Dr. Wajid Ali
Professor of Pulmonary and
Critical Care Medicine





Tobacco Related Statistics
• The tobacco industry sells six and a half trillion cigarettes worldwide
every year, according to a report by Very Well Mind, a health care
• According to the statistics of 2019, more than 40 million men and
women smoke in Pakistan.
• According to the World Health Organization, 8 million people
worldwide lose their lives every year due to tobacco use. The
government should take steps to make the young generation
• On April 25, 2019, according to a TV Channel report, tobacco is the
biggest silent killer in Pakistan. 438 people lose their lives every day
due to tobacco use.
• Every year more than 160,000 people die due to tobacco related
diseases in Pakistan.
• On May 1, 2019, the Pakistan Pediatrics Association said in its
research that an estimated 1,000 to 1,200 school-going children
between the ages of 6 and 16 in Pakistan use smoking daily.
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Tobacco Related Statistics
• In 2017, the consumption of cigarettes used in Pakistan was more than 70 billion.
• According to a report published in Daily Pakistan on June 9, 2020, the total
consumption of cigarettes in Pakistan in September 2018 was 80 billion per annum,
then during June 2019 it increased by 32%.
• According to the Global Youth Tobacco Survey 2013, two out of five smokers in
Pakistan started smoking before the age of 10.
• According to a report published in the journal August 25, 2020, a large number of
people worldwide die from heart disease.
• At least 12 Pakistanis die every hour of a heart attack and the biggest reason for this
is the increasing use of smoking among the youth of the country.
• Smoking causes people to develop heart disease as early as the age of 40.
• According to the WHO report, in 2018, Rs 192 billion was spent on diseases caused
by smoking, which is gradually increasing.
• Expenditure on smoking related to heart disease stood at Rs. 123 billion, which was
69% of the total economic cost of tobacco related diseases in Pakistan.
• Despite being a developing country, Pakistan is one of the 15 largest users of tobacco
in the world.
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Tobacco Related Statistics
Why should we be concerned
about smoking?
• Decreased oxygen to the heart and to other tissues in the body
• Decreased exercise tolerance
• Decreased HDL (good) cholesterol
• Increased blood pressure and heart rate
• Damage to cells that line coronary arteries and other blood vessels
• Increased risk of developing coronary artery disease and heart attack
• Increased risk of developing peripheral artery disease and stroke
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• Increased risk of developing lung cancer, throat cancer, urinary bladder cancer, chronic
asthma, chronic bronchitis and emphysema
• Increased risk of fatality in COVID-19 infection/other viral infections of lungs.
• Increased risk of developing diabetes
• Increased risk of developing a variety of other conditions including gum disease and
• Increase tendency for blood clotting
• Increased risk of recurrent coronary artery disease after bypass surgery
• Increased risk of becoming sick (especially among children: respiratory infections are
more common among children exposed to second-hand smoke)
Smoking is associated:
Effects of tobacco Smoking on the body
The effects of tobacco smoke on the respiratory
system include:
• Irritation of the trachea (windpipe) and larynx
(voice box)
• Reduced lung function and breathlessness due to
swelling and narrowing of the lung airways and
excess mucus in the lung passages
• Impairment of the lungs’ clearance system,
leading to the build-up of poisonous substances,
which results in lung irritation and damage
• Increased risk of lung infection and symptoms
such as coughing and wheezing
• Permanent damage to the air sacs of the lungs.
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Effects of tobacco smoking on the body
The effects of tobacco smoke on the circulatory system include:
•Raised blood pressure and heart rate
•Constriction (tightening) of blood vessels in the skin, resulting in a drop in skin temperature
•Less oxygen carried by the blood
•Increased number of red blood cells (Secondary Polycythemia)
•‘Stickier’ blood, which is more prone to clotting
•Damage to the lining of the arteries, which is thought to be a contributing factor to atherosclerosis (the build-up
of fatty deposits on the artery walls)
•Reduced blood flow to extremities (fingers and toes)
•Increased risk of stroke and heart attack due to blockages of the blood supply.
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Effects of tobacco smoking on the body
Effects of smoking on the immune system
•Greater susceptibility to infections such as pneumonia and influenza
•More severe and longer-lasting illnesses
•Higher case fatality rates in viral infections
•Lower levels of protective antioxidants (such as vitamin C), in the blood.
Effects of smoking on the musculoskeletal system
•Tightening of certain muscles
•Reduced bone density.

