Health effects of cigarette smoking:

Killing the fire

Dr Amitha Fernando MD (Colombo) FRCP (London)

Use of tobacco is the chief preventable cause of deaths worldwide. The culminative number of deaths due to the use of tobacco for the 20th Century was 100 million. Of the 1.1 billion current smokers in the world 70 percent are in developing countries. The World Health Organization (WHO) attributes four million deaths per year to tobacco, this is about one in 10 of all adult deaths. By 2020 annual deaths due to smoking is projected to rise to 8.4 million per year, 70 percent of these deaths will be in the developing world. Half a billion of the world’s population alive today will be killed by a smoking related disease, half of them will be between 35-69 years.

Most begin tobacco use before 18 years. Recent trends suggest an earlier age of starting smoking and a rising smoking prevalence among children and adolacents. Younger the age of starting smoking higher the chance of addiction and greater the risk of dying from smoking related diseases.

Sri Lanka took part in The Global Survey in 1999. The survey was conducted in 84 schools in children aged 13-15 years with 2,896 students participating. Twelve percent of the children surveyed had smoked during the 30 days prior to the survey, while 10 percent bought cigarettes from a store and smoked at home.

Of those who smoked, 79 percent wanted to stop and had tried unsuccessfully. Eighty four percent had been exposed to advertising promoting smoking in the media or at sports events.

Only 15 percent had been exposed to anti-smoking literature. Fifty six percent of the surveyed children were exposed to tobacco smoke at home.

Cigarettes contains over 4,000 chemicals - 200 are poisons, 63 of which cause cancer. Nicotine compounds found in tobacco are the source of addiction. Early smokers may not experience harmful effects of smoking, giving rise to a false sense of security and increased and prolonged use resulting in nicotine addiction. Over the years harmful toxins build up in the body with the potential to harm virtually any organ in the body.

Tar causes cancer stains teeth and nails, Metals such as arsenic, cadmium and lead causes cancer, Vinyl chloride, used to make vinyl products, on short-term exposure causes dizziness, headaches and tiredness. Long-term exposure can lead to cancer and liver damage, Creoste, a component of tar, when inhaled can cause irritation of the respiratory tract. Formaldehyde, a preservative substance used in dead bodies causes cancer in humans. Polonium 210, a radiative substance cause cancer of the liver and bladder, stomach ulcers, leukemia amongst other diseases. Bidis consists of 0,2-03 grams of sun-cured tobacco. Wrappers have low porosity and poor combustibility. The smoker has to puff longer and harder to keep the biddi alight and products of poor combustibility are absorbed deeper into the lungs and circulation.

Cigars go through a long fermentation process. During the fermentation process, high concentrations of cancer causing compounds are produced. Cigar and pipe smokers are at an increased risk for lip, mouth, tongue, and throat cancers.

Particles that make up sidestream smoke are much smaller than those of mainstream smoke. This means that these smaller particles that float in the air, will be inhaled deeper into the lungs and will be able to reach the furthest and deepest corners within a person’s respiratory system and therefore cause much more damage.

The impact of smoking

Heart and the circulatory system

Free radicals in cigarettes smoke causes damage to the lining of heart and blood vessels. This leads to build up of fatty material such as cholesterol in the walls of blood vessels. This results in hardening of the walls and narrowing of the inner opening of blood vessels. Blood flow through such narrowed blood vessels are sluggish depriving the heart of vital oxygen and nourishment.

Also the heart has to work harder to pump blood through narrowed hardened blood vessels leading to enlargement and thickening of the walls of the heart. Smoking also causes an incenses in blood pressure and heart rate.

Smoking increase in the clotting substances in blood. Such blood clots can block already damaged and narrowed blood vessels. When this happens in the blood vessels supplying the heart (coronary arteries) it results in large parts of the heart muscle being deprived of oxygen and vital nutrients ending in permanent damage.

Smokers are five times more likely to have heart attacks than nonsmokers and are four times more likely to die while having a heart attack, if smokers have other risk factors such as increased cholesterol, diabetes or high blood pressure the risk of a heart attack is 10 times more.

Similar changes in circulation to the brain can result in “strokes” damaging large parts of the brain. Strokes can result in death or serious disability. Longstanding changes in the circulation of the brain can give rise to dementia.

Disturbed blood circulation to the legs will result in cramps and pain on walking ending up even in gangrene of toes and amputation. Impotence will result if blood flow to the penis disturbed.

Lungs and airways

Constant exposure of nose and upper air passages to toxins and cancer producing substance in tobacco smoke causes serious and permanent damage to these organs.

It results in an increase in infections of the nose and sinuses. Sinusitis gives rise to headaches, “phlegm” in the throat, disturbance in the sense of smell.

Smoking is responsible for 90 percent of lung cancer in men and 80 percent in women. Men who smoke are 23 times more likely to develop lung cancer than non-smokers.

Smokers are at risk of blindness due to developing cataracts, macular degeneration breakdown of the retina (light sensitive layer of the eye), diabetics who smoke develop diabetic eye complications at an earlier age.

Cigarette smoke causes wrinkling of facial skin and pre-mature ageing.

Nicotine and tar causes staining of teeth, impairs sense of taste and caused disease of the gums.

Smoking in pregnancy

It increases the risk of miscarriage. complications of pregnancy, including bleeding during pregnancy, detachment of the placenta, premature birth, and ectopic pregnancy and low birth weight. Babies born to women who smoke are on average 200 grams (8 oz) lighter than babies born to comparable non-smoking mothers. Premature and low birth weight babies are more prone to illness and infections.

The economic impact

In the year 2002, 4700 billion cigarette sticks were consumed in Sri Lanka per capita consumption of legally manufactures cigarettes was 251. a single smoker above the age of 18 consumes four to five cigarettes per day.

Following the data gathered from the total population it can be calculated that in the year 2003 a single person spent over Rs 1,597.40 on cigarettes. (this data is for legally manufactured cigarettes)

According to the Central Bank, tobacco taxes paid to the Government accounted for seven percent of the total Government revenue in 2003. This was eight percent in 2002.

Illicit cigarettes play a vital role in the black market of Sri Lanka. The lack of taxes is the main reason behind the low price range. The value of the confiscated illegal cigarettes in the year 2003 was Rs 80 million.

In a developing country such as Sri Lanka much of the country’s revenue is sent on treating the sicknesses caused by smoking. This money could be more productively utilized for infrastructure development.

The writer is Consultant Chest Physician Central Chest Clinic Colombo/National Hospital