DON’T LET TOBACCO TAKE YOUR BREATH AWAY CHOOSE HEALTH NOT TOBACCO 31 MAY WORLD NO TOBACCO DAY #NoTobacco WHO/NMH/PND/2019.3 © World Health Organization 2019. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence. 31 MAY WORLD NO TOBACCO DAY CHOOSE HEALTH NOT TOBACCO TOBACCO KILLS ONE PERSON EVERY FOUR SECONDS TOBACCO IS DEADLY IN ANY FORM AND THREATENS THE LUNG HEALTH OF EVERYONE EXPOSED TO IT. TOBACCO KILLS ONE PERSON EVERY 4 SECONDS (1 ). Newer tobacco products contain chemicals similar to those in traditional tobacco products and are likewise harmful to health. Respiratory diseases are among the leading causes of death globally, and tobacco is a major risk factor (2). The millions of deaths caused by tobacco-related respiratory disease are distressing, but even more distressing is the tremendous suffering caused by these illnesses, the debilitating effects of which affect the quality of life of people of all ages, in all regions of the globe. 56.9 MILLION ANNUAL DEATHS 8 MILLION DEATHS caused by tobacco from all causes 1 MILLIONDEATHS due to second-hand smoke exposure #NoTobacco WHO | DON’T LET TOBACCO TAKE YOUR BREATH AWAYWHO | DON’T LET TOBACCO TAKE YOUR BREATH AWAY 32 MILLION DEATHS caused by tobacco every year 8 MILLION DEATHS due to second -hand smoke exposure 1 HOW DOES TOBACCO TAKE YOUR BREATH AWAY? WITH JUST A SINGLE BREATH, THE HUNDREDS OF TOXINS IN TOBACCO SMOKE BEGIN DAMAGING THE LUNGS (6 ). When tobacco smoke is inhaled, the structures that sweep mucus and dirt out of your airways are paralysed, allowing the poisonous substances in tobacco smoke to make their way into the lungs more easily. The harmful effects of tobacco smoke on the lungs are almost immediate (6 ). Tobacco smoke causes reduced lung function and breathlessness due to the swelling of airways and build-up of mucus in the lungs. The immediate respiratory symptoms are just part of the damage tobacco does to the lungs. TOBACCO EXPOSURE IS A THREAT TO LUNG HEALTH FOR EVERYONE – NOT JUST SMOKERS TOBACCO SMOKE CONTRIBUTES TO INDOOR AIR POLLUTION, WHICH IS A MAJOR THREAT TO LUNG HEALTH. EVERY YEAR, OVER 1 MILLION DEATHS GLOBALLY ARE CAUSED BY SECOND-HAND SMOKE (1 ). Second-hand smoke is smoke emitted from the burning end of a cigarette or from other smoked tobacco products, usually in combination with smoke exhaled by the smoker. Tobacco smoking and exposure to second-hand smoke are major risk factors for lung cancer, chronic obstructive pulmonary disease (COPD), tuberculosis (TB) and asthma. Before they even learn to walk, children may begin suffering the effects of exposure to tobacco smoke (3). Infants born to mothers who smoke, or to women who are exposed to second-hand smoke during pregnancy, are likely to suffer reduced lung growth and function (4). Chemicals found in tobacco smoke during critical stages of development in the womb have long-lasting, damaging effects on the lungs. Smokers’ children suffer reduced lung function, which continues to affect them in the form of chronic respiratory disorders in adulthood. Adolescents who smoke are more likely to suffer chronic respiratory disorders and risk permanently damaging their lungs. The lungs continue to grow well into adulthood, but inhaling the toxins found in tobacco smoke slows this process and causes potentially irreversible lung damage (5 ). TOBACCO CONTROL MUST BE A GLOBAL PRIORITY TOBACCO KILLS OVER 8 MILLION PEOPLE EVERY YEAR, DESPITE A STEADY REDUCTION IN TOBACCO USE GLOBALLY (1 ). Between 2000 and 2016, current tobacco smoking prevalence rates declined from 27% to 20%. However, the pace of action to reduce tobacco demand and related death and disease is lagging behind global and national commitments to reduce tobacco use by 30% by 2025 (7 ). If the trend continues, the world will achieve only a 22% reduction by 2025 (7 ). WHO | DON’T LET TOBACCO TAKE YOUR BREATH AWAYWHO | DON’T LET TOBACCO TAKE YOUR BREATH AWAY 54 ASTHMA SCHOOL-AGED CHILDREN OF SMOKERS ARE AT RISK OF DEVELOPING ASTHMA AND/OR THEIR ASTHMA GETTING WORSE. CHILDHOOD ASTHMA IS IRREVERSIBLE AND CONTRIBUTES TO MISSED SCHOOL-DAYS, DISRUPTED SLEEP AND RESTRICTED PLAY. Asthma is a chronic disease of the air passages to the lungs, which causes inflammation and recurrent attacks of breathlessness and wheezing (20 ). WHO estimates that 235 million people currently suffer from asthma. Inhaling tobacco smoke is one of the major triggers for asthma to develop and/or worsen (20). In people living with asthma, tobacco smoking further restricts activity, contributes to work disability and increases the risk of severe asthma requiring emergency care. Around one in nine asthma deaths can be attributed to tobacco smoking (21). Patients with asthma can control their asthma more effectively if they quit tobacco. TUBERCULOSIS LUNG CANCER TB is the top infectious killer in the world. In 2017, 1.6 million people lost their lives because of TB, and 10 million people fell ill with the disease (8). It primarily affects the lungs, and causes infected people to cough up blood and experience severe chest pain (9 ). The bacterium that causes TB (M. tuberculosis) enters the body and establishes an infection. However, this infection does not necessarily develop into active disease – a state called latent TB infection. Latent TB may develop into active disease at any time, particularly when the immune system is weakened. About one quarter of the world’s population has latent TB, placing them at risk of developing the active disease (9 ). Smoking substantially increases the risk of TB and death from TB. More than 20% of global TB incidence may be attributable to tobacco (10 ). TOBACCO SMOKING MORE THAN DOUBLES THE RISK OF TRANSFORMING TB FROM A LATENT STATE TO THE ACTIVE DISEASE (11 ). Exposure to second-hand smoke also increases the risk of progression from latent TB infection to active disease. If the disease is not treated appropriately, people with TB can die from respiratory failure. Tuberculosis patients are more likely to achieve better treatment outcomes by quitting tobacco use. GLOBALLY, 1.8 MILLION DEATHS ARE CAUSED BY LUNG CANCER ANNUALLY (12 ). Tobacco smoking is the most common cause of lung cancer, causing roughly 1.2 million lung cancer deaths every year (12). Smokers are up to 22 times more likely to develop lung cancer in their lifetime, compared with non-smokers (13-18 ). Non-smokers exposed to second-hand smoke at home or in the workplace have a 30% higher risk of developing lung cancer (3, 19). After 10 years free of tobacco, the risk of lung cancer is reduced to about half that of a smoker (4 ). 