Rewards of smoking cessation 2018

Rewards of Smoking
Cessation
Highlights on

In the past century smoking was common
as a symbol of simple pleasures

In the past century smoking was common
as a symbol of simple pleasures
Pipe would stand for thoughtfulness
and calm
Cigarette symbolized modernity,
strength and youth, but also nervous
anxiety
Cigar was a sign of authority, wealth
and power

Times have changed
Smoking is less socially acceptable now than ever...

Uncovering the effects of smoking
historical perspective

In retrospect it can now be seen that medical evidence of the
harm done by smoking has been accumulating for many years
The evidence was generally ignored until five case-control
studies relating smoking to the development of lung cancer were
published in 1950.
The interpretation that smoking caused various diseases was
vigorously debated for some years but came to be generally
accepted in respect of lung cancer by the late 1950s and of
many other diseases in the subsequent two decades.

WHO World Health Report .Tobacco Atlas .2008.
Global Cigarette Consumption

Where is the burden increasing the fastest,
1990 to 2020?
India
+1400%Middle
Eastern
Crescent
+700%
India
+1400%Middle
Eastern
Crescent
+700%
Latin
American
and
Caribbean
+300%
India
+1400%
India
+1400%Middle
Eastern
Crescent
+700%
Latin
American
and
Caribbean
+300%
Other Asia
and Islands
+250%
India
+1400%Middle
Eastern
Crescent
+700%
Latin
American
and
Caribbean
+300%
Sub-
Saharan
Africa
+200%
Other Asia
and Islands
+250%
India
+1400%Middle
Eastern
Crescent
+700%
Latin
American
and
Caribbean
+300%
Sub-
Saharan
Africa
+200%
Other Asia
and Islands
+250%
China
+175%
India
+1400%Middle
Eastern
Crescent
+700%
Latin
American
and
Caribbean
+300%
Sub-
Saharan
Africa
+200%
Other Asia
and Islands
+250%
China
+175%
Formerly Socialist
Economies of Europe
+120%
India
+1400%Middle
Eastern
Crescent
+700%
Latin
American
and
Caribbean
+300%
Sub-
Saharan
Africa
+200%
Other Asia
and Islands
+250%
China
+175%
Formerly Socialist
Economies of Europe
+120%
Established Market
Economies
+18%

The Economics of Tobacco andTobacco Taxation in Egypt 2010
International Union Against Tuberculosis and Lung Disease

Tobacco Road Map
Top 10 male smoking populations 2008

Decrease in smoking prevalence
• In 1950, about 80%
of UK men smoked
United Kingdom, 1950-2002
1950 1960 1970 1980 1990 2000
0
20
40
60
80
%
at ages
35-59
70%
50%
28%
26%
% smoked
% smoked
• In 1970, UK male death
rates from smoking were
the worst in the world
• 1970-2000, decrease in
male death rates from
smoking was the
best in the world

The Decline in US Smoking Prevalence

Growing Recognition of Value
of Smoking Cessation

 Smoking cessation intervention is one of the most cost-
effective interventions in medicine
 Compared with other preventive interventions, smoking
cessation is extremely cost-effective.
 Smoking cessation has been called the 'gold standard'
of health care cost effectiveness, producing additional
years of life at costs that are well below those estimated
for a wide range of healthcare interventions.

 Tobacco-use screening and intervention for adults
 Aspirin chemoprophylaxis for adults
 Childhood immunization
 Colorectal cancer screening
 Hypertension screening
 Influenza immunization
 Pneumococcal immunization
 Problem-drinking screening and brief counseling
 Vision screening—adults
 Cervical cancer screening
 Cholesterol screening
Smoking Cessation intervention
One of the Top 3 Most Important Areas for Focus
• The NCPP highlighted priorities among effective clinical preventive services
• Total score for each service is based on 2 measures: clinically preventable
burden and cost-effectiveness (both scored from 1 to 5 points)
Highest Ranking
Total Score: 10
Total Score: 8
Total Score: 7
Despite having a high ranking, tobacco-use screening and intervention still have low utilization rates.
NCPP=National Commission on Prevention Priorities.
Maciosek MV et al. Am J Prev Med. 2006;31(1):52-61. 50

