World No Smoaking Day

It is proven that tobacco consumption is responsible for a significant increase in mortality, whether associated with different oncological conditions (lung, bladder, larynx, mouth, oesophagus cancers), whether to other not least important pathologies, such as cardiovascular diseases (cerebrovascular disease, coronary disease, peripheral arterial disease), respiratory pathologies (COPD), changes in fertility, etc. Given this, WHO has considered smoking to be the main avoidable cause of death in the world.

Tobacco smoke, besides containing nicotine, also contains over 7000 chemical agents, most of them composed of pesticides and other organic and metallic compounds (carbon monoxide, DDT, tar, mercury, acetone, etc.). Several radioactive constituents are also present, including lead and polonium, which have a decisive influence in tobacco’s smoke carcinogenic effect.

Nicotine is extremely addictive and causes dependency symptoms very similar to those induced by narcotic substances such as morphine or cocaine.

Tobacco’s harmful action is multisystemic, affecting several organs and systems and is responsible, with a high level of evidence, for pathologies not only of the respiratory tract (worsening of asthma attacks and worst control of the situation, chronic obstructive pulmonary disease) but also of other systems: atherosclerosis, hypertension, increased incidence of vascular diseases, namely coronary disease, stroke, peripheral arterial disease, sudden death, worsening of diabetic retinopathy.

Because in its composition there are carcinogenic substances responsible for DNA mutations, it is responsible for a wider incidence of cancer in different organs (lungs, larynx, oral cavity, oesophagus, urinary tract, cervix and rectal cancer, …).

Concerning the female reproductive system, there is evidence that women smokers might experience reduced fertility, greater chance of miscarriage, prematurity, low weight at birth and perinatal mortality. Some studies also show a relation between smoking and early menopause.

Generalized awareness of the adverse effects of smoking, whether active or passive, with multiorgan repercussions, turned an individual problem into a social issue and one of the greatest public health concerns.

Every year, millions of people die due to smoking related diseases.

Tobacco smoke consequences in health are not immediate. There is a long interval, between 20 to 40 years, between the beginning of tobacco consumption and the appearance of negative health effects. There is an increase in mortality 3 to 4 decades later.

Due to this long latency time, most tobacco related diseases are only diagnosed in an advanced stage.

In Portugal, in the 60’s, tobacco consumption was an almost exclusively male habit, only about 3% of women were smokers. This profile changed from the 80’s onwards, when this habit gradually expanded into the female population. As a direct consequence, a great increase in female tobacco related mortality was registered, all over Europe.

Consequently, there has been a great need to find ways to reduce smoking. The most effective methods to help quit smoking usually include customized advice, if necessary together with the prescription of drugs.

However, the most important impact of this decision comes from the smoker himself/herself, as he/she needs to be truly motivated to stop smoking.

Given this, the participation of the patient in any customized plan for quitting is of extreme importance. A previous evaluation of the addiction level and the prescription of appropriate medication makes it possible to correct or minimize deprivation/withdrawal symptoms (anxiety, irritability, impatience).

In patients with a previous history of psychiatric disease, readjustment of anxiolytic medication is needed, with the support of their psychiatrist.

In conclusion:

- Tobacco is the main cause of avoidable disease and premature death in the world.

It is responsible for:

- About 20 to 30% of all cancer deaths (lungs, upper airways, bladder, …).

- Chronic Respiratory Diseases (COPD, emphysema).

- Cerebrovascular diseases (Stroke).

- Coronary disease, HBP.

- Tobacco related mortality is a consequence of habits sometimes initiated 2 to 3 decades earlier.

- When patients aren’t yet motivated to quit, the role of the assisting physician is of great importance, raising awareness and alert on the risks associated with this habit.

- Quitting smoking is the main avoidable cause for a decrease in mortality, contributing decisively for a better life quality.