2x higher risk for smokers asthma attack asthma normal 22x more likely for smokers CHRONIC OBSTRUCTIVE PULMONARY DISEASE Chronic obstructive pulmonary disease (COPD) is a lung disease that causes episodes of breathlessness, coughing and mucus production. These episodes are seriously disabling; they can last from several days to several months, and sometimes result in death (22 ). In 2016, it was estimated that over 251 million people live with COPD (22). Tobacco smoking is the most important risk factor for COPD, causing swelling and rupturing of the air sacs in the lungs, which reduces the lung’s capacity to take in oxygen and expel carbon dioxide (23). It also causes the build-up of purulent mucus in the lungs, resulting in a painful cough and agonizing breathing difficulties (24). One in five smokers will develop COPD in their lifetime (25), and almost half of COPD deaths are attributable to smoking (21). Adults who were exposed to second-hand smoke during childhood, and had frequent infections of the lower respiratory tract as a result, are at risk of developing COPD. People who started smoking in their youth or adolescence are especially susceptible to developing COPD as a result of reduced lung growth and function (26). Most cases of COPD are preventable by avoidance or early cessation of tobacco smoking. Patients with COPD who stop smoking regain more lung function and suffer fewer long-term effects. WHO | DON’T LET TOBACCO TAKE YOUR BREATH AWAYWHO | DON’T LET TOBACCO TAKE YOUR BREATH AWAY 76 WEEKS 2 YEARS 10 Scan me WORLD HEALTH ORGANIZATION RESPONSE No level of exposure to tobacco smoke is risk-free. The best measure to prevent respiratory disease and improve lung health globally is to reduce tobacco use and exposure to tobacco smoke. The WHO Framework Convention on Tobacco Control (WHO FCTC) provides a strong, concerted response to the global tobacco epidemic and its enormous health, social, environmental and economic costs (27). It also gives the Parties to the Convention the necessary foundation and framework – both legal and technical – to enact comprehensive, effective tobacco control measures covering all sectors of government. To help countries implement the WHO FCTC, WHO introduced the MPOWER technical package, which combines policy change with increased public awareness, in line with the key demand reduction measures of the Convention. Key strategies in this approach include creating smoke-free indoor public spaces, workplaces and public transport, banning tobacco advertising, promotion and sponsorship, significantly increasing taxes on tobacco products, requiring large pictorial health warnings on all tobacco products, supporting hard-hitting mass media campaigns, monitoring tobacco use and prevention policies, and offering tobacco users help to quit. Several organizations and networks, including the Global Alliance against Chronic Respiratory Diseases (GARD), contribute to WHO’s global work to prevent and control chronic respiratory diseases. GARD is a voluntary group of organizations, institutions and agencies that work together to assess needs, increase public awareness, advocate for action and formulate and promote policy to improve global lung health. IT’S NEVER TOO LATE TO QUIT Tobacco cessation saves lives and is a key element of the MPOWER measures, in line with Article 14 of the WHO FCTC. Quitting tobacco use has the potential to reverse some, but not all, of the damage done by tobacco smoke to the lungs. Quitting as soon as possible is therefore essential to prevent the onset of chronic lung disease, which is potentially irreversible once it has developed. Lung function improves within just two weeks of quitting tobacco use (4 ). Quitting smoking after a diagnosis of lung disease is associated with better treatment outcomes and improved quality of life. BRIEF ADVICE FOR TOBACCO CESSATION provided by health-care professionals as part of their routine practice is an essential intervention for prevention and management of lung diseases in primary care. Between 2007 and 2016, comprehensive tobacco cessation services were made available to about 28% of the world’s population across 17 countries. If they were adopted by all health-care providers, these interventions could reach a large number of tobacco users and encourage them to quit. Supporting TB patients’ efforts to quit tobacco is also important to the success of any TB control programme. Effective cessation strategies include the following: WHO | DON’T LET TOBACCO TAKE YOUR BREATH AWAYWHO | DON’T LET TOBACCO TAKE YOUR BREATH AWAY 98 Scannez-moi TOLL-FREE QUITLINES are convenient, population-based methods for giving tobacco users access to intensive behavioural counselling. Tobacco users increase their absolute quit rate by 4% using quitlines, and this rate can be MOBILE PHONE-BASED TOBACCO CESSATION programmes, such as the Be He@lthy Be Mobile mTobaccoCessation programme, reach a wide population of users with personalized support through mobile text messaging. These programmes help tobacco users to quit and are efficient and cost-effective. In India, the mTobaccoCessation programme achieved a self-reported 19% quit rate at 4–6 months of follow-up, compared with an estimated baseline population quit rate of 5% (28 ). The programme has been implemented in Burkina Faso, Costa Rica, India, the Philippines and Tunisia, but the content is readily available for local adaptation to any country context. 1. GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990- 2017: a systematic analysis for the Global Burden of Disease Study 2017. Seattle, WA: Institute for Health Metrics and Evaluation; 2018. 2. Forum of International Respiratory Societies. The global impact of respiratory disease, 2 nd edition. Sheffield: European Respiratory Society; 2017 (https://www. firsnet.org/images/publications/The_Global_Impact_ of_Respiratory_Disease.pdf, accessed 22 March 2019). 3. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2006. 4. The health consequences of smoking: 50 years of progress. A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014. 5. Preventing tobacco use among youth and young adults: a report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2012 6. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease: a report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2010. 7. Resolution WHA66.10. Follow-up to the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. In: Sixty-sixth World Health Assembly, Geneva, 20–27 May 2013. Resolutions and decisions, annexes. Geneva: World Health Organization; 2013 (WHA66/2013/REC/1; http://apps. who.int/gb/ebwha/pdf_files/WHA66-REC1/WHA66_2013_ REC1_complete.pdf, accessed 20 March 2019). 8. Global tuberculosis report 2018. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO. 9. Tuberculosis [fact sheet]. Geneva: World Health Organization; 2018 (https://www.who.int/news-room/ fact-sheets/detail/tuberculosis, accessed 20 March 2019). 