-Shristi Rana
I remember that day when I was about 4-5 years old and my mom told me “we are leaving home because your dad doesn’t quit smoking”. I innocently packed my school bag and waited for her at the doorstep. I thought she was serious but she isn’t … it was just a threat to my dad. It may be due to this my dad never smoked at home. Years passed, but his habit of smoking was still on. Being a grown-up daughter, I used to advise him not to smoke even though I haven’t seen him smoking. He used to throw the cigarette immediately if any of us see him smoking. One year back, at the age of 66, he felt extremely ill and was suddenly diagnosed with stage 4 lung carcinoma which means his cancer had spread to different parts of the body. It was a great shock for all of us. He had so much of suffering especially breathing problem. Radiotherapy was only the option for his palliative treatment.Day by day, his condition worsened with body pain, lack of appetite and severe respiratory problem and finally we lost him 2 months after his diagnosis. It was such a heartbreaking moment as our guardian is no more with us. We felt so helpless without him.
Smoking has been one of the biggest public health threats the world has ever faced. Worldwide, more than 8 million people die each year due to smoking while around 1.2 million deaths are the result of non-smokers being exposed to second-hand smoke (World health organization [WHO], 2019). Approximately 90% of all smokers start before age 18; So, the average lifespan of heavy smokers (smoking more than 20 cigarettes/day) is 13 years shorter than that of non-smokers. One in four heavy smokers die before their 65th birthday.
Billions of dollars are spent each year by the tobacco industry to create and market ads (in video games, online, TV) that show smoking as exciting, glamorous, and safe. Studies show that movies had a great influence on young people towards smoking.Nicotine, well known addictive substance in tobacco acts on the brain and central nervous system and provide pleasant feelings.Smokers suffer from physical and emotional (mental or psychological) withdrawal symptoms when they stop smoking. As a result, prolonged smoking affects an individual physically as well as mentally.
Most of the smokers ultimately develop cardiovascular diseases, stroke, respiratory diseases and cancer (particularly oral cancer, lung cancer)during their lifetime.Smoking causes 84% of deaths from lung cancer and 83% of deaths from chronic obstructive pulmonary disease (COPD). Tar present in the cigarettes narrow the blood vessels leading to increased blood pressure and heart rate along with increased chance of clot formation. Hence increasing the chance of heart attack and stroke. Premature skin wrinkling, particularly around the eyes and mouth make a person look much older than his/her actual age. Bones become more brittle and weaker. Unattractive problems, such as bad breath and stained teeth, gum disease, damage the sense of taste and can lead to oral thrush. The most serious problem of smoking is an increased risk of cancer in the lips, tongue, throat, voice box and oesophagus. More than 93% of oropharyngeal cancers are caused by smoking. Due to smoking, men in their 20s and 30s are impotent or have a lower sperm count than non-smokers. Along with reduced fertility, women had increased risk for Human papilloma virus which is the most common cause for cervical cancer. Smoking during pregnancy can lead to miscarriage, premature birth, stillbirth and illness, and it increases the risk of cot death by at least 25%.
Most importantly, the organ affected due to smoking is lungs. Coughs, colds, wheezing and asthma are just the start. Fatal diseases such as pneumonia, emphysema and lung cancer are in que if smoking is not ceased on time. Smoking causes 84% of deaths from lung cancer and 83% of deaths from chronic obstructive pulmonary disease (COPD). Smoking causes narrowed airways and destruction of lung tissueincreasing breathlessness, a persistent cough with phlegm and frequent chest infections. According to WHO, Lung Cancer is a leading cause of cancer death worldwide, accounting for an estimated 1.76 million deaths out of 2.09 million cases in 2018.Many patients with lung cancer report delays in diagnosing their disease. Common symptoms at the time of presentation of lung cancer include cough, dyspnea, chest pain, fatigue, chest infection, hemoptysis and weight loss. These symptoms are similar with that of other chronic respiratory conditions so due to this reason delay recognizinglead the cancer to reach advanced stage where long term survival is poor. The physical and emotional suffering due to cancer is so painful in one hand that we cannot imagine. While in another hand, treatment of cancer remains very costly requiring sophisticated infrastructure, highly specialized health personnel and expensive drugs. Patients from poor countries like Nepal can hardly afford these expensive treatments. So more than half of lung cancer patients will die within one year of diagnosis even with treatment. Without treatment, patients may die even sooner depending upon how much cancer is spread to other parts.The five-year survival rate for those diagnosed with stage IV lung cancer is less than 10 percent.
Several awareness programmes and campaign for the control of smoking has been conducted throughout the nation at different levels: individual, family/group or community level including education sectors (school, colleges, university). The draft Tobacco Control and Regulatory Bill 2010 of Nepal consists aprohibition on smoking in public places, on public transport and incertain workplaces. Although mentioned in this bill, there is no strict rules and regulationstaken in action regarding about how people are punished if they do so. Moreover, there is no control over its production and supply.Hence, the people has been using it carelessly even though they are aware of its negative impact on health.
In order to minimize the health consequences of smoking especially the lung cancer, firstly every individual must be self-motivated towards avoiding active and passivesmoking. Secondly, Government must play a vital role by implementingtheir rules and regulations properlyi.e. punishing public smokers through huge amount of charges. Along with this, government must take a stand by raising heavy taxover the tobacco products and hiking their price.The production and supply of these substancesshould be banned. Additionally, proper screening and diagnosis of lung cancer helps to facilitate adequate treatment on time and improve quality of life till he/she lives.
Smoking is a habit that drains your money and kills you slowly one puff after another. Quit smoking, its never too late.
(Nursing lecturer, Manmohan Memorial Institute of Health Sciences)