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Issue 4: 18/01/05 :: Distribution: 10,348 :: Vacancies: 1421  

A Tour around Passive Smoking
Derrick Garwood, Freelance Medical Writer and Editor

Passive smoking – not dangerous? Just ask the estimated 17,000 children admitted to hospital in the UK every year as a result of  illnesses caused by it. So, before lighting up at this year’s festive bash, spare a thought for those around you. The controversial question of the danger of passive smoking has already led to bans in places as diverse as Ireland, New York and California; the government’s White Paper on health suggests that England, Scotland and Wales may well follow suit and forbid smoking in public places by 2008. British addicts desperate to know the worst can find an  executive summary here.

Estimated figures for the annual UK death toll from passive smoking vary between 1,000 and 4,500 for otherwise healthy people. Among those over 65, the total figure could be as high as 16,900 – but 9,700 of these are from strokes, where medical evidence regarding contributory factors is weakest. According to one  recently published study, passive smoking in the workplace alone kills three people a day.

Like ‘active’ smoking, ‘secondhand’ smoke is carcinogenic and frequent or prolonged exposure also substantially increases the risk of ischaemic heart disease, stroke and other respiratory and circulatory disorders.   Research by the American Heart Associationindicates that the risk of heart attack is 91% higher in women who are regularly exposed to others’ tobacco smoke. In addition,  women whose partners smoke are three times more likely to have a stroke and 2.3 times more likely to suffer an ischaemic stroke, and living with a smoker  increases the risk of lung cancer by 30%.

Why is passive smoking so harmful? Fumes from a lit cigarette contain more than 4,000 chemicals, including tar, carbon monoxide, ammonia, dimethylnitrosamine, formaldehyde and acrolein. Smoke also contains hydrogen cyanide, not a substance noted for its health-giving effect! Many of these compounds have marked irritant properties and over 60 are either established or suspected carcinogens. Some of the unpleasant effects on the lungs can be  examined here. Also, many toxic substances are more concentrated in sidestream smoke (fumes from the end of a lit cigarette) than mainstream smoke (that which has already been inhaled and exhaled by a smoker) and nearly 85% of the smoke in a room is the former.

Most people are familiar with the immediate effects of environmental exposure - eye irritation, headache, cough, sore throat, dizziness and nausea. The physiological response to passive smoking unsurprisingly resembles that of the active smoker. The rate of mucus and white blood cell production can multiply up to 7-fold, and mucosal permeability to allergens increases. Exposure for as little as 30 minutes can reduce coronary blood flow, while aortic elasticity can also be seriously affected, impairing left ventricular performance. Asthmatics can experience a significant decline in lung function and tobacco smoke triggers attacks in more than 80% of sufferers.

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Infants and young children, whose airways are smaller and immune systems less developed, are particularly sensitive to environmental tobacco smoke. A study by the Environmental Protection Agency of America (EPA) found that exposure to tobacco fumes increases the number of respiratory tract infections like bronchitis and pneumonia by an estimated 150,000 to 300,000 cases annually. It may even contribute to the development of asthma in children; the Australian government concluded that children with a smoking parent were 1.4 times more likely to develop the condition than the children of non-smokers.

Evidence suggests that passive smoking during childhood also has a detrimental effect on IQ. Measuring the levels of cotinine, a nicotine by-product, in the bloodstream of over 4,000 American children, researchers discovered that less than one nanogram (a level produced by a parent smoking less than a pack a day) reduced IQ scores by 2 points. Those whose mothers smoked 10 or more cigarettes a day were, by the age of 10, between three and five months behind in reading, mathematics and general ability when compared to the offspring of non-smokers. Their physical development was also affected; they were an average of 1.0 centimetre shorter, even allowing for associated social and biological factors.

Maternal exposure to smoke during pregnancy can also affect the unborn foetus – passive smoking via the maternal bloodstream. As well as increasing the risk of respiratory disorders after birth, it can raise the likelihood of miscarriage and cot death. Children whose mothers smoked while pregnant are also more susceptible to psychological disturbances, such as attention-deficit hyperactivity disorder or ADHD.

Controversy erupted last year after the British Medical Journal published one study claiming the health risks of passive smoking had been greatly exaggerated, and it is available online here. However, as the BUPA overview at points out, funding was derived indirectly from the tobacco industry and the research methods employed were highly questionable.

This can only be a brief overview of a very extensive subject. Those wishing to explore passive smoking in (exhaustive!) detail could do worse than scrutinise the impressively comprehensive list of studies here.

Finally, it’s not just your major organs and vital bodily functions that are at risk from passive smoking. It can even rot your teeth and indirectly compromise your relationship with your partner!

