Should it be illegal to smoke in front of kids?

I have no problem with people smoking, so long as they do so in the privacy of their own homes or vehicles where no one else is being forced to inhale their stale, polluted air.  However, when little kids are involved, I draw the line.

This past spring and summer I attended many t-ball games where my 5-year-old daughter and her friends participated in a friendly we-don't-keep-score-and-just-play-for-fun game of t-ball.  Yet at every single one of those games some individual kept lighting up cigarette after cigarette after cigarette, forcing me and everyone else -- including the kids -- to inhale their smoke.

I have asthma too, and the smoke bothers me.  But I'm thinking of the kids first.  I have trouble fathoming the idea that an adult, addicted or not, can't go one hour without lighting up.

Liberty means to exercise  human rights in any manner a person chooses so long as it does not interfere  with the exercise of the right of others.  Going by this, all people have a right to smoke cigarettes, but that right should stop as soon as nonsmokers are in the room.

As an adult, I can easily avoid your stale, polluted air.  However, your children cannot.  For this reason, it should, by default, be illegal to smoke in front of children.

Seriously folks, I'm not a champion for more laws, as I believe every law takes away some liberty.  However, if that law would protect innocent children, then I'm all for it.  I think it is absolutely cruel to force children to inhale polluted air because you choose to smoke cigarettes.

There are already enough studies to show that second hand smoke is harmful, and especially to asthmatic children. When I was a kid I remember suffering heartily when adults smoked around me, and I make every effort to make sure that never happens to my kids.

Now, evidence suggests that even third hand smoke, the remnants of smoke that stick to carpet and furniture, can be inhaled with consequences.  Evidence suggests it may trigger asthma, and a new study shows that it may even cause cancer.

I don't like to judge people.  I don't want to make laws forcing people to take certain actions, or not to take certain actions.  But if people are going to continue to light up around people -- people who have a natural right to inhale pure air -- then it might be time to take action against it.

Further reading:

• 20 reasons to quit
• 10 tips to help you quit smoking

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Battle begins over 2nd hand smoke and e-cigs

Even while some people still smoke, I think it's safe to say that the battle against cigarette smoking has essentially been won.  According to the Centers for Disease Control and Prevention, in 1965 42% of the population smoked, and today it's down to 10%.  I think that's significant progress.

Most people, even smokers, now accept smoking is deadly.  The Surgeon General's office reports that over 20 million people have died from smoking related illnesses since 1965.  Science has proven this is probably due to the over 7,000 chemicals inside cigarettes, 70 of which have been linked to cancer.  The Institute of Medicine reports that 2nd hand smoke increases the risk of heart disease by 25-30%.

In fact, the battle has been so successful that even the dangers of second hand smoke, which at one time were considered harmless, are now commonly taught in schools.  Most people are now aware that exposure to second hand smoke may be just as harmful as first hand smoke.

Obviously there is still progress to be made.  Efforts are ongoing to finish the job of getting America over its addiction to cigarettes.  Yet the fight has advanced, somewhat to other areas.  Not satisfied with just getting people to quit smoking, some lawmakers have moved on to 3rd hand smoke and e-cigarettes.

Surely there are chemicals emitted from the stagnant smoke that lingers on furniture and carpet on rooms and vehicles where someone recently smoked.  Surely there are chemicals in e-cigarettes that are harmful, as the CDC has reported an increase in e-cig related calls to poison control offices.

While there are always advantages to public relations campaigns to encourage people to make wise choices, the battle against those individuals who continue to smoke even though they know it will kill them, and the battle to get people not to smoke e-cigs, and the battle to prevent someone from smelling cigarette smoke on someone's clothing, should be left to educational efforts.

Eli Lehrer recently wrote an article regarding this at National Review called "Diminishing Returns: The Campaign against (if you can believe it) third hand smoke."  He states that some states have even outlawed smoking e-cigarettes in public, studies don't conclude there are no risks to the smoker, although they do conclude risks to bystanders are negligible.

The author says:

This isn’t to suggest that e-cigarettes are safe. They contain nicotine, a very addictive stimulant that, like all stimulants, has the potential to cause heart problems. The fact that they’re quite addictive and may have long-term risks nobody has discovered (they’ve been on the market for less than a decade) is good reason to keep them away from children and out of schools, daycare centers, and medical facilities. Although not perfect, newly issued FDA regulations, which would ban sales to minors nationally, take a much more sensible approach to e-cig regulation than most localities have to date. But, whatever their dangers, e-cigarettes aren’t the same as cigarettes. People who use them instead of tobacco cigarettes can expect at least some of the same health benefits as those who quit smoking. And nothing suggests that their vapor is anything like secondhand smoke. Indeed, almost all research indicates the opposite.

He concludes:

The preponderance of the evidence indicates that both thirdhand smoke and e-cigarette vapor are the chemical equivalent of dirty looks. They may well be unpleasant or offensive to some people. But the public health case against them appears weak to nonexistent. Public policy would do well simply to leave them alone.

I would tend to agree.

The main crux of the battle against first and second hand smoke was that the person smoking was trampling on my natural right to breathe fresh air.  To extend this battle to third hand smoke and e-cigarettes would require taking the battle into a person's home, further trampling on personal liberties.

As Lehrer notes, "If thirdhand smoke or e-cig vapor caused the same ills, another campaign might be warranted. But they probably don’t."

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Grandpa's quote about smoking

She smokes.  She said, "You know, I know they want me to quit smoking, but I'm just not going to do it.  I have no interest in quiting.  I really enjoy it."

I said, "I understand what you're saying.  I tried to get my grandpa to quit smoking when I was a kid and he said, "I would rather do the things I enjoy and live a short and happy, as opposed to giving up what I enjoy and living an unhappy long life."

She said, "Can you please write that down for me, I want to script it and hang it on my wall for my kids to see."

I did. 

WHO spins facts about 2nd hand smoke

My uncle, who so happened to be a chain smoker, educated me one day about the fallacy that 2nd hand smoke caused cancer. He was a chain smoker, and he already had a lung removed, yet he still felt the facts were so that it was worthy to note the "bullshit that THEY teach kids these days."

At the time I just blew my uncle off as a smoker who didn't want to admit the truth. Yet being the person I am (and perhaps partly through his example), I decided a better response to his little speech was to do my own research.

In doing so I came upon this study that was independently funded by the World Health Organization (WHO). The study was a review of many other studies on the subject, and the goal was to prove that 2nd hand smoking causes cancer.

Ironically, the study proved the opposite: that 2nd hand smoke does not cause cancer. Yet since the study didn't show what they wanted, they didn't release it. They didn't do this because one of the goals of the progressive WHO is to create an ideal world. And in an ideal world people don't smoke because smoking kills.

