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SMOKING OR HEALTH?

Informative presentation on smoking's impact on health, types of tobacco products, effects of nicotine, toxicology of cigarettes, e-cigarettes, and smokeless products, mechanisms of health effects, and health damages caused by smoking. Discusses passive smoking, statistics, and addiction issues.

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SMOKING OR HEALTH?

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  1. SMOKING OR HEALTH? PREZENTATION FOR 3rd GRADE https://is.muni.cz/www/2422/um

  2. SMOKING IS: • THE MOST IMPORTANT SINGLE PREVENTABLE FACTOR OF MORBIDITY and MORTALITY (WHO), and • THE CHRONIC, PROGRESSIVE AND RECIDIVE DISEASE (Dg F 17) (U.S. Surgeon General)

  3. SORTS OF TOBACCO PRODUCTS (TP) • COMBUSIBLE (burned): cigarettes, pipes, cigars, waterpipes • HEATED: Electronicnicotinedeliverysystems (ENDS): e-cigarettes, iQOS (I Quit Original Smoking) • SMOKELESS: snufs, chewing • MEDICINAL: Nicotinereplacements(chewing gum, inhalator, patches, tablettes)

  4. NICOTINE IS THE REASON… • VERY STRONG DRUG (similar to heroine, coccaine)=>DEPENDENCE, ADDICTION • GATE FOR OTHER DRUGS • nACh RECEPTORS ACTIVATION => • RELEASE of DOPAMINE,SEROTONINE • STIMULATION of SYMPATICUS, SUPRARENALS • RELEASE OF ADRENALINE, ACTH • SUBJECTIVELY: MOOD CHANGE, SHORT-TIME ENHANCED PERFORMANCE = REVEAL

  5. PHARMACOLOGY of NICOTINE • Within 10-20 sec reaches the brain (inhalation) or • Slow kinetic (30 min)(transdermal, oral intake) • Short metabolic half-time (20-30 min; interindividual differences) • COTININE- the main metabolic; residues 2-3 days • NITROSAMINES – partial metabolics, mutagenic • Detection in body fluids (blood, urine, salivary, breast and cervix excretes, follicular fluid), and tissues (hair)

  6. TOXICOLOGY: cigarettes • Production of more than 7.000 chemicals, including • Majority of human carcinogens (class 1A, 2A, 2B) – approx. 70 • Contain: CO, HCN, volatile carbohydrates, tobacco specific nitrosamines (NNK), PAH, dioxine, heavy metals (Cd, Pb, As, radioactive polonium, stroncium), fine/ultrafine dust particles, and >500 additives • Many of chemicals are metabolically activated => free radicals

  7. TOXICOLOGY: e-cigarettes • Nicotine (as in convenial cig.) • Propylenglycole, glycerine (their metabolites are 2A carcinogens) • Formaldehyde (2A carcinogen) • Haevy metals, fine particles • Up to 8.000 additives – some of them are toxic, effects of majority of them are unknown • Explosions, fires (from battery)

  8. TOXICOLOGY: smokeless • Nicotine (as in convenial cigarettes) • Tar (carcinogenic) • Haevy metals

  9. MOST IMPORTANT MECHANISMS OF HEALTH EFFECTS: • HYPOXEMIA (COHb, enzymal bloccade by HCN, vasoconstriction by nicotine, placental infarctions by Cd) • ENHANCED activity of HAEMOCOAGULATION • CHANGES IN SERUM LIPIDS ( higher total +LDL, lower HDL cholesterol) • OXIDATIVE STRESS by free radicals • DAMAGES OF IMMUNITY, • HORMONAL DYSBALANCE =>damages of reproduction • TRANSFERE THROUGH PLACENTAL BARRIERE => damages of fetal development, postnatal diseases

  10. MOST IMPORTANT HEALTH DAMAGES • CONTRIBUTION TO 25 DISEASES, such as: • CVD (attributive risk AR 30 %) • CHOPD (AR 70 %) • CARCINOMAS (AR 30%, for lung cancer 80-90 %) • REPRODUCTIVE: erectile dysfunction, infertility • GRAVIDTY COMPLICATIONS: gr. extrauterina, placenta praevia, bleeding, stillbirth, abbortion • FETAL´S DAMAGES: intrauterine retardation, ADHD, heredital malformations, risk of carcinomas, CVD • WOUND HEALING, SKIN DISEASES, DIGESTIVE DISEASES, PSYCHIATRIC dis. includ. Suicides, ALZHEIMER dis. • INFECTIONS