10. Lönnroth K, Raviglione M. Global epidemiology of tuberculosis: prospects for control. Semin Respir Crit Care Med. 2008;29:481-91. 11. Lin HH, Ezzati M, Murray M. Tobacco smoke, indoor air pollution and tuberculosis: a systematic review and meta- analysis. PLoS Med. 2007;4(1):e20. 12. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. 13. Jayes L, Haslam PL, Gratziou CG, Powell P, Britton J, Vardavas C et al. SmokeHaz: systematic reviews and meta- analyses of the effects of smoking on respiratory health. Chest. 2016;150(1):164-79. 14. Pesch B, Kendzia B, Gustavsson P, Jöckel KH, Johnen G, Pohlabeln H et al. Cigarette smoking and lung cancer – relative risk estimates for the major histological types from a pooled analysis of case-control studies. Int J Cancer. 2012;131(5):1210-9. 15. O’Keeffe LM, Taylor G, Huxley RR, Mitchell P, Woodward M, Peters SAE. Smoking as a risk factor for lung cancer in women and men: a systematic review and meta-analysis. BMJ Open. 2018;8(10):e021611. 16. Jacob L, Freyn M, Kalder M, Dinas K, Kostev K. Impact of tobacco smoking on the risk of developing 25 different cancers in the UK: a retrospective study of 422,010 patients followed for up to 30 years. Oncotarget. 2018;9(25):17420-9. 17. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Tobacco smoke and involuntary smoking (IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol. 83). Lyon: International Agency for Research on Cancer; 2004. 18. Lee PN, Forey BA, Coombs KJ. Systematic review with meta-analysis of the epidemiological evidence in the 1900s relating smoking to lung cancer. BMC Cancer. 2012;12:385. 19. Öberg M, Woodward A, Jaakkola M, Peruga A, Prüss-Ustün A. Global estimate of the burden of disease from second- hand smoke. Geneva: World Health Organization; 2010. 20. Asthma [fact sheet]. Geneva: World Health Organization; 2017. 21. GBD Compare: Viz Hub. In: Institute for Health Metrics and Evaluation [website]. Seattle, WA: Institute for Health Metrics and Evaluation, University of Washington; 2019 (http://vizhub.healthdata.org/gbd-compare, accessed 20 March 2019). 22. Chronic obstructive pulmonary disease (COPD) [fact sheet]. Geneva: World Health Organization; 2017 (https://www.who. int/news-room/fact-sheets/detail/chronic-obstructive- pulmonary-disease-(copd), accessed 20 March 2019). 23. Janson C, Marks G, Buist S, Gnatiuc L, Gislason T, McBurnie MA et al. The impact of COPD on health status: findings from the BOLD study. Eur Respir J. 2013;42(6):1472-83. 24. Chronic obstructive pulmonary disease (COPD). In: American Lung Association [website]. Chicago, IL: American Lung Association; 2019 (https://www.lung.org/ lung-health-and-diseases/lung-disease-lookup/copd/ learn-about-copd/how-does-copd-affect-your.html, accessed 20 March 2019). 25. Terzikhan N, Verhamme KM, Hofman A, Stricker BH, Brusselle GG, Lahousse L. Prevalence and incidence of COPD in smokers and non-smokers: the Rotterdam Study. Eur J Epidemiol. 2016;31(8):785-92. 26. Chan JY, Stern DA, Guerra S, Wright AL, Morgan WJ, Martinez FD. Pneumonia in childhood and impaired lung function in adults: a longitudinal study. Pediatrics. 2015;135(4):607-16. 27. Resolution WHA56.1. WHO framework convention on tobacco control. In: Fifty-sixth World Health Assembly, Geneva, 19- 28 May 2003. Geneva: World Health Organization; 2008 (http://apps.who.int/gb/archive/pdf_files/WHA56/ea56r1. pdf, accessed 20 March 2019). 28. Gopinathan P, Kaur J, Joshi S, Prasad VM, Pujari S, Panda P et al. Self-reported quit rates and quit attempts among subscribers of a mobile text messaging-based tobacco cessation programme in India. BMJ Innovations. 2018;4:147-54. LIFE IS FULL OF BREATHTAKING MOMENTS DON’T LET TOBACCO BE ONE OF THEM Lung health is essential to achieving overall health and well-being, and tobacco smoke affects the lung health of both smokers and non-smokers throughout the world. The threat to lung health posed by tobacco use and exposure to tobacco smoke makes action for tobacco control relevant to many different categories of disease. If the commitment expressed in the United Nations Sustainable Development Goals – to reduce premature mortality from noncommunicable diseases by one third by 2030 – is to be achieved, tobacco control must be made a priority. scan me REFERENCES Photo credits: p. 4 © Chris Black / p. 8 © Sanjit Das / pp. 9 and 10 Curt Carnemark. WHO | DON’T LET TOBACCO TAKE YOUR BREATH AWAYWHO | DON’T LET TOBACCO TAKE YOUR BREATH AWAY 1110
DON’T LET TOBACCO TAKE YOUR BREATH AWAY CHOOSE HEALTH NOT TOBACCO 31 MAY WORLD NO TOBACCO DAY #NoTobacco WHO/NMH/PND/2019.3 © World Health Organization 2019. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence. 31 MAY WORLD NO TOBACCO DAY CHOOSE HEALTH NOT TOBACCO TOBACCO KILLS ONE PERSON EVERY FOUR SECONDS TOBACCO IS DEADLY IN ANY FORM AND THREATENS THE LUNG HEALTH OF EVERYONE EXPOSED TO IT. TOBACCO KILLS ONE PERSON EVERY 4 SECONDS (1 ). Newer tobacco products contain chemicals similar to those in traditional tobacco products and are likewise harmful to health. Respiratory diseases are among the leading causes of death globally, and tobacco is a major risk factor (2). The millions of deaths caused by tobacco-related respiratory disease are distressing, but even more distressing is the tremendous suffering caused by these illnesses, the debilitating effects of which affect the quality of life of people of all ages, in all regions of the globe. 56.9 MILLION ANNUAL DEATHS 8 MILLION DEATHS caused by tobacco from all causes 1 MILLIONDEATHS due to second-hand smoke exposure #NoTobacco WHO | DON’T LET TOBACCO TAKE YOUR BREATH AWAYWHO | DON’T LET TOBACCO TAKE YOUR BREATH AWAY 32 MILLION DEATHS caused by tobacco every year 8 MILLION DEATHS due to second -hand smoke exposure 1 HOW DOES TOBACCO TAKE YOUR BREATH AWAY? WITH JUST A SINGLE BREATH, THE HUNDREDS OF TOXINS IN TOBACCO SMOKE BEGIN DAMAGING THE LUNGS (6 ). When tobacco smoke is inhaled, the structures that sweep mucus and dirt out of your airways are paralysed, allowing the poisonous substances in tobacco smoke to make their way into the lungs more easily. The harmful effects of tobacco smoke on the lungs are almost immediate (6 ). Tobacco smoke causes reduced lung function and breathlessness due to the swelling of airways and build-up of mucus in the lungs. The immediate respiratory symptoms are just part of the damage tobacco does to the lungs. TOBACCO EXPOSURE IS A THREAT TO LUNG HEALTH FOR EVERYONE – NOT JUST SMOKERS TOBACCO SMOKE CONTRIBUTES TO INDOOR AIR POLLUTION, WHICH IS A MAJOR THREAT TO LUNG HEALTH. EVERY YEAR, OVER 1 MILLION DEATHS GLOBALLY ARE CAUSED BY SECOND-HAND SMOKE (1 ). Second-hand smoke is smoke emitted from the burning end of a cigarette or from other smoked tobacco products, usually