smoke | MY SPECIAL DOCTOR

HEALTH: Eliminating smoking and sedentary lifestyle can prevent one in three cancers

24 February 20246 January 2024 by clemente.ferrara

Once again this year, as is customary to do,AIRC (Italian Association for Field Research) has kicked off the“Oranges of Health” initiative. Awareness campaigns were held in some 2,500 squares throughout the country to fund cancer research and, in so doing, facilitate the work of some 5,000 researchers all working in universities, research centers and hospitals to make cancer increasingly curable. The choice of blood oranges is due to the fact that this fruit is rich in antioxidant pigments and contains about 40 percent more vitamin C than other citrus fruits. In addition to the oranges, informational leaflets were distributed with some tips for embarking on a healthy lifestyle and especially one that can minimize the risk of incurring cancer. Let us see together what the most important councils are.

Healthy nutrition

The first basic rule, if you want to embark on a healthy lifestyle, is to adopt a balanced and varied diet. In this respect, the Mediterranean diet is certainly one of the most valued by various scholars and nutrition experts, thanks to the beneficial and anti-oxidant properties of the foods that make it up, which are useful both in strengthening our bodies and our immune defenses and in the fight against cancer prevention. Mostly under indictment are sugars, which causes an increase in insulin, from excessive consumption of pasta, bread, cakes and refined flours. A diet too rich in sugar is very dangerous for our body, in fact it creates a state of chronic inflammation that promotes the development of various diseases such as diabetes, atherosclerosis and cancer.

Smoking and sedentary lifestyle

According to AIRC reports, a healthy diet alone is not enough to protect us from incurring diseases that are dangerous to our health. In fact, according to doctors and researchers, the other two factors that put our body’s well-being at risk are smoking and being sedentary. Even one cigarette a day in fact puts our bodies at risk of lung and heart disease that could prove fatal to our lives. Likewise, a sedentary lifestyle, in which any kind of physical activity is absent, contributes to weakening our bodies, making them more vulnerable and exposed to cardiovascular risks but not only. Doctors estimate that one in three cancers is preventable if you keep a proper diet, completely eliminate smoking from your life, and consistently exercise.

Life is the most precious possession we possess in the world, it would be a shame to ruin it with our own hands!

Smokers are increasing among young people : here’s the data

23 February 20246 January 2024 by Alessia Giannino

According to recent research, it appears that since the 1990s there has been a sharp increase in the number of young smokers between the ages of 11 and 15 in both Italy and much of Europe.

The alarm was raised by a team of researchers involved in the ALEC (Ageing lungs in European cohorts) project, a study aimed at testing risk factors on respiratory diseases, paying particular attention to smoking. The scholars, coordinated by Professor Deborah Jarvis of the National heart and lung Institute at the influential Imperial College London, obtained such a high percentage from data on some 120,000 European citizens from 17 countries involved in six separate epidemiological studies conducted between 1970 and 2009. The researchers, through the number of nations and participants, obtained a rather detailed overview. In fact, they divided Europe into four parts (North, South, East and West), in which there are major differences.

Scientists are most concerned about the number of adolescent smokers, in fact from what was indicated by Alessandro Marcon, professor of the Department of Diagnostics and Health at the University of Verona, a +50% relative to very young smokers has been recorded.

“In the 11-15 age group – said the scholar – an increase in new smokers has been observed since 1990, with rates reaching 40 new smokers per 1,000 young people per year in Western Europe, Belgium, France, Germany, the Netherlands and Switzerland, and about 30 per 1,000 per year in Southern Europe: Italy, Spain and Portugal.”. For the 16-20 age group, however, there has been a decrease throughout Europe, except in the South, which includes Italy. For Marcon, it is crucial to reduce the number of young people exposed to nicotine addiction, as health problems such as cancer and cardiovascular disease also result.

Smoking and alcohol cause early damage to adolescents’ arteries

20 February 20246 January 2024 by rosanna.feroldi

Cigarettes always lit and group drinking, often to the point of being frankly drunk and feeling sick. These are all too common behaviors among adolescents, engaged in more to feel included and appreciated by peers than out of real individual pleasure or goliardic spirit. In the general belief that challenging the limits of one’s body and having the “courage” to dare more than others serves to assert one’s worth.

