Dr Kevin McCarroll
Medical Matters
It’s now just over 50 years ago since it was first announced that smoking causes lung cancer, a moment which spelled the beginning of a decline in tobacco use. Despite all of the negative effects from smoking and restrictions on its use in public places, a considerable number of people still use cigarettes. Indeed, it is estimated that 21% of females and 24% of males smoke in Ireland with the highest rate among those aged 25-34.
The inhalation of tobacco smoke is believed to go as far back as nearly 10,000 years when Native Americans used it in a spiritual ritual involving pipes. The arrival of tobacco into Europe, though, was much later and largely as a result of Christopher Columbus who brought back the tobacco plant. While originally used as a decorative object, tobacco made a breakthrough in England in the 1500’s and by the 18th Century had spread around the world as a luxury good.
Then came the invention of the cigarette, which catapulted tobacco into a product of mass consumption. Indeed, in the mid-20th Century, tobacco products were associated with glamour, maturity and friendship as portrayed in films and media. A notorious example which encapsulates the nonchalant culture at the time was the TV advertisement that promulgated the tobacco product your doctor most prefers in the slogan “more doctors smoke Camels [cigarettes] than any other cigarette”!
We now know that smoking harms nearly every organ in the body and there is also no evidence of a safe level of exposure. Tobacco contains more than 7000 chemicals and over 70 are believed to cause cancer.
Apart from causing lung cancer, chronic bronchitis and emphysema, smoking has been implicated in over nine other cancers including throat, oesophagus, stomach, pancreas, kidney, bladder and cervix. It can raise your blood pressure and also hugely accelerates hardening of the arteries causing heart and stroke disease as well as circulatory problems. It also lowers your bone density, can cause cataracts, increases the risk of peptic ulcers, has a negative effect on your skin and in pregnancy can cause preterm delivery and low birth weight.
Importantly in non-smokers, second hand smoke has been linked to an increased risk of heart disease and lung cancer and in children respiratory/ ear infections and worsening asthma.
With such a litany of adverse effects, the message of never starting couldn’t be much stronger. Reassuringly, in Ireland, smoking prevalence in adolescents has reduced by about 70% since 1995 and across the population there is also a significant downward trend.
It’s always important to remember that it’s never too late to quit smoking. In fact, in Ireland there are just over one million ex-smokers. Within one year of stopping your risk of heart attack drops sharply and remaining off cigarettes for up to five years reduces your risk of several cancers by up to 50%. After 10 years lung cancer risk is also halved.
Nicotine is highly addictive and can reach your brain only after seven seconds of lighting up a cigarette. It can have a relaxing effect by acting on our brains natural reward system and amplifying the effect of dopamine, helping to explain withdrawal symptoms.
High rates of sustained abstinence of smoking is hard to achieve. Nearly half of all those who attempt to quit rely on will power alone, while 17% use nicotine products, 27% e-cigarettes and only 4% prescribed medication. However, importantly with any cessation programme, psychological support and motivation is crucial to improving success.
Nicotine replacement therapy can be in the form of patches applied to the skin, chewing gum, lozenges or inhalers (Nicorette). This can provide an effective way of dealing with withdrawal symtoms as they happen. The medication ‘Champix’ which binds to nicotine receptors in the brain not only mimics the effects of nicotine and reduces cravings but also reduces the strong pleasure hit you get if you smoke. It is taken as a twice daily tablet for a 12-week course, more than doubles your chance of quitting and has been shown to have a better success rate than nicotine products.
Vaping or using e-cigarettes has been questioned as an alternative strategy to quit smoking though results have been mixed when compared to standard nicotine replacement and guidelines on their use vary. In addition, there are concerns for some that vaping might become a long-term alternative to cigarette smoking which might result in as yet unknown potential adverse effects. Indeed, some are using them for recreational use as a perceived safer option.
However, the most significant intervention study of e-cigarettes was just published in January of this year and a showed a much superior sustained one-year abstinence rate of 18.0% versus 9.9% compared to standard nicotine replacement. Furthermore, users found it easier to tailor the nicotine dose to meet their individual needs. However, if using e-cigarettes as a way of quitting it’s sensible to plan on a stop date.
So remember, it’s never too late to quit smoking! The benefits will start soon after and there are nicotine products and medications to help.