LUNG DISEASES AND TOBACCO

1. LUNG DISEASES AND TOBACCO Prof. Dr. Sevda Özdoğan

2. HISTORY • Tobacco was used before 1492 for treatment and religious aims among Indians (war and peace sticks) • First European smokers were Christof Colomb and his staf. • First cigarette industry was constructed in 1867 by James Buchanan Duke • Tobacco and cancer relationship was first reported in 1761 by the British scientist John Hill

3. WORLWIDE: • 1,1 billion people smoke. • 47% male, 12% female smokers • Leading preventible cause of mortality • 6 million people die from smoking related causes every year. • 12000/day / Every 7 seconds • In 2030 ~10 million 70% in developing countries

4. WORLDWIDE

5. TURKEY: • 17 million people smoke. • 57% male, 28% female • 100000 die every year. • 250/day, Every 6 minutes

6. Rate of Smoking in Turkey( Bilir N. et al)Occupation Rate (%)Doctor 43.1Teacher 48.6Journalist 63.9Driver 74.3Police 64.7İmam 25.1Artists 46.2Sportsmen 34.9

7. 85% of Smoking mothers • 49% of Doctors • 63% of Teachers Smoke besides their children ( Bilir N. et al. )

8. What is in Cigarette???

10. Particulate phase (Catran) NICOTIN, (responsible from addiction) Fenol Cathecol* Anilin Toluidine* Naphtalamine* Benzen, Benzpyren Nickel Polonium 210 Antimone Gas Phase CO Formaldioxide* Formaldehyde Acrolein Amonium* Acetone* Piridine 3- Vinylpiridine Hydrogen syanide Nitrogen oxide* N-nitrosodimethylamine* N-nitrosopirolidine* Formic acid* Lactic acide*.... Cigarette consists *: Irritants

11. Particulate Phase Hydroxyl (OH-) Superoxide (O2-) Hydrogen Peroxide (H2O2) Semichinon radicale (HQ) Gas Phase Hydroxyl (OH-) Nitrogen dioxide (NO2) Peroxy radicale (ROQ) Oxidatives in Cigarette smoke

12. Carsinogens • Benzen • Nitrosamines • Naphtalamines • Formaldehyde • Policyclic aromatic hydrocarbons • Polonium 210... ~ 55 carsinogen material.

13. Peroksidase, Toxic radicalesCIGARETTE Peroksidase, Toxic radicales Alveolar Makrophage Stimulation Extracellular Damage Chemotactic factors Protease, Oksidative MPO Pulmonary Inflamation Parenchymal cell Damage Protease inh Protease, Oksidative MPO Chemotactic factors Extracellular Matrix Repair Emphysema

14. RESPİRATORY EPITHELIUM

15. Squamous Metaplasia

16. CANCERCELLS

17. The risk of bronchogenic carcinoma is proportional to the total lifetime consumption of cigarettes. The relative risk increases with both: • the number of cigarettes smoked per day as well as • the lifetime duration of smoking. • It has been estimated that a 35 year-old man has a 9 percent likelihood of dying from lung cancer before age 85 if he smokes fewer than 25 cigarettes per day, compared with an 18 percent likelihood if he smokes more than 25 cigarettes per day. Mattson ME et all, Am J Public Health 1987; 77-425

18. LUNG CANCER

19. Lung with emphysema Normal Lung

20. 50% of smokers develop Chronic Bronchitis, 15-20% develop COPD (Emphsema)

22. Smoking is responsible from; • 90% of Lung cancer deaths, • 30% of total cancer deaths, • 75% of deaths from Bronchitis, • 25% of heart attack deaths

23. Smoking Associated Lung Diseases • COPD • Asthma Attacks • Upper and Lower airway infections • Pneumonia • Tuberculosis • RBAILD • Hystiocytosis X • Lung Cancer

24. Other toxic effects of smoking in the body Organ Effect CVS Atherosclerosis, heart attack Mouth and Throat Loss of taste,halitosis, yellow teeth, tongue, lips, larenx cancer, frequent UAI Nose Diminished sense of smelling CNS Stroke

