II SMOKING AND DISEASE
     Smoking can be divided into two categories: active (actively smoking oneself) and passive (inhaling smoke because of proximity to a smoker). As per WHO study 9% Boys and 6% Girls of teenage group in India are smokers. Most of the male starts smoking at teenage. Cigarette smoking is the prime, but not the only, culprit; pipe and cigar smoking, while less hazardous than cigarette smoking, are not without risk. Smokeless tobacco (chewing tobacco, tobacco pouches, and snuff dipping) has now emerged as a major cause of oral disease and death from oral cancer.
     The average 20-a-day smoker is estimated to inhale tobacco smoke about 70,000 times a year. It is therefore not surprising that, with such abuse, a number of diseases, many of them fatal, are associated with smoking. These include cancer (particularly of the lungs, larynx, oral cavity, pharynx, oesophagus, pancreas, cervix, kidney, and bladder); coronary artery disease; cerebrovascular disease (strokes, intracerebral haemorrhages); and COAD (chronic obstructive airways disease, comprising chronic bronchitis and emphysema).It has been found that life expectancy of a 30 year old Smoker who smokes 15 cigrarettes per day, is shortened by more than 5 years. Clinical data from several countries show that smokers have 70% higher Death rate than non - smokers. The age group of 45 - 54 is most vulnerable to it. Approximately a Million deaths occur every year due to smoking.
III COMPONENTS OF TOBACCO SMOKE
     Cigarette smoking is an aerosol produced by the incomplete combustion of tobacco leaf by the burning cone. Burning cigrette temperature varies from 30 degree Celsius at mouth piece to 900 degree Celsius at the burning end. The composition of tobacco smoke when inhaled has been the subject of much investigation. Smoke contains over 4,000 chemicals; 43 of them are carcinogenic (cancer promoting). 92 -95% of total weight of smoke is in gas form. Nitrogen, Oxygen, and Carbondioxide forms 85%. The remaining gases, uncondensed vapours and droplets of small particles are of chief medical importance. Main constituents of smoke are Tar, Nicotine, and Carbon Monoxide. Nicotine is highly toxic and addictive comparable to heroin and cocaine. It stimulates as well as depresses the Nervous system. It increases the Rate, Output, Muscle Force, Excitability and Oxygen consumption of Heart. Cancerous substances present in Tar which initiates Cancer formation. These include chemicals such as polyneuclear Aromatic Hydrocarbons (Ben Zylpyrine) , Tar (Trace Elements) , Beta - Naphthylamines (Hydrazine), and also N - Nitrosamines (Vinyl Chloride). There aresome substances which actas Lung Irritants ,they cause immediate coughing, spasm and obstruction in breathing passages. It also contains cellular irritants such as ammonia, formaldehyde, and oxides of nitrogen. Carbon monoxide, which avidly binds to haemoglobin and reduces its oxygen-carrying capacity, is also present.
IV CARDIOVASCULAR DISEASE
     Coronary heart disease, particularly myocardial infarction (heart attack), is the primary cause of death related to cigarette smoking. This is caused by atherosclerosis (deposition of lipids, a type of fat, and fibrous tissue in the walls of arteries), one of the major risk factors for which is smoking. However, cardiovascular deaths are declining in a number of countries, including the United Kingdom and the United States.
V LUNG CANCER
     This is closely followed by lung cancer, which is directly causally related to smoking. The disease carries a greatly elevated relative risk for development when comparing smokers and non-smokers. The risk of mortality is dose-related: the more pack-years (the number of packs smoked per day multiplied by the number of years of smoking), the higher is the risk of the disease developing. Smoking is related to other typeof cancers also namely - Cancerof Mouth, Pharynx, Food Pipe or Oesophagus, Urinary Bladder and cancer of Pancreas all are associated with smoking.
