A total of 8 million preventable deaths are occurring every year worldwide due to the most notorious villain named tobacco. Covid 19 has been a nightmare since a few years which took life of 31 million people in such a short span of time. These both shares a relationship based on transmission, severity as well mortality rate. 

EFFECT OF TOBACCO ON LUNGS

 Tobacco products both smokeless and smokable form contains nearly 4000 toxic chemicals with 36 known carcinogens. Tobacco smoke even act as an immunomodulator in the lungs on top of triggering inflammation, diminishing the oxygen-carrying capacity of the blood, allergy, asthma, and other lung diseases.

INCREASED RISK OF COVID TRANSMISSION

SARS-CoV-2 is highly infectious virus which transmits by direct means using secretions from the nose or mouth of an infected person or by indirect contact with objects and airborne contagion where the virus can survive for a few hours to several days.  Tobacco users are in a higher urge to get transmitted with covid 19 due to constant contact of contaminated hands with oral cavity during product usage and sharing of mouthpieces and hoses during social gatherings. Contaminated Cigarette/bidis butts and tobacco spits out often act as a nidus of infection.

SEVERITY

Prolonged active tobacco consumption provides elevated covid 19 viral susceptibility and disease severity based on mechanism at cellular level of lungs. Smokers have 1.4 times more severe symptoms of COVID-19 compared to Non smokers.

IMMUNOMODULATION

Immunosuppressive property of tobacco by reducing antibody responses and T-cell proliferation increases the susceptibility of covid 19 infection which also scale down the remaining immunity and thereby leads to development of severe immunocompromised infections such as Mucor mycosis/black fungus.

MORTALITY

 Tobacco-related disorders such as asthma, COPD, and coronary artery disease are known to reduce the lung capacity, impair the immune system of the body and thereby greatly impede the ability to fight the coronavirus, making treatment more challenging and finally fail to thrive.

                                                                  Better late than never

The COVID-19 pandemic should be seen as a game changer in disguise for tobacco users for prompt quitting and to create interventions to reduce the risk of viral transmission and ultimately to achieve a tobacco free world.

Are you ready to quit? Quitting tobacco is one of the best things you can do for your health. Tobacco, either smoking or smokeless, are injurious to our body. Around one third of death occurs due to smoking and passive smoke. What is the need of the hour to quit tobacco?

How a health professional can help you?

Brief intervention skills training for all health professionals especially primary care providers for tobacco cessation in every patient encounter. At secondary level, tobacco cessation clinic services with intensive counselling and pharmacological management. At tertiary level, specialist services should be provided for long standing tobacco addiction. Finally, tobacco cessation should be included in curriculum of all health professionals.

The clinician can motivate patients to consider a quit attempt with the "5 R's" or "5 A's".

Relevance, Risks, Rewards, Roadblocks, and Repetition.

1. Relevance - Encourage the patient to indicate why quitting is personally relevant.

2. Risks - Ask the patient to identify potential negative consequences of tobacco use.

3. Rewards - Ask the patient to identify potential benefits of stopping tobacco use.

4. Roadblocks - Ask the patient to identify barriers or impediments to quitting.

5. Repetition - The motivational intervention should be repeated every time an unmotivated patient has an interaction with a clinician. Tobacco users who have failed in previous quit attempts should be told that most people make repeated quit attempts before they are successful.

Ask, Advise, Assess, Assist, and Arrange.

1. Ask - Identify and document tobacco use status for every patient at every visit. (You may wish to develop your own vital signs sticker, based on the sample below).

2. Advise - In a clear, strong, and personalized manner, urge every tobacco user to quit.

3. Assess - Is the tobacco user willing to make a quit attempt at this time?

4. Assist - For the patient willing to make a quit attempt, use counselling and pharmacotherapy to help him or her quit.

5. Arrange - Schedule follow up contact, in person or by telephone, preferably within the first week after the quit date.

When you stop smoking.

0 minutes: Heart rate starts to drop to normal levels

8-12 hours: Carbon monoxide levels in the blood drop and oxygen levels start to rise

48 hours: Nerve ending damage from smoking starts to reverse, improving smell and taste

2 weeks-3 months: Better circulation, lower blood pressure and improved lung function

9 months: Rise in energy levels, reduced shortness of breath and reduced coughing

1 year: Risk of heart disease is significantly lowered 

5 years: Risk of a stroke is significantly reduced

10 years: Risk of lung cancer drops to that of someone who’s never smoked before

15 years: Risk of heart disease is the same as someone who’s never smoked before

Benefits

Reduces the risk of oral cancer.

Sense of smell and taste return.

Reduces the risk of diabetes.