But this is as risky a belief as ever, as well as completely wrong, because even a young, healthy body suffers greatly from the toxic effects of smoking and alcohol. And not only after years of immoderate consumption, but also in the immediate term and for modest amounts, especially when their intake occurs at the same time, multiplying the damage at multiple levels, often synergistically.

The harmful effects on the organism

Even when taken individually, smoking and alcohol are harmful to the body on several fronts. The former, promotes respiratory diseases and several types of cancers (first and foremost that of the lung, but also of the mouth and throat, stomach, colorectum, and breast), reduces fertility, increases cardiovascular and metabolic risk, and complicates acute and chronic diseases already present, especially inflammatory and autoimmune diseases.

Alcohol, on the other hand, is neurotoxic (centrally and peripherally), harmful to the liver (promotes fibrosis and cirrhosis of the liver), the kidneys and the gastrointestinal system, and, if taken in excess, the cardiovascular system as well (where “excess” means more than a couple of glasses of wine a day, a limit beyond which any hypothetical benefit is lost). Not to mention the risks consequent to the psychotropic and sensory effects of alcohol (euphoria, reduced reflexes, drowsiness, altered vision, etc.), often the cause of traffic accidents and borderline behavior.

When the cigarette is in one hand and the glass in the other, the problems quickly multiply, even if the hands in question are those of beardless (or nearly so) teenagers, seemingly immune to acute or chronic ailments and diseases and far removed from vascular degenerative phenomena typical of old age, such as atherosclerosis.

Young arteries at risk

A collaborative study between a number of prestigious clinical institutions in the United Kingdom (University College and King’s College London, St. Thomas’ Hospital and the University of Bristol) and Queen Silvia Children’s Hospital in Gothenburg, Sweden, indicated that smoking and alcohol promote the early onset of stiffness and thickening of the walls of the arteries already in 17-year-olds taking only one or both of the two, even from relatively short periods of time (1-5 years).

The extent of the vascular damage mentioned, measured indirectly as blood flow velocity between carotid and femoral artery with pulsed Doppler (Pulse Wave Velocity, PWV), appeared to be correlated with the number of cigarettes smoked and the amount of alcohol consumed, being in both cases increasing with increasing consumption of each substance and particularly marked when smoking and alcohol were combined.

But there is also good news: quitting smoking and drinking when the atherosclerotic process is just starting allows it to regress completely, restoring the arteries of ex-smoking and “ex-drinking” teens to a condition comparable to those of never-smoking and lifelong teetotal peers. An outcome that cannot, however, be hoped for later in life, and which should lead to strong disincentives to smoking and alcohol use in young people, partly to prevent the consolidation of two decidedly harmful habits.

Sources:

Article: Charakida M et al. Early vascular damage from smoking and alcohol in teenage years: the ALSPAC study. European Heart Journal 2019;40:345-353
Editorial: Münzel T et al. Double hazard of smoking and alcohol on vascular function in adolescents. European Heart Journal 2019;40:354-356

Quitting smoking in pregnancy: why you should and why it is difficult

22 February 20246 January 2024 by rosanna.feroldi

Smoking is bad for you at every stage of life, but in pregnancy it hurts twice as much, because not only the woman but also the developing fetus suffers the deleterious consequences of smoking. To protect it, it is necessary to be able to quit in time.

Also thanks to good laws and numerous prevention initiatives, people in Italy today tend to smoke less and more consciously than 2-3 decades ago. However, compared to the past, more women smoke today, and on average they develop greater addiction and have a harder time quitting. So much so that they sometimes fail to break the smoking habit even during pregnancy, risking impairment and negatively affecting the development of the baby.

In a recent review published in the scientific journal Therapeutic Advances in Drug Safety, some American experts on the subject have summarized the reasons why all women wishing to engage in pregnancy should try to stop smoking before conception or, in the case of unplanned pregnancies, soon after (ideally, by the end of the 1st trimester).