in combination with smoke exhaled by the smoker. Tobacco smoking and exposure to second-hand smoke are major risk factors for lung cancer, chronic obstructive pulmonary disease (COPD), tuberculosis (TB) and asthma. Before they even learn to walk, children may begin suffering the effects of exposure to tobacco smoke (3). Infants born to mothers who smoke, or to women who are exposed to second-hand smoke during pregnancy, are likely to suffer reduced lung growth and function (4). Chemicals found in tobacco smoke during critical stages of development in the womb have long-lasting, damaging effects on the lungs. Smokers’ children suffer reduced lung function, which continues to affect them in the form of chronic respiratory disorders in adulthood. Adolescents who smoke are more likely to suffer chronic respiratory disorders and risk permanently damaging their lungs. The lungs continue to grow well into adulthood, but inhaling the toxins found in tobacco smoke slows this process and causes potentially irreversible lung damage (5 ). TOBACCO CONTROL MUST BE A GLOBAL PRIORITY TOBACCO KILLS OVER 8 MILLION PEOPLE EVERY YEAR, DESPITE A STEADY REDUCTION IN TOBACCO USE GLOBALLY (1 ). Between 2000 and 2016, current tobacco smoking prevalence rates declined from 27% to 20%. However, the pace of action to reduce tobacco demand and related death and disease is lagging behind global and national commitments to reduce tobacco use by 30% by 2025 (7 ). If the trend continues, the world will achieve only a 22% reduction by 2025 (7 ). WHO | DON’T LET TOBACCO TAKE YOUR BREATH AWAYWHO | DON’T LET TOBACCO TAKE YOUR BREATH AWAY 54 ASTHMA SCHOOL-AGED CHILDREN OF SMOKERS ARE AT RISK OF DEVELOPING ASTHMA AND/OR THEIR ASTHMA GETTING WORSE. CHILDHOOD ASTHMA IS IRREVERSIBLE AND CONTRIBUTES TO MISSED SCHOOL-DAYS, DISRUPTED SLEEP AND RESTRICTED PLAY. Asthma is a chronic disease of the air passages to the lungs, which causes inflammation and recurrent attacks of breathlessness and wheezing (20 ). WHO estimates that 235 million people currently suffer from asthma. Inhaling tobacco smoke is one of the major triggers for asthma to develop and/or worsen (20). In people living with asthma, tobacco smoking further restricts activity, contributes to work disability and increases the risk of severe asthma requiring emergency care. Around one in nine asthma deaths can be attributed to tobacco smoking (21). Patients with asthma can control their asthma more effectively if they quit tobacco. TUBERCULOSIS LUNG CANCER TB is the top infectious killer in the world. In 2017, 1.6 million people lost their lives because of TB, and 10 million people fell ill with the disease (8). It primarily affects the lungs, and causes infected people to cough up blood and experience severe chest pain (9 ). The bacterium that causes TB (M. tuberculosis) enters the body and establishes an infection. However, this infection does not necessarily develop into active disease – a state called latent TB infection. Latent TB may develop into active disease at any time, particularly when the immune system is weakened. About one quarter of the world’s population has latent TB, placing them at risk of developing the active disease (9 ). Smoking substantially increases the risk of TB and death from TB. More than 20% of global TB incidence may be attributable to tobacco (10 ). TOBACCO SMOKING MORE THAN DOUBLES THE RISK OF TRANSFORMING TB FROM A LATENT STATE TO THE ACTIVE DISEASE (11 ). Exposure to second-hand smoke also increases the risk of progression from latent TB infection to active disease. If the disease is not treated appropriately, people with TB can die from respiratory failure. Tuberculosis patients are more likely to achieve better treatment outcomes by quitting tobacco use. GLOBALLY, 1.8 MILLION DEATHS ARE CAUSED BY LUNG CANCER ANNUALLY (12 ). Tobacco smoking is the most common cause of lung cancer, causing roughly 1.2 million lung cancer deaths every year (12). Smokers are up to 22 times more likely to develop lung cancer in their lifetime, compared with non-smokers (13-18 ). Non-smokers exposed to second-hand smoke at home or in the workplace have a 30% higher risk of developing lung cancer (3, 19). After 10 years free of tobacco, the risk of lung cancer is reduced to about half that of a smoker (4 ). 2x higher risk for smokers asthma attack asthma normal 22x more likely for smokers CHRONIC OBSTRUCTIVE PULMONARY DISEASE Chronic obstructive pulmonary disease (COPD) is a lung disease that causes episodes of breathlessness, coughing and mucus production. These episodes are seriously disabling; they can last from several days to several months, and sometimes result in death (22 ). In 2016, it was estimated that over 251 million people live with COPD (22). Tobacco smoking is the most important risk factor for COPD, causing swelling and rupturing of the air sacs in the lungs, which reduces the lung’s capacity to take in oxygen and expel carbon dioxide (23). It also causes the build-up of purulent mucus in the lungs, resulting in a painful cough and agonizing breathing difficulties (24). One in five smokers will develop COPD in their lifetime (25), and almost half of COPD deaths are attributable to smoking (21). Adults who were exposed to second-hand smoke during childhood, and had frequent infections of the lower respiratory tract as a result, are at risk of developing COPD. People who started smoking in their youth or adolescence are especially susceptible to developing COPD as a result of reduced lung growth and function (26). Most cases of COPD are preventable by avoidance or early cessation of tobacco smoking. Patients with COPD who stop smoking regain more lung function and suffer fewer long-term effects. WHO | DON’T LET TOBACCO TAKE YOUR BREATH AWAYWHO | DON’T LET TOBACCO TAKE YOUR BREATH AWAY 76 WEEKS 2 YEARS 10 Scan me WORLD HEALTH ORGANIZATION RESPONSE No level of exposure to tobacco smoke is risk-free. The best measure to prevent respiratory disease and improve lung health globally is to reduce tobacco use and exposure to tobacco smoke. The WHO Framework Convention on Tobacco Control (WHO FCTC) provides a strong, concerted response to the global tobacco epidemic and its enormous health, social, environmental and economic costs (27). It also gives the Parties to the Convention the necessary foundation and framework – both legal and technical – to enact comprehensive, effective tobacco control measures covering all sectors of government. To help countries implement the WHO FCTC, WHO introduced the MPOWER technical package, which combines policy change with increased public awareness, in line with the key demand reduction measures of the Convention. Key strategies in this approach include creating smoke-free indoor public