World No-Tobacco Day 2022: Effects of tobacco on voice, medical and non-medical smoking cessation treatments

Tobacco smoke includes more than 7000 chemicals, many of these chemicals are carcinogenic. Ahead of World No-Tobacco Day 2022, doctors spill the beans on effects of tobacco on voice, health concerns and impact on oral health from smoking and medical and non-medical smoking cessation treatments

The Member States of the World Health Organization created World No-Tobacco Day in 1987 to draw global attention to the tobacco epidemic and the preventable death and disease it causes hence, it is annually observed around the globe on 31 May. Tobacco consumption has been linked to a variety of conditions, each more hazardous than the other and health experts insist that it is imperative to quit when there’s still time or else it may create unnecessary complications pertaining to health.

World No-Tobacco Day 2022: Effects of tobacco on voice, medical and non-medical smoking cessation treatments (Twitter/nitin_gadkari)

According to Dr Sanket Jain, Consultant Chest Physician - Pulmonary Medicines and Bronchoscopist at Masina Hospital, it so difficult to quit smoking because approximately 80% of smokers who attempt to quit on their own, relapse within the first month and only about 3% remain abstinent at 6 months. Other factors are that there is a high dependence to nicotine, occurrence of withdrawal effects and a lack of will power. Hence, what are patients looking for are decreased craving, none or reduction in withdrawal symptoms, improved health status and minimizing treatment side effects.

Effects of tobacco on voice:

In an interview with HT Lifestyle, Dr Prarthana Jagtap, Consultant, ENT surgeon at Global Hospital in Mumbai's Parel, shared, “Smoke from tobacco products such as cigarettes and cigars, has hundreds of chemicals in it. Those chemicals can irritate your vocal cords. Every time you inhale smoke, the smoke is going right past the vocal cords to get to your lungs. Any chemical that you inhale can lead to irritation, sore throat and increased mucus and cough.”

He added, “Smoking including electronic cigarettes can change voice characteristics by producing significant changes in the symmetry, amplitude and cycle of vocal cord as compared to non smokers. The only way to protect your voice is to stop smoking as soon as you can. Sounding like yourself again goes hand in hand with giving up smoking. You’ll usually see dramatic changes in just a few weeks however, it may take months for the vocal cord and laryngeal irritation to get better.”

Types of health concerns led by smoking:

• Chronic cough: The act of coughing causes the vocal cords to slam together to expel mucous,This cough increases vocal cord inflammation .

• Chronic Laryngitis: Inflammation is a result of the body’s immune system trying to eliminate tobacco smoke chemicals. This process leads to chronic laryngitis, which involves ongoing inflammation, vocal cord swelling, and often voice loss or hoarseness.

• Polyps: Smoking — together with acid reflux— can also cause growths on the vocal cords, which increase their density (polypoid corditis). “The polyps can cause voice changes, such as a deeper voice. It may even lead to difficulty in breathing with progressive increase in size.

• Cancer: Habitual smoking can lead to cancer. It can cause dysplasia, which is precancerous changes to the vocal cords cancer itself can also affect the oropharynx and the larynx .

Dr Pujan Parikh, Consultant, Pulmonary Medicine at Sir HN Reliance Foundation Hospital, explained, “Tobacco smoke includes more than 7000 chemicals, many of these chemicals are carcinogenic. Smoking related health consequences are broadly classified into pulmonary (related to lungs) and extrapulmonary. Pulmonary complications includes lung cancer, chronic obstructive pulmonary disease which includes chronic bronchitis and emphysema.”

He added, “Ischemic heart disease, hypertension, diabetes and stroke are some of the extrapulmonary complications. Apart from lung cancer smoking increases the risk of larynx, oesophageal, bladder cancer. Lung cancer is the leading cause of cancer deaths worldwide in men. Even passive smoking is harmful and increases risk of cancer. Smoking during pregnancy increases risk of miscarriage, birth defect, preterm birth and low birth weight.”

Commenting on the impact of smoking on oral heath, he cautioned, “Smoking increases risk of oral cancer, can lead to stained teeth, gum problems, losing teeth and tooth decay.”

Medical and non-medical smoking cessation treatments:

Suggesting steps to speed up the healing process, Dr Prarthana Jagtap recommended:

• Manage acid reflux and allergies.

• Stay hydrated.

Suggesting steps to quit smoking and start living, Dr Prarthana Jagtap advised:

• Take advantage of a tobacco helpline, which offers resources for quitting, including professional help from psychiatrists

• Chew gum or eat mints to combat the habitual nature of smoking.

• Talk to your doctor about smoking cessation medications, patches and gums.

• Motivate yourself to quit by considering the health risks and other negative effects.

Revealing the approach to smoking cessation, Dr Sanket Jain recommended:

1. Comprehensive approach - addresses all major aspects of tobacco addiction.

2. Both pharmacologic and non-pharmacologic.

3. Assess - Will power and motivation.

4. Behavioural therapy to combat conditioning.

5. Prescribing proper medication.

He listed the non-pharmacological intervention as:

1. Individual or group counselling is necessary to address the important role of conditioning in tobacco addiction.

2. Teach coping mechanisms for craving and withdrawal symptoms.

3. Self-help programs, telephone counseling, exercise programs.

Dr Sanket Jain explained about the coping mechanisms which includes the five Ds i.e. delay till the urge passes, distract yourself, drink water, deep breaths and discuss. He also encouraged first-line therapies like nicotine replacement therapy (transdermal patch, gum, nasal spray, inhaler, and lozenge), Bupropion - an atypical antidepressant, Varenicline- a partial agonist of α4β2 (nAchRs) and second-line therapies like Nortriptyline and Clonidine.