As a pulmonologist, I’ve witnessed firsthand the devastating impact of tobacco on respiratory health. 

World No Tobacco Day, observed annually on May 31, is an opportunity to raise awareness about the dangers of tobacco use and advocate for effective policies to reduce its consumption. 

Tobacco use is the leading cause of preventable death worldwide, responsible for more than 8 million deaths globally and approximately 1.35 million deaths in India each year. 

Of these deaths globally, approximately 1.2 million are non-smokers exposed to second-hand smoke. According to the Global Adult Tobacco Survey (GATS) 2016-17, 28.6% of adults (15 years and older) in India use tobacco in some form. This includes 42.4% of men and 14.2% of women. 

The prevalence of smoking tobacco is 10.7%, while smokeless tobacco use is significantly higher at 21.4%.Tobacco smoke contains over 7,000 chemicals, hundreds of which are toxic and about 70 can cause cancer. 

The primary respiratory diseases associated with tobacco use include chronic obstructive pulmonary disease (COPD), lung cancer, stroke, and respiratory infections.

Chronic Obstructive Pulmonary Disease (COPD)

COPD is a progressive lung disease characterised by chronic bronchitis and emphysema. It causes airflow blockage and breathing-related problems. 

India accounts for approximately 32% of the global COPD burden. According to the Global Burden of Disease Study 2016, COPD was the second leading cause of death in India, responsible for over 900,000 deaths annually. The prevalence of COPD is estimated to be around 4.2% among adults aged 30 and above, with millions suffering from the disease’s debilitating effects.

Tobacco smoking is the primary cause of COPD, accounting for about 85-90% of cases. The toxic chemicals in tobacco smoke damage the airways and air sacs of the lungs, leading to symptoms such as chronic cough, shortness of breath, wheezing, and frequent respiratory infections.

Lung Cancer

Lung cancer is the leading cause of cancer deaths worldwide. Smoking is the most significant risk factor for lung cancer, responsible for approximately 85% of cases. 

According to the National Cancer Registry Programme (NCRP) report 2020, lung cancer accounts for about 5.9% of all cancer cases and 8.1% of all cancer-related deaths in India. The age-adjusted incidence rate for lung cancer is approximately 9.3 per 100,000 men and 2.9 per 100,000 women.

For Indians, this is of dire concern since the vast majority of the populace don’t have adequate access to medical care. Lung cancer can also remain asymptomatic in its early stages, making it difficult to diagnose until it has progressed to an advanced stage.

Respiratory Infections

Smoking weakens the immune system and impairs the body’s ability to fight infections. Smokers are more susceptible to respiratory infections such as pneumonia, influenza, and tuberculosis. 

Second-hand smoke exposure also increases the risk of respiratory diseases in non-smokers, particularly children.

The World Health Organization (WHO) estimates that around 40% of children worldwide are regularly exposed to second-hand smoke at home.

The Youth Epidemic: Targeting the Next Generation

The tobacco industry has long targeted youth through marketing and advertising strategies designed to make smoking and nicotine use appear glamorous and appealing. 

The emergence of electronic cigarettes (e-cigarettes) and other vaping devices has added a new dimension to this challenge. Many young people perceive e-cigarettes as a safer alternative to traditional cigarettes, but they still pose significant health risks.

> https://indianexpress.com/article/cities/pune/vaping-pune-colleges-9301812/

E-cigarettes and Vaping

E-cigarettes heat a liquid to create an aerosol that users inhale. This liquid, e-liquid or vape juice, typically contains nicotine, flavourings, and other chemicals. 

While e-cigarettes may contain fewer harmful chemicals than combustible cigarettes, they are not without risks. Nicotine is highly addictive and can harm adolescent brain development, affecting learning, memory, and attention. 

Additionally, e-cigarette aerosols contain harmful substances that can cause lung damage and other health issues.

The Role of Flavored Products

Flavored tobacco and nicotine products are particularly appealing to young people. Flavours such as fruit, candy, and menthol mask the harsh taste of tobacco and make it easier for beginners to use these products. Research has shown that young people who use flavoured tobacco products are more likely to continue using tobacco and are at higher risk of becoming regular smokers.


> https://www.yalemedicine.org/news/juul-e-cigarette-ban 

Strategies for Prevention and Control

Addressing the tobacco epidemic requires a multifaceted approach that includes education, policy interventions, and cessation support. 

Here are some key strategies to protect youth and reduce tobacco use:

Education and Awareness

Public health campaigns that educate young people about the risks of tobacco and nicotine use are essential. Schools, communities, and healthcare providers should provide accurate information about the dangers of smoking and vaping. 

Peer education programs can also be effective in spreading awareness among youth.

Policy Interventions

Implementing strong tobacco control policies is critical to reducing tobacco use. These policies may include:

Increasing tobacco taxes: Higher prices can deter youth from purchasing tobacco products.

Properly enforcing the banning of flavoured products: Removing flavoured tobacco and nicotine products from the market can reduce their appeal to young people.

Enforcing smoke-free laws: Enforcing smoke-free environments in public places protects non-smokers from second-hand smoke and reduces the social acceptability of smoking.

Support for Cessation

Providing resources and support for individuals who want to quit smoking is crucial. This includes access to counselling, quitlines, and nicotine replacement therapies. Healthcare providers are vital in encouraging and assisting patients in their quit attempts.

Conclusion

World No Tobacco Day reminds us of the urgent need to address the tobacco epidemic. As a pulmonologist, I urge everyone to recognise the harmful effects of tobacco on respiratory health and take action to protect our communities, especially our youth. 

We can create a healthier, tobacco-free future by working together to implement effective prevention and control strategies.