spaces, workplaces and public transport, banning tobacco advertising, promotion and sponsorship, significantly increasing taxes on tobacco products, requiring large pictorial health warnings on all tobacco products, supporting hard-hitting mass media campaigns, monitoring tobacco use and prevention policies, and offering tobacco users help to quit. Several organizations and networks, including the Global Alliance against Chronic Respiratory Diseases (GARD), contribute to WHO’s global work to prevent and control chronic respiratory diseases. GARD is a voluntary group of organizations, institutions and agencies that work together to assess needs, increase public awareness, advocate for action and formulate and promote policy to improve global lung health. IT’S NEVER TOO LATE TO QUIT Tobacco cessation saves lives and is a key element of the MPOWER measures, in line with Article 14 of the WHO FCTC. Quitting tobacco use has the potential to reverse some, but not all, of the damage done by tobacco smoke to the lungs. Quitting as soon as possible is therefore essential to prevent the onset of chronic lung disease, which is potentially irreversible once it has developed. Lung function improves within just two weeks of quitting tobacco use (4 ). Quitting smoking after a diagnosis of lung disease is associated with better treatment outcomes and improved quality of life. BRIEF ADVICE FOR TOBACCO CESSATION provided by health-care professionals as part of their routine practice is an essential intervention for prevention and management of lung diseases in primary care. Between 2007 and 2016, comprehensive tobacco cessation services were made available to about 28% of the world’s population across 17 countries. If they were adopted by all health-care providers, these interventions could reach a large number of tobacco users and encourage them to quit. Supporting TB patients’ efforts to quit tobacco is also important to the success of any TB control programme. Effective cessation strategies include the following: WHO | DON’T LET TOBACCO TAKE YOUR BREATH AWAYWHO | DON’T LET TOBACCO TAKE YOUR BREATH AWAY 98 Scannez-moi TOLL-FREE QUITLINES are convenient, population-based methods for giving tobacco users access to intensive behavioural counselling. Tobacco users increase their absolute quit rate by 4% using quitlines, and this rate can be MOBILE PHONE-BASED TOBACCO CESSATION programmes, such as the Be He@lthy Be Mobile mTobaccoCessation programme, reach a wide population of users with personalized support through mobile text messaging. These programmes help tobacco users to quit and are efficient and cost-effective. In India, the mTobaccoCessation programme achieved a self-reported 19% quit rate at 4–6 months of follow-up, compared with an estimated baseline population quit rate of 5% (28 ). The programme has been implemented in Burkina Faso, Costa Rica, India, the Philippines and Tunisia, but the content is readily available for local adaptation to any country context. 1. GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990- 2017: a systematic analysis for the Global Burden of Disease Study 2017. Seattle, WA: Institute for Health Metrics and Evaluation; 2018. 2. Forum of International Respiratory Societies. The global impact of respiratory disease, 2 nd edition. Sheffield: European Respiratory Society; 2017 (https://www. firsnet.org/images/publications/The_Global_Impact_ of_Respiratory_Disease.pdf, accessed 22 March 2019). 3. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2006. 4. The health consequences of smoking: 50 years of progress. A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014. 5. Preventing tobacco use among youth and young adults: a report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2012 6. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease: a report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2010. 7. Resolution WHA66.10. Follow-up to the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. In: Sixty-sixth World Health Assembly, Geneva, 20–27 May 2013. Resolutions and decisions, annexes. Geneva: World Health Organization; 2013 (WHA66/2013/REC/1; http://apps. who.int/gb/ebwha/pdf_files/WHA66-REC1/WHA66_2013_ REC1_complete.pdf, accessed 20 March 2019). 8. Global tuberculosis report 2018. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO. 9. Tuberculosis [fact sheet]. Geneva: World Health Organization; 2018 (https://www.who.int/news-room/ fact-sheets/detail/tuberculosis, accessed 20 March 2019). 10. Lönnroth K, Raviglione M. Global epidemiology of tuberculosis: prospects for control. Semin Respir Crit Care Med. 2008;29:481-91. 11. Lin HH, Ezzati M, Murray M. Tobacco smoke, indoor air pollution and tuberculosis: a systematic review and meta- analysis. PLoS Med. 2007;4(1):e20. 12. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. 13. Jayes L, Haslam PL, Gratziou CG, Powell P, Britton J, Vardavas C et al. SmokeHaz: systematic reviews and meta- analyses of the effects of smoking on respiratory health. Chest. 2016;150(1):164-79. 14. Pesch B, Kendzia B, Gustavsson P, Jöckel KH, Johnen G, Pohlabeln H et al. Cigarette smoking and lung cancer – relative risk estimates for the major histological types from a pooled analysis of case-control studies. Int J Cancer. 2012;131(5):1210-9. 15. O’Keeffe LM, Taylor G, Huxley RR, Mitchell P, Woodward M, Peters SAE. Smoking as a risk factor for lung cancer in women and men: a systematic review and meta-analysis. BMJ Open. 2018;8(10):e021611. 16. Jacob L, Freyn M, Kalder M, Dinas K, Kostev K. Impact of tobacco smoking on the risk of developing 25 different cancers in the UK: a retrospective study of 422,010 patients followed for up to 30 years. Oncotarget. 2018;9(25):17420-9. 17. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Tobacco smoke and involuntary smoking (IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol. 83). Lyon: International Agency for Research on Cancer; 2004. 18. Lee PN, Forey BA, Coombs KJ. Systematic review with meta-analysis of the epidemiological evidence in the 1900s relating smoking to lung cancer. BMC Cancer. 2012;12:385. 19. Öberg M, Woodward A, Jaakkola M, Peruga A, Prüss-Ustün A. Global estimate of the burden of disease from second- hand smoke. Geneva: World Health Organization; 2010. 20. Asthma [fact sheet]. Geneva: World Health Organization; 2017. 21. GBD Compare: Viz Hub. In: Institute for Health Metrics and Evaluation [website]. Seattle, WA: Institute for Health Metrics and Evaluation, University of Washington; 2019 (http://vizhub.healthdata.org/gbd-compare, accessed 20 March 2019). 22. Chronic obstructive pulmonary disease (COPD) [fact sheet]. Geneva: World Health Organization; 2017 (https://www.who. int/news-room/fact-sheets/detail/chronic-obstructive- pulmonary-disease-(copd), accessed 20 March 2019). 