16 March 2009

To smoke or not to smoke?

Elena Prikhodko, "Weekly PHARMACY""Columbus discovered America – he was a great sailor, and at the same time he taught the whole world to smoke tobacco..." – says the song from the cartoon "Treasure Island", known to many since childhood.

But could the great traveler have guessed that the religious ritual of the inhabitants of the continent he discovered would become a daily habit and cause the death of a large number of people around the world? According to WHO data published in the 2008 Global Tobacco Epidemic Report, it is claimed that tobacco killed more than 5 million people in a year – more than tuberculosis, AIDS and malaria combined. If urgent measures are not taken, it will take the lives of 1 billion people this century (www.who.int ).
Columbus is not to blame for anythingThe Eastern legend tells about the prophet Muhammad.

He was walking in the desert one winter and found a half-frozen snake, picked it up and warmed it in his bosom. When the snake came to, she said to Muhammad: "I have to bite you because I made such an oath." To which the prophet replied: "In that case, you must keep your word," and offered his hand. Then, shaking off the snake, he sucked the poison out of the wound and spat on the ground. In this place grew a plant that has both the venom of a snake and the meekness of a prophet – tobacco.

The homeland of tobacco is America. Ancient civilizations attributed magical and healing properties to it. Shamans of Indian tribes smoked tobacco through pipes to communicate with the gods. The crew members of the Christopher Columbus ship became the first Europeans to try tobacco. Some of the sailors of the expedition did not abandon the habit of smoking it even after returning to Spain. Rodrigo de Jerez, one of the members of the expedition, was seen smoking and imprisoned for it. City residents, seeing smoke coming out of Rodrigo's nose, decided that he was possessed by the devil (www.tobacco.org ).

However, soon the Spaniards and Portuguese, despite the prohibitions of the Inquisition, brought the leaves and seeds of the plant to Europe and began to cultivate tobacco. The popularity of tobacco among Europeans grew rapidly due to the fact that medicinal properties were attributed to it. It was sniffed, smoked, chewed, mixed with various substances. The use of tobacco in Russia before the accession to the throne of Peter I was strictly prohibited. For snuffing or smoking, the culprit's nostrils were torn out and exiled to Siberia. The fashion for tobacco use was introduced by Peter I, who became addicted to smoking in Holland. He even forced people to smoke, believing that it would help Russians to learn the European way of life faster.

In 1571, the Spanish physician Nicolas Monardes wrote a book about the history of medicinal plants of the New World. He claimed that tobacco can cure 36 diseases. In 1588, a resident of Virginia, Thomas Harriet, began actively promoting tobacco smoking, claiming that this was the way to recovery. Soon he died of nasal cancer. In 1600, tobacco was so popular that it was often used instead of money. In 1760, Pierre Lorillard opened the first factory producing snuff and cigars in the USA. Tobacco use has become widespread with the advent of cigarettes. Smoking by women was unacceptable in Europe until the 1920s. However, the movement for equal rights of women, which actually promoted smoking among the weaker sex, led to the fact that tobacco factories began to produce women's cigarettes. In 1924, the Philip Morris company began producing cigarettes for women under the slogan "Soft as May" (www.udayton.edu ).

The true degree of danger of tobacco began to be realized after this addiction took root in society. By the beginning of the XX century, scientific evidence of harm from tobacco use began to multiply. The link between smoking and the development of lung cancer was first scientifically proven in 1938 by researchers at The Johns Hopkins University of Cologne (Pearl R., 1938). Since that time, the anti-smoking movement has been gaining momentum. In 1964, the report of the Chief Physician of the USA "Tobacco and Health" ("Smoking and Health") marked the beginning of the official anti-smoking company of the US National health System (www.profiles.nlm.nih.gov ). A significant role in shaping public opinion about the dangers of tobacco use belongs to the mass media.

A drop of nicotine kills a horseModern civilized society is aware that tobacco is dangerous to the health of not only the smoker, but also the people around him.

Despite this, tobacco use is widespread all over the world. The WHO report on the global tobacco epidemic in 2008 indicates that the popularity of tobacco is due to low prices, aggressive sales promotion, lack of sufficient awareness of the dangers associated with it and the inconsistency of state policies against its consumption. According to WHO, today tobacco kills one person every 6 seconds and shortens the life of a smoker by an average of 15 years. Passive smoking also often has fatal consequences. WHO indicates that in the United States, passive smoking annually causes the death of about 3.4 thousand people due to lung cancer and about 46 thousand people from heart diseases provoked by it (www.who.int ). In most cases, the harm caused to health as a result of tobacco use appears only after many years or even decades from the beginning of its use. This means that with the increasing number of people using tobacco products, the epidemic of diseases and deaths from tobacco has just begun.

