By Angela Success
Yesterday, the world celebrated ‘no tobacco’ day, wherein the dangers of smoking were underlined. With the theme, “Tobacco-a threat to development,” countries were encouraged to propose measures that governments and the public should take to promote health and development by confronting the global tobacco crisis.
In line with the theme, countries are expected to put in place measures that will protect the health of its citizens in order to reduce poverty.
In this interview, Dr. Fidelis Okoebor, a cardiologist in training with the University of Port Harcourt Teaching Hospital, talked about the effects of tobacco smoking on the body.
Could you tell us what tobacco is?
Tobacco is basically derived from the tobacco plant that has various species. It is planted in various part of the world, including American, Central America, and the Mexican community. It has its history, which is beyond the scope of this discussion. However, what is worthy of note is that tobacco has been smoked for several years in an unprocessed form. With time, the industries have taken over and started processing it into various products, like cigarette, cigar and ones smoked with pipe.
Tobacco can also be taken through other organs of the body, like the mouth for the oral form and nose for the sniffed ones, like snuff. The most active substances in tobacco are nicotine and alkaloids. When nicotine gains entrance into the body, along with other chemicals, it begins to cause various harms to the body, from the respiratory system, through the cardiovascular system to the liver, and to other parts of the body, which leads to different manifestation in form of disease. Some of them show up on long term basis while others may show up short term.
How rampant is tobacco smoking in our society?
Tobacco smoking is quite high. Let me just say that globally, about 1.1billion people are currently indulging in tobacco. Of course, we all know that a great number of these are the main smokers and others use it in form of snuff orally. In our own environment, the trend is rising. It was more common in males but now the females have joined them. What is even bothering the world now is the fact that while the trend is decreasing in the developed countries where it started, it is increasing more in developing countries. The developing countries are now contributing more to the increasing incident and the prevalence of tobacco smoking in the world. High percentage of the youths are involved in it.
Tobacco is said to be addictive. Why?
The addictive component of tobacco or one of the most addictive components is nicotine. Nicotine is actually a stimulant. When taken over time, causes the body to develop receptors to the substance, which leads to dependence and tolerance of the substance. After continuous use, the user develops increased number of receptors. The more the person takes, the more he or she wants to take more. They now get to that point where if the individual doesn’t take nicotine, the person becomes uncomfortable. Having a form of discomfort that will make the person reach for another stick or another potion. This leads to what is called craving. It is caused by the interaction between the receptors, where the nicotine acts upon and the nicotine itself. And it is built over a period of time.
What are receptors?
They are the points in the body where the nicotine will work, where it is received. These points encourage craving, eventually tolerance and dependency on the substance. It is just like being addicted to certain food. When it gets to that point, it will lead to some form of craving it is the same thing with nicotine but this is more important because of the hazards that comes with it.
What kind of hazards comes with taking nicotine?
Beyond the stimulatory and addictive effect of nicotine, which leads to dependency, there are other components of cigarette, which has various destructive effects when taken into the body. It damages the endocrinal system of the body and the respiratory system. The damage to the breathing system may lead to chronic obstructive airwaves disease, which is the senior brother of asthma. The difference between asthma and COPD is that when treated the asthmatic patient can recover but with COPD the person never recovers fully.
Smoking destroys the airwaves and this leads to bronchitis and other respiratory diseases. The person affected may not be able to breathe normally again in some of these cases. Tobacco smoking also leads to lung, pancreas and liver cancers. It also affects the blood and the parts that are involved in the pumping of the blood, from the heart to the vessels. It may lead to their stiffness, which may directly reduce the amount of space available for the blood to move to other organs.
Smoking tobacco deposits dangerous substances in the blood stream, which reduces pliability of the vessels and this may eventually lead to heart attack. Smokers are prone to hypertension because the vessels are stiff, blood pressure increases and may become difficult to control. It may also lead to peripheral vascular disease. All those coming into play may lead to stroke eventually.
Why is it that some people smoke all their lives and are yet to come down with any of these diseases?
The fact that a smoker has not come down with these conditions now does not mean that the person in perfectly all right. It is still a relative condition you don’t know how well that person is. You don’t know what would have been the standard of his health without tobacco smoking. The bottom line is that studies have shown with statistics that there are higher rate of premature death, high mortality rate, cancer, heart attack, hypertension among smokers than in non smokers. In fact there is no benefit in smoking.
These diseases affect people who smoke. What happens to people around them? Does smoking also affect them?
Yes it does, that is why the word second hand smoking was coined. That is passive smoking. You are not actively smoking but you are in an environment where others are doing it. In that case, the person is also at risk of having some diseases. In fact, it is estimated that 7.6 to 8 million deaths is caused by tobacco worldwide. Six hundred thousand people or 10 per cent of the population affected are second hand smokers, people who never smoked but stayed in either the same house with smokers or in the same environment with them.
If a pregnant woman smokes, does it have any effect on the baby?
Yes, a mother smoking can lead to a lot of negative effects not only to the mother but also to the unborn baby. The baby can develop some congenital anomaly and basically come out with low birth weight, which is below the standard weight for the same gestational age. This will predispose the baby to other developmental anomalies in the future. Low birth weight has been associated with a lot of cardio-vascular risk in our practice. We warn against it.
Does smoking affect fertility in any way?
Yes, it has effect in reproduction. Blood supply is important and when supplies to the organs are obstructed it can lead to erectile dysfunction or poor erection, which can affect reproductive health. Smoking in females can cause endocrinal dysfunction.
If someone has been addicted to tobacco, what are the ways to quit the habit?
Quitting tobacco smoking is very important. It is recorded that tobacco is one of the highest cause of preventable death worldwide. World Health Organisation discovered this as far back as 2006. With this a lot of effort has been put in place to encourage people to quit. It is a step by step process, because of the addictive nature of tobacco. The stepwise process encourages the person to recognize the benefit of quitting and the danger inherent in smoking. The person has to be given all the moral and psychological support during this process. The person should pick a date for stopping. He or she should also put down in writing the amount of money being spent, the physical and psychological implication too.
As far as tobacco use is concerned, when you put all these down you will discover that there are really no advantages in this habit. It is better stopped. For those who smoke, once they start quitting, the dangers and risks reduce. Before the day picked for stopping, the individual should start reducing the quantity or the number of cigarette smoked daily until he or she quits completely. He should stop hanging out with friends or going to places that will lead him or her break this process. Friends and family members should be told about the decision to quit for support and encouragement. Let them know that you intend to stop, as peer pressure is key in tobacco consumption. Create no smoking zones all around you as this will help. Put no smoking stickers all around the areas you spend your time, with a level of discipline you are not likely to smoke in those places. Don’t go back to old friends who still smoke for they will make you go back again to that habit.
Having picked the date, there are other medication we may give to the person to help reduce the dependence on nicotine. It is called nicotine replacement therapy. The individual is given nicotine chewing gum to replace the one cigarette used to give. You give the gum because the receptors are already there and the craving has to be reduced so that the person does not go back to smoking. As you continue to adjust the dose, the person it will help the person to eventually stops. Dosage may be adjusted at any point in time till the person stabilises. Of all, the most important part of stopping is self-discipline, decision, commitment and support. Outside this shore there are support groups available to help people stop but on this side of the world, most of them are still at their early stages. Our families are our biggest support group here. They will help monitor, praise and encourage you until you stop.