In particular, there is evidence that the Smoking in pregnancy increases the risk of preterm delivery (i.e., before 37 weeks, with associated complications), low birth weight, premature rupture of membranes, placenta previa (i.e., placed in front of the baby’s head at the time of delivery, resulting in criticality during expulsion), and loss of the baby. In addition, smoking in pregnancy is a recognized risk factor for congenital anomalies of the cleft lip and palate (cleft lip-palate), cardiac, gastrointestinal, and neurological defects of the newborn.

A wide range of studies also indicate that even when in pregnancy it’s okay, exposure to secondhand smoke in the first months/years of life increases a child’s risk of going through acute respiratory diseases (virus and bacterial airway infections) and chronic (asthma, respiratory allergies, etc.), as well as to otitis, short stature, and metabolic and behavioral changes (hyperactivity).

The woman who succeeds in quitting smoking on time and not starting again after the birth of the child enables herself and the whole family to live healthier lives. Since, often, good will is not enough, to succeed it is advisable to seek medical advice and be directed in the use of one or more of the many supports, pharmacological and otherwise, available today (nicotine replacement therapy in gum, chewing tablets, nasal spray, patch, etc.; bupropion; varenicline; counseling and psychological support; auricular acupuncture, etc.). Ideally, also involving the partner, if a smoker, in the venture. Of course, it will not be easy, but it is definitely worth it.

Source: Scherman A et al. Smoking cessation in pregnancy: a continuing challenge in the United States. Ther Adv Drug Saf. 2018;9(8):457-474. doi:10.1177/2042098618775366

Avoiding smoking reduces the risk of rheumatoid arthritis

19 February 20246 January 2024 by rosanna.feroldi

For some years now, the overall number of smokers in Western countries has been gradually decreasing. And that is good news. Unfortunately, however, this favorable trend does not apply to women, who are increasingly taking up smoking and managing to quit with considerable difficulty. The recent spread of
electronic cigarettes, falsely perceived as harmless, certainly does not help to improve the situation, unless they are actually used as a transitional support for smoking cessation.

The phenomenon is not insignificant because, as is well known, smoking harms health on many fronts and women’s health in particular: on the respiratory, cardiovascular, hormonal, oncological and reproductive life levels. A recent study conducted at Brigham and Women’s Hospital – Harvard Medical School in Boston (United States) adds another good reason why women should avoid smoking altogether or try to give it up as soon as possible: to reduce the risk of developing rheumatoid arthritis.

Rheumatoid arthritis is a chronic immune-based inflammatory disease that affects the joints (especially those of the hands and feet), causing painful periodic inflammation and degeneration of cartilage and bony joint surfaces and leading, over time, to the onset of persistent pain and disabling deformities. For reasons yet to be elucidated, regardless of whether they smoke or not, women tend to be more affected by the disease than men, especially from the age of 45.

Since time immemorial, smoking is strongly discouraged for those suffering from chronic inflammatory diseases or those involving autoimmune activation (such as systemic lupus erythematosus or multiple sclerosis) because its oxidizing and pro-inflammatory action facilitates the onset of flare-ups, with all that follows in terms of symptoms and unfavorable evolution of the clinical picture (organ and tissue damage and development of disability at various levels).

New evidence from researchers at Brigham and Women’s Hospital – Harvard Medical School confirms the strongly negative impact of smoking in the female population, assigning it the role of a definite and crucial risk factor for the onset of rheumatoid arthritis. Analyzing data on more than 230 thousand women included in the cohorts of two previous studies, the Nurses’ Health Study (NHS, 1976-2014) and the NHSII (1989-2015), the researchers found that, compared with women who had never smoked, smokers were about 50 percent more likely to be affected by rheumatoid arthritis, mainly in the “seropositive form” (+67 percent), that is, characterized by the presence of Rheumatoid Factor in the blood (the main marker of the disease).