Leading Health Agencies and Organizations Have
Recognized the Value and Are Advocating for Change
– Centers for Disease Control and Prevention (CDC)
– US Preventive Services Task Force (USPSTF)
– National Business Group on Health (NBGH)
– National Commission on Prevention Priorities (NCPP)
– World Health Organization (WHO)

Tobacco use is a risk factor for six of the eight
leading causes of death in the world

Finally, here’s a nice example of what stopping smoking can offer.
Richard Doll (1912-2005), who stopped smoking cigarettes at age 37,
photographed aged 91 at the 2004 BMJ press conference
on the 50-year results from his study of British doctorsMichael Crabtree, copyright Troika
Photos

Study of smoking and death
in male British doctors
• Recorded all deaths for 50 years (1951-2001)
• Main findings (for men born in the 20th century)
– Smokers lose, on average, 10 years of healthy life
• Asked all UK doctors in 1951, and periodically
thereafter, what they themselves smoked
– Stopping smoking at any age will add years to a persons life
– Those who stop smoking before 35 years of age avoid almost
all of the excess risk will have a life expectancy no different
from that of a nonsmoker.

Age40
A Study of Male Physicians Showed Quitting at Any Age
Increases Life Expectancy
35-44 years
Patients were studied over the period of 1951-2001.
Adapted from Doll R et al. BMJ. 2004;328:1519-1527.
Years
Nonsmokers
Cigarette Smokers
Stopped Age
%SurvivalFromMean
Quitatage35-44
Additional
9-year
life expectancy
60
N=34,439 British male physicians.

Years
%SurvivalFromMean
Age50
Quitatage45-54
Additional
6-year
life expectancy
45-54 years
61
Nonsmokers
Cigarette Smokers
Stopped Age

Years
%SurvivalFromMean
Age60
Quitatage55-64
Additional
3-year
life expectancy
55-64 years
62
Nonsmokers
Cigarette Smokers
Stopped Age

Tobacco is the single largest preventable cause
of cancer in the world today

Stopping smoking: avoiding lung cancer
% dead from
lung cancer
Continued smoking:
16% dead from lung cancer
Stopped age 50: 6%
Stopped age 30: 2%
Never smoked: <1%
15
10
5
0
45 55 65 75
Age
Cumulative risk at
UK male 1990 rates
BMJ 2000; 321: 323-9

• People diagnosed with cancer should quit smoking.
For those having surgery, chemotherapy, quitting
smoking helps improve the body’s ability to heal
and respond to therapy .
• It also lowers the risk of pneumonia and respiratory
failure .
• For people who have already developed cancer, quitting
smoking reduces the risk of the cancer returning or
developing a second cancer .

 One out of every five smoking-related deaths are
caused by cardiovascular diseases.
 Cigarette smokers are two to four times more likely to
develop coronary heart disease than non-smokers.
 Cigarette smoking doubles a person's risk of stroke.
 Cigarette smokers are more than ten times as likely as
non-smokers to develop peripheral vascular disease
 Smoking causes abdominal aortic aneurysm
The American Heart Association

 The risk for CAD among smokers is dose related &
smoking as little as one to four cigarettes per day
significantly increases risk.
 Smoking cessation should be viewed as therapeutic
rather than preventive intervention.

94
Smoking and Cardiovascular Diseases

 Smokers also have a higher risk of recurrent ischemia
after coronary artery bypass graft surgery and of re-
occlusion after an acute myocardial infarction
 For those smokers with diagnosed CHD, stopping
smoking appears to reduce the risk of recurrent
infarction and cardiovascular death by 50% or more.

