SMOKING AND ITS

HEALTH RISKS

Dr.P.Naina MohamedPharmacologist

INTRODUCTION Tobacco use is the leading preventable cause

of death. The practice of burning tobacco and inhaling

the smoke, is known as Smoking. There are about 1.3 billion cigarette smokers

worldwide and this number is still increasing. About 1 in 5 adults smoke. 4 out of 10 nonsmokers (40%) are exposed to

secondhand smoke. More than 1 out of 2 kids (aged 3–11 years)

are exposed to secondhand smoke. More men (nearly 24%) than women (about

18%) smoke. Smoking rates are higher among people with

a lower education level.

TOXIC COMPONENTS OF TOBACCO SMOKE

TOXIC COMPONENTS OF TOBACCO SMOKE

Tobacco smoke contains chemicals that are harmful to both smokers and nonsmokers.

Breathing even a little tobacco smoke can be harmful.

Tobacco smoke contains about 4800 compounds.

Tobacco smoke consists of two phases: The vapor (or gaseous) phase and Particulate phase

TOXIC COMPONENTS OF VAPOR PHASE

Carbon monoxide Carbon dioxide

Carbonyl sulfide Benzene Toluene

Formaldehyde Acrolein Acetone Pyridine

3-Methylpyridine 3-Vinylpyridine

Hydrogen cyanide Ammonia

Methylamine Dimethylamine Nitrogen oxides

Formic acid Acetic acid

Methyl chloride

TOXIC COMPONENTS OF PARTICULATE PHASE

Nicotine Anabatine

Phenol Catechol

Hydroquinone Cholesterol

γ-Butyrolacetone Quinoline Harman

Benzoic acid Lactic acid

Glycolic acid Succinic acid

TOXIC COMPONENTS OF TOBACCO SMOKE

TOXIC COMPONENTS OF TOBACCO SMOKE

The majority of compounds are found in the particulate phase.

Nicotine is the major component of the particulate phase.

Nicotine comprises 1.5% of the total weight of a commercial cigarette and is the primary alkaloid found in tobacco.

The carcinogens are also found in the particulate matter.

About 69 carcinogens are identified in tobacco smoke. Among them, 11 are known human carcinogens and 7 are probably carcinogenic in humans.

NICOTINE Nicotine is a stimulant and is one of the main factors leading to

continued tobacco smoking. According to studies by Henningfield and Benowitz, nicotine is

more addictive than cannabis, caffeine, ethanol, cocaine, and heroin when considering both somatic and psychological dependence.

Smoking

Nicotine

Facilitates dopamine release in the nucleus accumbens

Pleasurable effect

Triggers positive reinforcement

Nicotine addiction

various nicotine delivery systems, such as the nicotine patch or nicotine gum, that can satisfy the addictive craving by delivering nicotine without the harmful combustion by-products. This can help the heavily dependent smoker to quit gradually, while discontinuing further damage to health.

CHEMICAL CARCINOGENSTobacco smoke

Carcinogenic pyrolytic products, Polycyclic aromatic hydrocarbon (Benzopyrene) and Acrolein

Formation of epoxides

Irreversibly attaches to a cell's nuclear DNA

Genetic mutation

Cancer cell

About 69 carcinogens are identified in tobacco smoke. Among them, 11 are known human carcinogens and 7 are probably carcinogenic in humans.

RADIOACTIVE CARCINOGENS Tobacco smoke contain small amounts of lead-

210(210Pb) and polonium-210 (210Po) both of which are radioactive carcinogens.

Research by NCAR radiochemist Ed Martell suggested that radioactive compounds in cigarette smoke are deposited in "hot spots" where bronchial tubes branch.

Smoking an average of 1.5 packs per day gives a radiation dose of 60-160 mSv/year, compared with living near a nuclear power station (0.0001 mSv/year) or the 3.0 mSv/year average dose for Americans.

The radioactive smoke is deposited in lungs and releases radiation even if a smoker quits the habit.

If the smoker also breathes in the asbestos fibers which commonly occur in urban and industrial environments, the risk of cancer is greatly increased.

HEALTH RISKS OF SMOKING

HEALTH RISKS OF SMOKING Atherosclerotic diseases of the heart and blood

vessels:Cardiovascular disease (including

myocardial infarction and sudden death)Cerebrovascular disease (Stroke)Peripheral vascular disease (Claudication,

etc) Noncancerous lung diseases:

Chronic obstructive pulmonary diseaseAsthma

Cancers at many sites, including the lung, larynx, oral cavity, esophagus, bladder, kidney, pancreas, and uterine cervix.