Now it is still true that 2nd hand smoke is unhealthy, and most studies about it show this. Yet it is just about a proven fact now that 2nd hand smoke does not cause lung cancer. The WHO was hoping this study would help justify their attempts to get rid of smoking worldwide through higher taxes and laws banning it in public places.

The ultimate goal of the WHO is to ban smoking altogether, yet because of the U.S. Constitution, this is nearly impossible to do because people have a Constitutional right to be stupid so long as they don't infringe on the rights of others. Ideally, the Constitution protects us from each other, and not necessarily from ourselves. So if we want to smoke, so be it.

Of course another reason progressives want to get rid of smoking altogether is because another goal is universal healthcare. They don't want to pay for the health consequences of personal choices that are bad, like smoking.

This is yet another reason I'm opposed to universal healthcare, and even Obama care, because if someone is paying your bills, they have a right to tell you what to do. In other words, you are a slave to the person you are in debt to.

Thus, every time a new law is made, you lose another freedom. Every time we receive another government entitlement, we lose another freedom. So if we continue to allow our government to create more government programs, we will eventually be slaves to the state. The same thing happened in ancient Rome, and destroyed that republic.

The WHO once again has ignored the above mentioned study as it released a new study that shows that 2nd hand smoke kills up to 600,000 people each year, and this accounts for 1% of all deaths each year. You can read the report here.

The report notes that, "Researchers estimated that annually second-hand smoke causes about 379,000 deaths from heart disease, 165,000 deaths from lower respiratory disease, 36,900 deaths from asthma and 21,400 deaths from lung cancer."

In lei of the previous study by the NWO that showed 2nd hand smoke does not cause lung cancer, can we now assume the NWO is conveniently ignoring this study. Their ultimate goal is to get rid of smoking, regardless of facts.

This almost makes one wonder about the true intentions of progressives. Are they after what's best for the people, or the government? I almost think they want to get rid of smoking so the government doesn't have to pay for diseases caused by smoking.

So they raise taxes. They also create more rules or laws that ban smoking in public places. All of this with the intent of forcing people to quit, as opposed to people quitting by individual choice. Progressives don't believe in individual choice, the believe in the state making choices for the people.

Of course, as I've written before, too many rules (laws) and too high of taxes result only in people finding ways to get around the taxes or rules. It creates a world of cheaters and liars, because the natural tendency of human beings is to make their own decisions. People don't like people telling them what to do.

A great example of this is in New York where taxes are high on cigarettes and public smoking is not legal, a black market for cigarettes has been created, as you can read here.

I have no vested interest in people smoking. Well, I say that knowing that my career as an RT is mainly funded by patients who smoke. Yet I don't want people to smoke. It bothers my asthma when people smoke around me. It threatens the health of my kids.

So I don't want people to smoke. I want people to quit. I want my dad to quit, yet he has made the personal choice to smoke. And, yes, he does get cigarettes illegally over the Internet because he can get the cheaper that way.

Second hand smoke is bad as you can see by any link that lists the hazards of second hand smoke, such as this and even the WHO itself as you can see here.

You should educate your patients about the dangers of 2nd hand smoke. If someone says they quit smoking, make sure they know to not let others smoke around them. Yet also don't get all your wisdom from one place, and decide for yourself what is fact and what is not a fact.

Because Lord knows it's hard to get all the facts even from sources we otherwise think are trustworthy. Now I'm certain the American Cancer Society and other such resources are trying to provide honest facts. Yet they, like you and me, get their wisdom from sources they hope are being honest with us.

This is a perfect example of why I created this blog. You and I are interested in facts and then we make an educated decision, rather than just believing everything we read. While we might not have much of a choice what we do as RTs, we can be smart.

Facts about 2nd hand smoke

Here are some facts about 2nd hand smoke. This list may be different from other lists because I'm basing my list on facts obtained from studies and not my own personal opinion and vested interest.

Note, however, that I want people to quit smoking, and I want people who do not smoke to be protected from 2nd hand smoke. However I do not believe there should be any attempt by any government to force people to quit smoking other than through education.

It is my belief that most people are smart, and provided with facts they will make the best decision for themselves. I do not believe facts come from organizations and companies that in some way profit from smoking. I also do not believe the facts come from organizations like the World Health Organization (WHO) either.

In a way this is frustrating, because ideally we should be able to get all our facts from such organizations as the WHO, our government, or at least from the Media. Yes it's true, even the media can't fully be trusted.

So this is why we must keep our minds and ears open and get our news from a variety of sources. While I do not pretend to know all the truths, I do like to lay out all the facts so we can all make an educated decision. This, after all, is the goal of the RT Cave.

We do, however, agree that 2nd hand smoke is bad, even though all the information we receive might be twisted in one way or another. That in mind, here are some facts about 2nd hand smoke.

1. 2nd hand smoke may not cause lung cancer, as you can see by this WHO study. Despite this, the WHO notes that 2nd hand smoke kills as many as 600,000 people each year, as you can read here. We're neutral here, so you decide.
2. There are over 4,000 chemicals in cigarette smoke, and over 250 of them are known to cause damage to the human body such as aging the body, thinning the skin and arteries, destroying cilia in the lungs, etc. This effect is just as damaging to those who breath second hand smoke as those who inhale the smoke directly.
3. It causes 600,000 premature deaths each year
4. It causes hardening of arteries and heart disease (about 46,000 deaths annually)
5. It increases your risk for stroke and brain aneurysms (thinning arteries)
6. It increases your risk for getting chronic obstructive lung disease, especially if you have asthma
7. It increases your risk for getting pneumonia
8. It shortens your lifespan (yes, even if you inhale someone else's smoke)
9. Separate areas in a building to not decrease your risk for second hand smoke related exposure. This is why smoking sections have no effect.
10. Ventilation systems do not decrease your risk of inhaling 2nd hand smoke. Smoke can get from a smoking area to a non smoking area even if there's a door between rooms.
11. 40% of children are exposed to smoke at home.
12. 31% of smoking related deaths occur in children
13. 2nd hand smoke greatly increases the risk of sudden infant death syndrome
14. 2nd hand smoke increases risk your child will develop asthma
15. Kids exposed to 2nd hand smoke are 1.5 to 2 times more likely to smoke themselves
16. Results in increased sick days and lost wages
17. Increases economic costs to society by forcing all of us to pay for the care of smoking related diseases and smoking cessation programs
18. Decreases lifespans (each cigarette takes 7 minutes off your life)
19. The World Health Organization notes that, "More than 94% of people are unprotected by smoke-free laws. However, in 2008 the number of people protected from second-hand smoke by such laws increased by 74% to 362 million from 208 million in 2007. Of the 100 most populous cities, 22 are smoke-free. (Note here, however, that a government has the job of protecting us from each other, but not from ourselves)
20. Other breathing problems in non-smokers, including coughing, mucus, chest discomfort, and reduced lung function
21. 50,000 to 300,000 lung infections (such as pneumonia and bronchitis) in children younger than 18 months of age, which result in 7,500 to 15,000 hospitalizations annually
22. Increases in the number and severity of asthma attacks in about 200,000 to 1 million children who have asthma
23. More than 750,000 middle ear infections in children
24. Pregnant women exposed to secondhand smoke are also at increased risk of having low birth- weight babies.
25. It may be linked to breast cancer
26. Causes premature death and disease in children and in adults who do not smoke.
27. Smoking by parents causes breathing (respiratory) symptoms and slows lung growth in their children.
28. Secondhand smoke immediately affects the heart and blood circulation in a harmful way. Over a longer time it also causes heart disease and lung cancer.
29. The scientific evidence shows that there is no safe level of exposure to secondhand smoke.
30. Many millions of Americans, both children and adults, are still exposed to secondhand smoke in their homes and workplaces (a cause of occupational asthma) despite a great deal of progress in tobacco control.
31. The only way to fully protect non-smokers from exposure to secondhand smoke indoors is to prevent all smoking in that indoor space or building. Separating smokers from non-smokers, cleaning the air, and ventilating buildings cannot keep non-smokers from being exposed to secondhand smoke.
32. Driving in a car with the cigarette dangling out the window does not mean other people in the car will not be exposed to 2nd hand smoke

