Saturday, March 4, 2017

9 Little Ways Passive Smoking is Killing Your Family

This article enumerates the dangers of passive, second-hand, or environmental tobacco smoke. The article links to relevant articles and videos about the diseases that can kill you or your family should you be exposed to hazardous cigarette smoke. The article is targeted to the general population and the terminology and language are simplified. It answers the questions related to effects of passive smoking to pregnant women, immediate and chronic (long-term) effects to children and adults, and what it does to your body.

Do you know that more than half a million people die in this world each year because of passive smoking? The World Health Organization keeps a tally. I don't make numbers up to scare people. I look up at these statistics because I wanted to know how many people you and I can save. These people died from diseases that are preventable.

The scary part is that you and I are still exposed to cigarette smoke whether we like to or not. We are exposed to its effects. Even if governments have drafted and passed laws restricting smoking in public places, there is always the problem of implementation. For example, 14 years after the passage of RA 9211, people are still smoking everywhere in the Philippines. Big important people have spoken and scared people but people will continue to smoke. And people who do not smoke will continue to die from second-hand smoke. This post will tell you how.

From the Department of Health Philippines

1. Lung Cancer

You've seen cigarette packages with pictures of patients with lung cancer. If you're a smoker, you probably have very little care if at all. "Bad luck happens to people," "People die anyway," or "If my time comes, I'll accept it," are some of the rationalizations I have heard patients say to me. But in the end of their short lives, the very same persons that told me this all said one thing to me, "I don't want to die."

For cancer to develop in your family, you need both of these: time and dosage. Lung cancer can develop if you have repeated exposure to smoke for a long period of time. The risk is high even for a low dose such as one cigarette a day. The risk goes higher and higher for every day with an exposure (cumulative). The risk can also be high in a short period of time if you are exposed to a large dosage of smoke like working in a bar or restaurant which are lenient to smokers. Short in this case is somewhere between 5 to 10 years. How fast you develop lung cancer is also dependent on the antioxidants and other anti-cancer mechanisms in your body. Your body has an inherent way of fighting cancer but eventually it will give out. This is the same for everybody and your family is no exception. You have to realize that let's say you are a smoker and your special someone isn't, he or she may develop cancer instead of you. This scenario is not rare and I have seen a lot of cases like this. Because in the end, can you stand hearing your special someone say to you "I don't want to die."

2. Breast Cancer

You might have prematurely concluded as much as I did before that breast cancer only affects women. But you would be shocked that this 2017, it is expected that 2,470 men are going to have breast cancer. Even though there is a lot of controversy in linking passive smoking to breast cancer, research today are pointing to a correlation. If I were you, I wouldn't need more convincing. In order for a study to say passive smoking is the direct cause of breast cancer, it may mean that we would need more non-smoking individuals to die from breast cancer after exposure to passive smoke. You might think it cruel but such data are the only ones that tobacco companies will accept to admit that their products causes such.

3. Testicular Cancer

This is another smoking controversy because testicular cancer occurs primarily in young males with undescended testis. But older males can still develop testicular cancer even without undescended testes. There are currently no large multi-center medical studies regarding passive smoking and testicular cancer. However there is a population of workers in the United States that understand the effects of passive smoking and the development of testicular cancer among others, these are the firefighters. As a firefighter, they are prone to develop higher incidence of certain cancers against the general US population. If you are a firefighter, one of those cancers you can develop is testicular cancer. Although the study is not yet complete, preliminary evidence suggests that testicular cancer risk is higher among firefighters who were exposed to smoke than the general US population. The risk is a lot higher when a firefighter is a known cigarette smoker.

This is the basis why Fire Departments in the United States, including Virginia Beach Fire Department (VBFD), has added an exclusion criteria to their recruits and that is cigarette smoking. Also if you visit fire stations like those of the VBFD, smoking among career firefighters are not tolerated and current smokers are given a program for quitting to make sure that the risk of dying from cancer like testicular cancer is decreased. It may take a long time before you hear the correlation of passive smoke to testicular cancer but then again if you are a firefighter, you would know that there is a link. This is why even within the families of firefighters in Virginia Beach, they do not tolerate passive smoking.

4. Cervical Cancer

Cancers of a woman's cervix is 90% caused by a virus. And you'd be happy to know that today, this is one cancer that can be prevented by a vaccine to that virus. However, women exposed to passive or second-hand smoke carry an increased risk to develop cervical cancer.