 Smoking cessation is crucial in the management of
many contributors to heart attack e.g atherosclerosis.
 Smoking cessation significantly lowers the risk of
atherosclerosis

Increases LDL
Decreases HDL
Slightly increases triglycerides
Smoking and hypercholestorlemia

Smoking increases the cardiovascular risk, at any level
of blood pressure, for coronary heart disease, stroke
Drug treatment of hypertension is less effective in
smokers
Smoking should be avoided in any hypertensive patient
Smoking and hypertension

Diabetes and High Blood Pressure are Like Twins

Smoking has a multiplicative interaction with the major
risk factors for coronary artery disease, to increase
disease risk.
For example, if the presence of smoking alone doubles
the level of risk for CAD, the presence of another major
risk factor in conjunction with smoking results in
approximately a 4-fold increase in risk .
The presence of 2 other risk factors together with
smoking results in approximately an 8-fold increase in
risk.
Multiplicative Risk Factor CAD

Relationship Between CKD and CVD
CKD = chronic kidney disease; CVD = cardiovascular disease; CV = cardiovascular.
1. Menon V et al. Am J Kidney Dis. 2005;45:223–232.
CVD
CKD
Traditional
CV risk factors
Non-traditional
CV risk factors
CKD is a risk factor for CVD, and CVD may be a risk factor for the progression of CKD

Diabetes or hypertension are the two leading causes of
chronic kidney disease.
Smokers with diabetes or hypertension face an accelerated
rate of kidney damage compared to non-smokers with
chronic kidney disease, resulting in a much quicker
progress towards ESRD .

138
Diabetes Amplifies the CKD and CVD Paradigm

Smoking Is the Single Most Important Risk Factor for
COPD
Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, Global Initiative for Chronic
Obstructive Lung Disease (GOLD) 2008. Available from: http://www.goldcopd.org.

1990 2020
Ischaemic heart disease
Cerebrovascular disease
Lower resp infection
Diarrhoeal disease
Perinatal disorders
COPD
Tuberculosis
Measles
Road Traffic Accidents
Lung Cancer
Stomach Cancer
HIV
Suicide
6th
3rd
Future Mortality Worldwide
Source: Murray & Lopez. Lancet 1997

Am. J. Respir. Crit. Care Med. 2002; 166: 675-679
Years
FEV1(L)
2.0
2.1
2.2
2.3
2.4
2.5
2.6
2.7
2.8
2.9
0 1 2 3 4 5 6 7 8 9 10 11
Continuous smokers
Disease Progression in COPD
Lung Function

potential effect of stopping smoking early or late in the course of
COPD.
Fletcher CM, Peto R. BMJ. 1977;1:1645-1648. Reproduced with permissions from BMJ Publishing Group.
Smoked
regularly and
susceptible to
effects of smoke
Never smoked
or not
susceptible to
smoke
Stopped
smoking at
45 (mild
COPD)
Stopped
smoking at
65 (severe
COPD)
Disability
Death
FEV1
(%ofvalueatage25)
25
50
75
100
0
Age (years)
25 50 75

Smoking and pulmonary function
Anthonisen et al. Smoking and lung function of Lung Health Study participants
after 11 years. Am J Respir Crit Care Med 2002.

• Smoking Cessation is Single most effective
and cost effective intervention to reduce
the risk of developing COPD and stop
its progression
Am J Respir Crit Care Med 2001
CRJ . 10;(Suppl A). 2003

Corticosteroid resistance
Laboratory Investigation advance online publication
24 July 2006; doi:10.1038/labinvest.3700456

Smoking doesn't cause asthma, but in people
having asthma smoking makes their asthma worse.
155

Cigarette smoking in asthma is a risk factor for poor
asthma control
Emergency department visits as a result of exacerbations
of asthma occur more frequently amongst heavy cigarette
smokers with asthma
Every effort should be made to encourage individuals with
asthma who smoke to quit.
ERS 2004

Cigarette smoking increases the clearance of theophylline
by 60–100% in smokers compared with nonsmokers
by induction of several metabolising enzymes
Cytochrome P450-1A2
Smoking cessation for 1 week reduces the elimination
of theophylline by 35%.
ERS 2004