The following are facts about 2nd hand smoke some may not want you to know:

1. 2nd hand smoke may not cause lung cancer, as you can see by this WHO study. Despite this, the WHO notes that 2nd hand smoke kills as many as 600,000 people each year, as you can read here. We're neutral here, so you decide
2. The WHO also learned that parents smoked had had a 22% better chance of NOT contracting lung cancer than did adult children who came from homes where both parents did not smoke. WHO tried to hide this fact
3. The WHO has a vested interest in getting people to quit smoking because they believe governments should have universal health care, and smoking would therefore increase economic costs to various governments.
4. Despite what the WHO mentioned above, some studies show that technology such as air filtration systems in bars to filter as much as 100% of 2nd hand smoke from the atmosphere of the building. So ventilation systems can be effective.
5. The number of deaths caused by 2nd hand smoke is often exaggerated. The study showing 2nd hand smoke does not cause lung cancer, and the fact 2nd hand smoke is still attributed to 2nd hand smoke, is a perfect example. The WHO and the Environmental Protection Agency have invested interests in exaggerating these numbers.
6. Most people do not approve of smoking bans in public places. For example, in New York 85% said such laws went too far (however, personally, I believe such laws are necessary and Constitutional. The Constitution gives lawmakers the right to protect us from each other. However, I think such laws should give businesses the right to be smoke free or not smoke free and the people can choose whether or not to go to the businesses that allow smokers inside. Let the market decide and not some lawmaker in Washington).
7. There are no studies that show people miss more work due to 2nd hand smoke. There are many reasons people miss work, and none could be ruled out. It could be second hand smoke, but there's no real evidence to show this.
8. There is no real proof smoking increases medical costs. There is no proof these people would have had medical problems regardless whether they smoked or not. There is proof that people who smoke and have increased health problems have bad genes, so perhaps these people would have had bad health regardless that they smoked (or inhaled 2nd hand smoke).
9. Even scientific studies are interpreted by people who have biases. Questions can be asked to generate a certain response. Studies can be interpreted with bias. In this way, sometimes statistics can be skewered.
10. It is a fact that some studies show 2nd hand smoke causes certain diseases, and similar studies that show the opposite. As we can see by the WHO, the ones that are inconvenient to the biases of the organization are ignored and those that prove the bias are reported.
11. The smoking industry lied about the dangers of 2nd hand smoke until recent years. This is why some smokers have succeeded in suing these companies.
12. The U.S. government knew prior to WWI that smoking was dangerous to people's health, yet still gave out free cigarettes to soldiers in WWI and WWII. The U.S. government succeeded in getting America addicted to cigarettes knowing it was bad in order to help the smoking industry in order to boost the economy. This is a fact. Look it up for yourself.
13. In 1929 a study was published in Germany linking cigarette smoke with lung cancer (see here).
14. Automated cigarette machines were invented in the late 19th century which made it easy to make cigarettes. The industry soon took off, and it boomed with the help of the U.S. government

The above facts were obtained from common wisdom, the World Health Organization, the American Cancer Society, Citizens Freedom Alliance, Inc,

Smoking rates decline -- slightly

Fewer people are smoking these days, and those who do are smoking less.  This is according to a report released by the Centers for Disease Control and Prevention, the Associated Press notes. 

In 2005 21 percent of adults acknowledged smoking.  In 2011 19.3 percent of adults acknowledged smoking.  This was a decline of 3 million smokers.  While only a slight decline in the general scheme, this is a trend in the right direction. 

This is significant to us RTs because smoking is the number one contributor to lung disease.  Studies have shown that those who quit smoking allow their bodies to heal, and this reduces the risk of smoking related diseases. 

If the current trend continues, 17 percent will be smoking by 2020.  This will be far short of the government set goal of 12 percent.  Likewise, credit for the decline is given to educational efforts to inform people of the dangers of smoking, and the advantages of quitting if you do smoke.

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Apartment living may expose kids to 2nd hand smoke

I wonder if the 5.6 million Americans who live in apartments are aware of the fact that if anyone in any other apartment in the building in which they live is a smoker, so too are they smokers.  If anyone in the building smokes, every one in the building is automatically a second hand smoker at risk for the same diseases as those of a smoker.

How's that for some stunning news.  The reason is that smoke travels through the ventilation system, and is inhaled by anyone in the apartment building.

A new study conducted at the University of Rochester Medical Center, showed that a substance formed by the breakdown of nicotine called cotinine was found in the blood of over 5,000 youngsters 5-18 years old.  The study concluded that 73 percent of kids are exposed to cigarette smoke, yet the levels of cotinine was much higher in kids who lived in apartment complexes.

Another study done in 2001 showed that of the 5.6 million Americans who live in apartment complexes, said they do so as a matter of choice because they like to rent.  Yet they might want to reconsider, especially if they have children, because they may be inadvertently exposing their children to second hand smoke.