Two other observations helped support this indication: first, women’s risk of developing rheumatoid arthritis was the higher the greater the average number of cigarettes smoked; second, the likelihood of developing the disease decreased as the number of years elapsed since the women were able to quit smoking for good. In particular, compared with those who had quit smoking for less than 5 years, those who had quit for more than 30 years had a 40% lower risk of developing rheumatoid arthritis, although still somewhat higher than those who had never smoked (+25%).

Source: Xinyi Liu et al. Impact and timing of smoking cessation on reducing risk for rheumatoid arthritis among women in the Nurses’ Health Studies. Arthritis Care and Reasearch 2019; doi:10.1002/acr.23837 (https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23837)

More effective double support for smoking cessation

17 February 20246 January 2024 by rosanna.feroldi

Two is better than one. A rule that is true in many cases and remains true when it comes to quitting smoking. No small feat, which is rarely successfully accomplished without serious determination and the support of nicotine replacement preparations, which help reduce the withdrawal symptoms typical of the first few weeks.

The substitutes for the nicotine on the market are now many, allowing each person to choose the one that is most comfortable and best tolerated among slow-release transdermal patches, lozenges to dissolve in the mouth, chewing gum, nasal or oral sprays, some freely available from pharmacies without a prescription, others to be arranged with the doctor as part of a more structured cessation plan.

Generally, especially when using them spontaneously, only one type of nicotine replacement is used at a time, in view of the fact that the amount of active ingredient released is believed to be sufficient to lessen the desire to smoke, without inducing significant side effects.

According to the results of a review by the Cochrane Group, however, using two nicotine replacement preparations at the same time instead of just one would increase the likelihood of sustained, if not permanent, success in quitting smoking. The reviewers arrived at their conclusion by analyzing the results obtained in the 63 most robust studies that tested the effects of different nicotine substitutes and their combinations, on a total of more than 41,500 smokers with an average consumption of at least 15 cigarettes per day and eager to quit.

In particular, the most effective approach to abandoning the smoke appears to be one based on a combination of a slow-release patch to be applied to the skin and a second, fast-acting substitute, such as lozenges, chewing gum, or nasal spray, to be taken as needed, adhering to the timing and dosages indicated on the packages or recommended by the physician.

Lozenges and chewing gum with higher nicotine dosage (4 mg) were more effective than those with lower dosage (2 mg), while for patches it is unclear whether higher (21-25 mg) or lower (14-15 mg) nicotine dosage results in significantly different outcomes. Conversely, it would seem to be advantageous to start applying the transdermal patch and/or taking fast-acting substitutes not on the day set for quitting cigarettes, but the day before (this evidence, however, requires further verification).

“Nicotine substitutes are safe, effective and well-tolerated preparations,” said Nicola Lindson of the University of Oxford (UK), lead author of the review, “but to derive maximum benefits in smoking cessation, they must be used properly so as to maximize their potential, which is often not the case. The combined use of a slow-release patch and a fast-acting nicotine substitute offers greater chanches to quit smoking: many people fear that using two nicotine substitutes at the same time may pose risks, but clinical evidence informs that this is not the case.”

To be even safer, if you decide to quit smoking, the advice is to contact a specialized Smoking Cessation Center or your medical professional and identify a personalized plan, taking into account your age, gender and any medical conditions you have. In addition to nicotine substitutes, psychological support can further increase the likelihood of success.

Source

Lindson N et al. Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 2019; Issue 4; Art. No. CD013308 (https://www.cochrane.org/news/featured-review-different-doses-durations-and-modes-delivery-nicotine-replacement-therapy)

Electronic cigarettes at risk of lung damage?

14 February 20246 January 2024 by rosanna.feroldi

Smoking is bad for you, that’s for sure. Evidence collected over 70 years of studies has now confirmed that tobacco consumption in any form (cigarettes, cigars, pipe, etc.) is extremely harmful to the body on many levels: it increases the risk of cancers of the respiratory tract (lung first and foremost), mouth, vocal cords and other body sites (esophagus, stomach, liver, pancreas, colorectum, kidney, bladder, uterus, etc.); promotes the development of acute and chronic respiratory diseases (bronchitis, emphysema, chronic obstructive pulmonary disease – COPD etc.); promotes the onset of cardio and cerebrovascular diseases; reduces fertility and is harmful to the fetus during pregnancy.

