Impact Of Second And Third-Hand Smoking

The long-term impact of smoking is well-documented in various studies throughout the decades. With the Ministry of Health mulling creation of Designated Smoking Areas (DSAs), this raises questions about smoking and how non-smokers may be affected.

KUALA LUMPUR, May 30 — According to the World Health Organization (WHO), there is no safe level for exposure to second-hand smoke (SHS), and those exposed can contract various lung-related diseases including serious cardiovascular and respiratory diseases, prematurely killing over 1.3 million people every year.

In addition, there is also a lesser-known facet of smoking, namely third-hand smoking (THS).

According to the American Academy of Pediatrics, THS refers to tobacco contamination residue left on the surfaces of objects and its surroundings after a cigarette has been extinguished, most notably in indoor settings such as offices, homes, and confined spaces.

Being a vocal and passionate advocate for targeted lung cancer screening so the disease can be detected earlier and treated more effectively and cheaply, Sunway Medical Centre consultant cardiothoracic surgeon Dr Anand Sachithanandan observes that lung cancer is no longer just a male smokers’ disease only, with many new cases now involving non-smokers, predominantly women, many of whom may be victims of chronic SHS exposure.

Dr Anand opines that the proposed designated smoking areas (DSAs), however, are a pragmatic approach and achieveable if planned and implemented thoughtfully, and strongly enforced.

But he remains concerned that SHS is still an ongoing public health issue affecting mainly women and children.

“SHS or passive smoking is the inadvertent inhalation of tobacco smoke by individuals other than active smokers. SHS exposure occurs when we breathe in the smoke exhaled by smokers or from burning tobacco products. 

“With regard to THS, if left unattended, the surrounding environment may become progressively more toxic over time,” added Dr Anand, who is also the founding president of Lung Cancer Network Malaysia. 

Diseases Induced From SHS And THS

Dr Anand suspects many cases of lung cancer in non-smokers may be attributable to exposure to SHS, THS, or air pollution.

Long-term cumulative exposure to cigarette smoke, be it smoke exhaled by a smoker or the unfiltered sidestream smoke from a lit cigarette, is a significant risk factor for developing lung cancer in genetically susceptible individuals, he says. 

Apart from lung cancer, SHS and THS contribute towards other respiratory conditions including exacerbation of asthma, bronchitis and chronic obstructive pulmonary disease (COPD) as it damages the elasticity of the lung tissue and can irritate the airways causing inflammation.

Furthermore, smoking is a well-established risk factor for cardiovascular diseases like coronary artery disease and stroke, impairs our immune system, and causes premature aging.

Dr Anand states that children and adolescents are more susceptible to the perils of SHS and THS, due to their less robust, developing immune system.

Exposure at home, in common spaces such as eateries or the workplace, and especially in vehicles can further heighten the likelihood of contracting respiratory- diseases in the long run. 

According to the Global Adult Tobacco Survey (GATS), 77.6 per cent of Malaysians surveyed reported exposure to SHS in eateries. Although the sample size only covered a total of 5,780 households, more than half of them still experienced unpleasant odours while dining in, signifying that the issue of SHS and THS are still prevalent.

For vehicles in particular, a study by Tobacco Induced Diseases states that there is a higher concentration of SHS and by extension THS in confined spaces like cars, suggesting that even for a short period of time, smoking in the car still produces a high concentration of respirable particles that is possibly detrimental to children. 

Early Detection Is The Best Form Of Medicine

Which leads to an important question – Is there any way for the public to detect and address lung cancer in its early stages?

Dr Anand says that the gold standard for screening is with a low dose CT scan of the thorax (LDCT) which is widely available throughout Malaysia, but presently, screening targets mainly current or former smokers of a certain age.

This is a single- breath high resolution non-contrasted chest scan that requires no insertion of needles, blood test, or prior fasting. 

According to Dr Anand, people with a family history of lung cancer or a personal history of other cancers should also consider screening even if they don’t smoke. 

“Currently, we are exploring the use of artificial intelligence (AI) enabled chest X-rays as a prelude to LDCT screening as this is more affordable and widely accessible,” he said.

This is an area of ongoing clinical research for Dr Anand and his team, as is exploring the potential of using blood tests (biomarkers) to enhance detection or screening for lung cancer. That being said, he shares that screening for lung cancer in non-smokers remains a challenge. 

The public can also play their part by being considerate smokers including smoking only at DSAs in the future, avoiding smoky environments and to actively discourage their peers and family members from smoking. 

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