I have written many previous posts about the dangers of exposing kids to cigarette smoke:

• Smoking in front of kids is stupid!  Period!
• Smoking is hazardous to kids
• 20 reasons not to smoke if you have asthma

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Help FDA create new cigarette warning labels

Within the next year a package of cigarettes may look like a pack of Cyanide. The FDA has made a new regulation that requires the up to 50% of the package to feature warnings of the dangers of smoking.

The warnings will have to feature picture messages that would cover the top half of the front and back of the package -- 50% of the package.

Likewise, any advertisements will have to feature warnings about the dangers of smoking cigarettes covering 20% of the ad.

Once again, I'm not a fan of the government forcing people to smoke, yet considering there are still people who claim not to understand that smoking can kill and is highly addictive, I think it's about time for such a warning system.

For people that are coming to the hospital today because they can't breathe or because they have lung cancer or some other smoking related disease, they didn't know any better.

Prior to the 1980s the dangers of smoking were probably known to the manufacturers of cigarettes, and even to government officials, yet this information was not distributed to the folks. I believe the reason for this was that cigarette sales were good for the economy.

Yet there is not reason anyone on God's great earth should ever pick up a cigarette today not knowing that it's poison. And if the government has to put a big bold picture warning on cigarettes, then it's about time.

Now the FDA has listed some warning pictures to post on cigarettes, and they want you to choose which one you like best. To do this, click here.

I personally don't like any of the choices. I prefer something bolder like the following:

• SMOKE AND DIE
• SMOKING KILLS (this one is a choice)
• IT'S LEGAL TO BE STUPID! SMOKE AND YOU ARE STUPID!!!!
• SMOKE HAS 40,000 HAZARDOUS CHEMICALS, INCLUDING CYANIDE, ARSENIC, AND NICOTINE!!!!!!!!!
• If I had a nickel for every time a COPD or cancer patient said to me, "If I'd have known I'd die like this I never would have started smoking!" I'd be rich!!!
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I actually like the one that has a picture of a sick COPD patients.

Or, better yet, how about just placing a picture of a mom and dad on the package and write something like: "Mom and dad want you to smoke!!!!" Like this comic from the Grand Rapids Press.

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Most people who smoke are not evil

There is this stigma in America now that if you smoke you're for some reason a bad person. You are setting a bad example for kids. That you ought to quit smoking just for the principle of it. However I don't' agree with this at all.

It is true that I have written much about the dangers of smoking, and have recommended to many people they should quit. Yet I have never once written that a person who smokes is a bad person. I say this because I know many great people who do smoke or have smoked.

I bring this up because President Obama smokes, and some see this as something evil. How could he be President of the Greatest Nation in the history of the world and still smoke. If voters would have known about this, he never would have been elected.

The folly in that statement is it's simply folly.

The new Speaker of the House John Boehner admitted to smoking, and Matt Lauer of the Today show said the following to him, "Most people try to quit up to 20 times. How many times have you tried to quit?"

The Speaker said, "Not even close to that many. I know it's a bad habit, yet I haven't tried to quit much."

Some people frown on the Speaker for this "evil" habit. A friend of mine today said that Boehner is setting a bad example. He's being unfaithful to his seat. It shows how weak he is.

I think this is folly. That someone smokes does not determine how great or un-great that person is. Smoking is a choice, and if someone chooses to smoke that does not make that person a bad person.

On the other hand, if a person chooses to smoke and tosses their butts out the window, or if they choose to smoke in front of kids, or if they choose to smoke in public places, then that I consider a problem because then they are violating the right of others to clean air.

Yet simple smoking does not make a person a bad person. Our educators have properly educated kids to believe that smoking itself is bad, yet they have perhaps made a misrepresentation that the smoker too is bad.

It's in this way an attempt to perfect society. It's an attempt to make smoking a non-politically correct option. If you smoke you are now deemed as un-cool. It's another societal misrepresentation of the truth.

While most teachers may think smokers are uncool, most of us in society know that most people who smoke are as cool as you or me. It's another example of a minority making the rest of us think their view is the majority.

It is true that those who smoke are burdens on the rest of society. We are flipping their health care bill. Yet we must also note here that I have taken care of just as many patients who never smoked a day in their lives, and never drank, and they still get sick and die too.

I don't condone smoking. I will make every effort to educate people to quit. Yet I would never do anything to force someone to quit, and I think the government shouldn't' either. It's simply a choice, and most people who make that choice are no different than you and me.

(For related links click here)

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While you're at it, add this to Our Job Title

Regular readers of my blog know that I'm an ardent believer that the best way to get people to quit smoking is through education.

So when Tim Frymyer, RRT, and creator of StopSmokingHelper.org informed me about his new website, and his desire to write a guest post for the RT Cave, I eagerly accepted his proposal.

Check out his post published below, and then be sure to check out the new website he created with the intent of helping smokers quit. Enjoy.

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I'd like to first thank Rick for letting me post something in The Cave. I believe it is an honor and I hope the information lives up to his standards. Let me start off by telling you all a little about my experience as a therapist. I started 20 years ago in Dallas at the county hospital and then moved on to a private non-profit. All the time, I’ve worked exclusively with adult and geriatric patients. I have all the respect in the world for RTs who work with neonates and peds, because to this day, they still scare me. I'm not sure why exactly, I'm just more comfortable with adult patients. My co-workers would tell you it’s because I like to talk. They might be right.

Anyway, I've been a bedside therapist, run a pulmonary lab, presented numerous educational seminars and finally, managed my department for about 5 years. So given all that experience, I've come to realize that RTs who work in the adult-side of patient care have 1 industry to thank for our job security, our bread and butter as it were. Yes, that would be the tobacco industry. No real surprise here.

Sure, we treat asthmatics, post-op patients, and we can't wait for that next difficult ARDS case, but our primary energies are spent taking care of people who have bad lungs, a bad heart or some other disease related to their smoking. This is what compelled me from the bedside world to the virtual world and hence, the creation of "http://www.stopsmokinghelper.org/". I figured it was time to be a little more proactive instead of reactive. If I could help just one person stop smoking, then that would be one less patient some therapist may have to treat.

Currently, smoking in this country costs us, the taxpayers, over $193 Billion. That total is based on lost productivity and both direct and indirect healthcare costs. Back in 2004, COPD by itself costs Americans $37 Billion. So while everyone is talking about healthcare reform and Obamacare, think what would happen if everyone just stopped smoking?

