Tobacco use is a great individual and social health problem. A dependency is developing rapidly. Significant consequences are premature death and morbidity from coronary heart disease, lung cancer, chronic obstructive pulmonary disease (COPD) and other diseases. Smokers smoking cessation measures should be offered.

Tobacco use, even though it is in the US on the decline, is still playing an important role. Tobacco nicotine is used because of the pleasant effects of its main active ingredient. Nicotine can be toxic, and the combustion products of tobacco contain other substances that can lead to significant morbidity and mortality.

Tobacco use is a great individual and social health problem. A dependency is developing rapidly. Significant consequences are premature death and morbidity from coronary heart disease, lung cancer, chronic obstructive pulmonary disease (COPD) and other diseases. Smokers smoking cessation measures should be offered. Tobacco use, even though it is in the US on the decline, is still playing an important role. Tobacco nicotine is used because of the pleasant effects of its main active ingredient. Nicotine can be toxic, and the combustion products of tobacco contain other substances that can lead to significant morbidity and mortality. Epidemiology tobacco is almost always smoked, primarily in the form of cigarettes. Cigarette smoking is the most harmful form of tobacco consumption. However include all tobacco products toxins and possible carcinogens, including smokeless tobacco products are not safe alternatives to smoking. Since 1964 cigarettes for the first time the link between smoking and health problems from the Surgeon General (. Translator’s note:. Head of the top US health) has been released has decreased the percentage of cigarette smokers in the United States. Nevertheless, still nearly 20% of the adult population smokes. Higher prevalence in men with a low level of education (school years <12 years), with income at or below the poverty line and in people with psychiatric disorders (incl. Alcohol and drug abuse). Smoking is less common in the United States among immigrants from Central America and least common among Asian Americans. Most smokers are already starting to smoke in childhood. There are 5-year-old children who are already experimenting with cigarettes. 31% depend before the age of 16 and more than half before the age of 18 years, the entry age continuously decreases. The younger the person is, who starts smoking, the more likely it is that he will continue smoking is. Among the risk factors for onset in childhood include role models (parents, friends and celebrities) who smoke Poor school performance A bad relationship with their parents or living with a single parent high-risk behavior (eg excessive dieting -. Especially in girls, fights and drunk driving - especially in boys) availability of cigarettes Poor problem solving skills Other types of tobacco use Exclusive pipe smoking is in the US fairly rare (<1% of ? 12 years of age), even if the proportion among students of intermediate and advanced increases in 1999. In 2008, about 5.3% of people were smoking> 12 years cigars. This proportion has declined since the year 2000. People <18 years form the largest group of new cigar smokers. associated with pipe and cigar smoking risks are cardiovascular disease, chronic obstructive pulmonary disease (COPD), cancer (oral cavity, lung, larynx, esophagus, colon, pancreas) and periodontal disease and tooth loss. E-cigarettes deliver vaporized liquid, a desired component may be of the nicotine. There is no combustion in the use of e-cigarettes because of "smoke" emanating from the device is water vapor and nicotine and flavorings may or may not contain; many of the toxic products that are included in conventional cigarette smoke are produced not with e-cigarettes. According to the Centers for Disease Control and Prevention (CDC), the use of e-cigarettes among middle and high school students from 4.5% in 2013 to 13.4% in 2014 has tripled. Long-term risks of e-Zigarettn are not known. Smokeless tobacco (chewing tobacco and snuff) is used by about 3.3% of people ? 18 years, and of about 7.9% of the high school students. The toxicity of these tobacco varieties depends on the brand. Risks of cardiovascular diseases, diseases in the oral cavity (eg., Oral carcinomas, pyorrhea, gingivitis, periodontitis and sequelae) and teratogenicity. Accidental oral exposure to tobacco is unusual, but can lead to severe toxicity. Small children sometimes swallow cigarettes from open packs lying around, cigarette butts from ashtrays or nicotine gum. For example, the American Association of Poison Control Centers (AAPCC) have been reported in the years between 2006 and 2008> 13,700 cases of potentially toxic effects of tobacco products to children <6 years. The most common cause were cigarettes and the age group most affected was <1 year. Cutaneous exposure to tobacco may be toxic. In tobacco harvest workers and tobacco workers, raw tobacco (especially when wet) processed without protection, nicotine can be absorbed through the skin and develop symptoms of nicotine toxicity - a syndrome called "green tobacco sickness'. Passive exposure to tobacco smoke occurs when people inhale smoke from a smoking near them. The inhaled amount (and thus its effects) varies with the proximity and duration of exposure and the environment (for example, closed space) and the ventilation. Pathophysiology Nicotine is a dependence producing highly substance in tobacco and important component of cigarette smoke. A desire to begin within days after the first use. Nicotine stimulates the brain nicotinic acetylcholine receptors that release dopamine and other neurotransmitters that activate the reward system in the brain in a manner similar to pleasurable activities, just as with many other drugs also (overview of substance-related disorders). Dopamine, glutamate