Download Lung Diseases and Tobacco

LUNG DISEASES AND
TOBACCO
Prof. Dr. Sevda Özdoğan
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
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
WORLDWIDE
TURKEY:
• 17 million people smoke.
• 57% male, 28% female
• 100000 die every year.
• 250/day, Every 6 minutes
Rate of Smoking in Turkey
( Bilir N. et al)
Occupation
Doctor
Teacher
Journalist
Driver
Police
İmam
Artists
Sportsmen
Rate (%)
43.1
48.6
63.9
74.3
64.7
25.1
46.2
34.9
• 85% of
Smoking mothers
• 49% of
Doctors
• 63% of
Teachers
Smoke besides their children
( Bilir N. et al. )
What is in Cigarette???
Cigarette consists
• Particulate phase
(Catran)
– NICOTIN, (responsible from
addiction)
–
–
–
–
–
–
–
–
–
Fenol
Cathecol*
Anilin
Toluidine*
Naphtalamine*
Benzen, Benzpyren
Nickel
Polonium 210
Antimone
*: Irritants
• Gas Phase
–
–
–
–
–
–
–
–
–
–
–
–
–
–
CO
Formaldioxide*
Formaldehyde
Acrolein
Amonium*
Acetone*
Piridine
3- Vinylpiridine
Hydrogen syanide
Nitrogen oxide*
N-nitrosodimethylamine*
N-nitrosopirolidine*
Formic acid*
Lactic acide*....
Oxidatives in Cigarette smoke
• Particulate Phase
– Hydroxyl (OH-)
– Superoxide (O2-)
– Hydrogen Peroxide
(H2O2)
– Semichinon radicale
(HQ)
• Gas Phase
– Hydroxyl (OH-)
– Nitrogen dioxide (NO2)
– Peroxy radicale (ROQ)
Carsinogens
•
•
•
•
•
•
Benzen
Nitrosamines
Naphtalamines
Formaldehyde
Policyclic aromatic hydrocarbons
Polonium 210...
~ 55 carsinogen material.
Peroksidase, Toxic radicales
CIGARETTE Peroksidase, Toxic radicales
Alveolar Makrophage Stimulation
Chemotactic factors
Protease,
Oksidative
Parenchymal cell
Damage
Pulmonary
Inflamation
MPO
Chemotactic factors
Protease,
Oksidative
MPO
Extracellular Damage
Extracellular Matrix
Repair
Emphysema
Protease inh
RESPİRATORY EPITHELIUM
Squamous Metaplasia
CANCER
CELLS
• 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
LUNG CANCER
Lung with
emphysema
Normal Lung
50% of smokers develop
Chronic Bronchitis,
15-20% develop
COPD
(Emphsema)
Smoking is responsible from;
• 90% of Lung cancer deaths,
• 30% of total cancer deaths,
• 75% of deaths from Bronchitis,
• 25% of heart attack deaths
Smoking Associated Lung
Diseases
•
•
•
•
•
•
•
•
COPD
Asthma Attacks
Upper and Lower airway infections
Pneumonia
Tuberculosis
RBAILD
Hystiocytosis X
Lung Cancer
Other toxic effects of smoking in the body
Organ
CVS
Mouth and Throat
Effect
Atherosclerosis, heart attack
Loss of taste,halitosis,
yellow teeth, tongue, lips, larenx
cancer, frequent UAI
Nose
Diminished sense of smelling
CNS
Stroke
Organ
Gastrointestinal
Effects
Peptic ulcus, Stomach, pancreas cancer,
Bone
Osteoporosis
Skin
Wrinkles, color changes
Urogenital
Bladder cancer, premature menoposis,
erectile disfunction, premature birth, low
birth weight
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)
Recurrent nicotine stimulation increase the dopamine
secretion in Nucleus accumbens
Core
50
Nicotine
Dopamin
(pg/20 m)
40
SF
30
Serum physiologic
Nicotine
20
10
0
0
30
60
90 120 150
Time (min)
Smoking increases the
number of nicotine receptors
in brain
400
**
350
Receptor density
(fmoles/mg protein)
Nonsmoker
Smoker
300
250
200
*
**
150
100
50
0
**
*
Behavioral effects of Nicotine





Increased energy,
Increased concentration,
Increased hand-eye coordination
Euphoria
Decreased appetite
Nicotine Addiction Triangle
Neurochemical
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
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
Doll R, Peto R, Boreham J’ Sutherland I. BMJ 2004
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
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!!
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
• 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
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
Children of smoking parents
•
•
•
•
•
Low birth weight
Frequent upper and lower airway infections
Frequent otitis
Increased risk of asthma
Increased rate of smoking
• 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
Whom do we fight?
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
Cigarette industry make advertisement by being
sponsores of motor vehicle competitions
Smoking industry increase
the advertisement
activities in developing
countries; whereas the
number of smokers
decrease in developed
countries
USA stopped smoking but continues to sell
71 % of the developing world smoke (2001)
Smoking in the last 20 years;
Increased 80% in Turkey,
Decreased 30% in USA