The World Health Organisation has designated 31 May as 'World No Tobacco Day.' The theme this year is 'Commit to Quit', which assumes significant importance in the present times of the COVID-19 pandemic.
The association of smoking with the COVID-19 infection has been controversial. Initial studies from China and Europe seemed to suggest a lower prevalence of COVID infection among smokers and protective effects of smoking against the effects of COVID. However, subsequent analysis showed serious methodological flaws in those studies. And later studies showed that smokers in fact fare poorly after a coronavirus infection.
COVID infection and lung complications in smokers
COVID predominantly affects the lungs and smoking too damages the lungs. Worldwide research suggests that there is a higher incidence of severe lung complications following COVID in smokers as compared to non-smokers. The World Health Organisation released a scientific brief earlier this year showing that smokers are at higher risk of developing severe disease and death from COVID-19.
These findings of a negative impact of smoking should not be surprising given the fact that smokers have been traditionally known to be more susceptible to infections, especially respiratory infections like flu, pneumonia and tuberculosis.
Weakened immune system and increased risk of transmission
Tobacco smoke contains toxic chemicals which cause damages to the linings of the airways and the lungs. The chemicals in tobacco smoke suppress the activity of different types of immune cells leading to weakening of immunity and thus impairing one’s ability to fight the COVID-19 infection.
The act of smoking involves the fingers and possibly contaminated cigarettes coming in contact with the lips and thus increasing the risk of transmission of virus from hand to mouth. Moreover, chewing tobacco products is associated with usually spitting in public places which also accelerates the risk of transmission of COVID through saliva droplets.
Also, smokers are more likely to have heart disease, stroke, cancer, chronic lung disease and diabetes, all of which are important comorbidities for developing severe illness and adversely affecting the clinical outcome in COVID affected patients.
Therefore, it is vital that smokers quit the habit. And the COVID pandemic couldn’t be a better time to quit smoking. However, it can be a challenge given the economic and social stress prevailing during the pandemic. Smokers will need help to quit. And the WHO World No Tobacco Day 2021 campaign aims to empower and support tobacco users on their journey to quit.
There is no single and easy way to quit tobacco, but here are some tips
· Make a 'quit plan' and stick to it. It doesn’t matter if you fail a couple of times. Keep trying and don’t give up.
· Modify your diet. There are some food items which make cigarettes taste better like meat, alcohol, tea, coffee, and aerated beverages. Avoid them and instead have fruits, vegetables, cheese, water, and fresh fruit juices. Also, if you have a habit of post-meals cigarettes, then change your routine and do some activity to divert your mind.
· Have a support group in place to help you through this — family, friends, doctor, counsellor.
· Nicotine-replacement therapy like chewing-gum or skin-patches can be very helpful to tide over your withdrawal symptoms.
· Try to avoid stressful situations during the first few weeks after you stop smoking.
· Exercise, even a 5-minute walk or stretch, has been shown to reduce your cravings and ease some of your withdrawal symptoms.
· Try to be around your non-smoker friends and avoid your smoker companions for a while.
· Clean your house, your surroundings, clothes and belongings so that you do not get the familiar scent of cigarette smoke which will remind you of smoking.
Following are the responses to some common questions on the dangers of smoking:
What are the unique dangers of smoking for women?
While smoking is bad for both the genders, women experience certain additional detrimental health effects apart from the ones common to all genders. Some of these include:
premature menopause menstruation disturbances reduced fertility increased risk to cancers specific to women such as breast or cervical cancer premature ‘aging’. Smoking during pregnancy exposes the fetus to toxic substances that can result in several complications including abnormalities in the newborn or even miscarriages.
What are the long and short term health effects of smoking among young people?
The short term effects of smoking include throat irritations, cough, asthma, wheezing, unhealthy dental and oral hygiene. These are due to the carcinogenic substances like nicotine, tar and carbon monoxide present in tobacco.