25. Organ Effects Gastrointestinal Peptic ulcus, Stomach, pancreas cancer, Bone Osteoporosis Skin Wrinkles, color changes Urogenital Bladder cancer, premature menoposis, erectile disfunction, premature birth, low birth weight

26. Nicotine • When tobacco burns, Nicotine attaches to 0,1-1 micron particules and reaches the bronchioles and alveoli by inhalation, reaches shortly to the brain by the circulation • It is a physoactive agent that cause addiction • Causes increased secretion of norepinephyrin and dopamin • Stimulating effect (dopamine) • Abstinence symptoms (Norepinephyrin)

27. Recurrent nicotine stimulation increase the dopamine secretion in Nucleusaccumbens Core 50 Nicotine 40 SF 30 (pg/20 m) Serum physiologic Nicotine 20 Dopamin 10 0 0 30 60 90 120 150 Time (min)

28. Medulla Oblongata Gyrus Rectus Nucleus Cortex Median Raphe Cerebellar Smoking increases the number of nicotine receptors in brain 400 ** 350 Nonsmoker 300 Smoker 250 Receptor density (fmoles/mg protein) 200 * ** 150 * ** 100 50 0 Hippocampal Formation Hippocampal Neocortex

29. Behavioral effects of Nicotine • Increased energy, • Increased concentration, • Increased hand-eye coordination • Euphoria • Decreased appetite

30. Behavioral Psychological Neurochemical Nicotine Addiction Triangle

31. Genetics of Tobacco addiction • CYP2A6 enzim polimorphysm: Rapid metabolisers of nicotine are easily addicted • SERT (Seratonin transport gene): People with S alel are more resistant to antidepressive treatment, more aggresive and vulnerable to smoking addiction • Triptophane Hydroxilase: Effective in the beginning to smoking

32. Nicotine addiction is a threat to health Increased concentration Ephoria Decreased appetite Increased energy Physiologic addiction Psychologic addiction Cancer COPD CVS diseases Decreased life expectancy

33. Doll R, Peto R, Boreham J’ Sutherland I. BMJ 2004

35. American Federal Trade Commission (FTC) classification according to the amount of catran • Regular cigarette: > 15 mg • Light cigarette : 7-15 mg • Ultra Light cigarette : 1- 6 mg

36. But: Every 1mg decrease in catran amount of the cigarette smoked cause 2.13 times increase in the number of cigarettes smoked. Light Cigarettes are not less harmfull!!

37. Passive smoking • Exaled smoke of a person during smoking • The smoke that comes out of a cigarette burning in an ashtray (side smoke) • Smoke that comes from the paper or filtrate material of a burning cigarette Cause of passive smoking

38. Combination of the chemicals are different as the cigarette is burning in less temperatures in the ashtray and are more toxic. • 85% of the room air is formed by this side smoke. • Smoker is also effected by this side smoke

39. Side smoke is at least harmfull as the main smoke!!! • Nicotine content is higher. • Some carsinogens are 10-200 times increased. • 8 hours passive smoking= 20 cigarette smoking • Passive smoking increase the lung cancer risk by 30 • 30 minutes passive smoking acutely decrease coronary blood flow

40. Children of smoking parents • Low birth weight • Frequent upper and lower airway infections • Frequent otitis • Increased risk of asthma • Increased rate of smoking

41. Smoking is defined as a disease that should be treated by WHO • It is the primary responsibility of every medical doctor to lead to quit smoking of the patients • One “Quit smoking” message is found to be enough for 5% of the patients

42. Whom do we fight?

43. Majority of the smokers start smoking before the age of 20 Those young groups are the targets of smoking industry Todays healthy young age group is expected to be tomorrows cigarette addicted, permanent customers by the Smoking industry

44. Cigarette industry make advertisement by being sponsores of motor vehicle competitions

45. Smoking industry increase the advertisement activities in developing countries; whereas the number of smokers decrease in developed countries

46. USA stopped smoking but continues to sell

48. 71 % of the developing world smoke (2001) Smoking in the last 20 years; Increased 80% in Turkey, Decreased 30% in USA

49. Thanks