5. Atherosclerosis

This one word you know simply means narrowing of your arteries. How this narrows or becomes blocked starts when chemicals from smoke enters the bloodstream. The chemicals make the walls of your arteries inflamed. The inflammation causes cholesterol to stick to the walls and get attacked by your immune system. This creates hardened areas in your arteries that can rupture and cause a clot or a block. But the problem is that it doesn't confine itself to one artery, chemicals from smoke attacks all your arteries at the same time. Even your largest artery, the aorta is not spared:

From the Department of Health and Ageing, Australia

How passive smoking can kill your family this way is that, even though they are still young, they can die from an eventual clot occluding the brain, or the heart, and even the kidneys. The chemicals inhaled by passive smoking is known to lead to your arteries being blocked just the same as when you are actively smoking. So in effect, you and your family may be at risk of the same debilitating diseases that active smokers can get such as blockage of the arteries in the eye, the legs and arms, and other organs like the gut. Although studies correlating passive smoking and such have not yet been conducted, you cannot discount the possibility of causation since you know already how chemicals in smoke affects the active smoker (see the video above).

6. Asthma

You might find it disturbing but asthma attacks among kids by exposure to second hand smoke number in the tens of thousands a year. Deaths from asthma are caused by constriction of the lung tubes. How? If you read the effects on the arteries, it's almost the same thing and you probably guessed it: through inflammation. The difference is that it's faster and there are no fat deposits but rather it is mucous that traps the air in the lungs. Asthma is very common and most people are born with it or a variant thereof.

Passive smoking can cause asthma attacks. If you have asthma and you are reading this on your device, chances are that you are very near a facility (health center or pharmacy) that can reverse the effects of such an attack: the drug we call albuterol (salbutamol in the Philippines). However there are a lot of rural areas who live far from facilities like these. And if you are one of those who live in rural areas, chances are high that you can die from an asthma attack unless you have that drug.

7. Chronic Obstructive Pulmonary Disease

If you can't guess it yet, Chronic Obstructive Pulmonary Disease or COPD is brought about by the same thing: inflammation in the lungs because of chemicals in the smoke. But in COPD, you are not born with this disease, it happens for a long amount of time. In COPD, the air sacs and lung tubes are destroyed and you need more air to breathe and some of the air are trapped in the spaces. If you have COPD, the chances that you will live the rest of your life connected to an oxygen tank is high. The chances of getting infection almost every week is also high. And the chances that you will depend on a large number of medications just to get through the day is also very high. You can get COPD from all types of smoke and not just from cigarettes. As I mentioned above, all firefighters are at high risk of COPD even without smoking if they do not use a breathing apparatus when attacking fires. This is true in the Philippines where most firefighters do not equip themselves with breathing apparatuses. 

The effects of smoking, active or passive, is permanent. To tell you the truth, quitting smoke or getting out of areas where you are exposed to second-hand smoke does not reverse the damage done to you. It stays there and this is the basis why government enacts anti-smoking laws. The damage in your lungs could have been prevented if you were never exposed in the first place.

From the Centers of Disease Control and Prevention in the United States

8. Birth Defects

Chemicals in smoke goes to the lungs and goes to the bloodstream. You've read the effects on you but how about on an unborn child? Even with second-hand smoke, your child may be born smaller with low birth weight, longer legs, smaller head size and other abnormalities. Or your child may never be born alive at all or the mother may give birth at an earlier time than expected. And if born well, the risk of dying through what we doctors call Sudden Infant Death Syndrome is high.

From the Centers of Disease Control and Prevention in the United States

9. Respiratory Tract Infections

Your children are more affected than other adults in your family. The numbers affected only in the US range from 100,000 to 1 million depending on the disease. How much do you think passive smoking affects children globally? In the third world where I practice medicine, you will see me diagnose tuberculosis in children of parents who smoke left and right. Yet no studies have been conducted on the correlation. You may see me diagnose ear infections, asthma, and acute upper respiratory tract infection, and pneumonia in children of parents who smoke. You may understand that I cannot deny any link of passive smoking to these disease because I see it everyday. And the bad part is that I see these patients die because here in the third world, medicines and consultations are very hard to acquire. Even I, as a doctor, cannot make enough as a physician in rural health to pay my own hospital bills if I get admitted because of these diseases. There is a large number of countries in this world that is not subscribed to the 100% smoke-free environment. So I think that you can infer at this point that people, mainly children, will continue to die from these respiratory tract infections globally if smoke exposure is not stopped.

Little by Little, Passive Smoking Kills

Each little smoke leads to another little smoke. Pretty soon, all the little smokes fill up the air. Even if you don't smoke, you should realize that you breathe the same air. Your family breathes the same air. You do not see the dangers of a little smoke for now. But soon you will. For this is one of those times when the idiom "Time heals all things" does not apply. Because if you add time from this little smoke pretty soon you will see the effects on you or on your family. 

But I cannot take hope away when we all know that there is always hope. Someday in the near future, there will be a time when all tobacco products are no longer promoted and everybody will breathe clean air. Imagine for a minute, the nine diseases I mentioned above will only be on history books and websites and this blog post will just be discarded as utter nonsense. After all it is possible, because all diseases I've discussed thus far are preventable and not inevitable.

About the Author

Zero Mella MD is a rural health physician by trade. He has received training as a Firefighter I and II in the City of Virginia Beach in the United States and is currently holding positions in Olongapo City with regards to Disaster Management, Emergency Medical Services, and other programs. 

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