Tobacco smoke contains over 4,800 chemicals, including hundreds that are toxic and around 70 that cause cancer. The major toxic components are found in the particulate phase, including nicotine, which is highly addictive. Smoking causes serious health risks like cancer, cardiovascular and respiratory diseases, infertility and pregnancy complications. Quitting smoking reduces these health risks over time.

1. AND ITS
HEALTH
RISKS
Dr.P.Naina Mohamed
Pharmacologist

2. INTRODUCTION
 Tobacco use is the leading preventable cause of
death.
 The practice of burning tobacco and inhaling the
smoke, is known as Smoking.
 There are about 1.3 billion cigarette smokers
worldwide and this number is still increasing.
 About 1 in 5 adults smoke.
 4 out of 10 nonsmokers (40%) are exposed to
secondhand smoke.
 More than 1 out of 2 kids (aged 3–11 years) are
exposed to secondhand smoke.
 More men (nearly 24%) than women (about 18%)
smoke.
 Smoking rates are higher among people with a
lower education level.

3. TOXIC COMPONENTS OF
TOBACCO SMOKE

4. TOXIC COMPONENTS OF
TOBACCO SMOKE
 Tobacco smoke contains chemicals that
are harmful to both smokers and
nonsmokers.
 Breathing even a little tobacco smoke can
be harmful.
 Tobacco smoke contains about 4800
compounds.
 Tobacco smoke consists of two phases:
The vapor (or gaseous) phase and
Particulate phase

5. TOXIC COMPONENTS OF VAPOR
PHASE
 Carbon monoxide
 Carbon dioxide
 Carbonyl sulfide
 Benzene
 Toluene
 Formaldehyde
 Acrolein
 Acetone
 Pyridine
 3-Methylpyridine
 3-Vinylpyridine
 Hydrogen cyanide
 Ammonia
 Methylamine
 Dimethylamine
 Nitrogen oxides
 Formic acid
 Acetic acid
 Methyl chloride

6. TOXIC COMPONENTS OF
PARTICULATE PHASE
 Nicotine
 Anabatine
 Phenol
 Catechol
 Hydroquinone
 Cholesterol
 γ-Butyrolacetone
 Quinoline
 Harman
 Benzoic acid
 Lactic acid
 Glycolic acid
 Succinic acid

7. TOXIC COMPONENTS OF
TOBACCO SMOKE

8. TOXIC COMPONENTS OF
TOBACCO SMOKE
The majority of compounds are found in the
particulate phase.
Nicotine is the major component of the
particulate phase.
Nicotine comprises 1.5% of the total weight of
a commercial cigarette and is the primary
alkaloid found in tobacco.
The carcinogens are also found in the
particulate matter.
About 69 carcinogens are identified in tobacco
smoke. Among them, 11 are known human
carcinogens and 7 are probably carcinogenic in
humans.

9. NICOTINE
 Nicotine is a stimulant and is one of the main factors leading to
continued tobacco smoking.
 According to studies by Henningfield and Benowitz, nicotine is more
addictive than cannabis, caffeine, ethanol, cocaine, and heroin when
considering both somatic and psychological dependence.
Smoking
Nicotine
Facilitates dopamine release in the nucleus accumbens
Pleasurable effect
Triggers positive reinforcement
Nicotine addiction
 various nicotine delivery systems, such as the nicotine patch or
nicotine gum, that can satisfy the addictive craving by delivering
nicotine without the harmful combustion by-products. This can help
the heavily dependent smoker to quit gradually, while discontinuing
further damage to health.

10. CHEMICAL CARCINOGENS
Tobacco smoke
Carcinogenic pyrolytic products, Polycyclic aromatic hydrocarbon
(Benzopyrene) and Acrolein
Formation of epoxides
Irreversibly attaches to a cell's nuclear DNA
Genetic mutation
Cancer cell
 About 69 carcinogens are identified in tobacco
smoke. Among them, 11 are known human
carcinogens and 7 are probably carcinogenic in
humans.

11. RADIOACTIVE CARCINOGENS
 Tobacco smoke contain small amounts of lead-210(210Pb)
and polonium-210 (210Po) both of which are radioactive
carcinogens.
 Research by NCAR radiochemist Ed Martell suggested
that radioactive compounds in cigarette smoke are
deposited in "hot spots" where bronchial tubes branch.
 Smoking an average of 1.5 packs per day gives a radiation
dose of 60-160 mSv/year, compared with living near a
nuclear power station (0.0001 mSv/year) or the 3.0
mSv/year average dose for Americans.
 The radioactive smoke is deposited in lungs and releases
radiation even if a smoker quits the habit.
 If the smoker also breathes in the asbestos fibers which
commonly occur in urban and industrial environments, the
risk of cancer is greatly increased.