and gamma-aminobutyric acid (GABA) are important mediators of nicotine dependence. Psychological dependence is when people smoke to affect their mood or to avoid withdrawal symptoms. You can develop and enters up to about 25% of adolescents who try smoking within 2 weeks after the start of smoking. Physical dependence (. D. H the occurrence of withdrawal symptoms associated with discontinuation) develops also within 2 weeks. Smokers want to satisfy their nicotine addiction, inhale simultaneously with the cigarette smoke thousands of other components: including carcinogens, harmful gases and chemical additives. These toxic components are more severe for the diverse health effects of smoking than nicotine itself. Nicotine induces his Metabolisierungsenzym CYP2A6, resulting in several possible interactions with other drugs. Chronic Effects of Smoking Smoking harms nearly every organ in the body. Smoking is responsible for the leading cause of preventable deaths in the US, and an estimated 435,000 deaths a year, or about 20% of all deaths. About half of all smokers die prematurely from a disease that is directly related to smoking, on average they lose 10 to 14 years of their lives (7 minutes per cigarette). The major chronic consequences are an increased likelihood of: coronary heart disease lung cancer COPD Coronary heart disease is the cause of about 30-40% of all tobacco-related deaths. The risk of myocardial infarction increases likely to> 200% if <1 pack per day smoked. The risk of cardiovascular mortality increases by> 50% over a period of 35 years. Mechanisms can an endothelial cell damage, involving a temporary increase in blood pressure and heart rate, as well as the induction of a prothrombotic state and adverse effects on blood lipids. Lung cancer is responsible for about 15-20% of tobacco-related deaths. Tobacco is the leading cause of lung cancer in North America and Europe. The lung tissue is exposed to inhaled carcinogens when inhaled directly. COPD is the cause of about 20% of the tobacco-related deaths. Smoking affects the local defense mechanisms of the airways and leads, particularly in genetically susceptible people, to a rapid deterioration in lung function. Cough and shortness of breath during physical exertion are typical effects of smoking. To the less typical caused by smoking sequences include non-cardiac vascular diseases (eg., Stroke, aortic aneurysm), other cancers (eg. As bladder, cervix, esophagus, kidney, larynx, mouth and throat, pancreas -, stomach, throat cancer, acute myeloid leukemia) and pneumonia. In addition, smoking is also a risk factor for disorders that are burdened with high morbidity and other restrictions such. B. frequent respiratory infections, cataracts, infertility, premature menopause, peptic ulcer disease, osteoporosis and Parodontitis.Passive exposure to smoke Even passive smoking (tobacco smoke in indoor air) can have serious health consequences for children and adults. Adults are at risk from passive smoking from the same tumor, respiratory and cardiovascular diseases such as active smokers. The risk of disease is lower than that of active smoking and dose dependent. For example, the average risk increased with life partners by about 20% for lung cancer and about 20-30% for coronary heart disease. Passive smoking-loaded children more school days missed as Non smoking children due to illness. It is estimated that the treatment of children each year will cost 4.6 billion US dollars due directly caused by smoking-related diseases. likely to passive smoking in the United States responsible for a total of 50,000-60,000 deaths per year be (n. d. Talk .: in Germany over 3300 deaths). Based on these findings six states and local governments have banned across the US smoking in the workplace to protect workers and others from the significant health risks associated with smoke-filled environment. Currently,> 50% of the US population lives in a state which enacted comprehensive bans on smoking indoors. Smoking during pregnancy is a particularly risky form of passive exposure, as it may cause a miscarriage, ectopic pregnancy and premature birth leads (social recognized and illegal drugs during Schwamgerschaft). Infants born to mothers who smoke tend to have a lower birth weight and an increased risk of SIDS asthma and related respiratory disorders otitis media Indirect effects of smoking Indirect effects of smoking can be severe. Every year 80 children and more than 350 adults die as a result of accidental fires, while more than 900 people are injured; Cigarette burns in the US are the leading cause of death in not deliberately set fires. Furthermore, every year 43,000 children lose a parent or more custodians because they die from smoking-related diseases. Drug interactions with nicotine are common. Drug levels and sometimes clinical effects of the following medicines are reduced by chronic smoking, in most cases, by the induction of the CYP2A6 enzyme: antiarrhythmics: flecainide, lidocaine, mexiletine, inter alia, Antidepressants: clomipramine, fluvoxamine, imipramine, trazodone, inter alia, Antipsychotics: chlorpromazine, clozapine, fluphenazine, haloperidol, olanzapine, inter alia, Benzodiazepines beta-blockers caffeine estrogens (oral) insulin (delayed uptake by the vasoconstriction of skin vessels) pentazocine theophylline symptoms and discomfort Acute effects of nicotine slightly increased heart rate, blood pressure and respiratory rate. Smokers have to feel when smoking more active, more focused, less tired and more comfortable feel. Nausea is at a person who smokes for the first time, a normal reaction. Nicotine reduces appetite and can be a substitute for food. The ability to cope with physical stress, reduced because of the irritation of the respiratory tract. Low-grade carbon monoxide toxicity may also limit the physical activity and resilience, but probably scheint.Toxizität to be