"E-cigarettes are not a healthy alternative." Expert on supporting addicts in quitting smoking

• May 31st is World No Tobacco Day. Prof. Piotr Jankowski talks about how to deal with a patient addicted to nicotine
• - Tobacco smoking is the second most common cause of death in Poland, right after hypertension, and the cause of the greatest number of years of healthy life lost - emphasizes the expert
• He points out that the role of family medicine is to prevent smoking and support smokers in quitting the addiction, but in fact every doctor has the obligation to recommend that patients stop smoking
• - E-cigarettes are definitely not a healthy alternative. The risk of asthma in e-cigarette users is about 20-30 percent higher, and the risk of heart attack is 70 percent higher - he points out

Health Market: May 31 is World No Tobacco Day. This is a good opportunity to talk about supporting addicts in quitting smoking. In the minds of Poles, smokers are mainly killed by cancer, while the list of tobacco-related diseases also includes many other diseases, including cardiology. What do the data on this topic indicate?

Prof. dr hab. n. med. Piotr Jankowski, internal medicine specialist, cardiologist, head of the Department of Internal Medicine and Gerontocardiology at the Medical Center for Postgraduate Education in Warsaw: Tobacco smoking is the second most common cause of death in Poland, right after hypertension, and the cause of the greatest number of years of healthy life lost. It is one of the main causes of disability, sick leave associated with reduced productivity and work efficiency.

Of all deaths caused by smoking, 48% are deaths from cancer, 35% from circulatory system diseases, and 12% from chronic lung diseases. In other words, the highest number of deaths caused by smoking are from cancer and circulatory system diseases.

Tobacco smoking, in addition to hypercholesterolemia, hypertension, diabetes and obesity, is also one of the main causes of heart attack, heart failure, coronary artery disease, stroke, cardiac arrhythmias, aortic aneurysms and many other health problems related to the heart and vessels.

Can we cure nicotine addiction?

It must be clearly admitted that tobacco addiction is a serious, fatal chronic disease, with relapses. People who have stopped smoking have a greater risk of returning to the addiction, for example after three months or after a year. This often happens during a social gathering attended by smokers. Crisis situations, which cause increased tension, also contribute to the relapse of the disease. However, modern medicine has tools that significantly increase the patient's chance of quitting smoking.

There are two effective methods of treating tobacco dependence syndrome. I mean behavioral treatment, most often, but not exclusively, performed by psychologists, and increasingly commonly used pharmacotherapy.

It can be in the form of tablets taken orally or nicotine replacement therapy, for example in the form of patches, chewing gum, nasal spray. Some preparations are available only by prescription, but there are also those that can be purchased without a prescription.

Medication alone, regardless of which one we reach for, will not solve all problems. They will not replace strong will or awareness of the health risks and consequences of smoking. However, they can significantly facilitate and increase the patient's chances of quitting smoking.

The role of primary care physicians is, among other things, to support smokers. "There are too few anti-smoking clinics"

Experts from various fields of medicine have formed the Health Without Tobacco Coalition. What does it do and what are its priorities?

The Coalition is relatively young, and its primary goal is to prevent the occurrence of tobacco-related diseases. This can be achieved in two ways. On the one hand, by working to prevent young people from smoking, and on the other - by spreading knowledge about the dangers of smoking and access to effective methods of treating nicotine addiction. And this is exactly what the Coalition does.

What role should primary care physicians play in the treatment of nicotine addiction?

We have 8 million smokers in Poland and the role of family medicine is to prevent smoking and support smokers in quitting the addiction, i.e. in treating nicotine addiction. No one can replace family doctors and community nurses in this (other medical professions can support).

It is hard to imagine that all smokers would be treated by anti-smoking clinics or hospitals. Yes, many smokers end up under the care of specialists and in hospitals due to various tobacco-related diseases - cancers, circulatory system diseases or lung diseases.

It is recommended that every doctor, regardless of the reason for which the patient comes to him, asks about the use of tobacco products. Smokers should be advised to stop smoking. It should be assessed whether the patient wants and is ready for this, and if not, an attempt should be made to convince him to give up the habit. If he decides, the patient should be helped using available treatment methods, which I mentioned earlier.

We have only a few anti-smoking clinics in Poland, and eight million people smoke cigarettes. Shouldn't there be more of them?

There really should be many more of them. Moreover, anti-smoking clinics should deal with the treatment of particularly difficult cases. Secondly, they should emanate their knowledge and experience, deal with the training of doctors, nurses and psychologists working in other units of the health care system.

It would be best if there was an anti-smoking clinic in every district. So that primary care physicians would have a place to refer particularly difficult patients, because just like in the case of every disease we deal with severe cases, among smokers there are people who are severely addicted, whose treatment requires specialist knowledge, skills and experience.

It is worth emphasizing that the majority of patients suffering from tobacco dependence syndrome, recently renamed nicotine addiction, can and should be treated by primary care physicians.

Is a hospital without cigarettes possible? Can patients, for example, in cardiology departments in Poland count on support in quitting smoking?

Of course it is possible. The fact is that severely addicted people can experience strong nicotine withdrawal symptoms during hospitalization, but modern medicine has effective methods that allow them to be reduced. Hospitalization due to a tobacco-related disease, and such are heart and vascular diseases, is a good opportunity to stop smoking.

Can the patient count on help from the hospital psychologist in this regard?

Good centers provide the patient with psychological support. Such a center is, for example, the Clinic of Internal Medicine and Gerontocardiology of the Center for Postgraduate Medical Education at the Prof. W. Orłowski Hospital in Warsaw, where every smoker can count on expert, professional help on site.

E-cigarettes? "Not a healthy alternative"

Will switching to vaping (e-cigarettes) and other forms of nicotine use, which are sometimes suggested to smokers as an alternative by advocates of harm reduction strategies, be a good solution for the patient? What does the latest research say about this?

It is certainly not a healthy alternative. Studies show that smoking electronic cigarettes is less harmful than smoking traditional cigarettes, but it is not harmless to health. Although the risk of tobacco-related diseases, such as bronchial asthma or heart attack, in the case of smoking e-cigarettes is slightly lower than in the case of traditional cigarettes, it is significantly higher than in non-smokers. For example, the risk of asthma in electronic cigarette users is about 20-30 percent higher, and the risk of heart attack is about 70 percent higher compared to non-smokers.

It must also be clearly stated that the removal of the image of harmful addiction from electronic cigarettes and tobacco heaters makes many young people reach for them, and then also for traditional forms of nicotine delivery. They become a gateway to the use of classic tobacco products. Therefore, they should not be promoted, and their use and attractiveness should be limited.

How then can we effectively counteract youth addiction to cigarettes and electronic forms of nicotine delivery?

First, the attractiveness of cigarettes should be limited, i.e. the use of flavoring or fragrance additives. It is also necessary to ensure that their appearance is not attractive, especially for youth and young adults. Third, access to them and the affordability of these products should be made more difficult.

Do you mean legislative solutions here?

Yes, and I think that legislative solutions should also make it more difficult to display nicotine products in stores and on the streets. There is no need for traditional cigarettes, e-cigarettes and heaters to be displayed in stores at checkouts, at the customer's eye level. They should be hidden under the counter and available when the customer asks for them. Marketing tricks used by retail chains and petrol stations should be counteracted.

At the same time, society, not only smokers, but also children and young people, must be made aware of how harmful smoking cigarettes and using their alternative forms are. In this regard, apart from health education in schools, professionals from various fields should be reached - sociologists, social psychologists, but also marketers and popular influencers, to reach every person at risk of addiction. And we must honestly say that every young person is at risk of addiction.

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