This document summarizes information about tobacco smoking. It discusses that smoking is the number one preventable cause of death globally and kills over 8,000 people every day. It contains over 4,000 chemicals, many of which are carcinogenic. The document outlines the various health effects of smoking, including increased risk of cancer, cardiovascular and respiratory diseases. It also discusses nicotine addiction and the pharmacology of nicotine on the body. Finally, it covers methods for assessing smoking exposure like smoking index and pack years, as well as approaches to treating tobacco dependence and quitting smoking.

1. Shifa T P
Roll No:189
TOBACCO SMOKING

2.  Practice of burning tobacco & inhaling the smoke
 Early as 5000-3000 BC
 #1 preventable cause of death
 4000 chemicals in tobacco
 63/100 known to be carcinogenic
 Smoking kills more people than cocaine,heroin,alcohol
combined
 Every 8 seconds someone in the world dies from tobacco
related illness
TOBACCO SMOKING

3. Smokers drink more alcohol, coffee and tea
Early Menopause
Impaired exercise performance
Impaired immune system
Increase in hematocrit, WBC count and platelet count,
Decrease in leukocyte vitamin C levels, serum uric acid and
albumin in smoke
HDL to LDL cholesterol ratio reduced.
CHARACTERISTICS OF SMOKERS

4. 1. Nicotine
2. Acetic acid-hair dye & photo developer
3. Acetone-paint & nail polish remover
4. Ammonia – household cleaner
5. Benzene –rubber
6. Cadmium-oil paints
7. Carbon monoxide-poison
8. Hydrazine-fuel for jet and rocks
9. Formaldehyde-embalm dead bodies
10.Naphthalene-in explosives,mothballs & paint pigments
11.Nickel – used in electroplating
12. Arsenic-rat poison
CONTENTS OF CIGARETTE SMOKE

5.  Toxic alkaloid in cigarette smoke
 Is a ganglionic stimulant and depressent
 Causes addiction
NICOTINE

6.  Respond to Ach as well as nicotine
 Found in central and PNS
 Two types Nn & Nm
 transmit signals from pre to post synaptic terminal in
parasympathetic &sympathetic nervous system
 Muscle contraction
NICOTINIC RECEPTORS

7.  Increase systolic and diastolic BP
Increase heart rate
Increase force of myocardial contraction and excitability
Increase myocardial oxygen consumption
Increase coronary artery blood flow
peripheral vasoconstriction.
ACTION OF NICOTINE IN CVS

8. CLINICAL CORRELATION

9.  Impairs ciliary movement
 Inhibits functions of alveolar macrophages
 Hypertrophy & hyperplasia of mucus secreting glands
 Stimulates submucosal irritant receptors and increase airway
resistance
 Spontaneous pneumothorax
 Increase in incidence of infection
 Chronic laryngitis, chronic pharyngitis and chronic bronchitis
 Major risk factor for COPD
 Cause Chronic cough,sputum,change in lung function tests,
RESPIRATORY DISEASES

10.  Smoking, hypertension and hypercholesterolemia are three
major risk factors for coronary heart disease.
 Presence of two out of the three risk factors may produce a
4-fold increase in CHD.
 3 risk factors produces a 8-fold increase in CHD risk.
 CHD death rates are 60–70% greater in male smokers.
 Sudden death s 2–4 times more common in young male
smokers
 Those who continue to smoke after acute MI are most
likely to die from CHD than those who quit
CARDIOVASCULAR DISEASE

11.  cerebrovascular disease and stroke is also common in
smokers.
 In women smokers, subarachnoid haemorrhage is more
common
 Peripheral vascular diseases like thromboangiitis obliterans
(TAO) and arteriosclerosis common in smokers.
 Hypertensives who smoke are at a greater risk of developing
malignant hypertension

12.  discolouration of the teeth
 decreased sensation of taste and smell.
 Gastric, and duodenal ulcers.
 Smoking impairs ulcer healing, favours recurrence of ulcers
 inhibits pancreatic HCO3– secretion
 decreases the pressure of oesophageal and pyloric sphincters.
 Inhibition of nocturnal acid secretion by H2 blockers is also
prevented by smoking.
GASTROINTESTINAL DISEASES

14.  Prevalence of smoking is increased in those who have a major
depressive disorder
 .Smoking and Body Weight
There is an inverse association between smoking and body
weight. Weight gain occurs after cessation of smoking.
SMOKING AND DEPRESSION

15.  Smoking delays conception .
 chance of IUGR- due to impaired uteroplacental circulation.
 Spontaneous abortion
 IUD
 neonatal death
 physical growth mental development affected
SMOKING AND PREGNANCY

16.  induce hepatic microsomal enzyme systems which are important
in the metabolism of drugs like propranolol, theophylline
propoxyphene
 hence increase in dose in smokers is recommended.
 Benzodiazepines Less sedation
 Beta blockers Reduced effect due to increased 1st pass
clearance
 Imipramine,clomipramine decreased in serum
 concentration Chlorpromazine Decreased
SMOKING AND DRUG

17.  Oral cavity
 Pancreas
 Larynx
 Kidney
 Lung
 Urinary bladder
 Oesophagus
 Uterine cervix
 Stomach
 Myelocytic leukaemia
SMOKING CAUSES CANCER OF

18. SI = number of cigarette/day × total duration in years
SI < 100 Mild smoker
SI 101–300 Moderate smoker
SI > 300 Heavy smoker
Lung cancer is common if smoking index is more than 300.
SMOKING INDEX

19.  No of pack year=1 packet of cigarette/day x number of year
 One pack= 20cigaretts
 Risk of developing lung cancer is 40 times more in patients
who smoke 2 packs per day for 20 years
PACK YEAR

20. stop smoking in a step-wise process
First they think about quitting
decide to quit
maintain an ex-smoker status.
CESSATION OF SMOKING

21. Counselling
group therapy
behavioural training
hypnosis
acupuncture
DE- ADDICTION

22. Nicotine containing chewing gum
Transdermal nicotine patches
Nicotine nasal spray
Nicotine inhale r
 Nicotine lozenges
Sublingual nicotine tablets
Bupropion
Clonidine
Nortriptyline
 Varenicline
PHARMACOTHERAPY

23.  Content of smokes
 Pharmacology of smoke
 Charecteristics of smoker
 Clinical correlation
 Smoke index and pack year
 Cessation of smokings
SUMMARY

24. THANK YOU