SMOKING AND THE RISK SMOKING AND THE RISK OF SYSTEMIC DISEASEOF SYSTEMIC DISEASE

Dr. Mohamed Mostafa KamelDr. Mohamed Mostafa KamelMBBCh, MSc.,MDMBBCh, MSc.,MD

Asst. professor of Pulmonology Asst. professor of Pulmonology Cairo universityCairo university

2005-2012helpwithsmoking.com

The combustion of tobacco produces a type The combustion of tobacco produces a type of smoke that contains more than of smoke that contains more than 4000 4000 substances and chemicalssubstances and chemicals,, which are made which are made up of particles and gases that can be up of particles and gases that can be inhaled and absorbed into the bodyinhaled and absorbed into the body..  

Many of these chemicals are extremely Many of these chemicals are extremely dangerous, not only for the smoker but also dangerous, not only for the smoker but also for those people nearby. for those people nearby. 

2005-2012 helpwithsmoking.com

Three of the main components of Three of the main components of environmental tobacco smoke areenvironmental tobacco smoke are::

Nicotine -Nicotine - an addictive drug as powerful as cocaine an addictive drug as powerful as cocaine or heroin. It alters the brain as well as a person's or heroin. It alters the brain as well as a person's behaviour and mood. It is also used in insecticides.behaviour and mood. It is also used in insecticides.

Tar -Tar - a cancer causing substance that damages the a cancer causing substance that damages the lungs.lungs.

Carbon monoxide -Carbon monoxide - a gas that replaces some of the a gas that replaces some of the oxygen in the body that is needed for the lungs to oxygen in the body that is needed for the lungs to function properly. Carbon monoxide is a poisonous function properly. Carbon monoxide is a poisonous gas, which is also found in car exhaust fumes.gas, which is also found in car exhaust fumes.

Some of the carcinogenic substances found in tobacco Some of the carcinogenic substances found in tobacco smoke aresmoke are::

Tar -Tar - used to tarmac roads. used to tarmac roads. Arsenic -Arsenic - very potent deadly poison. very potent deadly poison. Cadmium and nickel -Cadmium and nickel - used in batteries. used in batteries. Vinyl chloride -Vinyl chloride - used to make vinyl products. Short-term used to make vinyl products. Short-term

exposure causes dizziness, headaches and tiredness. Long-exposure causes dizziness, headaches and tiredness. Long-term exposure can lead to cancer and liver damage.term exposure can lead to cancer and liver damage.

CreosoteCreosote - - a component of tar. If inhaled it can cause a component of tar. If inhaled it can cause irritation of the respiratory tract.irritation of the respiratory tract.

Formaldehyde -Formaldehyde - a preservative substance used in forensic a preservative substance used in forensic labs. It causes cancer in humans and in animals.labs. It causes cancer in humans and in animals.

Polonium 210 -Polonium 210 - a radioactive substance that can cause a radioactive substance that can cause cancer of the liver and bladder, stomach ulcers & cancer of the liver and bladder, stomach ulcers & leukaemia leukaemia

2005-2012helpwithsmoking.com

Other irritant toxins that are found in cigarette smoke Other irritant toxins that are found in cigarette smoke areare::

Ammonia -Ammonia - a pungent colourless gas a pungent colourless gas used in many cleaning products such used in many cleaning products such as window or glass cleaner.as window or glass cleaner.

Acetone - Acetone - the main component of nail the main component of nail varnish remover.varnish remover.

Acrolein -Acrolein - an extremely toxic an extremely toxic substance used to manufacture substance used to manufacture acrylic acid. It is considered a possible acrylic acid. It is considered a possible human carcinogen and it irritates the human carcinogen and it irritates the lungs and is the cause of emphysema.lungs and is the cause of emphysema.

Hydrogen cyanide -Hydrogen cyanide - deadly toxic deadly toxic poison used to kill rats. If breathed in poison used to kill rats. If breathed in in small doses, it can cause in small doses, it can cause headaches, dizziness and weakness.headaches, dizziness and weakness.

Carbon monoxide -Carbon monoxide - a deadly gas if a deadly gas if inhaled in enclosed spaces. Faulty inhaled in enclosed spaces. Faulty and leaking gas heaters, boilers, and leaking gas heaters, boilers, stoves and tobacco smoke all produce stoves and tobacco smoke all produce this gas.this gas.

