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Bamisile: Smoking is the worst invention of modern era

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The World No Tobacco Day comes up on Wednesday 31st May 2017. Dr. Tunmise Bamisile, a Consultant chest physician, Respiratory Unit, Department of Medicine, Lagos State University Teaching Hospital (LASUTH), and head of Clinical, Medical Emergency Services Department, LASUTH spoke with PAUL ADUNWOKE on dangers of smoking and smoking related diseases, prevention, treatment and management.

How can you describe smoking?
Smoking is the worst invention of modern era; it is worse than atomic bomb. It has killed more people than all that died from world wars I and II combined. According to World Health Organisation (WHO), more than one billion people are current smokers, that is, one in seven humans on earth are smokers. Put in other word, there are more smokers than entire inhabitant of each of the continents in the world apart from Asia. Consequently, WHO has postulated that more than one billion people will die from tobacco smoking in the 21st Century. It is sad enough that about 6.3 million people die from active and side stream smoking worldwide annually, constituting 6.3 per cent of global burden of diseases. The gory picture above is, however, completely avoidable and reversible, if only we quit cigarette smoking.

What are the smoking related diseases?
Tobacco smoking is dangerous to the smokers and any other person inhaling the smoke. It harms all the cells of the body, causing various diseases ranging from seemingly innocuous irritation of the eyes and characteristic smoker cough, to incurable cancers of virtually all the major organs in the body, lung, larynx, mouth, liver, pancreas, kidney, blood, uterus, cervix, esophagus and stomach, which will invariably claim the life of such victim.

Cigarette smoking decimates all the systems in the body. In the lung, it causes chronic obstructive pulmonary diseases (COPD), emphysema, chronic bronchitis, makes symptoms of asthma worse, makes the populace to be prone to different types of pneumonias and ultimately it’s the leading cause of cancer of the lung. Cigarette smoke is a major cardiovascular risk, leading to sudden death, heart attack, irregular heartbeat, high blood pressure and stroke. It is also noteworthy to stress that cigarette smoking is a major risk factor for the development of other diseases outside the heart and the lung, including peptic ulcer diseases, diabetic mellitus, mouth staining and odious dental health.

It will be a disservice to our women folk, who are now embracing the culture of smoking without mentioning that tobacco increases the speed and rate of skin wrinkling, defacing their God given beauty, making them to look older than their biological age. Not only that tobacco is strongly associated with infertility in both sexes, it causes low birth weight, premature birth and premature rupture of the membranes, spontaneous abortion and increased perinatal death. Osteoporosis and early menopause are also part of the menace of tobacco to our female population. It is equally important to note that children of smokers are not spared from this social malady called smoking. They are prone to various respiratory tracts infections, pneumonia inclusive, ear infection, bronchial Asthma and sudden infant death syndrome.

Everybody has a role to play in reversing the culture of smoking. The smokers, health workers, government at all levels and entire citizenry, all have significant roles to play in assisting the smoker to quit. All smokers expressing the desire to quit should be assisted. All health workers should make use of every opportunity to encourage a smoker to quit. We should not forget about the five ‘A’ s. Ask all patients at every visit whether they smoke or not. Advise all identified smokers to quit at every contact. Assess willingness to make a quit attempt. Assist the smoker in quitting, practical quit plan, counselling, provide support, including social and group support, recommend approved drugs, including nicotine replacement therapy. And the last ‘A,’ arrange follow-up contact – telephone, Facebook, email and WhatsApp. All physicians should see it as a routine duty to motivate and inspire smokers to quit at all times.

What are the cure and treatments for tobacco related diseases?
Nicotine replacement therapy can be in the form of nicotine skin patch, nicotine gum, nicotine nasal spray, nicotine lozenges and nicotine inhaler. Nicotine replacement drugs can be combined with other drugs, such as bupropion, if need be. Researches have shown that these drugs double the probability of quitting, when compared to placebo. Thus, physicians should not shy from offering them to smokers willing to quit. It should be noted that smoke filtered cigarettes does not reduce health hazards associated with cigarette. We should also not be carried away that e–cigarette is completely harmless. Although, it is not as dangerous as the real cigarette, but it is known to be associated with health hazards, especially when contaminated with alkanal, nitrosamine and ethylene glycol. In fact, it is not a good option for asthmatic and COPD cohort as propylene glycol irritates the airway and reduces dynamic airway resistance. By consensus e-cigarette is only of health benefit, if user quits cigarette smoking completely.

What can government do to frustrate importation of cigarette into the country?
At governmental level, laws should be made to discourage cultivation of tobacco, manufacturing and distribution of cigarette, as well as exportation and importation of tobacco. Direct and indirect taxes on tobacco products should be raised. The National Assembly should make a law to strengthen National Agency for Foods and Drugs Administration and Control (NAFDAC) in its modulatory roles on tobacco industries. Tobacco sales and marketing to youths should be further restricted. Warnings label on cigarette should be bolder and more prominent. False claims such as ‘light’, ‘mild’ cigarette should be prohibited. No form of cigarette is safe. NAFDAC should force tobacco companies to reduce nicotine content significantly, which will invariably reduce addiction and craving and ultimately assist smokers to quit.

What’s your message to mark the Day?
For every smoker that quits smoking, the overall benefit is unquantifiable. It makes our world a safer planet for you and me. It improves lung health and we will all breathe cleaner air. To the smoker, his probability of developing heart attack is significantly reduced, just as lung cancer. Most importantly, the trajectory of shortened life expectancy is altered with extended life expectancy of up to 10 years. To the government, it frees up health fund for other social services and economical activities. As the entire world marks World Tobacco Day this week, let us team up and say no to tobacco.


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