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Smoking: A Fascinating Silent Killer

Submitted by on October 27, 2013 – 10:53 PM

smoking-deathA cigarette is the perfect type of pleasure. It is exquisite and leaves one unsatisfied. What more can one asks?


Tobacco products are made entirely or partly of tobacco leaf as a raw material which are intended to be smoked, snuffed, chewed or sacked. All contain the highly addictive psychoactive ingredient, nicotine. Nicotine is a major risk factor for different chronic diseases including cancers of lung, diseases of cardiovascular system like myocardial infarction, ischemic heart diseases and reproductive system disorders of males and females. There are almost 4000 known chemicals in a tobacco plant in its natural form or after it has been cured or burnt for smoking.


Tobacco is either in its pure form or more often treated and mixed with other ingredients to be used in diverse forms. The most common and universal tobacco habit is smoking cigarettes, cigars, bidi, hookah, and chillum. And another thing, if you have not noticed, handheld vaporizers are everywhere now too, it’s the trend. Most people used it because it is a healthier alternative (go to to learn more portable vaping).

50,000 acres of land are used for tobacco cultivation in Pakistan, expanding at a rate of 5 percent per year, which is greater than Pakistan’s annual population growth rate of 2.6 percent, signifying an increase in tobacco usage. The government identifies smoking as one of major risk factor leading to death by preventable diseases.


31st of May is celebrated as a tobacco day worldwide including Pakistan. On this day different informative programs regarding health hazards of smoking are arranged to inform people and educate them. The government of Pakistan also launched a network, TOBACCO FREE INITIATIVE PAKISTAN (TFI-PAK) in May 2000.The objectives of TFI were to educate the people about adverse effect of tobacco and to lobby the government to introduce adequate control on tobacco sites and promotion.


Quitting smoking has many benefits: increases life expectancy, decreases risk of cancer, reduces heart risk, reduces risk of stroke, and reduces risk of living with chronic obstructive pulmonary diseases.


What is nicotine, what does nicotine addiction mean and how to prevent it?

Nicotine is an agonist at nicotine receptors in the peripheral and central nervous system .In man, as in animals, nicotine has been shown to produce both behavioral stimulation and depression. Nicotine is principle of constituent of tobacco responsible of tobacco for its addictive character. The addicted smokers regulate their nicotine intake and blood levels by adjusting the frequency and intensity of their tobacco use both to obtain the desired psychoactive effects and to avoid withdrawal. Unburned cured tobacco contains nicotine, carcinogens, and other toxins capable of causing gum disease, oral cancer, and risk of heart diseases.


Is there any impact of age in cigarette smoking?

Yes, there is obvious impact. The ratio of smoking –related diseases rates in smokers compared as to a non-smoker (relative risk) is greater at younger age, particularly for coronary artery diseases and stroke. At older age, the background rate of diseases in non-smoker increases, diminishing the fractional contribution of smoking and the relative risk. However, obsolete excess rates of diseases rates mortality found in smokers compare to non-smoker increase with increasing age. The organ damage caused by smoking and the number of smokers who die from smoking are both greater among the elderly.


What are the organs damaged by smoking?

LUNGS: Cigarette smoking is responsible for 90% of chronic obstructive pulmonary diseases. Within 1-2 year of many young regular smokers develop inflammatory changes in the small airways. After 20 years of smoking, pathophysiological changes in the lungs develops and progress proportional to smoking intensity and duration. Chronic mucous hyperplasia of the larger airways results in a chronic productive cough in as many as 80% of smokers >60 years. Chronic inflammation and narrowing of small airways and/ or enzymatic digestion of alveolar rowing of the walls resulting in pulmonary emphysema can result in reduce expiratory airflow sufficient to produce clinical symptoms of respiratory limitation in 15% of smokers.


CARDIOVASCULAR DISEASES: Cigarette smokers are more likely to develop large vessels atherosclerosis as well as small vessel diseases in comparison to non-smokers. Approximately 90% of peripheral vascular disease in the no diabetic population can be attributed to cigarette smoking, as can 50% of aortic aneurysms. In contrast, 20-30% of coronary artery diseases and 10 % of occlusive cereberovascular diseases are caused by cigarette smoking. Cigarette smoking also plays an important role in other heart diseases like myocardial infarction and sudden cardiac death by promoting platelet aggregation and vascular occulsion. Reversal of these effects may explain the rapid benefit of smoking cessation for a new coronary event demonstrable among those who have survived a first myocardial infarction.


What is role of physician intervention smoking cessation/nicotine addiction?

The practice by physician is given below step by step


  1. Ask: Systematically identify all tobacco users at every visit
  2. Advice: strongly urge all smokers to quit
  3. Identify smoker willing to quit
  4. Assist the patient in quitting
  5. Arrange follow-up contact


  1. Effective pharmacological intervention
  2. 1st line therapies
  3. Nicotine gum
  4. Nicotine patch
  5. Nicotine nasal inhaler
  6. Nicotine oral inhaler
  7. Nicotine lozenge
  8. Bupropion
  9. Varenicline
  10. 2nd line therapies
  11. Clonidine
  12. Nortriptyline


1. Physician or other medical personnel counseling (10 min)

2. Intensive smoking cessation programs (at least 4-7 session of 20-30 min duration lasting at least 2 and preferably 8 weeks)

3. Clinic-based smoking status identification system

4. Counselling by nonclinical and social support by family and friends telephone counseling.

Uphill now so much has been published on health consequences of smoking. To address such a large global issue in which each and every one is involved from almost every class of society is a really difficult task.

New Initiative can be taken to plan and to make this strategy more strong by involving young people in volunteer activities and by communicating with people in their local language and help teaming in having different medical facilities. More-over we have to implement these policies by using law enforcement agencies and making public areas free of this evil in disguise. These policies are needed to be more effective by making different steps and by involving different people because it’s a challenge to everyone in the society and somehow somewhere everyone is getting affected by this global issue. So we have to fight against this global issue starting 1st from our self and then making others also get involved and eradicating this salient killer and safe our self. You have to decide that do you want to combat  against this evil by collaboration and joining hands with each other.



1.Anthony S.Fauci,…etal.(2008)Harrison principle of internal medicine;nicotine addiction. 17thedn.United state of America:Library of congress.

2.Shah ilyas Ansari,……etal.(2003)Community medicine and public health:tobacco free initiatives.6th edn.Pakistan:Time publisher.medical division.

3.World Health Organisation(who)(2009):prevalence of tobacco smoking in Pakistan.Available at:

4.American legacy Foundation(legacy)(2009):facts associated with health of smoking. Available at : (accessed.4th December,2009)

5.World Health Organization (who)(2009):Chemical composition of cigarette .Available at http://www.whoint/fctc/reporting/qa/en/index.html

6.Google(2009):famous people who died due to smoking.Avaible at:  (Accessed.9th December,2009)

7.Hilten Mathew,..etal.(2000)Smoking in British popular culture(1800-2000).Great Britian.Library of congress.

8.stop smoking(2009):reason to stop smoking.Available at : December,2009)

9.Lloyds Burbura,…etal.(2001)Smoking in Adolescense.1st edn.Great Britian.Library of congress.

10.World Health organization (who)(2009):Pakistan health budget.Available at: (Accessed on.29th December,2009).

11.Medicolegal aspect of smoking(2009).Available at . on.27th November,2009).

12.Penchen David,…etal.(2009)Oxford hand of  public health practice.2nd edn.Great Britian:oxford university press.



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