Being a Kashmiri, it has been a very disturbing and disappointing trend for me to observe that there is a steady increase in the number of Kashmiri youngsters who are addicted to smoking. Whereas there has been a decreasing predilection towards smoking in Western youth, there seems to be no cessation in the habit of our young generation in Kashmir.
Smoking is a serious health hazard because tobacco contains some 4000 chemicals, 43 of which are known carcinogens. Some of these like nicotine, a poisonous alkaloid, tar and carbon monoxide are well known but acrolein, ammonia, prussic acid and other substances though less known are no less malicious.
Cigarette is a number one cause of lung cancer all over the world and a major culprit in the cancers of larynx, oral cavity, pharynx and oesophagus and is a contributing cause in the development of bladder, pancreas, uterine cervix, kidney, stomach cancers and a number of leukaemias. Cardiovascular disorders including hypertension, strokes and other heart attacks have also been increasingly linked with smoking.
COPD is a dangerous incurable and highly probable disorder associated with this habit. The list of smoking related maladies in an unending listening of debilitating and often fatal complications. Lung cancer and COPD being most formidable and prevalent of the lot will be the focus herein.
Lung cancer
Lung cancer is the leading cancer killer around the world. It also is the most tragic in being preventable, since smoking is its number one cause. 87% of all lung cancers are caused by smoking. The two major types of lung cancers are: Small cell cancers and non-small cell cancers. Non-small cell cancer is the most prevalent and spreads slower to different sites in the body than the other type. Squamous cell carcinoma, adenocarcinoma and large cell carcinoma are the three sub types within this type. Non small cell cancers account for 80% of all lung cancers.
The development of lung cancer is insidious with an interval of upto 30 years, before the onset of a symptomatic disease. There is no apparent threshold in the dose response relationship between exposure to tobacco smoke and incidence of the disease, but higher incidence rates are associated with higher lifetime levels of tobacco consumption and early age of starting the habit. Lung cancer is a passive killer, in its symptoms being rarely felt till the disease has reached an advanced stage.
Overall, lung cancer prognosis is not good. Only about 13% patients survive 5 years after diagnosis of the disease. These low numbers reflect the advanced stage of the most lung cancers. Prognosis for a young patient whose tumour has been surgically removed is much better. However, lack of symptoms and screening procedure means that most tumours are already advanced when detected.
Treatment options depend on the stage and extent of malignant growth. Most treatments are designed to provide palliative care and reduce symptoms rather than providing a cure. All in all, being by and large a preventable form of cancer, the better bet lies in preventing causation rather than pursuing cure.
COPD
Chronic obstructive pulmonary disease is an umbrella term used to describe airflow obstruction that is associated mainly with emphysema and chronic bronchitis. It is potentially terminal and has no known cure as of now.
Long term smoking is the most frequent cause of COPD. It accounts for 80 to 90% of all cases. COPD decreases the lung ability to take in oxygen and remove carbon dioxide. A typical course of COPD might begin after a person has been smoking for 10 years, during which symptoms are not very noticeable. Then the patient starts developing a productive, chronic cough. The patient usually also develops shortness of breath during exertion. While the symptoms may vary over time, the patient deteriorates progressively. Many patients with advanced COPD have so much trouble breathing when lying down that they sleep in a semi sitting up position. For COPD patients, the combination of too little oxygen and too much carbon dioxide in the blood begins to have impact on the brain and can cause headache, sleeplessness, impaired mental ability and irritability.
The quality of life for a person suffering from COPD diminishes as the disease progresses people with COPD eventually require supplemental oxygen and may have to rely on mechanical respiratory assistance. In latter stages of the disease, the heart may be severely affected. Eventually death occurs when the function of the lung and heart is no longer abdicate to deliver, oxygen to the body organs and tissues.
The only effective weapon against COPD is prevention; avoiding or cessation. Avoiding smoking almost always prevents COPD from developing and ceasing smoking slows the disease process. The preventive course of action is thus only hope as COPD is incurable. Smokers not only jeopardize their health but also expose people around them to unnecessary health hazards by way of passive smoking.
In conclusion, the mammoth proportions this habit has acquired in our community will not only reflect in the personal health and life-style of each smoker, it will also reflect in the productivity of our Society as a whole. A collective effort needs to be launched to combat this courage that eating away at the health and life of our community. The young from the valley need to spearhead a campaign that demands a total ban on public smoking. Whatever course of action be taken, it is clear that strong public sentiment against the habit will only be activated when a re-evaluation occurs at the individual level, serious enough to make abstinence a priority in our life-styles.
(Author is a Radiodiagnosis student at Government Medical College, Anantnag)