Let that sink in for a while. We'd be talking about the roughly 20% of our population that smokes, laying down their packs and lighters. That sounds like some kind of Twilight Zone episode doesn't it?But right off the top, you're talking about eliminating the 90% of all lung cancer cases related to smoking. What would happen to the lesser known diseases that smoking is a risk factor for like: osteoporosis, oral cancer, stroke, prematurity of infants, SIDS, bladder cancer, your kid's childhood ear infections, etc.? All these are risk factors of smoking. Now we're talking about making a real impact on universal healthcare reform.

What about the human element though? How many people would you say die in the U.S. because of smoking; 10,000, 50,000, 100,000 people? Well, you're getting warmer, roughly 400,000 deaths every year are attributable to smoking. That's 1 in 5 deaths in the United States (according to the CDC). It's kind of funny, because I will occasionally still read pro-smoking blogs that deny the overwhelming statistics associated with smoking and smoking related disease. To them, it's all one big conspiracy created by the government and big pharma. They believe that people who suffer from COPD, lung cancer or other smoking related illnesses, are just the exception to the rule, rather than the rule itself. Oh, if they could only round with us for one week in the hospital, then they’d see the truth.

Well, I hope I have convinced you that part of our job as respiratory therapists is to educate our patients and their families to the very real dangers of smoking. Most of my patients are very glad to discuss the topic in the hospital setting, but will typically dismiss the idea once they're discharged and feeling better. However, if we had a way of giving them something or following up with them on discharge, they might have a greater motivation and/or desire to quit smoking. We have to strike while the proverbial iron’s hot. Getting them in contact with a program or service while still in the hospital is a great way of helping the patient become smoke-free. Simply getting the patient to talk with his or her physician can greatly improve their chances of success, so feel free to employ their GP in your education efforts.

Here is one example of what this might look like. When I left the acute care world, we had just implemented a therapist-based smoking cessation program that did involve a 1-week post-discharge phone call by one of our therapists. We were fortunate in that these therapists were also in our asthma clinic, so it wasn't a stretch on our staff's resources to have them perform this task. I know not every facility has this luxury. But at the very least, you can leave them with some kind of a resource in their hands like a phone number to a quit center. Then you’ve at least done your part.

Ultimately though, it's up to the patient, isn't it? I never met a patient who quit because I asked them to. They have to be convinced and committed to the idea that smoking cessation is in their best interest. It's simply up to us, to help paint that picture while we're waiting for the albuterol to nebulize. So make use of your time wisely and help get the message out. Oh, and one of the best times to bring it up is when the family is in the room. Grandkids and little children can be the best motivation to help someone quit.

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Stay tuned. This post is part 1 of a series. To view part 2 click here.

Related links:

• Smoking cessation program
• Smoke and have asthma: here's 20 incentives to quit
• More good reasons to quit smoking
• Stop smoking in front of your kids. Period!
  

Lung cancer rates on the decline

One of the hospitals I did my clinicals in back in the mid 1990s had a cancer clinic, and when I had to give breathing treatments to those patients, there was kind of a gloomy feel. Most of those patients knew they had terminal cancer.

Yet, according to this post from Reuters, lung cancers and other cancers, such as colon cancer, are on the decline according to statistics accumulated from the American Cancer Society. The report noted the decline was due to fewer people smoking, better treatment, and early intervention.

The report noted that "Death rates for all cancer types fell by 2 percent a year from 2001 to 2006 among men and 1.5 percent per year from 2002 to 2006 in women."

Likewise, " lung cancer rates have fallen in men by 1.8 percent each year since 1991 and finally started leveling off among women... The overall U.S. death rate from cancer in 2007 was 178.4 per 100,000 people, a 1.3 percent drop from 2006, when the rate was 180.7 per 100,000."

According to one expert from the American Cancer Society, "In that time, mortality rates have decreased by 21 percent among men and by 12 percent among women, due primarily to declines in smoking, better treatments, and earlier detection of cancer."

Once again it should be known that smoking is the #1 cause of lung cancer, with nearly 90% of those getting lung cancer current or former smokers. As you can see from the graphic, lung cancer was nearly non-existent in America until people started smoking. About 20 years after people started smoking, the lung cancer rate climbed.

Thus, as people quit smoking, perhaps some with the help of us RTs and our smoking cessation education, and perhaps due to rising cigarette prices, and laws that continue to phase out cigarettes in public places, the lung cancer rate should continue to decline

In a related article from therecord.com, a study done in Canada showed that people are less sympathetic of people with lung cancer due to the link between smoking and lung cancer. The study showed that 1 in 4 Canadians noted little to no sympathy.

I suppose since smoking is no longer the "in-thing", and no longer "cool," many people who don't smoke (a growing number) believe that those who smoke got what they deserved. What they don't realize is that in the 1950s and 1960s when our parent's generation was growing up, and smoking was cool, there was no wisdom as to the dangers of smoking.

Actually, the wisdom was there, yet the powers that be didn't let this wisdom spread as the tobacco industry was a major profit maker for the American economy. So, in that sense, I think we ought to have sympathy for those with lung cancer as with any other victims of cancer.

One concern by lung cancer experts is that with so little sympathy for lung cancer patients, monies set aside for lung cancer research and treatment won't be as much as for other diseases. Although the American study mentioned above may show Americans are a little more sympathetic to smokers than Canadians, as U.S. lung cancer trends are on the decline.

Never quit quitting

So I had an early stage COPD patient today, and as is my job, I encouraged her to quit smoking. I didn't go as far to say she HAD to quit, but more so provided her with the ammo, and the incentive to do so, and pointed her in the right direction. That's, basically, how it goes. We RTs (as do RNs) plant seeds, and hopefully these seeds eventually blossom.

Yet this patient was adamant she wasn't going to quit smoking, "I love smoking. I have no interest in quitting. I love smoking when I have coffee in the morning, lunch, dinner, break at work. I just love it. Of course I know smoking is bad, but I don't want to quit. I know I should, but... you know."

"However, "I said, "Here is the information you need to quit. When you're ready to use it, you have it at your fingertips. Read up. Know what works best. Know the facts."

"Um, my doctor provided me with a pamphlet, and it said within 10 years your risk of other diseases goes down, but he said your COPD will keep progressing anyway. So I think: what's the point."

"I think you misunderstood your doctor. Either that or he's dead wrong. Because by all the facts I've read, your COPD will never go away if you quit, but it will be a lot easier to manage, progression will be slowed way down, and you will be able to live as you are now for a lot longer."

"Still," she said, "It's something I love to do. My daughter smokes too, and my husband. We just love doing it together."

Denial. The first step is admitting you have a problem. And that's the great thing about this country is you have a right to be stupid. However, I think this lady wants to quit, yet it's easier not to. It's easier to make excuses.

She said her grand daughter keeps trying to get her to quit. I said, "You should quit for her, so you can be around as she grows up."

