Dr. Aditya AgrawalConsultant Chest Physician

Bhatia Hospital

SMOKING & IT’S ILL EFFECTS

• Formerly regarded solely as a “lifestyle choice.”

• Smoking is now recognized as a chronic, relapsing disorder caused because of addiction.

• It has become the leading preventable cause of mortality and morbidity over the years.

Am J Med (2008)121 (4A), S1–S2

Am J Med (2008)121 (4A), S1–S2

Smoking – An epidemic

TobaccoTRADITIONAL COMMERCIAL

Smoked in a pipe for

ceremonial purposes

Used as an offering to a

healer, elder or other person

as a sign of respect or thanks

Medicinal tobacco was often

used as a painkiller

Deliberate targeting of

specific consumer groups

Premeditated and conscious

addition of chemicals that

lead to addiction

Scarcely contains actual

tobacco

4

Nicotine: 10-19 seconds to reach brain

ADDICTION

Approx 50 LAKHS people die from tobacco use every year (1 death every 6 seconds) Tobacco kills up to half of its users.

WHO report, 2011

• India has about 12 crore smokers & it is ever increasing

• 32.7% of adult males and 1.4% of adult females

• 17% of males and 9% of females in 13-15 yrs age group use

tobacco.

• Smoking currently causes approx 8-10 lakh deaths per year in

India.

WHO report on the global tobacco epidemic, 2008N Engl J Med 2008;358:1137-47.

How big is the problem of smoking in India

Tobacco-Related Health Risks

Cancer

Respiratory

Asthma Bronchitis COPD Emphysema

Cardiovascular

Aortic aneurysm

Cardiovascular disease

StrokeSudden cardiac death

Tobacco-Related Health Risks

Tobacco-Related Health Risks

Reproductive

• Miscarriage/• spontaneous abortion

• Premature baby• Reduced fertility

Endocrine

• Early menopause

• Irregular menstrual bleeding

• Premature wrinkling and aging

Neonatology

• Lower birth weight

• Sudden infant death syndrome (SIDS)

Tobacco-Related Health Risks

Infections

• Pneumonia• Influenza• Opportunistic respiratory infections

Others

• Accidents• Delayed wound healing

WHO report on the global tobacco epidemic, 2008

THERE IS AN EASIER WAY OF COMMITTING SUICIDE

Smokeless Tobacco in India• Only 20% of the total tobacco consumed in India is in

the form of cigarettes• About 40% consume bidis and the remaining 40%

chew tobacco, pan masala, snuff, gutkha, masheri and tobacco toothpaste.

• These products contain putrefied tobacco, paraffin, areca nut, lime, catechu, and 230 permitted additives and flavours including known carcinogens.

• India has one of the highest rates of oral cancer in the world

• Leading cause of oral cancer, oral mucosal fibrosis, periodontal disease, abrasion of teeth & bad breath.

1) http://www.cpaaindia.org/activities/projects.2) WHO3) Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:857-864)

Can smoking affect vision? 

• Smoking is as bad for your eyes as it is for the rest of your body. Research has linked smoking to an increased risk of developing age-related macular degeneration, cataract, and optic nerve damage, all of which can lead to blindness.

How does smoking affect bones?

• Recent studies show a direct relationship between tobacco use and decreased bone

density.

• Smoking is one of many factors—including weight, alcohol consumption, and activity

level—that increase your risk for osteoporosis

• Significant bone loss has been found in older women and men who smoke. Quitting

smoking appears to reduce the risk for low bone mass and fractures.

• In addition, smoking from an early age puts women at even higher risk for osteoporosis.

Smoking lowers the level of the hormone estrogen in your body, which can cause

menopause earlier, boosting the risk for osteoporosis.

How does smoking affect heart and blood vessels?

• The chemicals in tobacco smoke harm your blood cells and damage the function of your heart. This damage increases your risk for:

• Atherosclerosis, • Aneurysms• Cardiovascular disease (CVD), which includes:

– Coronary heart disease (CHD), narrow or blocked arteries around the heart– Heart attack and damage to your arteries– Heart-related chest pain– High blood pressure

• Peripheral arterial disease (PAD)• Stroke, which is sudden death of brain cells caused by blood clots or bleeding

How does smoking affect lungs and breathing? 

