You can stop smoking! Replace nicotine to help you so
- Part 2 -

Dr Y Premchandra Singh *

Students participating an anti tobacco rally in Imphal on May 31 2013 :: Pix - HL

Harm Caused by Smokeless Tobacco Use: Constant exposure to tobacco juice causes cancer of the esophagus, pharynx, larynx, stomach and pancreas. Smokeless tobacco users are at a heightened risk for oral cancer compared to non-users, and these cancers can form within five years of regular use.

Harms from Pregnant Smokers or Exposure to Secondhand Smoke: Research studies have found that smoking and exposure to secondhand smoke among pregnant women is a major cause of spontaneous abortions, stillbirths and sudden infant death syndrome (SIDS) after birth. Children exposed to secondhand smoke before and after birth are at a great risk of abnormal blood pressure, cleft palates and lips, childhood leukemia, attention deficit disorder, childhood wheezing and respiratory disorders.

Although most of the research on health harms focuses on cigarette smoking, recent studies have shown that other tobacco use, such as cigar and pipe smoking, also produce similar health risks to users.

New studies have found that the levels of the carcinogenic NNK in smokeless tobacco products were comparable to those cigarettes . A 2008 study from the WHO International Agency for Research on Cancer concluded that smokeless tobacco users have an 80 percent higher risk of developing oral cancer and a 60 percent higher risk of developing pancreatic and esophageal cancer.

A study by the National Institutes of Health and the Centers for Disease Control and Prevention found chewing tobacco users were four times more likely than non-users to have decayed dental root surfaces. In addition, high school seniors who are regular smokers and began smoking by grade nine are 2.4 times more likely than their nonsmoking peers to report poorer overall health. High school seniors who smoke are 2.4 to 2.7 times more likely to report cough with phlegm or blood, shortness of breath when not exercising, and wheezing or gasping.

MANAGEMENT

This essentially include assessment as well as treatment .Assesment includes the components of history,examination (including physical and mental state examination) as well as laboratory investigations. The treatment of substance disorders including smoking has traditionally aimed at helping the person achieve and maintain abstinence and also include the goals of treatment of complications, improving social and psychological functioning and preventing relapse. Development of an effective treatment plan will be based on the findings of the assessment and availability of treatment settings and modalities.

Treatment methods: It is essentially mulitimodal ,that be can executed simultaneously as well as sequentially in phases :

Detoxification: Many approaches are there in the task of helping a dependent person achieve abstinence from substance: it can be done by abrupt cessation of the substance and prescription of specific agents or by means of gradually tapering off the substance by decreasing amounts.

Quitting Is Difficult, But Not Impossible.

The three most effective components of smoking cessation treatment are pharmacological treatments (such as nicotine gum and patches), clinician-provided social support and advice, and skills training regarding techniques to achieve and maintain abstinence. Another treatment approach combines nicotine replacement, counseling and the use of anti depressants like bupropion. In general, more inclusive treatments are more effective in producing long-term abstinence from tobacco, and combined therapies raise the absolute percentage of smokers who remain abstinent.

Use of nicotine chewing gum as a substitute over long term makes the detoxification easier and this is recently made available in India.

Health Benefits From Quitting.

. A 2007 study in the New England Journal of Medicine found that 11.7 percent of the decrease in coronary heart disease deaths between 1980 and 2000 were avoided or postponed by quitting smoking. Upon quitting, former smokers’ blood circulation immediately increases, their blood pressure and heart rate quickly return to normal, and the carbon monoxide and oxygen levels in the blood soon return to normal. Within a few days of quitting, a person’s breathing becomes easier and their sense of smell and taste improve.

One year after quitting, a person’s additional risk of heart disease in reduced by half, and after 15 years, this risk equals that of a person who never smoked. Five to 15 years after quitting, the risk of stroke for an ex-smoker equals that of a person who never smoked. Within 10 years of quitting a former smokers risk of developing lung cancer is 30 to 50 percent below that of a person who continues to smoke. The risk of developing cancers of the mouth, throat and esophagus lessen significantly after five years of quitting.

And although smoking cuts at least 10 years on average from a person’s life expectancy, new evidence shows that individuals who quit before the age of 40 can regain almost all of those years. Those who quit between 35 to 44, 45 to 54 and 55 to 64 can regain 9, 6 and 4 years of life, respectively.

Suggested Nicotine Replacement Therapy (NRT) dose for different daily smoking levels

Type of NRT <10 cigarettes/day 10-20 cigarettes/day >20 cigarettes/day
Patches none 14 mg (Nicabate and Nicotinell) 10 mg (Nicorette 21 mg (Nicabate and Nicotinell) 15 mg (Nicorette)
Gum none 2 mg gum, 8-12 per day 4 mg gum, 8-12 per day
Nasal Spray none 1 mg (2 sprays) each hour 8-12 times per day 1-3 mg (2-6 sprays) each hour 8-12 times per day
Inhaler none 6-12 cartridges per day Not recommended

Nicotine (smoking) an extremely addictive drug and stimulates its own taking by its neurobiological actions: nicotine’s effects, the sensations of pleasure and wellbeing, produce rapid, positive reinforcement, i.e. the desire for more nicotine . Many systemic effects of smoking are seen in cardiovascular ,respiratory ,musculoskeletal and immune system etc . Smoking is asscociated with increased prevalence of cancer , heart disease ,heart attack ,infertility etc . Second hand smoking is equally dangerous . Other form of tobacco use, such as cigar and pipe smoking, also produce similar health risks .

Nicotine withdrawal causes physiological and behavioral changes including an increase in resting metabolic rate, a decrease in heart rate and feelings of aggression, irritability and insomnia. To quit, smokers must not only overcome their physiological dependence on nicotine but also cut their strong psychological and social ties to smoking or otherwise using tobacco.

There are substantial and immediate health benefits from quitting smoking at any age. Multimodal treatment plan including detoxification and patient support system is required to cope with the patient dependence of the substance . Nicotine gum replacement therapy is recently available in India and is one of the option in quitting smoking .

Concluded...