"Yeah," she said, "But if it's gonna be, it's gonna be."

I told her I understand her completely. I remember teasing my grandpa when I was a kid, that he should quit. He said, "I'd rather smoke, enjoy life, and be happy, and die young than live to be 100 and not have enjoyed life as I do now."

I understand grandpa completely. However, when he started smoking, the facts about the dangers weren't plastered everywhere as they are today. There are way too many facts, too many studies, that show smoking, and second and third hand smoke, is dangerous. Too many studies that show quitting is beneficial in every single way you can think.

"I know I'm going to sound like a parent when I say this," I said, "But you're responsible for your decisions. I understand your quest to be happy, but there are other things you can do to find happiness than smoking."

"You're completely right," she said, "I'm glad I had this talk with you."

While I think she means well, I have seen too many ladies (and gentlemen) in her situation, and way too many decide that quitting simply isn't worth it. And I have to watch them die over the next few years. It's the sad truth of this job.

Yet it's our jobs to never quit urging them on.

Facts about second hand smoke

Every day at MyAsthmaCentral.com we get lots of asthma related questions. Below are some questions I thought my readers at the RT Cave would enjoy.

Question: What are the hazards of second hand smoke? work at a nursing facility where the majority of the staff still smoke. The smoking shed is right next to my work shop and I can smell the smoke. Also, while I am working in the yard, smokers come up to me and continue to smoke. How dangerous is all of this? Can you help me with literature or information that I can give to my boss? He thinks I am over re-acting

My humble answer: Here's some ammo for you. All you have to do is follow the links:

1. Second hand smoke : facts about second hand smoke
2. Third hand smoke : Interesting article
3. Smokers quit kit: There's some info in here I think you'll find very useful, such as the listing of all the ingredients in a cigarette. Must read.
3. Second hand smoke and lung cancer

The is a war. We are in a war against ignorance. However, we can't just say, "Hey! You're ignorant." More or less, we have to lead by example, and we have to continue to learn the facts, and to share the facts.

You are wise to be concerned. Keep learning. And good luck on your quest to educate your friends and coworkers.

More good reasons to quit smoking

I think we all know by now that smoking is bad for your heart and lungs, but I bet you didn't know smoking also (according to this brochure from the Michigan Department of Community health) is responsible for:

1. Alzheimer’s Acceleration: Smoking speeds your rate of mental decline; smokers are 5 times more likely to develop Alzheimer’s in the later years of life – with or without a family history of the disease.

2. Increasing your chances of getting Lupus: Lupus is an autoimmune disease that causes inflammation, tissue damage, and pain throughout the body. Your risk of developing this disease increases when you smoke, but declines when you quit.

3. Increases your chance for impotence: Smoking has a serious effect on the prevalence of impotence; men who smoke nearly a pack a day increase their risk by a whopping 60%! Luckily, this risk can be decreased when you quit smoking – and the sooner the better.

4. Increases your chance for going blind: Your risk of age-related macular degeneration goes up 4 fold when you are a smoker – fortunately, quitting reduces that risk. This is a condition that causes a loss of central vision, which means you cannot see straight in front of you. If you enjoy activities like reading, sewing, or driving, it’s time to quit smoking.

5. Advancing arthritis: If you have Rheumatoid Arthritis in your family history, research shows you are 16 times more likely to get it when you smoke. Even when you don’t have the family history, you are 2.5 times more likely than non-smokers to be affected.

6. Causing Heartburn: If you have smoked for 20+ years, chances are you have heartburn. You are 70% more likely to get it than a non-smoker!

7. Causing insomnia: Withdrawal from nicotine may make it harder to fall asleep and the continued withdrawal overnight can cause increased insomnia.

According to the American Cancer Society, the following have also been linked to smoking:

Cancers caused by smoking:

• Acute myeloid leukemia
• Bladder and kidney
• Cervical
• Esophageal
• Gastric
• Laryngeal
• Lung
• Oral cavity
• Pancreatic
• Pharyngeal
• oral

Cardiovascular disease:

• Abdominal aortic aneurysm
• Coronary heart disease
• Cerebrovascular disease
• Peripheral arterial disease

Reproductive effects:

• Reduced fertility in women
• Poor pregnancy outcomes (e.g., low birth weight, preterm delivery)
• Infant mortality

Other effects:

• cataract
• osteoporosis
• periodontitis
• poor surgical outcomes (diminishes immune response and slows healing)

Periodontal effects:

• Gingival recession
• Bone attachment loss
• Dental caries

Smoking is no longer the IN thing

While smoking was once the in-thing, cool, and most people smoked, today smoking is rare and very few people smoke. Consider the following trends in adult smoking by sex as recorded in the U.S. between 1955 and 2005, and reported by the Center for Disease Control:

• 1955 Males = 54% smoked, females 24%
• 1965 Males = 52% smoked, females 34%
• 1975 Males = 44% smoked, females 30%
• 1985 Males = 34% smoked, females 28%
• 1995 Males - 23.9% smoked, females 18.0%

The ideal Smoking Cessation Program

Another responsibility laid upon us respiratory therapists is educating our patients who smoke on the importance of quitting. Most smoking cessation programs are fully reimbursed by most insurance companies, Medicaid and Medicare.

I always felt I was overstepping my bounds telling my patients they ought to quit. That was until I saw the latest statistics. The fact is, 70% of smokers say a health care professional has never told them to quit, and yet 70% of smokers say they want to quit.

Likewise, with the help of a clinical professional, the odds of a person quitting doubles. On top of that, the chances are that smoking is probably what caused and exacerbated the illness that caused the patient to be in the hospital in the first place. Smoking is also known to slow the immune process which delays healing. Quitting smoking, therefore, can prevent such an occurrence from re-occurring in the future.

Also, According to the CDC, " Constituents in tobacco smoke (e.g., polycyclic aromatic hydrocarbons) may enhance the metabolism of drugs, resulting in a reduced pharmacologic response. Smoking might adversely affect the clinical response to the treatment of a wide variety of conditions."

The job of the RT is not to finish the program, just start it. All we have to do is remind the patient of the importance of quitting, and what are the latest recommendations or products to help them quit, and then show them what steps they need to get started. Ultimately, our job is to nudge the patient.

The following is what the Michigan Department of Community Health recommends we do:

1. Ask about tobacco use at every visit:

• Advise patients to quit: "I realize that quitting is difficult. It is the most important thing you can do to protect your health now and in the future."
• Link current illness and tobacco use (Condition x is caused or worsened by smoking)
• Counsel on proper use of cessation medications
• Review the benefits of behavioral counseling

2. Assess readiness to quit: The Average person takes 9-11 attempts

3. Refer patient to tobacco quit line, or provide patient with tobacco quit kit

• refer to the Michigan Tobacco Quitline (1-800-480-QUIT)
• Refer patient to a self help quit book like this one.