12. HEALTH RISKS OF SMOKING

13. HEALTH RISKS OF SMOKING
 Atherosclerotic diseases of the heart and blood
vessels:
Cardiovascular disease (including myocardial
infarction and sudden death)
Cerebrovascular disease (Stroke)
Peripheral vascular disease (Claudication, etc)
 Noncancerous lung diseases:
Chronic obstructive pulmonary disease
Asthma
 Cancers at many sites, including the lung,
larynx, oral cavity, esophagus, bladder, kidney,
pancreas, and uterine cervix.
 Toxicity to the human reproductive system
Reduced Fertility

14. CARDIOVASCULAR DISEASES
 Cigarette smokers are more likely than nonsmokers to develop
both large-vessel atherosclerosis and small-vessel disease.
 Approximately 20–30% of coronary artery disease is caused by
cigarette smoking.
 According to a study by an international team of researchers,
people under 40 are five times more likely to have a heart attack
if they smoke.
Smoking
Promotes Atherosclerosis, platelet aggregation and vascular
occlusion
Increases the likelihood of myocardial infarction and sudden
cardiac death
 Cessation of cigarette smoking reduces the risk of a second
coronary event within 6–12 months.
 After 15 years of abstinence from smoking, the risk of a new
myocardial infarction or death from coronary heart disease in
former smokers is similar to that for those who have never
smoked.

15. CEREBROVASCULAR DISEASE
 10% of occlusive cerebrovascular disease are
caused by cigarette smoking.
Smoking
Atherosclerosis of cerebral blood vessels
Narrowing of arteries
Cerebral Ischemia
Stroke

16. PERIPHERAL VASCULAR DISEASE
 Approximately 90% of peripheral vascular
disease in the nondiabetic population can be
attributed to cigarette smoking.
Smoking
Atherosclerosis of peripheral blood vessels
Narrowing of arteries
Claudication
Gangrene

17. CANCER
 Cigarette smoking accounts for at least 30% of all cancer deaths. It is
linked with increased risk of cancers such as:
 Lung
 Larynx (voice box)
 Oral cavity (mouth, tongue, and lips)
 Nose and sinuses
 Pharynx (throat)
 Esophagus (tube connecting the throat to the stomach)
 Stomach
 Pancreas
 Cervix
 Kidney
 Bladder
 Ovary (a type called mucinous ovarian cancer)
 Colorectum (the colon and/or the rectum)
 Acute myeloid leukemia
 Smoking accounts for 87% of lung cancer deaths. Lung cancer is the
leading cause of cancer death in both men and women, and is one of the
hardest cancers to treat.
 The risks of cancer increase with the increasing number of cigarettes
smoked per day and with increasing duration of smoking.

18. RESPIRATORY DISEASE
 Cigarette smoking is responsible for 90% of chronic obstructive pulmonary
disease.
 Chronic mucous hyperplasia of the larger airways results in a chronic
productive cough in as many as 80% of smokers >60 years.
 Chronic obstructive pulmonary disease (COPD) caused by smoking, is a
permanent, incurable (often terminal) reduction of pulmonary capacity
characterised by shortness of breath, wheezing, persistent cough with sputum,
and damage to the lungs, including emphysema and chronic bronchitis.
 The carcinogen acrolein and its derivatives also contribute to the chronic
inflammation present in COPD.
Smoking
Long term exposure to Carbon monoxide and Cyanide
Chronic inflammation and narrowing of the small airways
Pulmonary damage and loss of elasticity in the alveoli
Emphysema and COPD
Reduced expiratory airflow
 Changes in the small airways of young smokers will reverse after 1–2 years of
cessation.

19. ERECTILE DYSFUNCTION
 Incidence of impotence is approximately 85 percent higher in
male smokers compared to non-smokers, and it is a key cause of
erectile dysfunction (ED).
 The British Medical Association estimates that up to 120,000 men
have ED because of smoking.
 Smoking increases the risk of erectile dysfunction (ED) by about
50 per cent, in men aged 30-40.
Smoking
Narrowing of arteries supplied to penis
Reduced blood supply
Erectile dysfunction

20. FEMALE INFERTILITY
 Smoking is harmful to the ovaries, potentially causing female infertility.
Smoking
Nicotine and other harmful chemicals
Interfere with the body’s ability to create estrogen
Affects folliculogenesis and ovulation
Female Infertility
 Cigarette smoking also interferes with folliculogenesis, embryo transport,
endometrial receptivity, endometrial angiogenesis, uterine blood flow and
the uterine myometrium.
 Some damage is irreversible, but stopping smoking can prevent further
damage.
 Smokers are 60% more likely to be infertile than non-smokers.

21. PREGNANCY COMPLICATIONS
Smoking
Intrauterine growth retardation (IUGR)
Low birth weight (<2500 g)
smoking in pregnancy also increases the risk of preterm
delivery.
Other adverse pregnancy outcomes linked to smoking are
miscarriage (spontaneous abortion) and stillbirth.
Smoking during pregnancy affects children even after birth.
Sudden infant death syndrome is two to four times more
common in infants born to mothers who smoked during
pregnancy.
Cognitive deficits and developmental problems in childhood
are also linked to maternal smoking during pregnancy.