VI PERIPHERAL VASCULAR DISEASE
     Peripheral vascular disease, which affects the feet and lower limbs, is more prevalent in smokers. Like coronary heart disease, it is caused by the development of atherosclerosis in the blood vessels of a limb. In severe cases this may lead to amputation of a foot or digit because of gangrene (death of tissues). The risk of developing peripheral vascular disease is again dose-related, and may decrease once the patient stops smoking.
For routine operations, smokers are at a higher risk of developing post-operative complications, including deep venous thrombosis (DVT), which can lead to pulmonary embolism and sometimes death.
VII EFFECTS OF PASSIVE SMOKING
     The effects of tobacco smoke on the unborn child are now well catalogued. Many studies have shown an association between cigarette smoking and the increased incidence of babies having low birth weight, spontaneous abortions, stillbirths, and sudden infant death syndrome (SIDS). Furthermore, certain complications of pregnancy, some of which may be life-threatening (such as raised blood pressure), are also associated with smoking.
     Involuntary smoking exposure (passive smoking) is detrimental to the health of adults and increasingly, children, who, according to recent studies, run a higher risk of developing lung problems. From the data to date, it appears that passive smoking carries a 1.5 relative risk of developing cancer of the lung as compared to non-smokers. There are also increased risks of heart attack and cerebrovascular diseases.
The fatality is related to the age of starting the smoking, number of cigarettes consumption and amount of smoke inhaled. It varies:-
If smoking has been started at early age.
- To the number of cigarettes smoked per day.
- If smokers inhale the smoke than those who don't inhale.
Smokers are found to have some other additional characteristic features:
They drink more Alcohol, Coffee or Tea.
- Their body weight and Blood Pressure may be slightly less.
- Their Heart rate is slightly faster.
- They have impaired exercise tolerence and Impaired Immune system.
- They have higher Sodium Thiocynite concentration in blood.
- They have low ratio of HDL cholestrol to LDL cholestrol.
- Female smokers have an early Meopause and frequent Miscarriages.
     Smoking in Females: As such smoking delays the conception , Pregnant ladies not only harm themselves by smoking but also the Foetus, Premature deaths and affects the development of baby.
     It has been observed that the children of the smoking parents pick up smoking at much early age than the children of non-smoking parents.
     Children suffering from Respiratory diseases e.g Recurrent Cough, Bronchitis and Asthmatic episodes are far more prevalent in the families where one or more people smoke - may be the husband, wife, uncles or other family members etc. smoke at home.
Would you like to see your children suffering because of your smoking?
VIII EFFECTS OF GIVING UP
     Cessation of smoking is slowly followed by a reduction in excess mortality. After ten years the risk of premature death is more than halfway towards that of someone who has never smoked. The increased risk of lung and laryngeal cancer begins to decline after one to two years. There is a prompt reduction in the risk of developing a heart attack after one year of stopping smoking. It is also believed that the risk of developing COAD is reduced.
Giving up smoking at any stage is always REWRDING in the form of minimising the damage done to the Respiratory System or otherwise.
     Most of the smokers are aware of the hazards of smoking partially. Many wish to give up the habit but feel unable to do so by themselves for one reason or the other. There is a very large group of smokers who have not taken the initiative to stop Smoking, they initially need some advice and encouragement from their doctor. As motivation is the prime thing in the treatment of any addiction.Physician is the best who may convince a patient or smoker in a routine talk because most sophisticated therapeutic methods are useless unless the patient is co-operative.
     Until and unless a person is motivated to stop smoking, none can approach them. We should make it routine to ask a patient regarding his smoking habit.
Remember it is the psycho - social forces that lead to initiation of smoking & later on drug dependence & psychological factors keep it going. I believe that people can stop and they would like to stop, once they have changed their preconceived ideas about smoking, about themselves, about what it means to quit. It is your own mind that holds you back & that only your own mind could help you succeed. This works because of miracles of human mind , the more we use it and stretch it, the better it works and expands. Remember it is the state of mind that decides the state of body.