Smoking

What is smoking?

Smoking can be defined as dependence on the consumption of tobacco products, caused by the presence of nicotine, a psychoactive substance (alkaloid) found in the leaves of the tobacco plant.

Smoking is the biggest preventable health risk and the leading cause of premature death in the EU, accounting for almost 700,000 deaths a year.

What are tobacco products?

Tobacco products are produced from the leaves of the tobacco plant. They contain nicotine and other addictive nicotinic alkaloids, as well as various substances that are harmful to health, some of which are carcinogenic, in particular those known as specific nitrosamines in tobacco leaves.

Can be smoked, sucked, chewed, or inhaled. Examples of these products are:

• cigarettes (most consumed product globally)
• tobacco:
  • for roll-your-own cigarettes
  • warmed
  • for pipe
  • for hookah (shisha)
• cigarillos
• cigars
• snuff

All tobacco products are harmful to health and addictive.

What are the signs of smoking?

Tobacco consumption causes psychoactive effects, that is, the substances that make up tobacco act on the brain, altering sensations and emotional state, with stimulant or depressant effects.

The main signs and symptoms of a tobacco user are:

• initially, cough and difficulty respiratory
• eye and throat irritation
• increase in heart rate, respiratory rate, and blood pressure
• feeling of satisfaction and pleasure
• decrease in anxiety and relaxation

With the continuation of consumption and the installation of dependence, other signs and symptoms appear:

• cough and difficulty breathing
• decreased sense of taste and smell
• decreased lung function
• desire to consume tobacco or nicotine products and the feeling that one needs nicotine to live
• feelings of sadness, anxiety or irritation
• withdrawal symptoms such as restlessness and difficulty sleeping
• need for larger amounts of nicotine to get the same satisfaction
• continue to smoke or use nicotine products despite known health risks
• Wanting to quit smoking or using nicotine products but can't

How can I identify that I am dependent on tobacco?

Nicotine in tobacco is the main substance responsible for smoking dependence. It reaches the brain in a few seconds and causes changes in brain function, causing addiction.

Dependence is initially expressed in the experimentation phase by the desire to consume. After the first experiences of consumption, the desire to smoke can turn into a compulsive need to consume, even when the person knows that tobacco is harmful, or even when there are already health problems that worsen with consumption.

This imperative need to crave and the appearance of unpleasant symptoms of tobacco withdrawal (withdrawal syndrome) whenever one cannot smoke characterise dependence.

Addiction usually sets in in adolescence or early adulthood, at a stage of life when the human brain is not yet fully mature and is more susceptible to substance use. There are different types of addiction that tobacco causes:

• physical (chemical) dependence: nicotine acts on the brain's reward system providing a sense of pleasure and well-being. However, after some time the amount of nicotine in the body begins to drop, which induces the need to smoke another cigarette. With continued consumption, nicotine tolerance develops, which leads to an increasing need to consume again to obtain the same degree of satisfaction. Some addicted people smoke only a few cigarettes a day, while others need to smoke as soon as they wake up, smoking repeatedly, sometimes 20 or more cigarettes, throughout the day. Thus, the degree of physical dependence is not the same in all people. The higher the degree of dependence, the greater the difficulty in quit smoking.
• dpsychological (behavioral) dependency: Psychological dependence varies from person to person and lasts longer than physical dependence, because it is more complex. Having a coffee, calling someone, or taking a break are common situations that serve as triggers for smokers to feel the urge to smoke. Thus, smoking can be considered by the smoker as a positive reinforcement that satisfies a physiological and emotional need.
• social dependence: This type of dependence is related to social acceptance of smoking and social pressure. The sense of security, mastery of the situation and the peer pressure in young people encourage tobacco use.

What are the consequences of smoking?

Smokers have, on average, 10 years less life than non-smokers, as the substances in tobacco smoke contribute to the development of the main non-communicable diseases, with emphasis on:

• respiratory diseases, such as Chronic Obstructive Pulmonary Disease (COPD), chronic bronchitis, worsening asthma and respiratory infections
• brain and cardiovascular diseases, such as coronary heart disease, stroke, acute myocardial infarction, or hypertension
• oncological diseases, different types of cancer in various locations of the human body
• type 2 diabetes mellitus
• decreased fertility
• bone density reduction
• risk of blindness due to macular degeneration

In addition to these diseases, smoking lowers immunity, increasing the risk of respiratory infections and death from tuberculosis.

Tobacco currently contributes to the annual deaths of more than 8 million people worldwide. In Portugal, in 2019, it is estimated that tobacco contributed to the death of more than 13 thousand people, of which about 1700 due to exposure to second-hand smoke.

