Best Pulmonologist in Delhi

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

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

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