Toxicity to the human reproductive systemReduced Fertility

CARDIOVASCULAR DISEASES

Cigarette smokers are more likely than nonsmokers to develop both large-vessel atherosclerosis and small-vessel disease.

Approximately 20–30% of coronary artery disease is caused by cigarette smoking.

According to a study by an international team of researchers, people under 40 are five times more likely to have a heart attack if they smoke.

Smoking

Promotes Atherosclerosis, platelet aggregation and vascular occlusion

Increases the likelihood of myocardial infarction and sudden cardiac death

Cessation of cigarette smoking reduces the risk of a second coronary event within 6–12 months.

After 15 years of abstinence from smoking, the risk of a new myocardial infarction or death from coronary heart disease in former smokers is similar to that for those who have never smoked.

CEREBROVASCULAR DISEASE

10% of occlusive cerebrovascular disease are caused by cigarette smoking.

Smoking

Atherosclerosis of cerebral blood vessels

Narrowing of arteries

Cerebral Ischemia

Stroke

PERIPHERAL VASCULAR DISEASE

Approximately 90% of peripheral vascular disease in the nondiabetic population can be attributed to cigarette smoking.

Smoking

Atherosclerosis of peripheral blood vessels

Narrowing of arteries

Claudication

Gangrene

CANCER

Cigarette smoking accounts for at least 30% of all cancer deaths. It is linked with increased risk of cancers such as: Lung Larynx (voice box) Oral cavity (mouth, tongue, and lips) Nose and sinuses Pharynx (throat) Esophagus (tube connecting the throat to the stomach) Stomach Pancreas Cervix Kidney Bladder Ovary (a type called mucinous ovarian cancer) Colorectum (the colon and/or the rectum) Acute myeloid leukemia

Smoking accounts for 87% of lung cancer deaths. Lung cancer is the leading cause of cancer death in both men and women, and is one of the hardest cancers to treat.

The risks of cancer increase with the increasing number of cigarettes smoked per day and with increasing duration of smoking.

RESPIRATORY DISEASE Cigarette smoking is responsible for 90% of chronic obstructive pulmonary

disease. Chronic mucous hyperplasia of the larger airways results in a chronic

productive cough in as many as 80% of smokers >60 years. Chronic obstructive pulmonary disease (COPD) caused by smoking, is a

permanent, incurable (often terminal) reduction of pulmonary capacity characterised by shortness of breath, wheezing, persistent cough with sputum, and damage to the lungs, including emphysema and chronic bronchitis.

The carcinogen acrolein and its derivatives also contribute to the chronic inflammation present in COPD.

Smoking

Long term exposure to Carbon monoxide and Cyanide

Chronic inflammation and narrowing of the small airways

Pulmonary damage and loss of elasticity in the alveoli

Emphysema and COPD

Reduced expiratory airflow Changes in the small airways of young smokers will reverse after 1–2 years of

cessation.

ERECTILE DYSFUNCTION Incidence of impotence is approximately 85 percent higher

in male smokers compared to non-smokers, and it is a key cause of erectile dysfunction (ED).

The British Medical Association estimates that up to 120,000 men have ED because of smoking.

Smoking increases the risk of erectile dysfunction (ED) by about 50 per cent, in men aged 30-40.

Smoking

Narrowing of arteries supplied to penis

Reduced blood supply

Erectile dysfunction

FEMALE INFERTILITY Smoking is harmful to the ovaries, potentially causing female

infertility.

Smoking

Nicotine and other harmful chemicals

Interfere with the body’s ability to create estrogen

Affects folliculogenesis and ovulation

Female Infertility Cigarette smoking also interferes with folliculogenesis, embryo

transport, endometrial receptivity, endometrial angiogenesis, uterine blood flow and the uterine myometrium.

Some damage is irreversible, but stopping smoking can prevent further damage.

Smokers are 60% more likely to be infertile than non-smokers.

PREGNANCY COMPLICATIONS

Smoking

Intrauterine growth retardation (IUGR)

Low birth weight (<2500 g)smoking in pregnancy also increases the risk of preterm delivery. Other adverse pregnancy outcomes linked to smoking are miscarriage (spontaneous abortion) and stillbirth. Smoking during pregnancy affects children even after birth. Sudden infant death syndrome is two to four times more common in infants born to mothers who smoked during pregnancy. Cognitive deficits and developmental problems in childhood are also linked to maternal smoking during pregnancy.