22. INFECTION
 Tobacco is also linked to susceptibility to infectious diseases,
particularly in the lungs.
 Smoking more than 20 cigarettes a day increases the risk of
tuberculosis by two to four times.
 Being a current smoker has been linked to a fourfold increase in
the risk of invasive pneumococcal disease.
 The usage of tobacco also increases rates of infection: common
cold and bronchitis, chronic obstructive pulmonary disease,
emphysema and chronic bronchitis in particular.
Smoking
Nicotine
Increase in CD4+ cell production
Affects immune system
Increased risk of pulmonary and respiratory tract infections

23. STRESS
 Smokers report higher levels of everyday stress.
 Several studies have monitored feelings of stress
over time and found reduced stress after
quitting.
 Recent studies have shown a positive
relationship between psychological distress and
salivary cotinine levels in smoking and non-
smoking adults, indicating that both firsthand
and secondhand smoke exposure may lead to
higher levels of mental stress.
 Medical researchers have found that smoking is
a predictor of divorce. Smokers have a 53%
greater chance of divorce than nonsmokers.

24. OTHER RISKS
 Smokers are at a significantly increased risk for chronic kidney
disease than non-smokers.
 A history of smoking encourages the progression of diabetic
nephropathy.
 Cigarette smoking also increases a woman's risk of
postmenopausal osteoporosis and fracture.
 Smokers have higher rates of peptic ulcer disease, and
sensorineural hearing loss than nonsmokers.
 The blood vessels in the eye are sensitive and can be easily
damaged by smoke, causing a bloodshot appearance and
itchiness.
 Heavy smokers are twice as likely to get macular degeneration, resulting
in the gradual loss of eyesight.
 Smokers run an increased risk of cataracts.
 Smokers have more prominent skin wrinkling than
nonsmokers, independent of sun exposure.

25. OTHER RISKS
 Smoking stains teeth and gums.
 Smoking increases risk of periodontal disease, which causes
swollen gums, bad breath and teeth to fall out.
 Smoking causes an acid taste in the mouth and contributes to
the development of ulcers.
Smoking
Reduces the blood supply to the skin and lowers levels of vitamin A
Paler skin and more wrinkles
Affects personal looks
Smokers are 4 times more likely to have gray hair and increased
hair loss.
 The majority of residential fire deaths are caused by smoking.

26. OTHER RISKS
 Smoking interferes with the healing of bone and
muscle injuries, and they lead to higher rates of
complications after surgery.
 50% more likely than nonsmokers to injure
themselves with sprains and fractures.
 Smokers are more vulnerable to headaches.
 People who smoke are more likely to have
sinusitis.
 Long-time smokers may face an increased risk of
multiple sclerosis.
 smoking impedes the blood supply to the lower
spine, it is also linked to chronic low back pain
and degenerative disk disease.

27. SECOND HAND SMOKE
 Nonsmokers are harmed by chronic exposure
to environmental tobacco smoke (ETS).
 The children of parents who smoke have
more serious respiratory infections during
infancy and childhood, more respiratory
symptoms, and a higher rate of chronic otitis
media and asthma than the children of
nonsmokers.
 Secondhand smoke exposure increases a
nonsmoker's risk of lung cancer and coronary
heart disease.

28. SMOKING KILLS

29. REFERENCES
 Behavioral Medicine: A Guide for Clinical
Practice,3e
Mitchell D. Feldman, John F. Christensen
 The MD Anderson Manual of Medical
Oncology, 2e
Hagop M. Kantarjian, Robert A. Wolff, Charles
A Koller
 Hurst's The Heart, 13e
Valentin Fuster, Richard A. Walsh, Robert A.
Harrington
 Harrison's Online
Featuring the complete contents of Harrison's
Principles of Internal Medicine, 18e

30. REFERENCES
 CURRENT Diagnosis & Treatment:
Psychiatry, 2e
Michael H. Ebert, Peter T. Loosen, Barry
Nurcombe, James F. Leckman
 Principles and Practice of Hospital
Medicine
Sylvia C. McKean, John J. Ross, Daniel D.
Dressler, Daniel J. Brotman, Jeffrey S. Ginsberg
 Goodman & Gilman's The Pharmacological
Basis of Therapeutics, 12e
Laurence L. Brunton, Bruce A. Chabner, Björn C.
Knollmann
 CURRENT Medical Diagnosis & Treatment
2013
Maxine A. Papadakis, Stephen J. McPhee, Eds.
Michael W. Rabow, Associate Ed.

31. REFERENCES
 http://www.who.int/tobacco/research/youth/he
alth_effects/en/index.html
 http://www.cdc.gov/tobacco/data_statistics/fac
t_sheets/health_effects/effects_cig_smoking/
 http://www.cancer.gov/cancertopics/factsheet/
Tobacco/cessation
 http://www.nhs.uk/chq/pages/2344.aspx?
categoryid=53&subcategoryid=536