Most damaging to the respiratory system are the byproducts of tobacco combustion, the additives it contains (a total of several hundred toxic compounds) and nicotine, together responsible for more than 90 percent of lung cancer cases and 80 percent of COPD cases. Critical to the cardiovascular system, however, are mainly nicotine and oxidizing compounds (free radicals and reactive oxygen species, ROS), which increase the risk of coronary heart disease, myocardial infarction, and stroke by 2-4 times, even after modest, short-term consumption.

Electronic cigarettes-which have now become a cult object and status symbol for many, especially among younger people-have immediately seemed an ideal means of reducing the impact of smoking on health without imposing a total abandonment of the habit, as well as a “solution-bridge” to facilitate a gradual and less painful cessation for those who have the hardest time quitting. The nicotine in solution contained in their reservoirs is, in fact, released in the form of vapor and in smaller quantities than one would take in by smoking a regular cigarette, greatly reducing the body’s exposure to toxic compounds.

Recent studies and severe adverse events encountered among regular e-cigarette users in the United States have, however, cast doubt on the harmlessness of so-called “vaping” (i.e., “electronic smoking” in vapor form) and its positive value in a cessation perspective, attributing to this mode of consumption also the ability to harm health and, in particular, the respiratory system, albeit in different ways.

The most recent alarm in this regard comes from an investigation conducted in Illinois and Wisconsin (U.S.), following reports of severe lung damage in e-cigarette smokers and preliminarily attributed specifically to vaping. The problem affected 53 people, mostly boys and young adults (the average age was 19), 83% of whom were men. In addition to respiratory symptoms and pulmonary infiltrates verified by CT scan, all had systemic symptoms (i.e., general malaise of various types) and in 8/10 cases gastrointestinal complaints. The clinical pictures were so severe that they required hospitalization for almost all patients and intubation and mechanical ventilation in one third of the cases, with one dying despite these interventions.

When analyzing the vaping devices used by these young people, it was seen that they were of various types, but shared a detail of no small importance: in 84 percent of the cases, in addition to the “common” ingredients of electronic cigarettes, they also contained tetra-hydro-cannabinol (THC), the active ingredient of marijuana responsible-along with cannabidiol (CBD)-for most of its psychotropic effects, but also capable of acting on various peripheral organs where specific receptors are present.

Many experts believe that it is this “addition,” along with the presence of numerous, undefined contaminating compounds, that has made e-cigarettes, which are considered safe in themselves, harmful unless modified. However, in the absence of clear and definitive data, the authors of the survey and several other colleagues suspect that even common e-cigarettes harbor hitherto underestimated risks that are now emerging as a result of increasingly widespread use of these devices, especially among adolescents.

Therefore, as a precautionary principle, pending more information on the health effects of vaping, this mode of smoking should also be avoided as much as classic smoking, giving serious thought to ultimate cessation and opting for other strategies that can help with quitting. Should the decision be made to continue, the advice is to report any unusual respiratory symptoms to the physician immediately to catch potentially serious disorders in the bud.

Sources:

Miech R et al. Trends in Adolescent Vaping, 2017-2019. NEJM 2019; doi:10.1056/NEJMc1910739
Butt YM et al Pathology of Vaping-Associated Lung In. NEJM 2019; doi:10.1056/NEJMc1913069
Christiani DC. Vaping-Induced Lung Injury. NEJM 2019; doi:10.1056/NEJMe1912032
Layden JE et al. Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin – Preliminary Report. NEJM 2019; doi:10.1056/NEJMoa1911614
doi: 10.4103/0971-5851.151771
Aseem Mishra A et al. Harmful effects of nicotine. Indian J Med Paediatr Oncol 2015;36(1):24-31
Center for Disease Control and Prevention (CDC) Health Effects of Cigarette Smoking(www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm). Accessed October 2019