Smoking and TB Form a Deadly Combination

 Cigarette smokers may be up to three times more likely
to develop latent TB infection than non-smokers
 For a person with latent TB infection, cigarette smoking
increases their risk of developing active TB disease by
two to three times, compared to non-smokers
 Smoking influences the clinical progress of TB lesions.
Smokers tend to have more cavitary disease, and were
more likely to be smear-positive compared to non-
smokers

 Smoking reduces the effectiveness of TB treatment which
can lead to longer periods of infection
 Smoking is associated with recurrent tuberculosis
disease and increase the risk of relapse
 Up to one in every five deaths from tuberculosis could be
avoided if the patients were not smokers

Patients submitted to liver transplantation are particularly
susceptible to increased postoperative pulmonary
complications esp. pneumonia
Transplanted patients who smoke have an increased risk
for vascular complications including hepatic artery
thrombosis

Herrero JI. Liver Transpl. 2011
Smoking cessation at least 2 years before liver
transplantation can significantly reduce the risk for
vascular complications.
Smoking cessation should be an essential requirement
for liver transplantation candidates to decrease the
morbidity arising from vascular complications
after liver transplantation.

Recurrence of viral hepatitis may be more frequent
among liver transplant recipients who are active or
former smokers
"Encouraging preoperative smoking cessation may
be beneficial in improving patient outcomes following
transplantation."

Other investigators recently reported that smoking
was a risk factor in the increased frequency of
malignancies after liver transplantation.
Smoking cessation after liver transplantation
reduced incidence of transplant-related carcinoma

Significant association between smoking and male sexual
impotence with the association increasing with the
number of cigarettes smoked per day
There is no “safe” level of smoking , even light smoking is
associated with reduced male fertility
AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE 2003
ASH Factsheet: Smoking and reproduction 2008

Research has shown that men who smoke are 60% more
likely to experience erection problems such as impotence,
which is why smoking is considered to one of the prime
lifestyle causes of impotence.
Not only is smoking a singular cause of impotence, but it
can also amplify the effects of some of the other causes
of impotence such as diabetes, high blood pressure

Women who smoke have increased risks for conception
delay and for both primary and secondary infertility
Smoking cessation by women during their reproductive
years reduces the risk for infertility.
Smoking causes women to reach menopause one to two
years early, but former smokers have an age at natural
menopause similar to those who have never smoked

Smoking is strongly associated with an increased risk of
spontaneous miscarriage and possibly ectopic pregnancy.
Women who smoke during pregnancy are about twice as
likely to experience premature rupture of membranes,
placental abruption, and placenta previa during pregnancy
Pregnant women who smoke cigarettes run an increased
risk of having stillborn or premature infants or infants
with low birth weight.

Women who stop smoking before pregnancy or during the
first 3 to 4 months of pregnancy reduce their risk of having
a low birthweight baby to that of women who never smoked
Reducing the number of cigarettes smoked, rather than
quitting completely, does not appear to benefit birthweight
of the foetus.

Smoking cigarettes may contribute to inadequate breast
milk production
In breastfeeding mothers who smoke, milk output is
reduced by more than 250 ml per day compared with non-
smoking mothers.
Nicotine is rapidly transported from the smoking mother’s
blood to her breast milk. The infant may be less willing to
feed since the breast milk tastes bad.
ASH Factsheet: Smoking and reproduction February 2011

Smoking should be discouraged for both male and female
partners in couples with a history of infertility or recurrent
miscarriage.
Smoking cessation may improve natural fertility and
success rates with infertility treatment.
Smoking cessation for at least two months
before attempting in vitro fertilization (IVF)
signiﬁcantly improved chances for conception.

Smoking has an inhibiting effect on estrogen ,the most
important hormone in preventing the loss of bone tissue.
Smoking is one of the risk factors for osteoporosis which
is a major cause of hip fracture.
Postmenopausal women who smoke have lower bone
density and an increased risk for hip fracture than women
who never smoked.
Stopping smoking prevents further excess bone loss.