According to WHO, tobacco is the cause of death of every second smoker. In 1990, 35% of all deaths of middle-aged men (35-69 years old) in economically developed countries were caused by smoking (Peto R., Boreham J., 1994). During the twentieth century, tobacco killed about 100 million people – this is more than died in World War II.

Most tobacco users are addicted. Many of the smokers want to quit smoking, but only a few of them can get rid of the addiction on their own. Most countries do not provide assistance to those who want to stop using tobacco. Tobacco consumption is growing at the fastest pace in low-income countries. According to WHO estimates, in 1995, 700 thousand deaths due to tobacco use were recorded in Central and Eastern Europe. Moreover, up to 4/5 of all the deceased are middle–aged people whose physical and mental activity is at its zenith (http://www.who.int /). By 2030, more than 80% of tobacco-related deaths will occur in low- and middle-income countries. This is not just a bad habit, it is a chronic disease that requires serious treatment by the national health service (http://www.who.int /).

Components of tobacco smokeIt should be noted that the smoker does not use the substances contained in the tobacco product, but the products of its combustion.

A modern cigarette is not just tobacco wrapped in paper. It may contain pesticides and other substances that are used in the cultivation of the plant. In addition, many different additives are added to the tobacco leaf during the production process. Today, about 4-5 thousand chemicals are found in tobacco products and tobacco smoke. When smoking tobacco products, the process of incomplete combustion of tobacco occurs. Tobacco smoke has a complex composition and contains many chemicals that exhibit toxic, mutagenic and carcinogenic properties.

Nicotine is a natural component of tobacco plants, which is a factor of protection against eating by insects. Nicotine is very toxic to humans. According to the International Chemical Safety Program (The International Program on Chemical Safety), the lethal dose of nicotine for an adult is 60 mg (0.5–1.0 mg / kg of body weight). A cigarette contains about 10 mg of nicotine, but through the smoke from one cigarette, a smoker receives 0.5–3 mg of nicotine. Novice smokers experience the toxic effects of nicotine, but addiction develops quite quickly, so WHO classifies nicotine as narcotic substances. Its main danger is that nicotine addiction supports tobacco use. At the same time, its importance in the development of diseases, including cancer and lung diseases, is small. Today, there are research data that assign nicotine an important role in the process of angiogenesis (formation of new blood vessels), which provides conditions for tumor growth (Cooke J.P., Bitterman H., 2004).

Tar is everything that is contained in tobacco smoke except gases, nicotine and water. Tobacco smoke, entering the respiratory tract in the form of a concentrated aerosol, condenses and settles when cooled, forming a resin. The chemicals contained in it cause cancer and other diseases of the respiratory system. The resin contains several classes of carcinogenic substances (causing cancer). Among them are: polycyclic aromatic carbohydrates, nitrosamines, as well as benzene, cadmium, arsenic, beryllium, etc.

The main representative of polycyclic aromatic hydrocarbons is benzpyrene, which is considered as a classical carcinogen (Rubin H., 2001). Tobacco N-nitrosamines are an etiological factor of malignant tumors of the lung, esophagus, pancreas, oral cavity in people who use tobacco (Hoffmann D., 1994).

Carbon monoxide is present in tobacco smoke in high concentrations. It damages the walls of the arteries and increases the risk of narrowing of the coronary vessels, which can cause acute myocardial ischemia (Harris J., 1996). Tobacco smoke also contains: prussic acid, which refers to substances of general toxic action, acrolein and formaldehyde, which provoke the development of bronchial asthma, as well as free radicals, which play an important role in the pathogenesis of diseases such as atherosclerosis of blood vessels, cancer, bronchitis, chronic obstructive pulmonary disease (Traber M.G., 2000). The radioactive components found in tobacco smoke in high concentrations include polonium-210, lead-210 and potassium-40 (Skwarzec B., 2001; Desideri D., 2007).

We have listed only some of the chemicals that make up tobacco smoke. It should be noted that according to a study conducted by a group of scientists in Italy, tobacco smoke is more toxic than exhaust gases (Invernizzi G., 2004).

Tobacco use and health statusIt is well known that tobacco use is the main cause of lung cancer.