with athletes only a decisive factor or Overdose Acute nicotine poisoning will usually be treated with oral (eg. As when children eat a cigarette or nicotine gum ) or dermal exposure, rather than caused by smoking. Slight toxicity, as occurs in the green tobacco sickness and small ingestions in children (eg. As <1 cigarette or three cigarette butts), typically manifested as nausea, vomiting, headache, and weakness. The symptoms disappear spontaneously h usually 1-2 after ingestion if the poisoning is easy; However, symptoms can last for 24 hours when there is a severe poisoning. A severe nicotine poisoning causes a cholinergic Toxidrom with nausea, vomiting, salivation, lacrimation, diarrhea, urgency, fasciculations and muscle weakness. Patients have crampy abdominal pain usually, and if the poisoning is very difficult, arrhythmias, hypotension, seizures and coma. The lethal dose of nicotine is about 60 mg in adult non-smokers, at 120 mg in adult smokers and only at 10 mg in young children. Each cigarette contains about 8 mg of nicotine (only about 1 mg is absorbed by smoking). However, the amount taken by children, usually difficult to determine because the revenue is rarely observed. Therefore, each taking as potentially dangerous consequences viewed werden.Chronische Visible signs of smoking should be yellow discoloration of teeth and fingers and, compared to people of the same age, a slightly lower weight (? 5 kg difference). In addition, the skin is dry and wrinkled and the hair is thinner. Other symptoms include lung and cardiovascular diseases related to smoking. Chronic cough and shortness of breath on exertion are common. Circulatory and respiratory disorders reduce the stress tolerance, which often leads to a sedentary lifestyle, which the resilience further senkt.Entzug Discontinuation of cigarettes often leads to intense nicotine withdrawal symptoms, especially a strong desire for cigarettes, but also other symptoms (eg . as anxiety, difficulty concentrating, insomnia, smoking cessation Depression-: withdrawal) and possibly weight gain. Diagnostic Direct Survey The acute toxicity is not always clear from the patient report. Children can z. B. when taking tobacco or nicotine gum not been observed, and patients forget the green tobacco sickness may be mentioned that they process tobacco. Therefore, should children and farm workers who come with typical symptoms for treatment, including particularly cholinergic manifestations, will be asked for a possible tobacco exposure. Tests are not required. More than 70% of smokers embark annually in medical treatment, but when they leave the practice again, very few have received counseling or medications that could help them quit. To convince more smokers that quitting smoking is not only for itself but also for the entire health system of advantage, should all patients - even those who do not come to practice because of typical smoking complaints - will be asked if they smoke. Patients with smoking typical symptoms such. B. circulatory or respiratory problems should be explicitly asked whether they are smokers or not. Treatment Treatment of acute poisoning Symptomatic that has come into contact with nicotine smoking cessation measures skin should be rinsed off. Otherwise, the treatment is supportive in acute nicotine poisoning. A gastric emptying is not recommended. In patients with mild symptoms, or those that have been broken, no money is given. Some doctors would otherwise recommend activated charcoal in patients who have severe symptoms or larger amounts are swallowed without vomiting. In unconscious patients or patients with increased respiratory secretions production or respiratory muscle weakness airways must be protected and it must be ventilated assists. Seizures are treated with benzodiazepines. A shock is treated with infusions and if this has no effect with vasopressors. Atropine may be considered for patients with excessive respiratory secretions or bradycardia considered, anticholinergics are not recommended. All recognizable symptoms, which are a consequence of smoking are treated. All smokers should be advised to quit be helped to stop smoking, with good advice and possibly with medication (see table: medications for smoking cessation). Pregnant women who smoke should be advised to stop smoking, and they should be helped by intensive smoking cessation counseling there. However, the US Preventive Services Task Force in 2015 concluded that the evidence were not sufficient to assess the advantages and benefits of drug therapy for smoking cessation in pregnant women (see Tobacco Smoking Cessation in Adults, Including Pregnant Women: Behavioral and Pharmacotherapy Interventions). Summary Cigarette smoking, the leading cause of preventable deaths in the United States, often begins early in life, with about 31% of smokers become addicted before the age of 16 and more than half before age 18. A strong desire for nicotine can already use within a few days after the first cigarette. For most negative health effects that nicotine itself, but the other ingredients of cigarettes (z. B. carcinogens, harmful gases, chemical additives) is not responsible. Harmful effects include increased risk of fatal diseases (eg. As lung cancer, COPD, coronary heart disease), indirect effects (eg. As fire) and interactions with other medications. Nicotine acts in the usual dose acutely mild stimulant, but may in acute overdose lead to a cholinergic Toxidrom (usually by oral or dermal exposure). All patients - even those without smoking typical symptoms - should be asked if they smoke. For more information Centers for Disease Control and Prevention - Youth Tobacco Cessation: A Guide for Making Informed Decisions US Preventive Services Task Force - Tobacco Smoking Cessation in Adults, Including Pregnant Women: Behavioral and Pharmacotherapy Interventions

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