You can stop smoking! Replace nicotine to help you so
- Part 1 -

Dr Y Premchandra Singh *

Campaign espouses tobacco free Manipur in August 2014 :: Pix - TSE

Nicotine is the main component of the hazardous material produced while smoking. Smoking leads to nicotine addiction with serious systemic side effects involving the cardiovascular , respiratory , immunological and musculoskeletal systems. Smoking cause lung cancer and other forms of cancer too . Smoking and smokeless tobacco cause equal amount of health risk .

Detoxification and multimodal treatment plan can help in quitting smoking and can help in overcoming the problems. Nicotine gum is recently available as replacement therapy Cigarette smoke contains over 4,000 different chemicals and compounds, 43 are known carcinogens viz Nicotine , Carbon monoxide , Polonium – 210 , Tar , Carbon disulfide, Cadmium ,Ammonia, Hydrogen cyanide , Mercury , Lead , Menthol , Benzene , Licorice , Acetone , Formaldehyde , Cocoa , Arsenic.

The major component, Nicotine is a natural component of the tobacco plant leaf and is present in cigarettes in varying concentrations. Nicotine delivery from the smoke of a cigarette influences smoking behavior as the smoker is trying to meet their body’s ‘demand’ for nicotine. If a cigarette has a low nicotine concentration then the smoker may draw from the cigarette more frequently and more deeply and inhale larger volumes of smoke thereby , inhaling more of the other harmful components of cigarette smoke.

Nicotine is efficiently extracted in the lungs where it enters the circulatory system and is absorbed throughout the body. It easily crosses the blood-brain-barrier and there are nicotine receptors throughout the central and peripheral nervous systems. Nicotine has multiple neurobiological effects and follows a variety of neurological pathways that control pleasure and reward within the central nervous system.

Nicotine is principally metabolized in the liver to cotinine, its main metabolite but some nicotine remains active for 6 to 8 hours, especially if the person regularly smokes another cigarette. Nicotine has various effects on the cardiovascular system. Although the effect of one dose of nicotine may be small and transient, repeated doses throughout the day can have a significant effect.

Systemic Effects of Smoking

Cardiovascular System Effects

o Nicotine, one of the main compounds found in cigarettes exerts its effects on the cardiovascular system by stimulating the production of cateccholamines (epinephrine & norepinephrine) resulting in:
1. increased heart rate,
2. elevated blood pressure,
3. increased peripheral vascular resistance
4. increased myocardial oxygen demand.
5. tissue hypoxemia,
6. increased plasma viscosity (polycythemia 2° to tissue hypoxemia from carbon monoxide),
7. elevated total cholesterol and LDL levels,
8. increase fibrolytic and platelet activity.

Respiratory System Effects

1. paralysis of mucociliary transport. (1 cigarette = ~ 20 minutes of paralysis!)
2. destruction of lung cilia leads to increased mucosal production.
3. small airway narrowing, reduced pulmonary surfactant and compliance mean less oxygen exchange and a tendency for a ventilation-perfusion (V/Q) mismatch

(2). Immune System Effects

1. decreased neutrophil activity.
2. impaired immunity increases the risk for lung infection.
3. impaired wound healing attributed to the toxins in smoke which are the result of poor oxygen perfusion throughout the body.

(3) Musculoskeletal System Effects

1. increased risk of osteoporosis.
2. increased risk of fracture(s) with impairment of fracture healing
o smoking may impair osteoblast (bone forming cells) function.
o Non-smokers produce approximately 1cm of bone in 2 months while it takes a smoker 3 months to make the same amount of bone.
3. increased risk of herniation of an intervertebral disc.
o It is suggested that smoking makes discs more susceptible to disease by affecting the blood supply to the discs.

Disease Associated With Smoking:

Smoking-Caused Cancer : Smoking is responsible for 87 percent of lung cancer deaths (90% in men, 80% in women). Over 125,000 men and women die of smoking caused lung cancer each year. Compared to nonsmokers, men and women who smoke are 25 times more likely to die from lung cancer . Thirty percent of all other cancer deaths are also due to smoking. Smoking is a known cause of cancer of the lung, larynx, oral cavity, bladder, pancreas, uterus, cervix, kidney, stomach and esophagus.

Smoking-Caused Respiratory Diseases : Twenty three percent of smoking-attributable deaths—more than 100,000 smoking deaths per year—involve respiratory diseases. Smoking is a known cause of most cases of chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis.14 Smoking is accountable for more than 90 percent of all COPD deaths.

Compared to nonsmokers, men who smoke are more than 25 times as likely to die from COPD; and women who smoke are more than 22 times as likely. Male and female smokers increase their risk of death from bronchitis and emphysema by 10 times.

Smoking-Caused Heart Disease and Heart Attacks: Twenty-one percent of all coronary heart disease deaths in the United States each year are attributable to smoking. This risk is strongly dose related. Smoking triples the risk of dying from heart disease among middle-aged men and women.Two-thirds of deaths due to ischemic heart disease among smokers are attributable to their smoking. Cardiovascular smoking deaths are also due to hypertension and stroke. The risk of ischemic stroke is nearly doubled by smoking. Smoking accounted for 18 percent of all stroke deaths.

Other Direct Health Harms From Smoking : Smoking may reduce fertility and lead to impotence among men. Cigarette smoking increases both the risk and the severity of rheumatoid arthritis. Hearing loss and vision problems, including cataracts, have been linked to smoking. Chronic coughing, increased phlegm, emphysema and bronchitis have been well-established products of smoking for decades; and smokers are also more susceptible to influenza and more likely to experience severe symptoms when they get the flu.

To be continued...