Toluene -Toluene - used to manufacture paint, used to manufacture paint, paint thinners, nail varnish and paint thinners, nail varnish and adhesives. Low - moderate levels can adhesives. Low - moderate levels can provoke tiredness, weakness, loss of provoke tiredness, weakness, loss of appetite and memory loss.appetite and memory loss.

Systemic inflammationSystemic inflammation

Systemic oxidative stressSystemic oxidative stress

Effects of smoking on vasomotor and Effects of smoking on vasomotor and endothelial functionendothelial function

Systemic inflammation

ERS research seminar2007

Decrease in Decrease in Neutrophil deformabilityNeutrophil deformability leading to increase in leading to increase in adherence and migration and eventually to an increase in adherence and migration and eventually to an increase in reactive oxygen speciesreactive oxygen species..

Increase in Increase in abnormal forms of abnormal forms of NeutrophilsNeutrophils from bone marrow from bone marrow

Increase in cytokines such as Increase in cytokines such as IL-6IL-6

Chronic smoking increases Chronic smoking increases WBC WBC countcount which correlates with changes which correlates with changes in FEV1in FEV1

Decrease in number ofDecrease in number of CD 19 +ve B CD 19 +ve B cells cells

Monocytes Monocytes show increase expression show increase expression ofof CD 11b and CD 18 CD 11b and CD 18 which increase which increase their adhesion to endothelial cells , their adhesion to endothelial cells , together with an increase intogether with an increase in ICAM-1 ICAM-1 which are important in the which are important in the pathogenesis of atherosclerosis.pathogenesis of atherosclerosis.

ERS research seminars 2007ERS research seminars 2007

Systemic oxidative stress

ERS research seminars 2007

Cigarette smoke in the gas and tar phases contains 1015-17 oxidant molecules per puff. It is not surprising therefore that inhalation of tobacco smoke results in local lung, but also systemic oxidative stress. Circulating neutrophils from smokers release increased amounts of reactive oxygen species whose release is further enhanced in COPD patients.

Further evidence of increase systemic oxidative stress induced by smoking is shown by increase circulating products of lipid peroxidation and a marked decrease in plasma antioxidant capacity, which may have profound effects on many organs.

Cigarette smoking also affects systemic lipid profiles increasing serum cholesterol, triglyceride and low density lipoproteins, but lowering high-density lipoproteins and oxidising LDL.

Vasomotor and Endothelial Function.

ERS research seminars 2007

Enhanced risk of Cardiovascular diseaseEnhanced risk of Cardiovascular disease

Decrease in Decrease in NO NO and and increase in increase in PeroxynitritePeroxynitrite which which affect vasomotor and affect vasomotor and endothelial function.endothelial function.

Decrease in sytemic Decrease in sytemic arterial wall arterial wall compliancecompliance and and increase stiffness.increase stiffness.

ERS research seminars 2007

Decrease Decrease endogenous endogenous fibrinolytic activity fibrinolytic activity demonstrated by demonstrated by decrease decrease t-PAt-PA release and increase release and increase in in PAI-1PAI-1

Increase in pro-Increase in pro-coagulants such as coagulants such as fibrinogen, D-dimer fibrinogen, D-dimer and tissue factorand tissue factor

CARDIOVASCULARCARDIOVASCULAR

J.Am.soc.Nephrol.15,558-563-2004

Increases Increases NephrotoxicityNephrotoxicity in old age in old age

Increase risk of Increase risk of End stage renal diseaseEnd stage renal disease

Damage to the Damage to the renal transplantrenal transplant

?? Mechanisms include :?? Mechanisms include :- Acute :Acute : increase in BP and Intraglomerular increase in BP and Intraglomerular

pressurepressure- Chronic:Chronic: Endothelial cell dysfunction. Endothelial cell dysfunction.

INFLUENZAINFLUENZA

Smoking seems to cause a higher relative Smoking seems to cause a higher relative influenza-risk in older populations than in influenza-risk in older populations than in younger populations. younger populations.

In a prospective study of community-dwelling In a prospective study of community-dwelling people 60–90 years of age, during 1993, of people 60–90 years of age, during 1993, of unimmunized people 23% of smokers had clinical unimmunized people 23% of smokers had clinical influenza as compared with 6% of non-smokers.influenza as compared with 6% of non-smokers.