Currently, this type of cancer has become the most frequently diagnosed. In 2000, 850 thousand people died due to lung cancer in the world (Ezzati M., 2003). This disease is characterized by high mortality. The results of a study conducted in the United States indicate that tobacco smoke damages the TR53 gene, which is responsible for preventing the development of a cancerous tumor. The risk of lung cancer depends on the dose and duration of smoking: longer experience and consumption increase the likelihood of developing the disease (Denissenko M.F., 1996). Smoking in adolescence causes irreversible genetic changes in the lungs and permanently increases the risk of developing lung cancer, even if a person subsequently quits smoking (Hirao T., 2001).

According to a study conducted by specialists of The American Cancer Society, tobacco use, especially in the form of commercially manufactured cigarettes, is the most significant cause of cancer of the oropharynx, larynx, esophagus. A third of pancreatic, small intestine, cervical, kidney, and bladder cancers are caused by tobacco use (Wiencke J.K., Thurston S.W., 1999). It has been found that in tobacco users, stomach cancer occurs approximately 1.5 times more often than in non-smokers (Tredaniel J., 1997). The negative effects of tobacco use in women are particularly pronounced. Cigarette smoking has been proven to increase the risk of developing squamous cell carcinoma of the cervix (Berrington de Gonzalez A., 2004), ovary (Modugno F., 2004), breast (Reynolds P., 2002). In men, it significantly increases the risk of developing penis cancer (Hellberg D., 1987). And these are not all types of cancer, the main etiological factor in the development of which is tobacco use.

Smoking is fraught not only with malignant tumors. Thus, it affects the risk of development and severity of a significant number of lung diseases from acute respiratory disease to pneumonia, pulmonary hemorrhage and various interstitial lung diseases (Desai S.R., 2003). Tobacco use is associated with the development of diseases of the cardiovascular system: coronary heart disease, including sudden coronary death, atherosclerosis of blood vessels, cardiac arrhythmias, disorders of cerebral circulation. According to the report of the chief physician of the USA in 1983, the risk of developing an angina attack in a smoker is 2-3 times higher than in a non-smoker (http://www.profiles.nlm.nih.gov /). It should be noted that the risk of myocardial infarction in smokers under 40 years of age is 5 times higher than in people of the same age who do not use tobacco (Mahonen M.S., 2004). Even those who smoke little have an increased risk of developing coronary heart disease up to sudden coronary death (Bartecchi C.E., 1994). The risk of stroke in smokers is 2-4 times higher than in non-smokers (Aldoori M.I., 1998).

According to the International Classification of Diseases of the 10th revision, nicotine addiction is a mental or behavioral disorder. Studies show that the health status and quality of life of smokers is significantly lower than that of non-tobacco users. Half of people with severe nicotine addiction show signs of at least one more mental disorder (Schmitz N., Kruse J., 2003).

Smoking causes yellowing of teeth and bad breath. People who use tobacco are at risk of losing teeth faster due to caries and periodontitis (Ide R., Mizoue T., 2002). Smoking increases the risk of developing peptic ulcer disease (Avramenko A.A., 2003) and type II diabetes mellitus (Manson J.E., 2000). Heavy smokers have more pronounced fatigue due to the fact that their body is slower to restore glycogen reserves – an energy source (Price T.B., 2003). Data from a study conducted in the USA indicate that smokers have reduced bone density, so they have an increased risk of developing osteoporosis (Ward K.D., 2001). Smoking is a risk factor for rheumatoid arthritis, which is more often diagnosed in women (Krishnan E., 2003). Finally, smoking has a negative impact on the reproductive function of both men and women, as well as on the health of the unborn child. Studies have shown that women who smoke have a reduced ability to conceive (Baird D.D., 1985), including infertility (Tzonou A., 1993). In addition, tobacco use causes the early onset of menopause (Harlow B.L., 2000). Male smoking also reduces the likelihood of conception (Handelsman D.J., 1984) and, in addition, worsens the genetics of sperm (Zenzes M.T., 2000). The risk of erectile dysfunction (impotence) in smokers is 1.5 times higher than in non-smoking men, which is typical for all ages (Condra M., 1986). It has been noticed that smokers have earlier and pronounced facial wrinkles, especially around the eyes and mouth (Ernster V.L., 1995). In women, the effect of smoking on the development of wrinkles is more pronounced than in men (Model D., 1985).

We have listed only a small number of diseases associated with smoking, without pursuing the goal of intimidating. As you know, forewarned means armed. Our task is to warn smokers about the dangers associated with tobacco use. The quality and duration of life depends on what kind of lifestyle a person chooses for himself. Remember this when you pick up a cigarette!

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