GUEST COLUMN
Dr Gaurav Sanjay
Each year World No Tobacco Day is observed on May 31. This day serves as a reminder to raise awareness about the dangers of smoking and to encourage smokers to quit the habit of smoking around the world.
The habits of smoking and chewing tobacco have been prevalent in the society since hundreds of years, across all civilizations and cultures in different forms. Smoking, dhumapana (literally “drinking smoke”), has been practiced for at least 2,000 years in India and has been first mentioned in Atharvaveda.
Although, the overall smoking rate worldwide has decreased but the number of smokers has increased due to increased population. There are more than a billion smokers worldwide, over 80 per cent of them live in developing countries. According to WHO, India is home to 120 million that is 12 per cent of the world’s smokers and more than 10 million of them die each year due to tobacco consumption.Another global adult tobacco survey India (India GATS2) showed that India is home to over 27 crore tobacco users.Globally it is the second largest producer and consumer of tobacco products.This is preventable and can be prevented only with the effort of both government and society.
The ill effects of tobacco are known to cause respiratory disorders such as COPD, oral and lung cancers.Smoking precipitates hypertension and cardiac problems.The negative impact of tobacco smoking on health are well established and known to the society. There is a statutory warning on each pack of cigarette or tobacco pouch reminding the consumer the negative effects of smoking.
Covid-19 virus usually affects the respiratory system.Think of your respiratory tract as an upside-down tree. The trunk is your trachea, or windpipe. It splits into smaller and smaller branches in your lungs. At the end of each branch are tiny air sacs called alveoli. This is where oxygen goes into your blood and carbon dioxide comes out.The novel coronavirus can infect the upper or lower part of your respiratory tract. If it travels down your airways, the lining can become irritated and inflamed. In some cases, the infection can reach all the way down into your alveoli.
Covid-19 is a still a new condition and scientists are learning more every day about what it can do to your lungs. They believe that the effects on your body are similar to those of two other coronavirus diseases, severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS). As the infection travels in your respiratory tract, your immune system fights back. Your lungs and airways swell and become inflamed. This can start in one part of your lung and spread.About 80 per cent people who have Covid get mild to moderate symptoms. You may have a dry cough or a sore throat. Some people have pneumonia, a lung infection in which the alveoli are inflamed.
There are not many scientific research papers on the effect of smoking on the Covid-19 infection. A review of literature has revealed that 34 peer review studies have shown that smokers constituted 1.4 to 18.5 per cent of the hospitalised adults. In another study it was found that a there is a statistically significant association between smoking and severity of Covid-19 cases.The available evidence suggests that even passive smoke exposure is harmful.
Tobacco smoking is known to increase the heart rate and blood pressure and increase of carbon mono oxide level in the blood stream. WHO recommends quitting tobacco use in every way and suggests that within 20 minutes of quitting the elevated heart rate and blood pressure drops, within three months of quitting, blood circulation improves and lung function increases and after 3-9 months coughing and shortness of breath distress improves. Quitting will not save the patients but also their loved ones,especially children from exposure to passive smoking.Tobacco is a known risk factor to predispose to infection like TB of lungs and cancer of oral cavity and the lungs. In addition to that nicotine can causes hypertension, heart failure, cancer and blindness. The habit of smoking is injurious to health. Considering the role of smoking which increased the severity of illness in Covid the Ministry of Health and Welfare, Government of India issued a warning on May 11, 2020 against the use of any tobacco products during Covid-19 pandemic and took measures to reduce tobacco use given its potential to increase likelihood of virus infection while exhaling respirators droplets, spitting and sharing of the bidi or cigarette etc.
The Covid-19 pandemic is an opportunity to increase awareness to quit tobacco use in every form. Tobacco contains nicotine which is responsible for constriction of peripheral arteries which leads to gangrene usually of the limbs. A noted Indian cardiologist, emphasised in a recent webinar that hypertension, Covid-19 and tobacco are a deadly triad. The author has an experience of treating many patients of peripheral vascular disease and gangrene and in these patients whenever there is a need of painkillers, they do not give them as much relief as to the general populations.
Smoking itself decrease the tolerance of pain and nicotine blunts the effect of painkillers. This becomes a challenge especially after any surgery in these patients. The management of pain in these patients becomes difficult because pain is usually ischemic and these patients are usually advised to stop smoking. As is known, smoking is an addiction and because of that smokers suffer physiological and psychological impacts on the body and brain. The problem should be understood not only by the patient and the treating team but the family as well.
Any kind of tobacco consumption predisposes a person to many diseases. The habit of smoking and chewing tobacco usually starts in teenage. Hence, there should be strict ban of tobacco sale in or around schools and others education institutes. All forms of advertisement about tobacco sale should be prohibited in mass media, merely statuary warning that smoking is injurious to health is not enough in cases of children and people those who are ignorant and illiterate.
(The author is an orthopaedic surgeon based in Dehradun)