  11. HEALTH DAMAGES- EPIDEMIOLOGY • EVERY SECOND SMOKER WILL DIE DUE TO SMOKING • Half of them will die prematurely, before age of 70 y • Annualy 6,4 mil of people die due to smoking worldwide • During 20th Century 60 mil people were killed by tobacco • In 21st Century 1 mld people will be killed by tobacco • Smokers have 8 y shorter life expectancy • Women are more vulnerable, their relative risks are higher • Dose-effects relationships are not linear, but exponential • The „safe threshold“ does not exist, every cigarette kills

  12. PASSIVE INVOLUNTARY SMOKING • Burned-heatedtobaccoproducts are onlyuniquearmskilling by bothends • MAIN STREAM : mixtureinhaled by activesmoker • SIDE STREAM: mixture in whitesmoke, imperfekt combusting, higherlevels of chemicals • SECONDHAND SMOKE (Environmental TobaccoSmoke ETS) = sidestream + air expirated by smoker THIRDHAND SMOKE: re-emission of chemicalsfrom ETS adsorbed in theinterier – residuesthroughdays, weeks, months WATER PIPES are more important source of ETS thancigarettes E-CIGARETTES products are not „purewatervapor“

  13. VICTIMS of ADDICTION: • 80 % OF CURRENT USERS OF NICOTINE or HEROINE or COCCAINE • 32 % OF OCCASIONAL SMOKERS • Itis a PEDIATRIC PROBLEM • DEPENDENCE IS: PHARMACOLOGICAL(nicotine), and BEHAVIORAL (ceremony, typicalsituations)

  14. ADOLESCENCE IS • A criticaltimebothfor start of smoking and depression (mainlydue to…) • THE DYSBALANCE of BRAIN DEVELOPMENT: - The limbicstructures are maturatedduring puberty=> risk seeking, negativism, self-assurance - The frontalcortexmaturateslater (16 – 21 y) => cognitivebehavioralcontrol NICOTINE DISTURBES frontalcortexmaturation => damages of cognice, psychiatricdiseases

  15. EVALUATION OF ADDICTION: • COMMON PSYCHIATRIC CRITERIA • FAGERSTRŐM´s QUESTIONAIRE: • 6 QUESTIONS • 10 „BAD“ POINTS • 4 LEVELS OF DEPENDENCE • DECREASED/LOST of AUTONOMY

  16. EFFECTS OF STOPING SMOKING • LOWER BLOOD PRESSURE + HEART FREQUENCY within 20-30 min • REACHING NORMAL VALUES OF COHb within 8 hours • IMPROVING VALUES FEV1 within 72 hours • DECREASING OF THROMBOGENIC ACTIVITY within 3 months • Within 3-5 yeard the risk of CVD is similar to never smokers • Within 10 – 20 years the risk of CARCINOMA similar to never smokers • Within 1st trimester the risk for INTRAUTERINE FETAL DEVELOMPMENT is similar to never smokers

  17. PROGRAMME 5A/5P(in Czech) • ASK ABOUT SMOKING • ADVICE TO STOP • ASSESS the level of ADDICTION • ASSIST WITH CESSATION • ARRANGE FOLLOW-UP

  18. PHYSICIAN: • PERSONALIZES THE INDIVIDUAL RISK • EXPLAINS THE PROBLEM • HELPS TO LOOK FOR MOTIVATION SUCH PSYCHOTHERAPY IS THE MOST IMPORTANT • PRESCRIBES TREATMENT (MEDICAMENTS)

  19. MEDICAMENTs: • NICOTINE REPLACEMENT THERAPY (chewing gums, pathes, inhalator, sprey, subligual tablets) • VARENICLINE (Champix) - nicotine agonist • BUPROPIONE (Zyban, Wellbutrin) -antidepresant • VACCINATION (clinical testing) – bloc transfer of nicotine into brain • ALTERNATIVE METHODS: joga, hypnosis, auriculopressure/puncture • E-cigarettes, iQOS – low effect, not reccommended

  20. RELAPS DISTURBES ATTEMPT • WITHDRAWAL SYMPTOMS • CRAVING • TYPICAL SITUATIONS (friends, coffee, alcohol) • STRESS Forthesuccessfulstoping – 4-5 attempts are necessary

  21. RECOMMENDATION: • DON´T START, BE SMART • DON´T ALLOW TO SMOKERS TO TROUBLE and TO JEOPARDIZE YOU • MAKE A STRONG DECISSION TO STOP and KEEP IT

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