4. Encourage the patient by emphasizing that quitting is possible.

5. Address ambivalence by reminding patient that it is normal to be scared about quitting smoking, and "getting stuck there is not!" Try to get them to look at the advantages of quitting smoking; of how they will be healthier; "Is there any way at all in which you’d be better off if you quit? That might be something to think about."

Types of ambivalence include:

• The products don’t work: The truth is, medications significantly improve quit rates, and all smokers should be encouraged to use them. If they didn't work in the past, it's because they weren't used properly, or the wrong dose was prescribed. Make sure the patient understand how to take medicine properly, and that they never quit. Encourage patient to use on a steady basis, and not as needed.
• I’m trading one addiction for another: Nicotine is absorbed from the lungs and reaches the brain in 11 seconds. That's what makes smoking so addictive. Cessation meds provide nicotine very slow, and therefore it's harder to get addicted. Also, it's easier to wean off the meds than cigarettes.
• I can quit on my own:
  Fewer than 5% of people who quit without assistance are successful in quitting for more than a year. Most people do not succeed on their own, and medications double your chances of quitting.
• NRT is harmful: NRT is the nicotine used in medications. Nicotine, however, is not the harmful component of tobacco. Harm comes from the 4,800 hazardous chemicals in cigarette smoke (see below). NRT is safe and when you are getting NRT you are not getting the 4,800 hazardous chemicals that come with smoking cigarettes. Likewise, people don't die from using nicotine meds, they do die of smoking cigarettes.

6. Address withdrawal concerns:

Nicotine withdrawal effects include:

• Depression
• Insomnia
• Irritability/frustration/anger
• Anxiety
• Difficulty concentrating
• Restlessness
• Increased appetite/weight gain
• Decreased heart rate
• Cravings

It must be noted here that most symptoms peak 24–48 hours after quitting and subside within 2–4 weeks.

7. There are many products available for you and your doctor to choose from:

• Nicotine gum
• nicotine lozenge
• Nicotine transdermal patch
• Nicotine nasal spray
• Nicotine inhaler
• Zyban
• Chantix

8. The advantages of nicotine replacement:

• Reduces physical withdrawal from nicotine
• Eliminates the immediate, reinforcing effects of nicotine that is rapidly absorbed via tobacco smoke
• Allows patient to focus on behavioral and psychological aspects of tobacco cessation

9. Encourage Behavioral change:

• Fewer than 5% of people who quit without assistance are successful in quitting for more than a year
• Few patients adequately plan and prepare for quitting on their own
• Many patients do not understand the need to change behavior.
• Often, patients think they can just "make themselves quit."
• Patients who get help are more likely to be able to quit for good."

Triggers for tobacco use: What situations lead to temptations to use tobacco?

Routines/situations associated with tobacco use:

• When drinking coffee
• While driving in the car
• When bored or stressed
• While watching television
• While at a bar with friends
• After meals
• During breaks at work
• While on the telephone
• While with specific friends or family

Control your environment:

• Create a tobacco-free home and workplace: Don't let other smoke around you
• Actively avoid trigger situations as listed above
• Modify behaviors that you associate with tobacco
• Create substitutes for smoking: nicotine gum, etc.

10. Note facts: It is not nicotine that causes health problems, it is the 4,800 chemicals in cigarettes. Nicotine replacement therapy is not addicting because you receive smaller doses that can be controlled. You cannot control the amount of nicotine in a cigarette.

Some chemicals in cigarettes besides nicotine include:

• Arsenic
• Acetic Acid
• Acitone
• Ammonia
• Benzene
• Butane
• Cadmium
• Carbon Monoxide
• Ethanol
• Formaldehyde
• Hydrazine
• Hexamine
• Hydrogen Cyanide
• Lead
• Methane
• Methanol
• Naphthalene
• Nickel
• Phenol
• Polonium
• Steric Acid
• Styrene
• Tar
• Toluene

Consider the following facts about quitting smoking:

• Within hours after you stop your carbon monoxide level falls to normal and the oxygen in your blood increases
• One day after you stop your risk for heart attack starts to go down
• Two days after you stop your nerve endings start to repair themselves so your senses of taste and smell start to return to normal
• Two weeks after you quit your lungs are working 30% better than before you quit
• Within 1-9 months lung function continues to improve, cough, sinus congestion, fatigue and shortness of breath all decrease as your lungs regain normal function
• Within one year your risk of heart disease is cut in half.
• Within 15 years risk of stroke, lung cancer and heart disease are that of a person who never smoked, and you can consider yourself fully healed.

10. Allay the fallacies:

• "Smoking gets rid of all my stress." Truth: There will always be stress in one’s life.
• "I can’t relax without a cigarette." Truth: There are many ways to relax without a cigarette.
• Smokers confuse the relief of withdrawal with the feeling of relaxation.
• Second hand smoke is safe. Truth: Studies show even short term exposure to 2nd hand smoke can increase the risk of heart attacks and cancer. It also increases childhood risk of respiratory tract infections like RSV and bronchiolitis, which can lead to hospitalization and even death. It's also linked to increased risk for sudden infant death syndrome (SIDS). It also causes asthma attacks and is even linked to causing asthma.
• Third hand smoke is safe. Truth: The smell of smoke in your house and on your clothing has also been linked to disease.

The following are the five R's to motivate a patient to quit smoking as per the Certified Respiratory Therapy Review Guide (2010, page 273):

1. Relevance: Use facts to encourage patient to indicate why smoking is relevent (risk to my own health, risk to my family and friend's health, etc.)
2. Risks: Ask patient to identify the negative consequences of tobacco use. Highlight those that are most relevent to patient: shortness of breath, exacerbation of asthma, harm to pregrancy, impotence, risk of heart attack, cancer and stroke. Also, increased risk of health complications for others.
3. Rewards: Ask the patient to identify potential benefits of quitting. Examples: Smoking will improve your health, smell, taste, length of life, improve self esteem, good example for kids, have healthier babies and children, stop forcing others to breath in your smoke, feel better, perform better physically, reduced wrinkles, etc.
4. Roadblocks: Ask the patient to identify barriers or impediments to quitting and note elements of treatment (problem solving, pharmacotherapy) that could address these parriers. Typical bariers might include withdrawal symptoms, fear of failure, weight gain, lack of support, depression, and enjoyment of tobacco.
5. Repeat: Repeat all the above motivational interventions as needed.