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Effects of tobacco smoking on the body
Effects of smoking on the sexual organs
•Lower sperm count
•Higher percentage of deformed sperm
•Genetic damage to sperm
•Impotence, which may be due to the effects of smoking on blood flow and damage to the blood
vessels of the penis.
Effects of tobacco smoke on the female body
•Reduced fertility
•Menstrual cycle irregularities or absence of menstruation
•Menopause reached one or two years earlier
•Increased risk of cancer of the cervix
•Greatly increased risk of stroke and heart attack if the smoker is aged over 35 years and taking the
oral contraceptive pill.
•Higher rate of neonatal/birth defects.
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Effects of tobacco smoking on
the body
Other effects of tobacco smoke on the body
•Irritation and inflammation of the stomach and
•Increased risk of painful ulcers along the
digestive tract
•Reduced ability to smell and taste
•Premature wrinkling of the skin
•Higher risk of blindness
•Gum disease (periodontitis).
Effects of other forms of tobacco use
•Oral and Tongue Cancer
•Non Healing Oral Ulcers
•Higher rate of Esophageal Cancer
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Effects of smoking on babies
The effects of maternal smoking on an unborn baby include:
•Increased risk of miscarriage, stillbirth and premature birth
•Low birth weight, which may have a lasting effect of the growth
and development of children. Low birth weight is associated
with an increased risk of heart disease, stroke, high blood
pressure, being overweight and diabetes in adulthood
•Increased risk of cleft palate and cleft lip
•Paternal smoking can also harm the fetus if the non-smoking
mother is exposed to second-hand smoke.
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Smoking Causes
How does cigarette smoke affect others?
•Cigarette smoke does not just affect smokers. When you smoke, the people
around you are also at risk for developing health problems, especially
children. Environmental tobacco smoke (also called passive smoke or
second-hand smoke) affects people who are frequently around smokers.
Second-hand smoke can cause chronic respiratory conditions, cancer and
heart disease.
•The American Heart Association estimates that each year, about 37,000 to
40,000 people die from heart and blood vessel disease caused by other
people’s smoke.
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The most damaging components of tobacco smoke are:
•Tar – this is the collective term for the various particles suspended in tobacco
smoke. The particles contain chemicals, including several cancer-causing
substances (carcinogens). Tar is sticky and brown, and stains teeth, fingernails
and lung tissue. Tar contains the carcinogen benzo(a)pyrene
•Carbon monoxide – this odourless gas is fatal in large doses because it takes the
place of oxygen in the blood. Each red blood cell contains a protein called
haemoglobin that transports oxygen molecules around the body. However,
carbon monoxide binds to haemoglobin better than oxygen. This means that less
oxygen reaches the brain, heart, muscles and other organs
•Hydrogen cyanide – the lungs contain tiny hairs (cilia) that help to clean the
lungs by moving foreign substances out. Hydrogen cyanide stops this lung
clearance system from working properly, which means the poisonous chemicals
in tobacco smoke can build up inside the lungs. Other chemicals in smoke that
damage the lungs include hydrocarbons, nitrous oxides, organic acids, phenols
and oxidising agents
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The most damaging components of tobacco smoke are:
•Free radicals – these highly reactive chemicals can damage the heart muscles and
blood vessels. They react with cholesterol, leading to the build-up of fatty
material on artery walls. Their actions lead to heart disease, stroke and blood
vessel disease
•Metals – tobacco smoke contains dangerous metals including arsenic, cadmium
and lead. Several of these metals are carcinogenic
•Radioactive compounds – tobacco smoke contains radioactive compounds that
are known to be carcinogenic
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Various Forms of Tobacco
• Cigarettes
• Cigars
• Pipes
• Hooka (Shisha)
• E-Cigarettes
• Chewable tobacco
• Pan & Gutka
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One hour Shisha Smoking
session equal to 100
cigarettes smoked
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What Are E-cigarettes?
• E-cigarettes are electronic devices that heat a liquid and produce an aerosol, or mix of
small particles in the air.
• E-cigarettes come in many shapes and sizes. Most have a battery, a heating element, and
a place to hold a liquid.
• Some e-cigarettes look like regular cigarettes, cigars, or pipes. Some look like USB flash
drives, pens, and other everyday items. Larger devices such as tank systems, or “mods,”
do not look like other tobacco products.
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• E-cigarettes are known by many different
names. They are sometimes called
“e-cigs,” “e-hookahs,” “mods,” “vape
pens,” “vapes,” “tank systems,” and
“electronic nicotine delivery systems
• Using an e-cigarette is sometimes called
“vaping” or “JUULing.”
Aren’t E-cigarettes Safer
Than Cigarettes?
• E-cigarettes expose users to fewer
harmful chemicals than burned
But burned cigarettes
are extraordinarily dangerous,
killing half of all people who smoke
• The use of any tobacco product,
including e-cigarettes, is unsafe for
young people.
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What Is in E-cigarette
• E-cigarette aerosol is NOT harmless “water vapor.”
• The e-cigarette aerosol that users breathe from the
device and exhale can contain harmful and potentially
harmful substances, including:
Ultrafine particles that can be inhaled deep into the
Flavorings such as diacetyl, a chemical linked to a
serious lung disease
Volatile organic compounds
Cancer-causing chemicals
Heavy metals such as nickel, tin, and lead1
The aerosol that users inhale and exhale from
e-cigarettes can expose both themselves and
bystanders to harmful substances.
It is difficult for consumers to know what e-cigarette
products contain. For example, some e-cigarettes
marketed as containing zero percent nicotine have
been found to contain nicotine
Smoking — Health Ef
Anti Smoking Campaigners
• Government agencies
• Academic institutions
• Professional associations
• Civil society organizations
• International institutions
• Developmental agencies
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Anti Smoking Campaigners
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Anti Smoking Campaigners
• M Monitor tobacco use
• P Protect people from tobacco use
• O Offer help to quit tobacco use
• W Warn about the dangers of tobacco
• E Enforce ban on advertising , promotion and
• R Raise taxes on tobacco products
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Tobacco Related Statistics
Anti Smoking Campaigners
Cancer or Death

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