23. Janson C, Marks G, Buist S, Gnatiuc L, Gislason T, McBurnie MA et al. The impact of COPD on health status: findings from the BOLD study. Eur Respir J. 2013;42(6):1472-83. 24. Chronic obstructive pulmonary disease (COPD). In: American Lung Association [website]. Chicago, IL: American Lung Association; 2019 (https://www.lung.org/ lung-health-and-diseases/lung-disease-lookup/copd/ learn-about-copd/how-does-copd-affect-your.html, accessed 20 March 2019). 25. Terzikhan N, Verhamme KM, Hofman A, Stricker BH, Brusselle GG, Lahousse L. Prevalence and incidence of COPD in smokers and non-smokers: the Rotterdam Study. Eur J Epidemiol. 2016;31(8):785-92. 26. Chan JY, Stern DA, Guerra S, Wright AL, Morgan WJ, Martinez FD. Pneumonia in childhood and impaired lung function in adults: a longitudinal study. Pediatrics. 2015;135(4):607-16. 27. Resolution WHA56.1. WHO framework convention on tobacco control. In: Fifty-sixth World Health Assembly, Geneva, 19- 28 May 2003. Geneva: World Health Organization; 2008 (http://apps.who.int/gb/archive/pdf_files/WHA56/ea56r1. pdf, accessed 20 March 2019). 28. Gopinathan P, Kaur J, Joshi S, Prasad VM, Pujari S, Panda P et al. Self-reported quit rates and quit attempts among subscribers of a mobile text messaging-based tobacco cessation programme in India. BMJ Innovations. 2018;4:147-54. LIFE IS FULL OF BREATHTAKING MOMENTS DON’T LET TOBACCO BE ONE OF THEM Lung health is essential to achieving overall health and well-being, and tobacco smoke affects the lung health of both smokers and non-smokers throughout the world. The threat to lung health posed by tobacco use and exposure to tobacco smoke makes action for tobacco control relevant to many different categories of disease. If the commitment expressed in the United Nations Sustainable Development Goals – to reduce premature mortality from noncommunicable diseases by one third by 2030 – is to be achieved, tobacco control must be made a priority. scan me REFERENCES Photo credits: p. 4 © Chris Black / p. 8 © Sanjit Das / pp. 9 and 10 Curt Carnemark. WHO | DON’T LET TOBACCO TAKE YOUR BREATH AWAYWHO | DON’T LET TOBACCO TAKE YOUR BREATH AWAY 1110
WHO/NMH/PND/2019.3 ©世界卫生组织 2019。部分版权保留。 作品署名-非商业性使用-相同方式共享的政府间组织3.0版本适用 于该作品 (CC BY-NC-SA 3.0 IGO)。 每4秒钟就有 1人因烟草死亡 选择健康 远离烟草 5月31日世界无烟日 任何形式的烟草都是致命的，并且威胁 到每个与其接触的人的肺部健康。每4秒钟 就有一人因烟草死亡(1)。 与传统烟草制品相比，新型烟草制品含有相似 的化学物质，同样对健康有害。呼吸系统疾病是全 球死亡的主要原因之一，而烟草是其主要的危险因 素(2)。烟草相关呼吸系统疾病造成的数百万例死 亡令人痛心，但更令人痛心的是这些疾病所造成的 巨大痛苦，它们对人体的伤害影响到全球所有地区 所有年龄段人群的生活质量。 5690 万人死亡 每年有 800 万人死亡 烟草导致 100 万人死亡 接触二手烟雾造成 #你有控吗# 世卫组织 | 不要让烟草夺去你的呼吸世卫组织 | 不要让烟草夺去你的呼吸 32 烟草如何 夺去你的呼吸？ 只需吸一口，烟草烟雾中的数百种毒 素就会开始损害肺部(6)。 当吸入烟草烟雾时，扫除呼吸道粘液和污垢的 结构会瘫痪，使烟草烟雾中的有毒物质更容易进入 肺部。 烟草烟雾对肺部的危害几乎是立竿见影的(6)。 由于呼吸道肿胀和肺部粘液积聚，烟草烟雾会导致 肺功能降低和呼吸困难。但即刻的呼吸道症状只是 烟草对肺部所造成损害的一部分。 接触烟草对每个人的肺部 健康都是一种威胁 不仅仅是对吸烟者 烟草烟雾引起室内空气污染，对肺部 健康造成重大威胁。每年，全球有100多万 人死于二手烟雾(1)。 二手烟雾是从卷烟燃烧端或其它吸用的烟草制 品排放的烟雾，通常与吸烟者呼出的烟雾混在一起。 吸烟和接触二手烟雾是导致肺癌、慢性阻塞性肺病、 结核病和哮喘的主要危险因素。 甚至在儿童学会走路之前，他们可能就会开始受 到接触烟草烟雾的影响(3)。吸烟的母亲或怀孕期间 接触二手烟雾的妇女所生的婴儿，可能会出现肺部发 育迟缓和肺功能低下(4)。在子宫内发育的关键阶段， 烟草烟雾中存在的化学物质会对肺部产生持久的破 坏性影响。吸烟者的子女肺功能低下，到成年期会以 慢性呼吸系统疾病的形式继续对他们造成影响。 吸烟的青少年更容易罹患慢性呼吸系统疾病， 并有可能造成永久性的肺部损害。肺部在成年期还 会继续发育，但吸入的烟草烟雾毒素会减缓这一过 程并可能导致不可逆转的肺损伤(5)。 烟草控制必须成为 全球重点工作 尽管烟草在全球范围内的使用正在逐 步减少，但烟草每年仍造成800多万人死亡 (1)。 在2000年至2016年期间，吸烟率从27%下降到 20%。然而，减少烟草需求及相关死亡和疾病的行 动速度却已经落后于全球和许多国家所做出的到 2025年将烟草使用降低30%的承诺(7)。如果这种趋 势继续下去，到2025年全世界仅将做到减少22%(7)。 万人死亡 烟草每年导致 800 接触二手烟雾造成 万人死亡 100 世卫组织 | 不要让烟草夺去你的呼吸世卫组织 | 不要让烟草夺去你的呼吸 54 哮喘 吸烟者的学龄子女面临发生哮喘和/ 或哮喘加重的风险。儿童期哮喘是不可逆 转的，会造成缺课、睡眠障碍和活动受限。 哮喘是肺部气道的慢性疾病，会导致炎症和反 复发作的呼吸困难和气喘(20)。世卫组织估计目前 有2.35亿人患有哮喘。吸入烟草烟雾是哮喘发生和/ 或恶化的主要诱因之一(20)。在哮喘患者中，吸烟会 进一步限制其活动，导致无法工作并增加需要急救 护理的严重哮喘风险。大约九分之一的哮喘死亡可 归因于吸烟(21)。如果戒烟，哮喘患者可以更有效 地控制哮喘。 结核病 肺癌 结核病是全球头号传染病杀手。2017年，全球 有160万人因结核病而丧生，共有1000万人患病(8)。 该病主要影响肺部，导致受感染的人咳血并感到严 重的胸痛(9)。导致结核病的细菌（结核分枝杆菌） 进入体内并产生感染。然而，这种感染并不一定会 发展成活动性疾病，却可以出现称为潜伏性结核感 染的状态。潜伏性结核病可在任何时候发展成活动 性疾病，特别是当免疫系统减弱时。世界上大约四 分之一的人口患有潜伏性结核病，从而面临发展成 活动性结核病的风险(9)。吸烟会大大增加感染结核 病和死于结核病的风险。全球结核病发病率的20% 以上可以归因于烟草(10)。 吸烟使结核病从潜伏状态转变为活动 性结核病的风险增加一倍以上(11)。 接触二手烟雾也会增加从潜伏性结核感染发展 成活动性结核病的风险。如果疾病得不到适当治疗， 结核病患者可能会死于呼吸衰竭。结核病患者更有可 能通过戒烟来获得较好的治疗效果。 在全球，肺癌每年导致180万人死亡 (12)。 吸烟是导致肺癌最普遍的原因，每年造成约120 万例肺癌死亡(12)。吸烟者比非吸烟者一生中患肺 癌的可能性要高出22倍(13-18)。在家中或工作场所 接触二手烟雾的非吸烟者患肺癌的风险要高出30% (3，19)。在戒烟10年后，肺癌的风险可降低到吸烟者 的一半左右(4)。 2倍 吸烟者的风险 是非吸烟者的 哮喘 发作 哮喘 正常 22倍 吸烟者患病的 可能性要高出 慢性阻塞性肺病 慢性阻塞性肺病是一种导致阵发性呼吸困难、 咳嗽和咳痰的肺病。这些症状可严重影响日常生活， 可以持续数天到数月，有时还会导致死亡(22)。2016 年，估计有超过2.51亿人罹患慢性阻塞性肺病(22)。 吸烟是慢性阻塞性肺病最主要的危险因素，导致肺 部气囊肿胀和破裂，从而降低肺部摄入氧气和排出 二氧化碳的能力(23)。该病还会引起肺部脓性粘液 积聚，导致疼痛的咳嗽和难以忍受的呼吸困难(24)。 每五个吸烟者中就有一人将在其一生中患上慢 性阻塞性肺病(25)，几乎半数的慢性阻塞性肺病死 亡归因于吸烟(21)。 成年人若在儿童时期接触二手烟雾并且因此经 常发生下呼吸道感染，则存在罹患慢性阻塞性肺病 的风险。在青年时期或青春期开始吸烟的人特别容 易因肺部发育和功能低下而发生慢性阻塞性肺病 (26)。大多数慢性阻塞性肺病病例可通过避免或尽 早停止吸烟来预防。戒烟的慢性阻塞性肺病患者可以 恢复较多的肺功能并可遭受相对较少的长期影响。 世卫组织 | 不要让烟草夺去你的呼吸世卫组织 | 不要让烟草夺去你的呼吸 76 世界卫生组织的 应对策略 接触烟草烟雾没有安全水平可言。预防呼吸系 统疾病和改善肺部健康的最佳措施就是减少烟草 使用和减少烟草烟雾的接触。《世界卫生组织烟草 控制框架公约》针对全球烟草流行及其所导致的巨 大的卫生、社会、环境和经济负担做出了强有力且一 致的应对(27)。它还为《公约》缔约方提供了必要的 基础和框架，包括在法律和技术两方面，以便制定 涵盖政府所有部门的全面、有效的烟草控制措施。 为了帮助各国实施《世界卫生组织烟草控制框架 公约》，世卫组织制定了MPOWER一揽子措施，其中 将政策变化与提高公众意识结合起来，并与《公约》 中减少需求的关键措施保持一致。其中的主要策略 包括创建无烟室内公共场所、工作场所和公共交通 工具，禁止烟草广告、促销和赞助，大幅增加对烟草 制品的税收，要求所有烟草制品上有大幅图形健康警 示，支持开展有力的大众媒体宣传活动，监测烟草使 用和预防政策，以及向烟草使用者提供戒烟帮助。 包括全球抗击慢性呼吸道疾病联盟（GARD）在 内的若干组织和网络对世卫组织预防和控制慢性呼 吸道疾病的全球工作做出了贡献。GARD是一个由不 同组织、机构和部门组成的自愿团体，以便共同努力 评估需求，提高公众意识，倡导采取行动，并制定和 促进改进全球肺部健康的政策。 戒烟永远都不晚 根据《世界卫生组织烟草控制框架公约》 第14条，戒烟可挽救生命，因此是MPOWER 措施的关键要素之一。戒烟虽然不能扭转烟 草烟雾对肺部造成的全部损害，但可以扭转 一部分损害。因此，尽快戒烟对于预防慢性 肺病的发生至关重要，因为慢性肺病一旦发 生就可能是不可逆转的。戒烟后仅两周内， 肺功能就有所改善(4)。在确诊肺病后戒烟， 有可能会改善治疗效果和提高生活质量。 简短戒烟干预由初级保健专业人员作 为常规惯例的一部分提供，是初级保健中预防 和管理肺病的必要干预措施。2007年至2016 年期间，17个国家中约占全球28%的人口获得 了全面的戒烟服务。 如果被所有卫生保健提供者采用，这些 干预措施可以接触到大量烟草使用者并鼓励 他们戒烟。支持结核病患者戒烟对任何结核 病控制工作的成功开展都非常重要。 有效的戒烟战略包括以下内容： 请扫描 2周 10年 世卫组织 | 不要让烟草夺去你的呼吸世卫组织 | 不要让烟草夺去你的呼吸 98 免费戒烟热线是基于广泛人群的非 常便捷的戒烟方法，为烟草使用者提供强化 的行为学咨询。 烟草使用者使用戒烟热线，可以使其完全 戒烟率提高4%。如果戒烟辅导员进行后续随 访，这一比率还可以进一步提高。 基于移动电话的戒烟项目，例如“Be He@lthy Be Mobile”移动戒烟项目，通过手 机短信向广大用户提供个性化支持。这些项 目帮助烟草使用者戒烟，并且高效且具有成 本效益。在印度4-6个月的随访中，移动戒烟 项目达到了19％的自我报告戒烟率，与之形 成对比的预估基线人群戒烟率仅为5% (28)。 该项目已在布基纳法索、哥斯达黎加、印度、 菲律宾和突尼斯实施，内容可根据国情随时 为当地进行调整。 生活充满了令人屏息的时刻 不要让烟草成为其中之一 肺部健康对于实现人类健康和福祉至关重要，而 烟草烟雾会影响全世界吸烟者和非吸烟者的肺部健 康。由于烟草使用和接触烟草烟雾对肺部健康造成威 胁，烟草控制对许多不同类别的疾病均会产生影响。 如果要实现联合国可持续发展目标中的承诺，即 到2030年将非传染性疾病导致的过早死亡减少三分 之一，就必须将烟草控制作为重点工作。 参考文献 Photo credits: p. 4 © Chris Black / p. 8 © Sanjit Das / pp. 9 and 10 Curt Carnemark. 1. 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Impact of tobacco smoking on the risk of developing 25 different cancers in the UK: a retrospective study of 422,010 patients followed for up to 30 years. Oncotarget. 2018;9(25):17420-9. 17. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Tobacco smoke and involuntary smoking (IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol. 83). Lyon: International Agency for Research on Cancer; 2004. 