KATHMANDU: A report published by the World Health Organisation (WHO) in 2016, tobacco kills around six million people each year. More than five million of those deaths are the result of direct tobacco use, while more than 6,00,000 are the result of non-smokers being exposed to second-hand smoke. Further it shows that tobacco kills up to half of its users. And nearly 80 per cent of the world’s one billion smokers live in low- and middle-income countries. Nepal is no exception to smoking. Despite the Tobacco Product (Control and Regulation) Act, 2010 to reduce, control and regulate the import, production, sales, distribution and consumption of tobacco products, people smoke cigarettes, cigars, pipe kakkad, e-cigarettes and consume other tobacco products. Despite the act which prohibits people from smoking or consuming tobacco in public places, people are seen doing just that. This casual habit causes health hazards including cardiovascular diseases, lung cancer, chronic obstructive pulmonary disease (COPD) and stroke, among others. “There are chances for one to suffer from peptic ulcer, cancers in various organs such as mouth, larynx, oesophagus, and bladder among others,” informs Dr Deebya Raj Mishra, DM Trainee, Pulmonology, BP Koirala Institute of Health Sciences, Dharan. How is smoking harmful? The doctor answers, “Cigarette smoke contains thousands of chemicals. The tobacco has nicotine and burning it produces tar along with several toxic gases. Nicotine is highly addictive. It also has cancer-causing (carcinogenic) compounds,” adding, “That is why smokers are always under the risk of suffering from cancer be it the cancer of lungs or leukaemia — a group of different cancers of the blood cells.” There are more health risks apart from cancer, especially respiratory disease. As per him, smoke usually enters the respiratory tracts and damages the protective layer which as a result becomes the cause for respiratory diseases. Pneumonia is one of them — viral and bacterial pneumonia is quite common. “All such elements like nicotine in cigarettes are likely to decrease immunity of the cells in lungs. Defensive cells in lungs get destroyed and as a result the person is likely to suffer from pneumonia — it also affects the mucosa in the lungs. There is a chance of severe pneumonia in smokers,” he further elaborates. Heart diseases are likely to occur very early in them. “Peripheral vascular disease (PVD) is common in smokers. It is a blood circulation disorder which causes the blood vessels in heart and brain to narrow or block. And as a result there are chances for one to get heart attack or a stroke,” Dr Mishra says further informing, “When the arteries get blocked, there are chances for one to get gangrene. The limb then dies and must be amputated. Erectile dysfunction is also likely to occur due to lack of blood circulation. However, COPD and lung cancer are likely to occur when one smokes for a long time. The risk for the diseases depends upon the pack year. Pack year is calculated by multiplying the number of packets of cigarettes smoked per day by the number of years the person has smoked,” explains Dr Mishra. The risk for diseases varies according to the dose though it is not fixed. Women, smoking and bones If you are a female and smoke, then it is advisable that you stop right now as you are under high risk to suffer from osteoporosis and bone fracture. Nicotine and tar in tobacco do not let calcium get deposited in the body. There is a difficulty in absorption of calcium. Women are more susceptible to suffer from osteoporosis. The level of estrogen drops post-menopause and smoking usually speeds up the process. Though osteoporosis occurs in males too, women are prone to fracture risk, as per Dr Mishra. Smoking during pregnancy is risky. Women are likely to lose their pregnancy. Smoking can cause the baby to be born too early or to have a low birth weight. Heart defect is likely to occur in babies whose mothers smoke during pregnancy. Second-hand smoking “I do not smoke so I don’t need to worry.” No, this is not the attitude. And as per WHO, “Second-hand smoke is the smoke that fills restaurants, offices or other enclosed spaces when people burn tobacco products such as cigarettes, bidis and water-pipes.” In adults second-hand smoking causes heart and respiratory diseases along with lung cancer. In infants there is precipitation of asthma, infection, irritation et cetera. WHO further adds, “Second-hand smoke causes more than 6,00,000 premature deaths per year.” If you wish to remain healthy and make people in your surrounding healthy, then it is time for you to give up smoking. However, one needs to be determined to give up smoking. “One can chew gums or a candy if there is an urge to smoke,” suggests the doctor.