With the Asia Pacific region accounting for more than half of the world’s tobacco consumption, the need to tackle the addiction to smoking is crucial, writes Meera Murugesan
WHEN we look at a smoker, most of us see a person who has chosen an unhealthy habit. But we need to start viewing him as someone suffering from a disease that will threaten his life and those around him if he doesn’t get the help he needs.
Given the huge implications of tobacco use worldwide, approaching and treating the problem as a disease is one way to tackle its increasingly damaging effects.
Worldwide, the “tobacco epidemic”, as it’s called, causes 5.4 million deaths every year, according to the World Health Organisation (WHO).
By 2030, there will be more than eight million deaths annually and an estimated one billion deaths due to tobacco use in the 21st Century. Sadly, more than 600,000 non-smokers around the world also die each year from exposure to secondhand smoke (SHS), the majority of them being women and children.
Tobacco use is present in every segment of the population worldwide, children and the elderly included, says Tara Singh Bam from the International Union Against Tuberculosis And Lung Disease (The Union). “The use of tobacco is like a disease and if we wait until the end of a disease before doing something, it’s too late,” says Tara, who was one of the speakers at the 2014 IASLC Asia Pacific Lung Cancer Conference.
As much effort as possible must be put into preventing others from taking up the habit while helping existing smokers to quit; this is deemed the best approach to tackling this disease.
ASIAN CRISIS
The countries in Asia remain most vulnerable to the tobacco epidemic. The Asia Pacific region accounts for 56 per cent of the world’s cigarette consumption. Of this, the Asean region with 127 million adult smokers is home to 10 per cent of the world’s smokers.
Tobacco is the leading cause of preventable disease, both in the developing and developed world, but Asian countries are particularly at risk, says Dr Carolyn Dresler, from the United States.
“Asian countries cannot afford to take care of the number of people who are eventually going to get lung cancer from smoking.”
If a smoker does not quit, he has a 50 per cent chance of dying and 50 per cent of such deaths will occur in middle age.
Cigarettes cause about 75 per cent of lung cancers globally. More than one in five cancers globally is also caused by smoking. Lung cancer is also the most common cause of cancer deaths.
Dr Dresler says people assume it’s the number of cigarettes per day that causes damage but actually, it’s the years of smoking. While the number of cigarettes a day matters, the smoking duration creates the increased risk for lung cancer. To prevent lung cancer, one needs to decrease the duration of tobacco use and if smokers quit in middle age, it will be reflected in a rapid drop in lung cancer deaths.
“Similarly, if we can get children not to start now, we will see an impact for lung cancer six to seven decades later.”
DEADLY ADDICTION
Dr Dresler says people smoke for the nicotine. It’s a highly addictive drug because of the method of delivery, which is pulmonary inhalation.
“When you smoke, it goes directly to the lungs and from there, to the left side of the heart. And seven to 12 seconds later, it’s in the brain, having an impact.”
For those who have already been diagnosed with cancer, it is absolutely crucial that they quit smoking. Smoking during cancer treatment is very dangerous because it can lead to a decreased response to chemotherapy. Patients who smoke will not get the same impact from chemotherapy as a non-smoker and they will have a higher mortality risk.
Smoking cessation clinics can play a huge role in helping someone give up the habit, says Associate Professor Dr Mohamad Haniki Nik Mohamed, a certified smoking cessation service provider and deputy dean (academic affairs) at the faculty of pharmacy, International Islamic University Malaysia.
He says such service providers should aim to treat at least five per cent of their local smoking population and such services are most effective when they are configured according to local needs.
Groups that are known to experience a high smoking prevalence or require specific targeting include routine and manual workers, people with mental health disorders (including alcohol and substance use), prisoners and the homeless. Pregnant smokers will also benefit from such interventions.
Mohamad Haniki says we often assume women will stop smoking when pregnant but a small number will continue to and need help to stop. “The way to reduce the number of smokers is not by letting them die but by helping them to quit. We must change our perspective of smokers and look at them as patients in need of intervention, or individuals suffering from a disease.”
SAVING SMOKERS
In Malaysia, there are over 200 quit smoking clinics in various settings and community pharmacists have also been trained and certified to deliver quit smoking services. The most commonly used technique by smokers themselves is to go “cold turkey”. It does work for some people but the relapse rate is high.
Mohamad Haniki says when a combination of behavioural support plus medication is used to treat the problem in a formal clinical setting, it does show better results. While doctors and other health professionals may be too busy during their daily practice to deliver a full intervention for smokers, what they can do is identify smokers among their patients and refer them to a quit smoking facility.
Mohamad Haniki says the majority of his patients are referred to him by other healthcare professionals and most of them turn up because they are aware of the health dangers. Some are also worried about the effects of SHS on their family. This, in fact, can be a motivating factor for them to quit.
“It is important to have a reason to quit but it doesn’t matter whether it’s related to you or to others. The main thing is to quit.”