Minutes

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• Patches provide a slow, consistent release of nicotine throughout the day

• Available in various shapes and sizes,• Common side effects with patches include skin sensitivity and

irritation

Cigarette (1-2mg nicotine)

Venous lev els

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NRT: Nicotine gum



Nicotine gum (4mg nicotine)

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• Instruct the patient to ‘chew and park’• Absorption may be impaired by coffee and some acidic drinks • Common side effects with gum include gastrointestinal

disturbances and jaw pain• Dentures may be a problem!


Venous lev els

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NRT: Nicotine nasal spray



Nicotine nasal spray (1mg nicotine)

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0 30 60 90 120Minutes

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• Nasal sprays more closely mimic nicotine from cigarettes• Common side effects with nasal sprays include nasal and

throat irritation, coughing and oral burning


Venous lev els

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NRT: Nicotine lozenges



• Nicotine tablets deliver 2-mg or 4-mg dosages of nicotine over 30-minutes

• Common side effects with gum include burning sensations in the mouth, sore throat, coughing, dry lips, and mouth ulcers


Venous lev els

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Varenicline

• Begin varenicline a week before the quit date, increasing dose gradually.

• Alleviates withdrawal symptoms, reduces urge to smoke

• Common side effects include: nausea (30%), insomnia, (14%), abnormal dreams (13%), headache (13%), constipation (9%), gas (6%) and vomiting (5%).

• Contra-indicated in pregnancy

• New drug

Cahill K, et al. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev 2007

Varenicline increases the odds of quitting about 2.5 fold

Bupropion• Begin bupropion a week before the quit date

• Normal dose 150mg bd, (reduce in elderly, liver/renal disease)• Contra-indicated in patients with epilepsy, anorexia nervosa, bulimia,

bipolar disorder or severe liver disease.

• The most common side effects are insomnia (up to 30%), dry mouth (10-15%), headache (10%), nausea (10%), constipation (10%), and agitation (5-10%)

• Interaction with antidepressants, antipsychotics and anti-arrhythmics

Hughes J, et al. Antidepressants for smoking cessation. Cochrane Database Systematic Reviews 2007

Bupropion increases the odds of quitting about 2 fold

The World Health Organization (WHO) selects "The WHO

Framework Convention on

Tobacco Control" as the theme of the next World No Tobacco Day,

which will take place on Tuesday, 31 May

2011 .

“People who smoke may not realize how noxious smoke is to

non-smokers. Passive smoking is damaging, not just disagreeable,

and can actually be lethal to people with severe asthma ” .

-Claire Rayner, writer and health campaigner

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(Tobacco damages and cure)