Nicholson, K. G.; Kent, J.; Hammersley, V. (1999). Nicholson, K. G.; Kent, J.; Hammersley, V. (1999). "Influenza A among community-dwelling elderly persons in Leicestershire during winter 1993–4; ci"Influenza A among community-dwelling elderly persons in Leicestershire during winter 1993–4; cigarette smoking as a risk factor and the efficacy of influenza vaccination"garette smoking as a risk factor and the efficacy of influenza vaccination". . Epidemiology and InfectionEpidemiology and Infection  123123(1): 103–8.  (1): 103–8. 

ORAL EFFECTSORAL EFFECTS

ORAL CANCERORAL CANCER

LEUKOPLAKIALEUKOPLAKIA

Smokers melanosisSmokers melanosis

Hairy tongueHairy tongue

Submucous fibrosisSubmucous fibrosis LeukoedemaLeukoedema Tooth decay, Tooth decay,

abrasions and abrasions and erosionserosions

HalitosisHalitosis

REPRODUCTIVE SYSTEMREPRODUCTIVE SYSTEM

ImpotenceImpotence Incidence of Incidence of impotenceimpotence  is approximately 85 is approximately 85

percent higher in male smokers compared to percent higher in male smokers compared to non-smokers, and it is a key cause of erectile non-smokers, and it is a key cause of erectile dysfunction (ED). Smoking causes impotence dysfunction (ED). Smoking causes impotence because it promotes because it promotes arterial narrowingarterial narrowing..

Female infertilityFemale infertility Smoking is harmful to the ovaries, potentially Smoking is harmful to the ovaries, potentially

causing causing female infertilityfemale infertility, and the degree of , and the degree of damage is dependent upon the amount and damage is dependent upon the amount and length of time a woman smokes. length of time a woman smokes.

Nicotine and other harmful chemicals in cigarettes Nicotine and other harmful chemicals in cigarettes interfere with the body’s ability to create interfere with the body’s ability to create estrogenestrogen, a , a hormone that regulates hormone that regulates folliculogenesisfolliculogenesis and  and ovulationovulation. .

Some damage is irreversible, but stopping smoking can Some damage is irreversible, but stopping smoking can prevent further damage. Smokers are 60% more likely to prevent further damage. Smokers are 60% more likely to be infertile than non-smokers.be infertile than non-smokers.

Kendirci M, Nowfar S, Hellstrom WJ. (2005). "The impact of vascular risk factors on erectile function". Kendirci M, Nowfar S, Hellstrom WJ. (2005). "The impact of vascular risk factors on erectile function". Drugs Today (Barc)Drugs Today (Barc)  4141(1): (1): 65–74. 65–74. 

    D echanet, C.; Anahory, T.; Mathieu Daude, J. C.; Quantin, X.; Reyftmann, L.; Hamamah, S.; Hedon, B.; Dechaud, H. (2010). D echanet, C.; Anahory, T.; Mathieu Daude, J. C.; Quantin, X.; Reyftmann, L.; Hamamah, S.; Hedon, B.; Dechaud, H. (2010). "Effects of cigarette smoking on reproduction". "Effects of cigarette smoking on reproduction". Human Reproduction UpdateHuman Reproduction Update  1717 (1): 76 (1): 76

   By the American Society for Reproductive Medicine (ASRM). Retrieved on Jan 4, 2009By the American Society for Reproductive Medicine (ASRM). Retrieved on Jan 4, 2009

PsychologicalPsychological Immediate effect:Immediate effect: Users report feelings of Users report feelings of relaxationrelaxation, sharpness, , sharpness, calmnesscalmness, and , and alertnessalertness.Those new .Those new

to smoking may experience nausea, dizziness, and rapid heart beat. Generally, to smoking may experience nausea, dizziness, and rapid heart beat. Generally, the unpleasant symptoms will eventually vanish over time, with repeated use, as the unpleasant symptoms will eventually vanish over time, with repeated use, as the body builds a tolerance to the chemicals in the cigarettes, such as nicotine.the body builds a tolerance to the chemicals in the cigarettes, such as nicotine.

Stress : Stress : Smokers report higher levels of everyday stress. Several studies have monitored Smokers report higher levels of everyday stress. Several studies have monitored

feelings of stress over time and found reduced stress after quitting.feelings of stress over time and found reduced stress after quitting. The apparent relaxant effect of smoking only reflects the reversal of the tension The apparent relaxant effect of smoking only reflects the reversal of the tension

and irritability that develop during nicotine depletionand irritability that develop during nicotine depletion. . Dependent smokers need Dependent smokers need nicotine to remain feeling normal.nicotine to remain feeling normal.

