Smoking

tobacco addiction
smoking
smoking cessation
chest diseases
tobacco related diseases
cancer lung
COPD

1. By
Dr. Adel Hamada
MD CHEST
EDIC
Tobacco
Smoking

2. Tobacco was introduced to Europe from South
America in the 16th century
thereare1.1billionsmokersworldwide.
In1990therewere3millionsmoking-related
deathsperyear,projectedtoriseto8million
by2020(representing12%ofalldeaths)
introduction

3. COMPOSITION
Theprincipalcomponentsaretarandnicotine,theamountsof
whichcanvarygreatlydependingonthecountryinwhichcigarettes
aresold.
Thecompositionoftobaccosmokeiscomplex(morethan500
compoundshavebeenidentified)andvarieswiththetypeof
tobaccoandthewayitissmoked.Thechiefpharmacologically
activeingredientsarenicotine(acuteeffects)andtars(chronic
effects).

4. Smokeofcigarsandpipesisalkaline(pH8.5)
andnicotineisrelativelyun-ionisedandlipid-solubleso
thatitisreadilyabsorbedinthemouth.
Cigarandpipesmokersthusobtainnicotine
withoutinhaling(theyalsohavealowerdeathrate
fromlungcancer;whichiscausedbynon-nicotine
constituents).

5. Smoke of cigarettesis acidic and nicotine is Relatively
insoluble in lipids.
Desired amounts are absorbed only if nicotine is taken into the
lungsfor compensates for the lower lipid solubility.
Cigarette smokers therefore inhale (and have a high
rate of death from tar-induced lung cancer).

6. Tobaccosmokecontains1-5%carbonmonoxide,andhabitual
smokershave3-7%(heavysmokersasmuchas15%)oftheir
haemoglobinascarboxyhaemoglobin.
carcinogenicsubstances(polycyclichydrocarbonsand
nicotine-derivedN-nitrosamines)havebeenidentifiedintobacco
smokecondensatesfromcigarettes,cigarsandpipes.
Polycyclichydrocarbonsareresponsibleforthehepaticenzyme
inductionthatoccursinsmokers.

7. Types of Tobacco Smoke Exposure
First Hand Smoke Exposure
is the smoke inhaled by a smoker.
Second Hand Smoke Exposure
tobacco smoke inhaled by non-smokers.
I.side stream smoke which is released by the burning end.
II.main stream smoke which is exhaled by a smoker.
Third Hand Tobacco Exposure
Itincludesinvisiblesmokeleftintheairafteracigaretteis
extinguished
Thisiscigarettesmokedepositsonfurniture,clothingandothersurfaces.

8. Disease Patterns Related to Tobacco
Smoke
Smokingisassociatedwithvariousdiseasesof
thecardiovascularandrespiratorysystemsaswell
ascancer.
Itisestimatedthat,ifcurrentsmokingtobaccoconsumption
patternsaremaintained,about450millionadultswilldieasa
consequenceoftobaccosmoke-relateddiseasesbetween
2000and2050.Ofthe450million,about50%willbebetween
30and69yearsofage(Jha,2009).
three-tofour-decadelagbetweenthepeakinsmoking
prevalenceandthesubsequentpeakinsmokingrelated
mortality(Lopezetal.,1994).

9. Disease Patterns Related to Tobacco Smoke
Smoking is associated with various diseases of the cardiovascular
and respiratory systems as well as cancer.

10. Smoking and cancer

11. Pulmonary Diseases
And Smoking

12. Smoking related ILDs

13. Cardiovascular
Diseases And Smoking

14. Other effects of
Smoking

15. Other
effects
of
Smokin
g

16. Health Hazards of Secondhand
Smoke in Nonsmokers

17. Waterpipetobacco
smoking

18. The prevalence of waterpipetobacco smoking has increased
worldwide, in part, because of misconceptionsabout its safety.
Today, waterpipesmoking typically consists of a combination
of tobacco, water, wood charcoal, and a device known as a
waterpipe, shisha, chica, hookah, hubble-bubble arghileh,
goza, ghalyan, or mada’A(depending on the country).

19. TheWorldHealthOrganization(WHO)hasdeclaredwaterpipe
tobaccosmokinganewpublichealthproblem.(2010)
Althoughwaterpipesmokingisperceivedasbeinglessharmful
thancigarettes,evidencesuggeststhatitcontainssimilar
harmfulagentsandhassimilaraddictivepotentialascigarettes
Unlikecigarettesmoking,waterpipesmokinghasbeen
associatedwithinfectiousdiseases,andpossibly,a
predispositiontowarduseofpsychoactivesubstances.