INFECTION Tobacco is also linked to susceptibility to infectious diseases,

particularly in the lungs. Smoking more than 20 cigarettes a day increases the risk of

tuberculosis by two to four times. Being a current smoker has been linked to a fourfold increase

in the risk of invasive pneumococcal disease. The usage of tobacco also increases rates of infection: common

cold and bronchitis, chronic obstructive pulmonary disease, emphysema and chronic bronchitis in particular.

Smoking

Nicotine

Increase in CD4+ cell production

Affects immune system

Increased risk of pulmonary and respiratory tract infections

STRESS Smokers report higher levels of everyday

stress. Several studies have monitored feelings of

stress over time and found reduced stress after quitting.

Recent studies have shown a positive relationship between psychological distress and salivary cotinine levels in smoking and non-smoking adults, indicating that both firsthand and secondhand smoke exposure may lead to higher levels of mental stress.

Medical researchers have found that smoking is a predictor of divorce. Smokers have a 53% greater chance of divorce than nonsmokers.

OTHER RISKS Smokers are at a significantly increased risk for chronic

kidney disease than non-smokers. A history of smoking encourages the progression of

diabetic nephropathy. Cigarette smoking also increases a woman's risk of

postmenopausal osteoporosis and fracture. Smokers have higher rates of peptic ulcer disease, and

sensorineural hearing loss than nonsmokers. The blood vessels in the eye are sensitive and can be

easily damaged by smoke, causing a bloodshot appearance and itchiness.

Heavy smokers are twice as likely to get macular degeneration, resulting in the gradual loss of eyesight.

Smokers run an increased risk of cataracts. Smokers have more prominent skin wrinkling than

nonsmokers, independent of sun exposure.

OTHER RISKS Smoking stains teeth and gums. Smoking increases risk of periodontal disease, which causes

swollen gums, bad breath and teeth to fall out. Smoking causes an acid taste in the mouth and contributes

to the development of ulcers.

Smoking

Reduces the blood supply to the skin and lowers levels of vitamin A

Paler skin and more wrinkles

Affects personal looks

Smokers are 4 times more likely to have gray hair and increased hair loss.

The majority of residential fire deaths are caused by smoking.

OTHER RISKS Smoking interferes with the healing of bone

and muscle injuries, and they lead to higher rates of complications after surgery.

50% more likely than nonsmokers to injure themselves with sprains and fractures.

Smokers are more vulnerable to headaches. People who smoke are more likely to have

sinusitis. Long-time smokers may face an increased

risk of multiple sclerosis. smoking impedes the blood supply to the

lower spine, it is also linked to chronic low back pain and degenerative disk disease.

SECOND HAND SMOKE

Nonsmokers are harmed by chronic exposure to environmental tobacco smoke (ETS).

The children of parents who smoke have more serious respiratory infections during infancy and childhood, more respiratory symptoms, and a higher rate of chronic otitis media and asthma than the children of nonsmokers.

Secondhand smoke exposure increases a nonsmoker's risk of lung cancer and coronary heart disease.

SMOKING KILLS

REFERENCES Behavioral Medicine: A Guide for

Clinical Practice,3e Mitchell D. Feldman, John F. Christensen

The MD Anderson Manual of Medical Oncology, 2e Hagop M. Kantarjian, Robert A. Wolff, Charles A Koller

Hurst's The Heart, 13e Valentin Fuster, Richard A. Walsh, Robert A. Harrington

Harrison's Online Featuring the complete contents of Harrison's Principles of Internal Medicine, 18e

REFERENCES CURRENT Diagnosis & Treatment:

Psychiatry, 2eMichael H. Ebert, Peter T. Loosen, Barry Nurcombe, James F. Leckman

Principles and Practice of Hospital Medicine Sylvia C. McKean, John J. Ross, Daniel D. Dressler, Daniel J. Brotman, Jeffrey S. Ginsberg

Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12eLaurence L. Brunton, Bruce A. Chabner, Björn C. Knollmann

CURRENT Medical Diagnosis & Treatment 2013 Maxine A. Papadakis, Stephen J. McPhee, Eds. Michael W. Rabow, Associate Ed.

REFERENCES http://www.who.int/tobacco/research/

youth/health_effects/en/index.html http://www.cdc.gov/tobacco/

data_statistics/fact_sheets/health_effects/effects_cig_smoking/

http://www.cancer.gov/cancertopics/factsheet/Tobacco/cessation

http://www.nhs.uk/chq/pages/2344.aspx?categoryid=53&subcategoryid=536