Gilbert Lagrue, François Lebargy, Anne Cormier, "From nicotinic receptors to smoking dependence: therapeutic prospects"Alcoologie et Addictologie Vol. : 23, N° : 2S, juin 2001, pages 39S - 42

Parrott, Andrew C. (1998). "REVIEW Nesbitt's Paradox resolved? Stress and arousal modulation during cigarette smoking". Addiction 93 (1): 27–39..

• Cognitive function :Cognitive function :

- - Alzheimer’s disease : Alzheimer’s disease : conflicting results.. conflicting results..

- Increase inIncrease in incidence ofincidence of dementia and dementia and cognitive decline, cerebral atrophy, anxiety cognitive decline, cerebral atrophy, anxiety disordersdisorders

- Increase inIncrease in mental concentration mental concentration similar to similar to caffeinecaffeine

Anstey, K.; Von Sanden, C.; Salim, A.; O'Kearney, R. (2007). "Smoking as a risk factor for dementia and cognitive decline: a Anstey, K.; Von Sanden, C.; Salim, A.; O'Kearney, R. (2007). "Smoking as a risk factor for dementia and cognitive decline: a meta-analysis of prospective studies". meta-analysis of prospective studies". American journal of epidemiologyAmerican journal of epidemiology  166166 (4): 367–378.  (4): 367–378. 

Jacobsen, L.; Krystal, J.; Mencl, W.; Westerveld, M.; Frost, S.; Pugh, K. (2005). "Effects of smoking and smoking abstinence Jacobsen, L.; Krystal, J.; Mencl, W.; Westerveld, M.; Frost, S.; Pugh, K. (2005). "Effects of smoking and smoking abstinence on cognition in adolescent tobacco smokers". on cognition in adolescent tobacco smokers". Biological PsychiatryBiological Psychiatry  5757(1): 56–66. (1): 56–66. 

Former and current smokers Former and current smokers have a lower incidence have a lower incidence of Parkinson's of Parkinson's disease compared to people disease compared to people who have never smoked. who have never smoked.

Possible role of nicotine in Possible role of nicotine in reducing Parkinson's risk: reducing Parkinson's risk: nicotine stimulates nicotine stimulates the dopaminergic system of the the dopaminergic system of the brain, which is damaged in brain, which is damaged in Parkinson's disease.Parkinson's disease.

Other compounds in tobacco Other compounds in tobacco smoke inhibit MAO-B, an smoke inhibit MAO-B, an enzyme which produces enzyme which produces oxidative radicals by breaking oxidative radicals by breaking down dopamine.down dopamine.

Quik, M. (2004). "Smoking, nicotine and Parkinson's disease".Trends in Neurosciences 27 (9): 561–568.

SKIN DISEASESKIN DISEASE

OTHER EFFECTSOTHER EFFECTS

Decreases appetiteDecreases appetite

Increases expression of AZGP1 gene that increases Increases expression of AZGP1 gene that increases lipolysislipolysis

Increases symptoms associated with crohn’s Increases symptoms associated with crohn’s diseasedisease

Increase risk of abdominal aortic aneurysm Increase risk of abdominal aortic aneurysm formationformation

Vanni, HVanni, H..; Kazeros, A; Kazeros, A..; Wang, R; Wang, R..; Harvey, B; Harvey, B..; Ferris, B; Ferris, B..; De, B; De, B..; Carolan, B; Carolan, B..; Hübner, R; Hübner, R. . et al et al ((20092009).).  "Cigarette smoking "Cigarette smoking induces overexpression of a fat-depleting gene AZGP1 in the human"induces overexpression of a fat-depleting gene AZGP1 in the human"..ChestChest  135135 (5): 1197–1208.  (5): 1197–1208.

Cosnes J et alCosnes J et al.., , ((19991999). "). "Effects of current and former cigarette smoking on the clinical course of Crohn's diseaseEffects of current and former cigarette smoking on the clinical course of Crohn's disease".".  Aliment Aliment Pharmacol. Ther.Pharmacol. Ther.  1313 (11): 1403–11  (11): 1403–11

Lung TransplantationLung Transplantation

DiagnosiDiagnosiss

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11 YearYear55 YearsYears

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AATAAT858594%94%83%83%59%59%

CFCF868695%95%63%63%46%46%

IPFIPF575795%95%60%60%44%44%

PPHPPH393985%85%77%77%60%60%

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