This medical briefing was written by Derrick Garwood, a Freelance Medical Writer and Editor, and first published, on this same date, in the series of InPharm Tours at InPharm.com. It is reproduced here with permission from the publishers.

A-Z: Methods of giving up smoking
From GivingUpSmoking.co.uk

Read about the A-Z of giving up methods from Acupuncture to Zyban. There's more than one way to give up so choose the one that feels right for you.

Acupuncture: Acupuncture involves needles being inserted into key pressure points on various parts of the body. The process is not painful and patients are then left to relax for half an hour or so. The needles are then removed except for two tiny ones which remain in the ear. The idea is to touch an ear lobe when a craving comes on. There are no clinical tests to prove the effectiveness of acupuncture in helping people give up, but some smokers have found it valuable.

Cold turkey: Stopping without any kind of aid. Although physical symptoms can be more extreme in the early few days, they fade away within the first two or three weeks. Most people give up smoking using this method.

A resolve to get fit can be a great way to help you, go to Getting fit for life for more advice and information.

Email motivator: Sign up for regular email messages tailored to specific points in your recovery to update you on the progress your body is making and give you plenty of reasons to stay strong if you're tempted to give in…

Hypnotherapy: Although nicotine is a physically addictive drug, smoking also has many psychological associations. Hypnotherapy tries to alter the subconscious mind's dependence on smoking as a habit. There are no clinical tests to prove the effectiveness of hypnotherapy in helping people give up, but some smokers have found it valuable.

Laser treatment: This is a new treatment developed by a former smoker, which uses a painless, low-powered laser to stimulate energy points on the body. These in turn stimulate production of endorphins - the body's natural pain relief chemicals - and, theoretically, relieve nicotine cravings. There are no clinical tests to prove the effectiveness of laser treatment in helping people give up.

NHS Smoking Helpline: The NHS Smoking Helpline is an excellent source of practical advice and support on smoking and giving up. Friendly helpline advisers can also provide details of your local NHS Stop Smoking Service, and information packs. Lines are open daily from 7am - 11pm, with specialist advisers available from 10am - 11pm. Call 0800 169 0 169 (for deaf and hard of hearing people, please use textphone 0800 169 0 171).

Alternatively, if you would like specialist advice relating to smoking and pregnancy, call the NHS Pregnancy Smoking Helpline on 0800 169 9 169. Lines are open daily 12 noon - 9pm.

NHS Stop Smoking Services: Evidence shows that you're more likely to stop smoking for good if you get the right support. Local NHS Stop Smoking Services offer free, specialist advice tailored to your individual needs. Most services offer both group sessions and one-to-one support, and can help you get nicotine gum and patches on prescription.

Find your NHS Stop Smoking Service. Alternatively, call 0800 169 0 169 or text GIVE UP with your full postcode to 88088.

Nicotine Replacement Therapy (NRT): Now available on prescription, NRT is clinically proven to be twice as effective as the cold turkey method. NRT eases withdrawal symptoms while the smoker gets used to not smoking and the dose is gradually reduced. For the best results, follow the instructions carefully and consult your pharmacist or GP if you are unsure about anything. NRT is available in many forms allowing you to choose which will suit you best.

NRT is generally safe for everyone to use and certainly much safer than smoking. However, if you are pregnant or suffering from a heart condition, you should consult your GP first.

For more information about NRT products, see the following product manufacturers' sites:

http://www.nicotinell.co.uk
http://www.nicorette.co.uk
http://www.niquitin.co.uk

Publications: A range of self-help materials are available that provide information and advice on stopping smoking - from the physical side-effects to details about health problems and smoking related disease. You can download some of the most popular resources, or order from the full range of resources free of charge.

Zyban (buproprion): Zyban is one of the newest drugs to the market and is available on prescription. It works by suppressing the part of the brain that gives the smoker a nicotine buzz when smoking a cigarette. The smoker starts taking Zyban before giving up, and the drug puts them off cigarettes, because they no longer get the "hit". It reduces the cravings as well as the usual withdrawal symptoms of anxiety, sweating and irritability. Some users of Zyban have reported unpleasant side effects such as nausea, headaches, dry mouth and blurred vision. Zyban is not recommended if you are pregnant, breast feeding, have a history of epilepsy, liver disease or an eating disorder. Early findings show it to be highly effective, but for maximum effect it should be used as part of an overall give-up smoking plan.

This briefing has been reproduced with the kind permission of Givingupsmoking.co.uk. Givingupsmoking.co.uk is your online resource for all the advice, information and support you need to stop and stay stopped.

Crown copyright material is reproduced with the permission of the Controller of HMSO and the Queen’s Printer for Scotland. Licence number: C02W0005702

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