Quitting smoking is as important as wearing a mask

World ‘No Tobacco Day’ falls tomorrow on the theme ‘Commit to Quit’

by Randima Attygalle- 2021/05/30

Chemicals found in nail polish, rat poison, battery acid, car exhaust fumes, paints, rubber cement and gasoline are just a handful of what you will find in a single cigarette. A lighted cigarette create more than 7,000 chemicals and nearly 70 of them are known to cause cancer; and many are toxic. While many of these chemicals found in consumer products carry warning package labels (eg. rat poison), there is no such warning about toxins in tobacco smoke, points out the American Lung Association.

While cigarette smoking is the most common form of tobacco use worldwide, all forms of tobacco including water pipe tobacco, smokeless tobacco products, cigars, pipe tobacco, bidis and kreteks (used in Indonesia) are all harmful. ‘The tobacco epidemic’, according to the WHO, is one of the biggest public health threats the world has ever faced, killing more than eight million people a year around the world. More than seven million of those deaths are the result of direct tobacco use while around 1.2 million are the result of non-smokers being exposed to tobacco smoke. ‘Over 80% of the 1.3 billion tobacco users worldwide live in low and middle-income countries, where the burden of tobacco-related illness and death is heaviest. Tobacco use contributes to poverty by diverting household spending from basic needs such as food and shelter to tobacco,’ notes the WHO.

Cigarette smoke reduces the amount of oxygen carried to tissues and even in case of COVID patients, oxygen saturation (percentage of oxygenated hemoglobin returning to the right side of the heart) levels are low. Consultant Respiratory Physician and Senior Lecturer from the Department of Anatomy, Faculty of Medicine, University of Colombo, Dr. Yamuna Rajapakse points out that several studies have now confirmed that oxygen saturation is less in patients who smoke compared to non-smokers. “Smokers function in a low oxygen saturation environment, hence they are at greater risk than non-smokers during COVID lung involvement.”

Smoking causes thrombosis or blood clot formation. This could lead to stroke, heart disease and peripheral vascular disease. COVID too causes thrombotic effects and smoking may increase this risk she explains. Tobacco smoking is a significant risk factor for both viral and bacterial infections of the respiratory system. Smokers are five times as likely to develop influenza and twice as likely to have pneumonia. This, as many reputed medical journals including the British Medical Journal (BMJ) confirms, is an important factor worsening the impact of COVID-19. ‘There is evidence from case series that smoking is associated with more severe disease, a greater risk of intensive care need and excess mortality in people with COVID-19 admitted to hospital,’ notes the BMJ.

Smokers have more phlegm in their system and experience bouts of what is commonly known as the ‘smoker’s cough’. “Tobacco smoke burns the protective mechanism we have in our lungs which acts as a buffer against dust, viral and bacterial particles entering the respiratory system,” says the physician. She adds that smokers are more likely to develop pneumonia and this risk is aggravated in COVID patients who smoke.” Dr. Rajapakse also remarks that while the majority of COVID patients are asymptomatic, smokers show more COVID symptoms as research findings from China and UK also confirm.

New tobacco trends such as shisha smoking (smoking tobacco through a water bowl via a hose or tube) has also become an added problem notes Dr. Rajapakse who also warns that sharing of cigarettes and shisha tubes could increase the transmission of COVID and other respiratory infections.

Lung cancer which is the leading cause of cancer death the world over with smoking long established as a major cause, is now being diagnosed in a younger adult population. “Today we see advanced lung cancers in those in their 30s and 40s. Although genetic predominance is also present in lung cancer, a sizable percentage is attributed to second-hand or passive smoking (involuntary inhalation of other people’s smoke). Victims include women exposed to a smoking spouse.” Pregnancy is the worst time one could be around smoke, says the physician who warns that babies born to mothers exposed to passive smoking have lower lung reserves. Low birth weight is also common among such babies. Third-hand smoke where residual nicotine and other chemicals are left on indoor surfaces, clothing etc. is also bad for people who are exposed to them.