The long terms effects of smoking are more dangerous. Smoking has been shown to be strongly correlated with a number of life-threatening diseases such as a variety of cancers, diabetes, respiratory disorders and cardiovascular diseases like heart attack and stroke. Vision issues and infertility issues as well as weak immune systems are also more prevalent in smokers than non-smokers. Overall, smoking is associated with a lower life expectancy.
In terms of mental health, while smoking is commonly known to relieve stress and help people relax, it is has been shown to increase anxiety levels, and smokers are at an increased risk of clinical depression. For people dependent on nicotine, missing a smoke can cause irritability and mood swings and come in the way of normal functioning. Loss of appetite and disturbed sleep cycles are also frequently observed in smokers.
Can smokers and tobacco users be at higher risk for COVID 19 infection?
The association of smoking with the Covid-19 infection has been controversial. Initial studies seemed to suggest a lower prevalence of Covid infection among smokers and protective effect of smoking against the effects of Covid. However, subsequent analysis showed serious methodological flaws in those studies. And later studies showed that smokers in fact fare poorly after a Covid infection.
Smokers may be more susceptible to Covid-19 infection and the associated severe lung complications for the following reasons:
Tobacco smoke contains toxic chemicals which cause damages to the linings of the airways and the lungs and suppresses the activity of different types of immune cells, thus impairing one’s ability to fight the Covid infection.
The act of smoking involves the fingers and possible contaminated cigarettes coming in contact with the lips and thus increasing the risk of transmission of virus from hand to mouth.
Smokers are more likely to have heart disease, stroke, cancer, chronic lung disease and diabetes, all of which are important co-morbidities for developing severe illness following Covid infection.
What are the effects of quitting smoking on the body?
The beneficial effects of quitting smoking begin almost immediately within minutes to hours and continues to be seen over several years to a decade.
Within 30 to 60 minutes, heart rate and blood pressure begin to drop.
At around 12 hours, the carbon monoxide level in blood drops to normal.
By 4-12 weeks, blood circulation and lung function improve.
By 3-6 months, coughing and shortness of breath decrease and risk of respiratory infections also reduces.
At 1 year, the risk of coronary heart disease reduces to about half that of a smoker's.
At 5 years, the risk of having a heart attack or a brain stroke risk is reduced to that of a nonsmoker.
At 10 years, the risk of lung cancer falls to about half that of a smoker and the risk of cancer of the mouth, throat, esophagus, etc also decreases.
Though in the initial days after quitting, one could have withdrawal symptoms but in the long run, stopping smoking would lead to lesser mental irritability, anxiety, depression and mood swings.
Abstinence from smoking also reduces the chances of impotence, infertility, having premature births and miscarriage.
And finally, quitting smoking improves life expectancy.
Tips to effectively quit smoking
There is no single and easy way to quit tobacco. Some of the following tips could help you in kicking this habit:
Make a quit plan and stick to it. Doesn’t matter if you fail a couple of times. Keep trying and don’t give up.
Modify your diet. There are some food items which make cigarette taste better like meat, alcohol, tea, coffee, aerated beverages. Avoid them and instead have fruits, vegetables, cheese, water, fresh fruit juices. Also, if you have a habit of post-meals cigarette, then change your routine and do some activity to divert your mind.
Have a support group in place to help you through this --- family, friends, doctor, counsellor Nicotine-replacement therapy like chewing-gum or skin-patches can be very helpful to tide over your withdrawal symptoms.
Try to avoid stressful situations during the first few weeks after you stop smoking.
Exercise, even a 5-minute walk or stretch, has been shown to reduce your cravings and ease some of your withdrawal symptoms.
Try to be around your non-smoker friends and avoid your smoker companions for a while.
Clean your house, your surroundings, clothes and belongings so that you do not get the familiar scent of cigarette smoke which will remind you of smoking.
The author is a Senior Interventional Cardiologist at the Asian Heart Institute.
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