Tobacco Cessation: Help is at Hand, Lets Seek It!

by Vikas Mittal Best Pulmonologist in West Delhi

In India, nearly 8 -9 lakh persons every year die due to tobacco use. Thirty percent of cancer deaths, majority of heart and lung disorders; 40% of TB and other related diseases are related to tobacco consumption. More than 80% of oral cancers are caused due to tobacco use. Seven percent of all deaths (for ages 30 and over) in India are attributable to tobacco, as per the WHO Global Report on “Tobacco Attributable Mortality” 2012.

The WHO framework convention on tobacco control (WHO FCTC) adopted in 2003 aims at reducing the burden of disease and death caused by tobacco. Government of India (GOI) passed the Cigarettes and Other Tobacco Products (COTP) Bill, in April 2003 which entails Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution. The Ministry of Health and Family Welfare (MHFW), GOI, has launched the National tobacco control programme (NTCP) in 2010 to facilitate the implementation of the Tobacco Control Laws.

However, these policy measures of tobacco control does not help any individual who may be wanting to quit as nicotine in tobacco is very addictive, making quitting difficult. Two out of every 3 tobacco users wish to Quit, out of then 50% try on their own and only 30% seek help, but only 3–6% actually succeed in doing so unaided. Tobacco Cessation Clinics/Centers (TCC) helps current tobacco users to quit tobacco in a scientific manner. According to an estimate, lack of cessation services may lead to an additional 160 million global deaths among smokers by 2050. One of the major highlights of WHO/MHFW collaborative programme is setting up of Tobacco Cessation Clinics/Centers in India.At TCC’s, pharmacological interventions are used along with behavioural strategies to produce quit rates of about 25-30%. Each patient is offered a brief intervention method the “five A’s”: Ask-all patients about tobacco use; Advise- tobacco users to quit; Assess-readiness to make a quit attempt; Assist- with the quit attempt; and Arrange-follow-up care. Treatments available to increase the long-term smoking abstinence rates include:

1. Medication that decrease craving – Bupropion, Vareniciline, Nortryptiline, etc.

2. Nicotine Replacement Therapy (NRT) – combination of Nicotine gum and Nicotine patch. Patch used in combination with gums provides a slow and steady supply of nicotine in order to relieve craving and withdrawal symptoms, and is associated with quit rates of about 23% as against 13% with placebo.

There are only few centres and set-ups in India which are offering tobacco cessation services. There were 13 TCC in 2002 which increased to only 19 in 2011. These centres are mainly in public sector hospitals and are not well advertised or known to patients or even medical fraternity. A physician dealing with a patient with tobacco addiction is clueless how to offer him tobacco cessation and where to send him for treatment to improve success rate of tobacco cessation. Very few centres in private sector offer Tobacco cessation treatment. All patients attending my clinic are not only offered the above mentioned “the 5A’s” framework for tobacco cessation counselling but are taken care of individually. They are given a personalized treatment providing what is called precision medicine, an emerging approach to treatment in medical practice. Individual/group counselling and psychosocial/behavioural treatments, technology-driven interventions like telephonic, internet-based, and social media–based modalities are also provided. Repeated contact counselling is a key to the success of tobacco cessation and prevention of relapses which is provided proactivity by telecom or by encouraging frequent follow-ups.

It is known fact that a simple advice by health professional, taking as little as 30 seconds, can produce quit rates of 5–10% per year. Even though pharmacological and behavioural treatment for nicotine addiction are relatively simple, physicians fail to acknowledge tobacco addiction as disease warranting medical attention and intervention, There is also a belief among healthcare providers as well as smokers that quitting is an act of willpower and free choice. So most quit attempts today are still unaided, under treated and thus relapses are common. Sensitizing and educating all health care professionals for tobacco control and cessation is vital. Eventually, if all healthcare professionals participate in tobacco control and cessation, it will have a huge impact.

Expansion beyond tobacco cessation clinics in the form of community outreach clinics, interventions provided at schools, colleges, workplaces, youth groups, women's groups, etc is the need of the hour, thus raising a mass movement against tobacco.

I plan to take the lead in this mission of helping all those who wish to Quit Tobacco and get Free. Help is at Hand, Lets Seek It!

Dr Vikas Mittal

MD (Pulmonary Medicine)

Sr. Consultant, Lungs and Sleep Specialist

Department of Respiratory Medicine

Manipal Hospital, Dwarka, New Delhi

message2vikas@gmail.com, +91 9312508514