THE LEADING PREVENTABLE CAUSE OF DEATH IN THE WORLD

How to combat smoking? Do you know your level of addiction? What is the Fagerström Test? Which treatment has proven to be most effective in helping you stop smoking?

Smoking is the leading cause of preventable premature morbidity and mortality in developed countries. Among the components of tobacco there are some that are specifically related to different diseases, such as cancer, cardiovascular diseases or respiratory diseases. The consumption of ONE SINGLE daily cigarette increases the risk of myocardial infarction by 48% and the risk of stroke by 25%.

The substance responsible for its addiction is nicotine, belonging to the group of alkaloids, and which during its combustion process gives rise to new products also harmful to the body. With its combustion, nicotine vaporizes and reaches the lungs, through which it reaches the pulmonary circulation and from there to the systemic circulation. In individuals who do not inhale the smoke when smoking the absorption of nicotine takes place through the buccal mucosa. The blood concentrations reach a high peak in a few seconds and quickly reach a large amount of body tissues, highlighting the brain, stomach, liver and kidney

Among the effects that the consumption of tobacco produces on the organism, dyspnea, fatigue, dysphonia, headache, tensional lability, decreased libido, impotence, yellowing of the teeth, gingivitis and diffuse chest pain stand out. What is known as the smoking abstinence syndrome includes changes in mood, mouth ulcers and constipation, increased appetite, difficulty concentrating in work or studies, general malaise, anxiety and excessive nervousness. Most of these symptoms reach a peak in the first days to disappear after several weeks since the cessation of consumption.

To measure the level of dependence on nicotine, a scale designed in 1978 by the Swedish psychologist Karl Olov Fagerström, known as the "Fagerström Test", is used to evaluate the following aspects:

• How much time does it take between getting up and smoking your first cigarette? (0 to 3 points)

• Do you find it difficult not to smoke in places where it is prohibited (movies ...)? (0 to 1 point)

• Which cigarette do you most like to stop smoking? (0 to 1 point)

• How many cigarettes do you smoke each day? (0 to 3 points)

• Do you smoke more during the first hours after getting up than during the rest of the day? (0 to 1 point)

• Do you smoke even if you are so sick that you have to stay in bed most of the day? (0 to 1 point)

So that a total score in the test between 0 and 3 points indicates mild dependence, between 4 and 7 moderate dependence, and greater or equal to 8 points serious dependence.

Nowadays teens tend to start smoking cigarettes at an earlier age than in previous generations. To avoid the start of consumption, it is necessary to start raising awareness among the younger population from the media, and in the colleges and institutes. In the prevention of smoking there are two types of interventions. On the one hand, avoid the initiation of consumption, and on the other favor the abandonment of it (increase the number of ex-smokers). Most of the actions focus on the second one. For both, politics and advertising campaigns against tobacco become important. WHO, together with the United Nations and the Pan American Health Organization (PAHO), established World No Tobacco Day on May 31 of each year since 1988

To favor long-term abstinence, physicians rely on both behavioral and pharmacological interventions, and it is important to highlight nicotinic substitution therapy, varenicline and bupropion as first-line treatment lines. Varenicline has shown a greater success in the rate of cessation of snuff and most of its side effects are mild (nausea, vomiting, headache, sleep difficulties, unusual dreams or sleepwalking, constipation or flatulence) although recent publications suggest that it could increase the risk of cardiovascular disease.

You must not forget either that these are general recommendations or that treatment must always be individualised, that is, adjusted to your particular case. Therefore, we recommend medical supervision before any change in your treatment.