Smoking can prematurely age the skin , Smokers’ skin can
be prematurely aged by between 10 and 20 years
The risk of moderate or severe facial wrinkling is 3 times
as high for women who smoke than those who have
never smoked and twice as high for male smokers
“Tobacco kills beauty and much more.”

Teenagers care about the immediate benefits to their
appearance, well being and financial status rather
more than future health gains

You’ll Save Money
Smoking is expensive - multiply how much money
you spend on tobacco every day by 365 (days per
year).

Your Self Esteem Will Improve
 You will feel more in
control of your life.
 Your self esteem will
improve by knowing
you are doing
something positive to
help yourself!

You’ll Look Better
 Your clothes and breath
will no longer smell like
smoke.
 Your teeth will be whiter.
 You’ll lose the yellow
nicotine stains on your
fingers

Food Will Taste Better
 Your sense of smell and
taste will return!
 Your appetite will improve
and you’ll get more
enjoyment out of eating!

Be good role model by either not
smoking, or quitting

You’ll Protect Those You Love

2005 2006-2015 (cumulative)
Geographical
regions (WHO
classification)
Total
deaths
(millions)
NCD
deaths
(millions)
NCD
deaths
(millions)
Trend: Death
from infectious
disease
Trend: Death
from NCD
Africa 10.8 2.5 28 +6% +27%
Americas 6.2 4.8 53 -8% +17%
Eastern
Mediterranean
4.3 2.2 25 -10% +25%
Europe 9.8 8.5 88 +7% +4%
South-East Asia 14.7 8.0 89 -16% +21%
Western Pacific 12.4 9.7 105 +1 +20%
Total 58.2 35.7 388 -3% +17%
Noncommunicable Diseases (2006-2015)
Death trends (2006-2015)
WHO projects that over the next 10 years, the largest increase in
deaths from cardiovascular disease, cancer, respiratory disease and
diabetes will occur in developing countries.
(WHO, Chronic Disease Report, 2005)

Noncommunicable diseases in developing countries
are a major public health and socio-economic problem
The major challenge to development
in the 21st century


Noncommunicable Diseases
4 Diseases, 4 Modifiable Shared Risk Factors
Tobacco
Use
Unhealthy
diets
Physical
Inactivity
Harmful
Use of
Alcohol
Cardio-
vascular
Diabetes
Cancer
Chronic
Respiratory

Global Tobacco Control is Underfunded
Globally, tobacco tax
revenues are 500
times higher than
spending on tobacco
control.
In low- and middle-
income countries, tax
revenues are 5,000
times higher.

 Decision makers need to be fully informed with
the up-to-date evidence about the burden and
impacts of chronic diseases.
 Placing Chronic Diseases Higher on the Political
and Health Agenda is a must.

Hypertension: A Growing Problem
Prevalence (%)
United States7
Egypt9
Japan8
Italy7
Sweden7
England7
Spain7
Finland7
Germany7
0 10 20 30 40 50
Taiwan9
Canada7
South Korea9
*Defined as systolic/diastolic blood pressure 140/90, (160/95 for Taiwan) or receiving treatment.
†South Korea is defined as men, aged 30 to 59.
7. Wolf-Maier et al. JAMA. 2003;289:2363-2369; 8. Data on file. Pfizer Inc, New York, NY;
9. WHO Collaborating Centre on Surveillance of Cardiovascular Disease Web site. Available at: www.cvdinfobase.ca. Accessed February 22, 2005.

Egypt Vs World Average
Source: Central Bank of Egypt

Vital Signs Stamp
VITAL SIGNS
Pulse:
Temperature:
Respiratory Rate:
(circle one)
Current Former NeverTobacco Use:
Blood Pressure:
Weight:
Fiore et al. Treating Tobacco Use and Dependence. Clinical Practice Guideline. Rockville, MD: US Department of
Health and Human Services, Public Health Service. June 2000.

Rewards of smoking cessation 2018

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