Entailing symptoms similar to asthma with wheezing and coughing, Chronic Obstructive Pulmonary Disease (COPD) is another serious smoke-induced condition. A non-reversible condition, COPD does not respond very well to inhalers, explains Dr. Rajapakse. Smokers with a specific enzyme deficiency can end up with COPD prematurely, she warns. Besides noncommunicable diseases such as high blood pressure, heart disease and stroke, smokers are also at a higher risk of having intermittent claudication and vascular ulcers leading to amputation of limbs, she says.

Despite tobacco smoking being established as a real risk factor for COVID-19, seriously compromising immunity and structural functioning of the respiratory system, there is very little discourse on it, observes the Consultant Psychiatrist from the National Hospital of Sri Lanka and the Director, Centre for Combating Tobacco, Dr. Mahesh Rajasuriya.

“Not smoking is as important as wearing a mask, yet the tobacco industry has been careful in downplaying this,” says the Psychiatrist who adds that apart from developing very serious complications, tobacco smoking also directly violate COVID control measures. “Smokers are compelled to remove their masks to smoke and even if they are smoking outdoors, there is a tendency for them to interact with a few more people in a small enclosure inhaling and exhaling each other’s breath more sharply. Here the risk of contracting COVID is enormous. Secondly our health care system is already exhausted with COVID patients and if a smoker suffers a heart attack, a stroke or gets pneumonia to which they are more susceptible, it will add to the burden.”

While hardly anyone “pledges to smoke to the grave”, most smokers wish to quit at sometime but several factors prevent them from doing so, says Dr. Rajasuriya. “These can be broadly classified into demand and supply factors. While the former makes smokers want to smoke again, the latter keep the environment conducive to smoking such as making cigarettes cheaper and more accessible.” Although the price of a cigarette should be more than what it is now in the Sri Lankan market compared to other consumer goods, it has on the contrary become more affordable, driving those from lower socioeconomic levels and youngsters who are still dependent to become addicted, says Dr Rajasuriya. “The tax increases on cigarettes too has been fraudulent with less money going to government coffers and larger proportions to the tobacco industry.”

The non-availability of a local license system as in the case of many countries including several in the region such India and the Maldives, makes cigarettes freely available, he points out. The absence of a law banning single stick sales adds fuel to fire during the pandemic he says. “Added to the physical touch when selling single sticks, the smoker does not see the pictorial health warnings on cigarette packs.”

A large majority of smokers quit without any psychological help says the psychiatrist who observes that the tobacco industry has created a myth that quitting is an uphill task and only those with extraordinary willpower can do so. “It is imperative to see through this myth first if you want to quit smoking,” he reflects. Certain stereotypes ingrained in the brain such as the need for physical pharmaceutical support for quitting often discourages a smoker wanting to quit the habit. “Another myth which needs to be debunked is that cigarettes need to be replaced with another chemical to help one to quit.”

The benefits of quitting tobacco are almost immediate, confirms the WHO. ‘After just 20 minutes of quitting smoking, your heart rate drops. Within 12 hours, the carbon monoxide level in your blood drops to normal. Within two to 12 weeks, your circulation improves and lung function increases. Within one to nine months coughing and shortness of breath decreases. Within five to 15 years, your stroke risk is reduced to that of a non-smoker. Within 10 years, your lung cancer death rate is about half that of a smoker. Within 15 years, your risk of heart disease is that of a non-smoker.

While some can navigate the transitional phase after quitting, many experience ‘withdrawal symptoms’ such as irritation, anxiety for which medication may be required. Getting rid of not merely cigarettes but all smoking associated paraphernalia including lighters and ashtrays is vital when preparing to quit says Dr. Rajasuriya. The comprehensive course designed by the Centre for Combating Tobacco, Help Quit sponsored by the WHO country office helps those who aspire to quit smoking and other support personnel including doctors, nurses, psychotherapists, counselors etc. to assist others to quit.

“The image about smoking is negative today, although the tobacco industry is trying hard to project otherwise. In this exercise, social media is now heavily used to induce the smoking habit and also to target a locally untapped market of young girls and women. Hence it is important for the public to see the true picture and not be deceived by the tobacco industry’s marketing strategy,” concludes Dr. Rajasuriya.