Smoking causes:

•Chronic obstructive pulmonary disease (COPD)

•Emphysema

•Chronic bronchitis

•Pneumonia

•Asthma

•Tuberculosis

Exposing an infant to second-hand smoke greatly increases the child’s risk of:

• asthma

• pneumonia

• bronchitis

• fluid in the

middle ear

Each year, second-hand tobacco smoke is responsible for thousands of:• deaths from heart disease in adults• deaths from lung cancer in adults• deaths from other cancers in adults• cases of lung infections, such as pneumonia

and bronchitis, in infants and young children• Infertility, spontaneous abortion, and low birth

weight babies

Second-hand Tobacco Smoke

The Consequences of Second-hand Tobacco Smoke on Health

Effects Causally Associated with Second-hand Smoke Exposure

Developmental EffectsFoetal growth: low birth weight or small for gestational age

Sudden infant death syndrome (SIDS)

Respiratory EffectsAcute lower respiratory tract infections in children (bronchitis,

pneumonia)Asthma induction and exacerbation in children

Chronic respiratory symptoms in childrenEye and nasal irritation in adultsMiddle ear infections in children

The Consequences of Second-hand Tobacco Smoke on Health

Effects Causally Associated with Second-hand Smoke Exposure (cont.)

Carcinogenic EffectsLung cancer

Nasal sinus cancer

Cardiovascular EffectsHeart disease mortality

Acute and chronic coronary heart disease morbidity

The Consequences of Second-hand Tobacco Smoke on Health

Effects With Suggestive Evidence of a Causal Association With Second-hand Smoke Exposure

Developmental EffectsSpontaneous abortion

Adverse impact on cognition and behavior

Respiratory EffectsExacerbation of cystic fibrosisDecreased pulmonary function

Carcinogenic EffectsCervical cancer

When Smokers Quit

Risks from Environmental Tobacco Smoke (ETS)

– Mainstream—smoke drawn through tobacco while inhaling

– Sidestream—smoke from the burning end of a cigarette or smoke exhaled by a smoker

– Contains 2 times more tar and nicotine, 5 times more carbon monoxide, and 50 times more ammonia than mainstream smoke

– Causes more deaths a year than any other environmental pollutant

The Wrinkles The Lie The Truth

A smoker’s risk of heart attack is more

than twice that of nonsmokers.

Cigarette smoking is the biggest risk factor

for sudden cardiac death.

Smoking and Strokes

• Cigarette smoking doubles the risk of a stroke.

• Smoking damages the cardiovascular system.

• Cigarette smoke makes clotting more likely.

• Smoking cessation today would significantly cut

risk of stroke within two years.

Smoking & Reproduction• Women smokers have greater risks of:

– Primary and secondary infertility

– Miscarriage and premature delivery

– Stillbirth, neonatal deaths, and sudden infant death

syndrome (SIDS)

– Danger to the mother, eg, bleeding

– Menstrual problems

– Premature menopause + osteoporosis

Women who plan to have children need to know that smoking is associated with:

• Reduced fertility

• Early menopause

• Increased likelihood of delayed pregnancy

• Complications of pregnancy

• Reduced oxygen to placenta

• Significantly increased risk of sudden infant death syndrome

(SIDS)

Womenwho takebirthcontrol pillsand smokeare:

39 times more likely to have a heart attack

22 times more likely to suffer from certain forms of stroke

EFFECTS OF TOBACCO ON HEALTHTobacco affects all parts of the body from head to toe

Skin Premature agingSkin creasing andSkin cancers

Teeth StainingWearing off of teethReceding gum line

Mouth Oral cancerSubmucosal fobrosis

Vocal cords Cancer

Eyes Visual problems – cataracts, premature blindness

Brain AddictionStrokesBrain hemorrhage

Heart Heart attacks AneurysmsSudden death

Blood vessels Hardening and bloackage leading to gangrene

Lungs Chronic bronchitis EmphysemaInfections Chronic obstructive lung diseaseCancer

Bladder/ Kidney CancerMale impotence

Esophagus/ stomach/ pancreas Cancer

Reproductive system Male impotenceFemale infertilityAbortionsPremature birthOsteoporosis

Bones Thining and risk of fractures

Is smoking a risk factor for autoimmune diseases? 

• Smoking compromises the immune system, making smokers more likely to have

respiratory infections.

• Smoking also causes several autoimmune diseases, including Crohn’s disease and

rheumatoid arthritis.

• It may also play a role in periodic flare-ups of signs and symptoms of autoimmune

diseases.

• Smoking doubles your risk of developing rheumatoid arthritis.

• Smoking has recently been linked to type 2 diabetes, also known as adult-onset

diabetes. Smokers are 30% to 40% more likely to develop type 2 diabetes than

nonsmokers.

DEPARTMENT OF PULMONARY MEDICINE