19-25 April 2013 #652

Kicking butts

In Nepal alone, more than 15,000 die annually of smoking related cause
Dhanvantari by Buddha Basnyat, MD

BIKRAM RAI
One out of every five death in the developed world is related to cigarette use. In Nepal alone, more than 15,000 die annually of smoking related cause. Smoking has been linked to an increased risk in mouth, throat, and lung cancers, cardiovascular disease, hypertension, and stroke.

Epidemiological studies show that the risk of lung cancer in a smoker is about 25 per cent more than a non-smoker. Tobacco use is also associated with cataract, delay in peptic ulcer healing, higher rates of complications during pregnancy, and impotence in men.

And yet people keep smoking. There are more than one billion smokers in the world, 30 million new smokers join every year. Over a quarter of Nepalis smoke regularly. What drives people to indulge in this self-destructive behaviour? While the tar, carbon monoxide, and smoke from burning tobacco are dangerous, it is nicotine that makes smoking remarkably addictive and maintains a potentially fatal grip on the minds of smokers. It is imperative to make this distinction between addictive and dangerous substances to understand how to quit the habit. So how exactly can you kick butts?

Stopping ‘cold turkey’ (or suddenly) may be great if you are extremely motivated, but for many people counseling is an integral part of quitting. As part of the counseling process, the healthcare provider should negotiate a ‘quit date’ with her patient, typically two to three weeks after the appointment. Counseling should be combined where available with pharmacological interventions to improve success. The drug option is based primarily on providing only nicotine to the smoker without the tar and carbon monoxide.

Nicotine replacement therapy comes in different forms: nicotine patches, lozenges, nose and oral inhalers. Some even resort to electronic cigarettes (e-cigarettes) which use electricity from a small battery to vaporise a nicotine-containing solution which the smoker can inhale. Unfortunately nicotine replacement therapy is not generally available in Nepal.

Curbing tobacco use is critical to promoting public health and preventing the harmful outcomes related to cigarette use. However, due to the hugely satisfying effects of nicotine, sustained success rates (called ‘quit rates’) in smoking cessation are a measly 20 to 30 per cent. So the best advice we can give here is not to start smoking in the first place.

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