20. Contrarytopopularbelief,waterpipeandcigarette
smokecontainsimilartoxicagentsand,duetothe
longerinhalationalpuffsrequiredtogeneratethe
smokewithwaterpipesmoking,itisbelievedthatupto
100timesmoresmokeisinhaled,therebyexposing
theindividualtolargeamountsofnicotine,carbon
monoxide,andpolyaromaticHydrocarbons.

21. Comparedwithcigarettes,waterpipesemitamuchgreater
amountofultrafineparticlesinthesizeof0.02-1μminsize,
particularlyfromtheburningcharcoal.
particlesthatare0.8-3μmdepositintheterminalairwaysand
alveoliorairsacsoftheLungs.Irreversiblelungdisease,suchas
chronicobstructivepulmonarydisease,occursintheseterminal
airsacs.
studiesinvestigatingthepulmonaryfunctiontestsofwaterpipe
smokersfoundnotonlyadecreaseintheFEV1,butalso
decreasedvaluesinpeakexpiratoryflowrates

22. Carcinogenic effects
of waterpipesmoking
95% of the polyaromatichydrocarbons were generated from
the charcoal.
Asinglesessionofwaterpipetobaccosmoking
producedasmuchtaras20low-tarcigarettes
andwaterpipetobaccomainstreamsmoke
producedmuchhigherlevelsofarsenic,chromium,
andlead.
Compared with a single cigarette, waterpipetobacco smoke
yielded 20 times the total polycyclic aromatic hydrocarbon yield
and 50 times the heavy polycyclic aromatic hydrocarbons.

23. Waterpipesmokingrequireslargertidalvolumesandlonger
inspiratorytimes.Thelargerinhaledrespiratoryvolumesexpose
thesmokertomorecarcinogensthancigarettesmoking.
Carcinogenic effects
of waterpipesmoking
so
The carcinogenic effect is at least
as ( if not more than) that of
cigarette smoking

24. WHO Study Group on Tobacco Product Regulation
(TobReg) recomendationsas regard waterpipesmoking
Waterpipesand waterpipetobacco should be subjected to the
same regulation as cigarettes and other tobacco products.
Waterpipesand waterpipetobacco should include strong
health warnings.
Claims of harm reduction and safety should be prohibited.
Misleading labeling, such as “contains 0 mg tar, which may
imply safety, should be prohibited.

25. Waterpipesshould be included in comprehensive tobacco control
efforts,including prevention strategies and cessation interventions.
Waterpipesshould be prohibited in public places consistent with
bans on cigarette and other forms of tobacco smoking.
Education of health professionals, regulators, and the public at
large is urgently neededabout the risks of waterpipesmoking,
including high potential levels of secondhand exposure among
children,pregnantwomen, and others.
The TobRegrecommends that a full document be produced in the
WHO Technical Report Series to evaluate thoroughly the health
effects of waterpipesand to develop recommendations.

27. Smoking cessation

28. An algorithm for treating
tobacco use.

29. The “5 A’s” strategy for helping
patient to quit smoking

30. General Clinical Guidelines for
Prescribing Pharmacotherapy for
Smoking Cessation
five types of nicotine replacement therapy,.
sustained-release bupropion, an antagonist of the nicotinic receptor,.
varenicline, a partial agonist of the nicotinic receptor.
all smokers trying to quit smoking should be offered
pharmacotherapy.
There are seven first-linesmoking cessation
medications

31. Second-line therapies include clonidineand
nortriptyline.
These should be reserved for individuals with contraindications to/or
failure of response to first-line medications.
As regard weight gain after smoking cessation:
Bupropion and nicotine replacement therapies may delay but not prevent
weight gain after smoking cessation.
It is recommended that patients start or increase physical activity, but strict
dieting is discouraged because this appears to increase the likelihood of relapse
to smoking.
Patients should be reassured that weight gain after quitting is self-limited and
poses much less of a risk to health than smoking.

32. As regard safety of medications
Transdermal nicotine (patches), nicotine gum, and bupropion
appear to be safe for patients with chronic cardiovascular disease.
Other medications are likely to be much safer than smoking in the
presence of medical disease, but need further evaluation.

33. long-term therapy with nicotine replacement
medication, bupropion, or varenicline
In those with prolonged withdrawal symptoms or in those who cannot
resist smoking without medication appears to be safe and effective therapy,
Combination therapy is better than monotherapy
Recentresearchsuggeststhatcombiningbupropionwithnicotinepatches
orcombiningnicotinepatcheswithadlibitumuseofnicotinegumor
nicotinenasalsprayincreasesabstinenceratescomparedwiththerates
producedbyasingleformoftherapy.

34. First line pharmacotherapiesfor smoking
cessation

35. Second line pharmacotherapiesfor smoking
cessation
Smoking-cessation therapy is far
more cost-effective than almost
any other preventive medicine
intervention.