18. Lee PN, Forey BA, Coombs KJ. Systematic review with meta-analysis of the epidemiological evidence in the 1900s relating smoking to lung cancer. BMC Cancer. 2012;12:385. 19. Öberg M, Woodward A, Jaakkola M, Peruga A, Prüss-Ustün A. Global estimate of the burden of disease from second- hand smoke. Geneva: World Health Organization; 2010. 20. Asthma [fact sheet]. Geneva: World Health Organization; 2017. 21. GBD Compare: Viz Hub. In: Institute for Health Metrics and Evaluation [website]. 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Prevalence and incidence of COPD in smokers and non-smokers: the Rotterdam Study. Eur J Epidemiol. 2016;31(8):785-92. 26. Chan JY, Stern DA, Guerra S, Wright AL, Morgan WJ, Martinez FD. Pneumonia in childhood and impaired lung function in adults: a longitudinal study. Pediatrics. 2015;135(4):607-16. 27. Resolution WHA56.1. WHO framework convention on tobacco control. In: Fifty-sixth World Health Assembly, Geneva, 19- 28 May 2003. Geneva: World Health Organization; 2008 (http://apps.who.int/gb/archive/pdf_files/WHA56/ea56r1. pdf, accessed 20 March 2019). 28. Gopinathan P, Kaur J, Joshi S, Prasad VM, Pujari S, Panda P et al. Self-reported quit rates and quit attempts among subscribers of a mobile text messaging-based tobacco cessation programme in India. BMJ Innovations. 2018;4:147-54. 请扫描 世卫组织 | 不要让烟草夺去你的呼吸世卫组织 | 不要让烟草夺去你的呼吸 1110
13 أيار/مايو اليوم العالمي للامتناع عن تعاطي التبغ occaboToN# ملايين وفاة منها لا تجعل التبغ يحبس أنفاسك لا تجعل التبغ يحبس أنفاسك 32 OHW | OHW | 8 9.65 يقتل التبغ شخصا واحدا كل أربع ثوان التبغ قاتل في أي شكل من أشكاله ويهدد صحة رئة جميع المعرضين له. ويقتل التبغ شخصا واحدا كل 4 ثوان (1). ومنتجات التبغ الأحدث عهدا تحتوي على كيماويات مماثلة لتلك التي تحتويها منتجات التبغ التقليدية، وهي أيضًا تضر بالصحة. و أمراض الجهاز التنفسي من أبرز أسباب الوفاة عالميا، ويمثل التبغ أحد أبرز عوامل الخطر (2). ولئن كانت ملايين الوفيات الناجمة عن أمراض الجهاز التنفسي المرتبطة بالتبغ مفجعة، فالأكثر إفجاعا هو المعاناة الهائلة الناجمة عن هذه الأمراض، وآثارها المدمرة التي تؤثر على نوعية حياة البشر من جميع الأعمار وفي جميع مناطق العالم. مليون وفاة سنويا يتسبب التبغ في تقع مليون وفاة بسبب التعرض لدخان التبغ غير المباشر occaboToN# اختر صحتك، وليس التبغ 13 أيار/مايو اليوم العالمي للامتناع عن تعاطي التبغ 3.9102/DNP/HMN/OHW. حقوق محفوظة. هذا المصنف متاح بمقتضى الترخيص2019© منظمة الصحة العالميةلبعض ا . OGI 0.3 AS-CN-YB CC مليون وفاة تقع بسبب التعرض لدخان التبغ غير المباشر ملايين وفاة يتسبب فيها التبغ كل عام 8 لا تجعل التبغ يحبس أنفاسك لا تجعل التبغ يحبس أنفاسك 54 OHW | OHW | يساهم دخان التبغ في تلوث الهواء الداخلي، وهو ما يجعله يشكل تهديدا رئيسيا لصحة الرئة. وكل عام، يتسبب دخان التبغ غير المباشر في أكثر من مليون وفاة في العالم (1). يساهم دخان التبغ في تلوث الهواء الداخلي، وهو ما يجعله يشكل تهديدا رئيسيا لصحة الرئة. وكل عام، يتسبب دخان التبغ غير المباشر في أكثر من مليون وفاة في العالم (1). ودخان التبغ غير المباشر هو الدخان الذي ينبعث من الجزء المحترق في مقدمة السيجارة أو من غيرها من منتجات التبغ التي ُتدخَّ ن، وعادًة ما يكون ممزوجا بالدخان الذي ينفثه المدخِّ ن. تدخين التبغ والتعرض لدخان التبغ غير المباشر عاملا خطر رئيسيان ينذران بالإصابة بسرطان الرئة والانسداد الرئوي المزمن والسل والربو. قد يبدأ الأطفال، حتى قبل أن يتعلموا أن يخطوا خطواتهم الأولى، في المعاناة من آثار التعرض لدخان التبغ(3). مع أخذ َنَفس واحد، تبدأ مئات من السموم الموجودة في دخان التبغ في إتلاف رئتيك (6). فعندما ُيستنشق دخان التبغ، ُتصاب الهياكل التي تكنس المخاط والأوساخ من شعبك الهوائية بالشلل، وهو ما يسمح للمواد السامة الموجودة في دخان التبغ بأن تشق طريقها إلى الرئتين بسهولة أكبر. يقتل التبغ أكثر من 8 ملايين شخص كل عام، على الرغم من الانخفاض المطرد في تعاطي التبغ عالميا (1). بين عامي 0002 و 6102، انخفض معدل انتشار تدخين التبغ الحالي من %72 إلى %02. ومع ذلك، لا تزال وتيرة الإجراءات التي اتخذت للحد من الطلب على التبغ والوفيات ذات الصلة به دون مستوى الالتزامات العالمية والوطنية التي ُقِطعت للحد من تعاطي التبغ بنسبة %03 بحلول عام 5202 (7). و إذا استمر هذا الاتجاه، سيحقق العالم خفضا لن تزيد نسبته عن %22 بحلول عام 5202. التعرض للتبغ خطر يهدد صحة رئة الجميع - لا المدخنين وحدهم كيف يحبس التبغ أنفاسك حرفيا؟ يجب أن تحظى مكافحة التبغ بالأولوية عالميا والُرضع الذين يولدون لأمهات يدخن، أو لنساء يتعرضن لدخان التبغ غير المباشر أثناء الحمل، من المحتمل أن يعانوا من انخفاض في نمو الرئة ووظائفها (4). وإذ تترك المواد الكيميائية التي ُتوَجد في دخان التبغ خلال مراحل النمو الحرجة في الرحم آثارا طويلة الأمد ومدمرة على الرئتين. و يعاني أطفال المدخنين من الانخفاض في أداء وظيفة الرئة، وهو ما يستمر في التأثير عليهم في شكل اضطرابات مزمنة في الجهاز التنفسي في مرحلة البلوغ. المراهقون المدخنون أكثر عرضة للمعاناة من أمراض الجهاز التنفسي المزمنة ويخاطرون بإتلاف رئاتهم إتلافا لا علاج له. وتواصل الرئتان النمو جيدا في مرحلة البلوغ، ولكن استنشاق السموم الموجودة في دخان التبغ يؤدي إلى إبطاء هذه العملية ويسبب ضررا بالرئة يحتمل ألا ُيمكن علاجه (5). الآثار الضارة لدخان التبغ على الرئتين تكاد تحدث أثاراها فورا (6). ويتسبب دخان التبغ في الانخفاض في أداء وظيفة الرئة وُعسر التنفس بسبب تورم المسالك الهوائية وتراكم المخاط في الرئتين. وأعراض الجهاز التنفسي المباشرة ليست سوى جزء من الضرر الذي يحدثه التبغ في الرئتين. لا تجعل التبغ يحبس أنفاسك لا تجعل التبغ يحبس أنفاسك 76 OHW | OHW | نوبة الربو الربو زيادة المخاطر الطبيعي المحدقة بالمدخنين بمقدار الِضعف المدخنون أكثر عرضة للسرطان بمقدار 22 مرة سرطان الرئة الربوالُسّل مرض الانسداد الرئوي المزمن يسبب سرطان الرئة 8.1 مليون وفاة في العالم سنويا (21). دخان التبغ هو أكثر أسباب سرطان الرئة شيوعا، إذ يتسبب في نحو 2.1 مليون وفاة بسرطان الرئة سنويا (21). تدخين التبغ يزيد من خطر تحويل السل من الحالة الكامنة إلى حالة المرض النشط بأكثر من الِضعف (11). والتعرض لدخان التبغ غير المباشر يزيد أيضا من خطر تطور عدوى السل الكامنة لتصبح مرضا نشطا. وإذا لم ُيعالج المرض علاجا ملائما، فيمكن أن ُيتوفى المصابون به من جراء فشل الجهاز التنفسي. ويزيد احتمال تحقيق مرضى السل حصائل علاجية أفضل بالإقلاع عن تعاطي التبغ. الانسداد الرئوي المزمن مرض يسبب نوبات من ُعسر التنفس والسعال وإنتاج المخاط. وهذه النوبات تسبب تعطلا شديدا في أداء الوظائف؛ إذ يمكن أن تستمر من عدة أيام إلى عدة أشهر، وتؤدي في بعض الأحيان إلى الوفاة (22). وفي عام 6102، أشارت التقديرات إلى أن أكثر من 152 مليون شخص مصابون بمرض الانسداد الرئوي المزمن (32). وتدخين التبغ أهم عامل من عوامل الخطر المنذرة بالإصابة بالمرض، إذ يتسبب في التورم والتمزق في الأكياس الهوائية في الرئتين، وهو ما يحد من قدرة الرئة على امتصاص الأكسجين وطرد ثاني أكسيد الكربون (42). ويتسبب كذلك في تراكم المخاط القيحي في الرئتين، مما يؤدي إلى سعال مؤلم وصعوبات بالغة في التنفس (71). ُيصاب واحد من كل خمسة مدخنين بالانسداد الرئوي المزمن في حياته (52)، وُيمكن أن ُيعزى نحو نصف الوفيات الناجمة عنه إلى التدخين (12). أطفال المدخنين ممن هم في سن المدرسة معرضون لخطر الإصابة بالربو أو تدهور حالة إصابتهم به أو كليهما معا. والربو الذي ُيصيب الأطفال لا علاج له، وُيسهم في التغيب عن المدرسة، واضطراب النوم، وتقييد اللعب. الربو مرض مزمن يصيب مسالك الهواء إلى الرئتين، مما يسبب