Helps in the smooth functioning of heart, lungs and blood vessels.

Reduces coughing and shortness of breath.

You will save money. You can figure out the amount of money you spent for tobacco.

You will reduce the risk for family members. Children who breathe passive smoke are more

likely to develop bronchitis, pneumonia and ear infections.

How tobacco affects teeth and gums?

Tobacco contains harmful toxins and tars that can stain teeth.

Toxins in tobacco enter bloodstream and reduces blood supply to the gums. Thus, it results in poor healing.

Increased risk of periodontal diseases and tooth loss.

Halitosis or bad breath.

Oral lesions and oral cancer.

How to quit?

Write down the reasons for quitting – Health, Family, Money

Set a quit date. Make a promise to yourself.

Throw away your cigarettes, lighters and ashtrays.

Tell others also about this day.

Introduce yourself to other enjoyable activities.

Talk to your doctor about counselling, medicines and other resources that can help you.

Avoid stressful situations or people that urges you to smoke.

Use nicotine gums and patches.

Chewing sugarless gums or candy to resist tobacco cravings.

Exercise regularly. Try other relaxation techniques such as deep breathing, yoga etc.

How a nicotine gum is used?

Chew to activate.

Park or rest between cheek and gums.

Repeat chew if flavour fades for up to 30 minutes.

Don’t eat or drink 15 minutes before or while you chew gum. 

Chew 1 piece every 1-2 hours for the first few weeks of your quit. 

How a nicotine replacement therapy can help you?

Nicotine therapy contains low level of nicotine but no other poisonous chemicals that are found

in tobacco products.

When you try to quit, there are withdrawal symptoms like hunger, irritability, headache,

constipation, tiredness etc. Nicotine therapy can ensure less withdrawal symptoms.

Increase the quit rates as it reduces the urge to consume tobacco.

Safe and effective.

31st May is World No Tobacco Day (WNTD). The theme of WNTD 2024 is focused on advocating for an end to the targeting of youth with harmful tobacco products. According to 2022 data, worldwide, at least 37 million young people aged 13–15 years use some form of tobacco.

The tobacco industry targets mainly youth to keep making billions of dollars in revenues, and to replace the millions of customers who die and those who quit tobacco use every year.

The industry develops products and advertises tactics that appeal to children and adolescents, reaching them through social media and streaming platforms. Therefore WNTD 2024 calls on the governments and tobacco control community to protect current and future generations and to hold the tobacco industry liable for the harm it causes.

✓ Prenatal exposure to tobacco has been shown to affect lung development

and increases risks and severity of respiratory illness. Rates of exposure to

e-cigarette aerosol have increased over the last decade.

✓ Children from communities that have historically experienced high levels of

discrimination and stigma are disproportionately affected by tobacco and

nicotine use and tobacco smoke exposure. There are actionable steps

pediatricians, parents, and communities can take to break this cycle and protect children and families."

✓ The AAP calls for heightened prevention efforts, early intervention and federal regulations to reduce tobacco use and nicotine exposure in children and adolescents. Tobacco prevention strategies should start no later than 11 or 12 years of age.

Recommendations include:

• The FDA should regulate all tobacco and nicotine products to protect public health.

• Tobacco and nicotine product prices should be increased to reduce child and adolescent tobacco use initiation.

• Enforce the tobacco product sales age of 21 years.

• All flavor ingredients, including menthol, should be prohibited in all tobacco and nicotine products.

• All tobacco and nicotine product advertising and promotion in forms that are accessible to children and adolescents should be prohibited.

• Depictions of tobacco and nicotine products in movies and other media, such as content through streaming platforms that can be viewed by children and adolescents, should be restricted.

• Tobacco industry-sponsored mass-media and school-based tobacco control programs should be prohibited.

• Refer youth who want to quit using nicotine and tobacco to behavioral interventions.

• Inquire about parents' use of nicotine and tobacco. When parents quit tobacco use, they eliminate the majority of their children's secondhand smoke exposure and decrease the risk of smoking initiation among their children.

• Implement systems to identify, counsel, treat, and refer caregivers who smoke or use other tobacco products.

• A technical report details the evidence base for each recommendation. One strong and consistent finding is that children and adolescents who use e-cigarettes are significantly more likely to go on to use traditional cigarettes.

Strategies for prevention:

• Building children’s knowledge of the ill-effects

• Reducing access to tobacco

• Building children’s resilience

• Parents view suggested innovative or radical strategies, such as banning the

sale of tobacco, fining children for smoking.

Continued clinical and policy advocacy can help prevent new addiction, end

the tobacco epidemic, and promote a nicotine and tobacco-free future.