What types of cancer are associated with smoking?

Tobacco smoke contains more than 7,000 chemicals that cause additive, toxic and irritating effects and contribute to the decrease of immunity and the development of various types of cancer:

• lip
• language
• boca
• esophagus
• pharynx and larynx
• lung
• rins
• bladder
• stomach
• pancreas
• liver
• cervix
• colorectal (colon and rectum)
• acute myeloid leukemia (blood cancer)

In addition to diseases, what other effects does tobacco consumption have?

In addition to the development of various diseases and increasing the risk of premature mortality, tobacco use causes a number of other health problems and negatively affects physical appearance, the most notable signs being:

• Oral health issues: bad breath, periodontal disease, and yellowing teeth
• yellowing fingers and fingernails
• dry and wrinkled skin
• thinning and thinning hair
loss
• air tired due to decreased sleep quality
• increased tiredness and decreased physical capacity
• early menopause
• irregular periods
• reduction of taste and smell
• cataracts
• gastric ulcers

Does my smoking disorder harm the health of those around me?

Yes. Tobacco smoke is harmful not only to those who smoke, but also to those who are exposed to environmental smoke or secondhand smoke.

What is environmental smoke or secondhand smoke?

Environmental tobacco smoke is defined as the combination of the smoke from the lit cigarette and the smoke exhaled by smokers into the environment.

Second-hand smoke is the inhalation of environmental tobacco smoke by non-smokers who are in the vicinity of people smoking or who remain in smoke-polluted spaces.

Breathing tobacco smoke into the environment contributes to the development of several diseases, in particular respiratory and cardiovascular diseases, increased risk of lung cancer and increased mortality of both smokers and passive smokers.

Which groups are most vulnerable to the effects of exposure to secondhand smoke?

Inhalation of secondhand smoke poses a significant risk to:

• babies and children: are more likely to develop sudden infant death syndrome, cough, asthma, ear infections, or respiratory infections such as pneumonia and bronchitis. A child exposed to secondhand smoke is more likely to become a smoker in adulthood
• elderly people
• patients with asthma or other respiratory conditions
• people with cardiovascular or other chronic diseases
• individuals with weak immune systems

Can smoking during pregnancy affect the development of the fetus?

Yes. Smoking during pregnancy can affect the development of the fetus and cause:

• miscarriage
• ectopic pregnancy
• death of fetus
• preterm birth
• low birth weight
• congenital malformations, such as cleft lip and cleft palate
• sudden infant death

I want to quit smoking. What should I do?

If you need help, talk to your doctor or make an appointment to quit smoking by specialist doctors who can help you quit smoking.

To succeed, there are 15 steps you should consider:

1. Make a list of the reasons why you want to quit smoking
2. Learn more about your smoking habits
3. Calculate how much you'll save if you quit smoking
4. Set a quit date
5. Communicate your decision to those around you
6. Get ready for D-Day
7. Mentally train strategies to deal with the urge to go back to smoking
8. On D-Day, the first day without tobacco, don't smoke again, not a single cigarette
9. Avoid the times or circumstances when you used to smoke a cigarette all the time
10. Avoid being in the vicinity of smokers
11. Eat healthy. Don't replace tobacco with food
12. Increase your daily level of physical activity
13. Learn to refuse tobacco if someone offers it to you
14. Keep all the money you're saving by quitting tobacco in a visible place
15. Just won! Celebrate success!

For more information, see the guide Quit Smoking and learn about the benefits of quitting smoking.

What symptoms will I have with the cessation?

The sudden elimination of nicotine levels in the blood produces a set of symptoms called smoking withdrawal syndrome, which is manifested by several symptoms, such as:

• uneasiness or excitement
• increased cough and sputum due to improved cleaning function of bronchial tree hair cells
• anxiety, irritation, and aggression
• bad mood
• difficulty concentrating that can decrease attention when driving
• improvement of smell and taste
• increased appetite and body weight
• rate decrease heart rate
• sleep change
• Concentration Difficulties
• headaches and dizziness

There are several medications that can greatly mitigate these symptoms: some over-the-counter, such as nicotine substitutes in gums, lozenges, and patches; others with a mandatory medical prescription. They should always be taken according to the respective therapeutic indications and degree of dependence. Ask your doctor or pharmacist for advice or seek a smoking cessation consultation.

In addition to medication, you can receive behavioral counseling, learn relaxation techniques to cope with the need to go back to smoking, and receive information on how to avoid weight gain by adopting a more active lifestyle and eating healthier.

Source: National Programme for the Prevention and Control of Smoking – Directorate-General for Health