التهابا ونوبات متكررة من ُعسر التنفس والَصفير (02). وتفيد تقديرات منظمة الصحة العالمية أن 532 مليون شخص يعانون حاليا من الربو. واستنشاق دخان التبغ أحد المسببات الرئيسية لتطور الربو أو تدهور حالة المصابين به أو كليهما معا (02). وتزيد فرصة تعرض المدخنين للإصابة بسرطان الرئة في حياتهم بنحو 22 مرة، مقارنة بغير المدخنين (81-31). وغير المدخنين الذين يتعرضون لدخان التبغ غير المباشر في المنزل أو في مكان العمل تزيد مخاطر إصابتهم بسرطان الرئة بنسبة %03 (3، 91). وبعد 01 سنوات من التحرر من التبغ، يقل خطر الإصابة بسرطان الرئة إلى نحو نصف الخطر المحدق بالمدخن (4). الُسّل أكبر الأمراض القاتلة المعدية في العالم. وفي عام 7102، فقد 6.1 مليون شخص حياتهم بسبب الُسّل، وأصيب به عشرة ملايين شخص (8). ويؤثر الُسّل على الرئتين في المقام الأول، وُيسبب معاناة المصابين به من سعال مصحوب بالدم ومن آلام شديدة في الصدر (9). والبكتريا المسببة للسل (البكتريا المتفطرة الُمقرَّ حة) تدخل الجسم وتصيب بالعدوى. ومع ذلك، هذه العدوى لا تتطور بالضرورة لتصبح مرضا نشطا - وهي حالة ُيطلق عليها مصطلح عدوى السل الكامنة. والُسّل الكامن قد يتطور ليصبح مرضا نشطا في أي وقت، وخصوصا عندما ُيضَعف الجهاز المناعي. وربع سكان العالم تقريبا لديهم ُسّل كامن، وهو ما يجعلهم عرضة لخطر الإصابة بالمرض النشط (22). وُيؤدي التدخين إلى زيادة كبيرة في خطر الإصابة بالُسّل والوفاة الناجمة عنه. ُيمكن أن ُتعزى نسبة تفوق %02 من معدل الإصابة بالسل عالميا إلى التبغ (01). والبالغون الذين تعرضوا لدخان التبغ غير المباشر خلال مرحلة الطفولة، وأصيبوا بالتهابات متكررة في الجهاز التنفسي السفلي نتيجة لذلك، معرضون لخطر الإصابة بالمرض. أمَّ ا الأشخاص الذين بدؤوا التدخين في سن الشباب أو المراهقة، فهم معرضون بشكل خاص للإصابة بالمرض نتيجة للانخفاض في نمو الرئة وفي أداء وظيفتها (02). ومعظم حالات المرض يمكن الوقاية منها عن طريق تجنب تدخين التبغ أو الإقلاع عنه مبكرا. والمرضى الذين يعانون من المرض ويقلعون عن التدخين يستعيدون قدرا أكبر من وظيفة الرئة ويعانون من آثار أقل على المدى الطويل. وفي الأشخاص المصابين بالربو، ُيقيد تدخين التبغ ممارسة النشاط البدني، ويسهم في عدم القدرة على العمل ويزيد من خطر الإصابة بالربو الحاد الذي يتطلب الرعاية الطارئة. يمكن أن تعزى واحدة من كل تسع وفيات تقع نتيجًة للربو إلى تدخين التبغ (12). والمرضى المصابون بالربو يمكن أن يسيطروا على حالتهم بمزيد من الفاعلية إذا أقلعوا عن تعاطي التبغ. بعد زيادة في أداء أسبوعين وظيفة الرئة بعد 01 سنوات انخفاض في خطر الاصابة بسرطان الرئة إلى النصف امسح ضوئيا هنا لا تجعل التبغ يحبس أنفاسك لا تجعل التبغ يحبس أنفاسك 98 OHW | OHW | منظمة الصحة العالمية استجابة ما من مستوى من التعرض لدخان التبغ غير محفوف بالمخاطر. وأفضل مقياس للوقاية من أمراض الجهاز التنفسي وتحسين صحة الرئة عالميا هو الحد من تعاطي التبغ ومن التعرض لدخانه. وتوفر اتفاقية منظمة الصحة العالمية الإطارية بشأن مكافحة التبغ استجابة منسقة وقوية لوباء التبغ المستشري عالميا وما يترتب عليه من تكاليف صحية واجتماعية وبيئية واقتصادية هائلة (72). وتوفر للأطراف في الاتفاقية أيضا الأساس والإطار الضروريين -القانوني والتقني على السواء- لاتخاذ تدابير شاملة وفعالة لمكافحة التبغ بحيث تغطي جميع القطاعات الحكومية. ولمساعدة البلدان على تنفيذ اتفاقية المنظمة الإطارية، أطلقت المنظمة حزمة السياسات الست (REWOPM) التقنية، التي تجمع بين التغيير في السياسات والزيادة في توعية الجمهور، وذلك تمشيا مع تدابير خفض الطلب الرئيسية التي نصت عليها الاتفاقية. وتشمل الاستراتيجيات الرئيسية في هذا النهج منع التدخين في الأماكن العامة المغلقة وأماكن العمل ووسائل النقل العام، وحظر الإعلان عن التبغ والترويج له ورعايته، وزيادة الضرائب المفروضة على منتجات التبغ زيادة كبيرة، واشتراط وضع تحذيرات صحية كبيرة مصورة على جميع منتجات التبغ، ودعم الحملات الشديد اللهجة التي تشنها وسائل الإعلام ضده، ورصد تعاطي التبغ وسياسات الوقاية منه، وتقدم المساعدة لمتعاطي التبغ للإقلاع عن تعاطيه. الإقلاع عن تعاطي التبغ ينقذ الأرواح وهو عنصر أساسي في تدابير مجموعة السياسات الست، بما يتماشى مع المادة 41 من اتفاقية المنظمة الإطارية. ويمكن أن ُيعالج الإقلاع عن تعاطي التبغ بعضا من الأضرار التي يسببها دخان التبغ على الرئتين لا الأضرار كلها. لذلك، من الضروري للغاية الإقلاع عن التدخين في أقرب وقت ممكن للوقاية من ظهور أمراض الرئة المزمنة، التي يحتمل ألا ُيمكن علاجها بمجرد ظهورها. وتحدث زيادة في أداء وظيفة الرئة في غضون أسبوعين فقط من الإقلاع عن تعاطي التبغ (4). والإقلاع عن التدخين بعد انتهاء التشخيص إلى الإصابة بمرض في الرئة مرتبط بتحقيق حصائل علاجية أفضل وتحسين نوعية الحياة. وتساهم منظمات وشبكات عديدة، منها التحالف العالمي لمكافحة الأمراض التنفسية المزمنة، في الأعمال العالمية التي تنفذها المنظمة للوقاية من الأمراض التنفسية المزمنة ومكافحتها. والتحالف مجموعة تطوعية من المنظمات والمؤسسات والوكالات التي تعمل معا لتقييم الاحتياجات، وزيادة الوعي العام، والدعوة للعمل، ووضع وتعزيز السياسات الرامية إلى تحسين صحة الرئة على الصعيد العالمي. لا يفوت أوان الإقلاع عن التدخين أبدا ومن ضمن استراتيجيات الإقلاع الفعالة ما يلي : تقديم نصائح موجزة للإقلاع عن تعاطي التبغ النصائح التي يقدمها مهنيو الرعاية الصحية بوصفها جزءا من ممارسة أعمالهم الروتينية تدخٌل لا غنى عنه للوقاية من أمراض الرئة وتدبيرها علاجيا في الرعاية الصحية الأولية. وفي الفترة بين عامي 7002 و 6102، أتيحت لنحو %82 من سكان العالم خدمات شاملة للإقلاع عن تعاطي التبغ في 71 بلدا. ويمكن أن تصل تلك التدخلات، إذا اعتمدها جميع مقدمي الرعاية الصحية، إلى عدد كبير من متعاطي التبغ، وأن تشجيعهم على الإقلاع عن تعاطيه. ولدعم جهود مرضى السل للإقلاع عن تعاطي التبغ أهمية كذلك لإنجاح أي برنامج لمكافحة السل. انه ايئوض حسما | WHO | WHO 1011 كسافنأ سبحي غبتلا لعجت لا كسافنأ سبحي غبتلا لعجت لا 1. 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Photo credits: p. 4 © Chris Black / p. 8 © Sanjit Das / pp. 9 and 10 Curt Carnemark. علاقلإل ةصصخملا ةيناجملا لاصتلاا طوطخ يطاعتمل يلحملا عمتجملا دارفأ اهمدقي ةحيرم ةمدخ .ةفثكم ةيكولس ةروشم ىلع لوصحلا لجأ نم غبتلا فتاهلا ربع ةلماعلا غبتلا يطاعت نع علاقلإا جمارب لاوجلا Be He@lthy Be جمانرب لثم ،جماربلا كلت لصت نم ريبك ددع ىلإ ،Mobile mTobaccoCessation مهتاجايتحا دسل اممصم امعد مهيلإ مدقُتل ناكسلا دعاستو .ةيصنلا لاوجلا لئاسر للاخ نم ةيصخشلا نيخدتلا نع علاقلإا ىلع غبتلا يطاعتم جماربلا هذه جمانرب ققح ،دنهلا يفو .ةيدودرملاو ةءافكلاب مستتو نع يتاذ غلابإ لدعم mTobaccoCessation رهشأ 6 ىلإ 4 نم تحوارت ةرتف يف 19% غلب علاقلإا نع علاقلإل يساسلأا لدعملاب ةنراقم ،ةعباتملا نم ذفُن دقو .)28( 5% غلبي يذلا ناكسلا ىدل غبتلا يطاعت نيبلفلاو دنهلاو اكيراتسوكو وساف انيكروب يف جمانربلا اقفو ف َّيكُيل ةلوهسب حاتم نومضملا نكل ،سنوتو .دلب يلأ ةيلحملا فورظلل هجوب ةيفاعلاو ةحصلاب عتمتلا قيقحتل ةئرلا ةحص نع ىنغ لا ريغو نينخدملا نم لك ةئر ةحص ىلع غبتلا ناخد رثؤيو ،ماع ةئرلا ةحصب قدحملا ديدهتلا نإ .ملاعلا ءاحنأ عيمج يف نينخدملا تاءارجإ لعجي غبتلا ناخدل ضرعتلاو غبتلا يطاعت هببسي يذلا ضارملأا تائف نم ريثك ةحفاكم يف ةيمهأ تاذ غبتلا ةحفاكم فادهأ يف هنع برعُأ يذلا مازتللااب ءافولا ديرأ اذإو .ةفلتخملا نم دحلا يأ- ةدحتملا مملأا اهتعضو يتلا ةمادتسملا ةيمنتلا ثلثلا رادقمب ةيراسلا ريغ ضارملأا نع ةمجانلا ةركبملا تايفولا ةمئاق نمض غبتلا ةحفاكم عضوت نأ بجيف - 2030 ماع لولحب .تايولولأا ةبسنب مهعلاقإ لدعم نم نوديزي غبتلا وطاعتمو ةصصخملا ةيناجملا لاصتلاا طوطخ مادختساب 4% ىرجأ اذإ لدعملا اذه ةدايز نكميو ،هنع علاقلإل .ةعباتم تاملاكم نوراشتسملا سبحت يتلا تاظحلاب ةئيلم ةايحلا اهادحإ غبتلا لعجت لا سافنلأا عجارملا