CRUSH THE CRAVE WITH NICOTINE REPLACEMENT THERAPY
QUIT Smoking! This world Tobacco Day
Tobacco smoking is one of the biggest public health threats the world has ever faced and the smokers are not only putting themselves at risk, but also the non-smokers. Tobacco use is the leading cause of preventable diseases and death in India. Yet millions continue to smoke. Tobacco smoking is the most important risk factor for developing COPD2. At least 1 amongst 4 continuous smokers are at the risk of developing COPD3. In both asthma and COPD, cigarette smoking is associated with - accelerated decline of lung function, increased mortality and worsening of symptoms4.Smokers had 3 times more risk to develop COPD as compared to non-smokers5. 40% of smokers developed chronic bronchitis and half of those (20%) developed COPD6. Lifelong smokers have a 50% probability of developing COPD during their lifetime7.
Smoking is the leading modifiable risk factor for chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), and lung cancer. Smoking cessation is the only proven way of modifying the natural course of COPD. It is also the most effective way of reducing the risk for myocardial infarction and lung cancer. The risk of total mortality and rate of recurrence of lung cancer is substantially lower in smokers who manage to quit smoking following the diagnosis of early stage lung cancer or small cell lung cancer. The risk is nearly 50%9. The prevalence of smoking tobacco use among current tobacco users is 35.1%. Smoking tobacco exposes the smoker to more than 7,000 chemicals, of which nearly 250 and nearly 69 chemicals are proven harmful and carcinogenic respectively. Oral and Lung cancers account to more than 30% of all the cancers in India. In India, about quarter of oral cancers are attributable to tobacco use.
More than 40 chemicals in tobacco smoke have been identified to cause cancer. Smoking also damages your lungs and other parts of your respiratory system, raises your blood pressure, and robs your body of oxygen, just to name a few of its harmful effects1. The average smoker is at a risk: 14x higher risk of dying from cancer of the lung, throat, or mouth, 4x higher risk of dying from cancer of the esophagus, 2x higher risk of dying from a heart attack and 2x higher risk of dying from cancer of the bladder.
According to Dr.Ajay Godse, MD Chest Physician, Bhakti Vedanta Hospital “Quitting the habit is made more difficult by the physical addiction to nicotine (the chemical stimulant in tobacco). Nicotine is a highly addictive drug that causes strong physical cravings and withdrawal symptoms like other drugs that stimulate the nervous system. Fortunately, medical treatments are now available that can help you control the withdrawal symptoms and cravings. With the treatment, significant improvements in the quality of life, daytime symptoms, and bronchial hyper-reactivity can be witness.”
Effects of cigarette Smoke on clinical outcomes in COPD
FEV1 Decline (mL/5 years)a
Mortality Risk Ratiob
Effects of cigarette Smoke on clinical outcomes in Asthma
FEV1 Decline (% change from FEV1 predicted age 18 and 40)c
Hospitalization Rates (%)d
Mortality Rates (OR)e
a Figures are the cumulative 5 year average decline in FEV1 for control group (smokers with COPD) and for those with sustained cessation for 5 years (non-smokers with COPD).14
b Mortality risk ratios for cigarette smokers compared with non-smokers vary markedly, as reported from 8 major prospective studies.18
c A study of 4000 adults initially aged 18e30 yrs, who were followed for over 10 yrs with serial spirometry measurements. This was a subgroup within the study comparing asthmatics who didn’t smoke with asthmatics who smoked at least 15 cigarettes/day.15
d A study of 1847 patients between 18 and 54 yrs, who presented to the emergency department with acute asthma. Current and former smokers together made up 58% of admissions.17
e A study of 6-year mortality rate following a near-fatal asthma attack with an age-adjusted odds ratio (OR).16
Interestingly, female continued smokers experienced a faster decline in lung function compared with male continued smokers for the number of cigarettes they smoked10. However, female smokers experienced larger gains in lung function when they stopped smoking compared with male quitters8.
Nicotine Replacement Therapy (NRT) is recognized globally as an effective form of treatment to help smokers to quit smoking.
Cigarettes are an effective means of delivering nicotine quickly to the brainstem where it stimulates the release of dopamine via the nicotinic receptors. NRT aims to take away the cravings for cigarettes and mitigate nicotine withdrawal symptoms by providing steady stimulation to the nicotinic receptors and preventing the rapid fluctuations in the release of dopamine in the forebrain.
Dr. Bipeenchandra Bhamre, Cardio-Thoracic Surgeon at Sir H N Reliance Foundation Hospital and Research Centre said, “Smoking increases the risk of developing cardiovascular diseases, which includes coronary heart disease and stroke. Smokers are almost twice as likely to have a heart attack compared with people who have never smoked. Quitting smoking is the single best thing you can do for your heart health.”
“Tips to help you stop smoking
· 1. After quitting smoking for one year your chances of getting heart attack drastically reduces and after 5 years of quitting smoking the risk to stroke is almost same as non-smokers.
· 2. Smoking damages the lining of your arteries, leading to a build up of fatty material (atheroma) which narrows the artery. This can cause angina, a heart attack or a stroke.
· 3. Keep busy to help take your mind off cigarettes. Try to change your routine, and avoid the shop where you normally buy cigarettes”.
Further, Dr Nilesh Chinchkar, Chest Physician, Niramaya Hospital mentioned, “Nicotine replacement therapy (NRT) helps reduce nicotine withdrawal and craving by supplying your body with nicotine. It contains about one-third to one-half the amount of nicotine found in most cigarettes. This is one of the best options and needs to be promoted. NRT is a way of getting nicotine into the bloodstream without smoking. There are nicotine gums, patches, inhalers, tablets, lozenges, and sprays. Many clinical trials show NRT can increase the chances of quitting smoking by 50-70% compared to unassisted quitting.”
Tobacco is linked with many health problems in addition to lung disease and cancer. As our knowledge about the health consequences of smoking grows, these health concerns have also been extended to the innocent bystanders (those who regularly encounter second-hand smoke). If you are ready to quit, talk to your physician. Your doctor can help you successfully quit smoking by treating your addiction to nicotine and by giving you information on how to change your behavior.
It is necessary to create awareness about the NRT and its benefits. Tobacco smoking is an important issue and needs to be addressed and awareness around it needs to be created on regular intervals. It’s time to emerge stronger than addition. Let us say NO to tobacco and CRUSH THE CRAVE!