All forms of tobacco smoking including cigarettes, cigar, pipes and hookahs can produce ill health effects and addiction.
There are more than 4000 substances in cigarette smoke
It contains:
  • Carcinogens – Tar, polynuclear aromatic hydrocarbons, benzopyrene, nickel, arsenic, nitrosamine, hydrazine, vinyl chloride
  • Co-carcinogens – Phenol, cresol, catechol
  • Addicting Agents – Nicotine
  • Other – Carbon monoxide

Main stream smoke – smoke emerging from mouthpiece during puffing
Side stream smoke – smoke emitting between puffs at the burning end and from mouth end. Contains more carcinogens than main stream smoke.

Smoking Index

Number of cigarettes/ day X number of years smoked
  • Mild smoker - <100
  • Moderate smoker – 100 to 300
  • Heavy smoker - >300

Pack Year

Number of packs of cigarette/day X number of years smoked (1 pack = 20 cigarette)

Passive Smoking

  • Also known as second hand smoking, involuntary smoking and environmental tobacco smoke exposure.
  • Occurs when smoke from one person’s burning tobacco product is inhaled by others.
  • It increases the risk of CAD, cancer, respiratory illness and death.

Health Effects of Chronic Smoking

Effects of Smoking
  • Cancers
    • Lung
    • Oral cavity
    • Larynx
    • Esophagus
    • Stomach
    • Urinary bladder
    • Kidney
    • Colon
    • Cervix
  • Coronary artery disease
  • Stroke
  • Chronic obstructive lung disease
  • Infertility
  • Aortic aneurysm
  • Peripheral vascular disease
  • Periodontitis

Nicotine Withdrawal Symptoms

Withdrawal symptoms in chronic users begin to appear approximately 30 minutes after every dose.
Features includes-
  • Confusion
  • Restlessness
  • Anxiety
  • Insomnia
  • Dizziness
  • Depression
  • Feeling of frustration and anger
  • Nightmares
  • Poor concentration
  • Headache
  • Increased appetitie

Smoking Cessation

Nicotine Replacement Therapy
  • Use of nicotine patches, nicotine gums, lozenges and nasal sprays.
  • Contraindicated in unstable coronary artery disease, untreated peptic ulcer, recent MI and recent stroke.

Methods of gum use:
  • Chew slowly until a strong taste or tingling sensation felt.
  • Stop chewing and place the gum between cheek and gums.
  • Chew again wen intensity of tingling decreases.
  • Repeat this cycle of “park and chew” for about 30 minutes or until the tingling sensation subsides.

  • Antidepressant
  • Dose is 75-150 mg twice a day
  • Side effects include dry mouth, insomnia and skin rash

  • More effective than nicotine and bupropion
  • Contraindicated in pregnancy and lactation
  • Side effects include nausea, insomnia, abnormal dreams, agitation, depressed mood, suicidal ideation, visual disturbances and alteration in consciousness.

Other medications – Clonodine and Nortryptyline

Electronic Cigarettes
  • A battery-powered vaporizer which contains nicotine derived from tobacco plant and gives the feeling of smoking a cigarette.
  • Reduces various health effects of cigarette smoking.


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