Health

Smoking kills

Dr Derrick Aarons

Sunday, May 07, 2017

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Smoking causes premature death and it is one of the leading causes of preventable death.This habit does harm to the body in several ways. The carbon particles and chemicals present in smoke, when deposited repeatedly along the air passages during smoking, stains the teeth; irritates the gum (gingivitis), the lining of the throat, bronchi and bronchioles (lower airways); and produces chronic inflammation of these tissues. This manifests as a repetitive cough that is present in nearly all smokers (excessive phlegm produced with spitting often), and wheezing, asthma, and chronic obstructive lung disease (chronic bronchitis and emphysema) may occur.

The carbon particles and chemicals also deposit in the lung tissue, changing the lungs from a healthy pink to a dark grey colour, and decreasing the efficient uptake of oxygen from the air inhaled. Smokers are also more predisposed to developing respiratory infections, including acute bronchitis and pneumonia.

Carcinogens and addiction

The American Lung Association reports that cigars, tobacco, and cigarettes contain 69 ingredients that can cause cancer. These chemicals stimulate changes in the throat, air passages, and lung tissue that can eventually progress to cancer.

Further, the nicotine present in cigarettes is what makes smoking so addictive. When inhaled, nicotine goes to the brain very quickly, making the smoker feel good ('nicotine rush') temporarily, but can also make the smoker feel anxious, nervous, moody, irritable, and depressed after its effect wears off. The smoker then feels compelled to smoke again.

Nicotine also increases acid secretion that can cause an ulcer in the stomach. It also causes constriction of blood vessels and so increases your heart rate and blood pressure, and can precipitate heart disease and a heart attack.

Beware smokers

The problem for smokers is that they never should have started. It is a historical fact that, because of its highly addictive properties, cigarette manufacturers increase the concentration of nicotine in cigarettes to help ensure that once a teenager or adult starts smoking, it is extremely difficult for them to stop. That is the nature of addiction. So even though these persons are aware that smoking can cause heart attack, cancer, and premature death, the power of the addiction for the large majority of smokers is too great to overcome. They therefore live in hope or denial that, despite the alarming statistics from smoking, such terrible effects won't happen to them.

Due to nicotine's strongly addictive effects, the strategy to stop smoking involves reducing the number of cigarettes smoked each day until the smoker is able to stop smoking completely. Despite such reductions however, unless smokers are eventually able to stop completely, they are still at an increased risk of premature death. A new study on the issue published in JAMA Internal Medicine has shown that smokers who go through much less than a pack of cigarettes each day still have a higher risk of an early death than persons who do not smoke. In other words, there is no safe level of cigarette smoking.

Even with one cigarette per day, the odds of an early death are higher.

Researchers at the National Cancer Institute in Maryland, USA found in their study that even smokers who consistently smoked less than one cigarette per day were more likely to die than 'never-smokers'. To get a better picture of the health effects of 'light' smoking (less than half a pack of cigarettes a day), the researchers tracked more than 290,000 adults aged 59-82 years, including 22,000 current smokers and more than 156,000 former smokers who had completed research surveys in 2004 and 2005.

By 2011, when compared to people who never smoked, persons who consistently smoked at least a part of one cigarette a day were 64 per cent more likely to have died of any cause. Further, smoking from 1-10 cigarettes a day was associated with 87 per cent higher odds of dying from all causes. Lung cancer deaths in particular were much more likely among light smokers than non-smokers.

Take away message

Former smokers fared better when they were able to quit at younger ages. The researchers found that ex-smokers of 1-10 cigarettes daily who 'kicked' the habit after age 50 years, unfortunately had a 42 per cent higher risk of death from all causes, when compared to those who kicked the habit at younger ages. These findings thus reinforce the fact that even 'light' smokers can face serious health risks from the habit of smoking.

The takeaway message is that all smokers should stop smoking, even if they smoke only occasionally. Low-intensity smokers often downplay their use of cigarettes and may even identify themselves as non-smokers and rationalise their behaviour as low risk, the researchers reported. However, the research findings should compel all persons to act when there is any level of smoking, and the sooner individuals quit smoking, the greater the health benefits will be in extending that person's years of life.

Derrick Aarons MD, PhD is a consultant bioethicist/family physician, a specialist in ethical issues in medicine, the life sciences and research, and is the ethicist at the Caribbean Public Health Agency - CARPHA. (The views expressed here are not written on behalf of CARPHA)

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