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