This post based on this power point presentation by the Michigan Department of Community Health. I also used some information from this power point presentation MSFH.

Michigan to go smoke free, yet we still cringe

Michigan passed a seat ban on smoking in public places recently. This includes restaurants and bars. My wife came into the house and smiled as she told me she just learned this. I said glumly, "That sounds great!"

"Aren't you excited," she said.

"Well, I don't know."

"I thought you'd be excited because you always complain that people are smoking in a restaurant you're in. You hate it when you are seated in a non smoking booth, and the one next to you is a smoking booth."

"I am happy," I said. "I think the government screwed up in that they are responsible for generations getting addicted to smoking, what with their free war cigarettes and their lies. Still, whenever the government makes another law telling people what they can and can't do, I feel terrible in the pit of my stomach."

"I see," she said.

Do you guys see where I'm coming from? I think that my right to fresh air trumps your right to pollute it. Yet for legislators to decide they know what's best for us and tell us what we can and can't do just gives me the eebie jeebies.

And, yes, it is true government lies got our grandparent's or great grand parents addicted to smoking. Then, even while there was documented evidence that smoking was dangerous as early as 1920, the government hid this information to the benefit of the big tobacco companies who were helping out the economy.

So it only seems just that the government undo the lies and get the U.S. un-addicted. And through public relations and public choice that is exactly what has happened over the past 60 years.

While smoking was once the in-thing, cool, and most people smoked, today smoking is rare, uncool, and very few people do it. Consider the following trends in adult smoking by sex as recorded in the U.S. between 1955 and 2005, and reported by the Center for Disease Control:

• 1955 Males = 54% smoked, females 24%
• 1965 Males = 52% smoked, females 34%
• 1975 Males = 44% smoked, females 30%
• 1985 Males = 34% smoked, females 28%
• 1995 Males - 23.9% smoked, females 18.0%

This is a perfect example of how, by our own accord, most Americans have decided not to smoke. They did not need a law to ban their right to do so.

Likewise, many restaurants and bars are going smoke free, and many of those that do go smoke free are thriving even more so than bars that allow smokers. Which shows by providing such competition, well educated consumers make wise choices. In this way, through capitalism, smoking has become the uncool thing, extremely unpopular, the outward trend, and the exception instead of the rule.

Still, we must consider that high taxes on cigarettes has almost made them unaffordable, which baffles me when I see a person who doesn't have a job, or who can't afford food, or who can't afford healthcare, lighting up. It simply baffles me.

Yet, because government lies caused the smoking crisis, I have always believed it is the job of the government to educate and end the smoking crisis. Now the smoking beast is "butt" on it's last breath, withering and moaning yet refusing to die a timely death. And so it's time for Uncle Sam to come in for the final jab and end it all -- it's time to go in for the kill.

Granted it is unconstitutional for the Federal government to step in here based on the 10th Amendment leaving anything that is not covered in the U.S. Constitution up to the states and to the people to decide. And I hereby give my permission for my state to ban smoking in public places to protect our right to clean air.

Still I cringe. I cringe because as I give my state government this permission, I wonder what freedom they will want to take away next. And the next time it may be a freedom that I don't want to give up. So, it only makes sense that I cringe as I learn the news that Michigan's legislature has ruled to ban smoking in public places as of 2010. We all should cringe.

Pinheads smoke in front of asthmatic children

I've written more than a few times on this blog how unwise it is to smoke in front of children, let alone anyone; that those who smoke in front of kids are pinheads. If that's not bad enough, smoking around an asthmatic kid should land the smoker in jail for child abuse.

I reiterated this point in my latest asthma blog post:

Smoking around asthmatic children is unwise
by Rick Frea Tuesday, April 14, 2009 @MyAsthmaCentral.com

If common sense were to prevail, no person would ever smoke in front of kids -- especially kids with asthma. Yet we all know it happens.

Just the other day I was paged to do a breathing treatment on a six-year-old boy with asthma. I couldn't help but notice that both parents reeked of cigarette smoke.

As a respiratory therapist, few things frustrate me more than this, perhaps because I was a child asthmatic who, on occasion, had to sit in smoke filled rooms (I wrote about this experience here).

I knew a doctor once who would call the police when he learned a parent was smoking in front of a child with a chronic lung disease. He would say, "This is child abuse."

My job as an RT is to educate these parents not just on the dangers of smoking, but that second-hand smoke can trigger an asthma attack, and make an ongoing attack worse.

Cigarette smoke also further damages not just the smoker's lungs, but the lungs of nonsmokers who are forced to breath in second hand smoke -- like kids.

Some parents heed my advice and stop smoking, at least stop smoking in front of kids. However, a few choose to ignore the wisdom I present. One dad completely denied second-hand smoke was dangerous.

Now, however, thanks to a new study conducted at the University of Alabama (and discussed here), we have proof a link between tobacco smoke and asthma morbidity exists.

The study consisted of 290 children with persistent asthma, 28% of whom were exposed to smoke in the house, and 19% who were exposed to smoke outside the house. All the children were educated on the dangers of second hand smoke, and were educated about avoiding their asthma triggers -- especially second hand smoke. Of the children whose exposure to second hand smoke decreased, "fewer hospitalizations and emergency department visits were reported in the 12 months prior to the second interview compared to the 12 months prior to the first interview. Additionally, these children were 48% less likely to experience an episode of poor asthma control."

While this is a new study, this is not new wisdom. In fatal asthma, a book published in 1998, the authors write:

"Surveys have shown 53-76% of children's homes have one or more smokers, and an estimated 8.7 million children in the U.S. under age 5 are exposed to cigarette smoke at home. Asthmatic children whose parents smoke may have more asthma symptoms and more frequent exacerbation's requiring emergency department management."

I have no problem with people smoking. I think it's fine if a grown adult chooses to put arsenic, acetic acid, acetone, ammonia, benzene, butane, carbon monozide, ethanol, formaldehyde, hydrazine, hexamine, hydrogen cyanide, lead, methane, mathanol, napthalene, nickel, nicotine, phenol, polonium, stearic acid, styrene, tar and toluene and 3,580 other substances into his body (which are the contents of one cigarette). But, a child doesn't get to choose. He is forced to breath whatever air is provided for him.

The importance of the Alabama study is that it acts as a reminder to members of the medical profession the importance of asthma education. It is my job as an educator to inform the asthmatic -- which include my patients and you -- to avoid your asthma triggers, which include cigarette smoke.

If your child has asthma, and you are smoking in front of him, chances are you're making his asthma worse. So, here's my lecture to you: Be a responsible parent and don't smoke in front of your asthmatic child, or any kid for that matter.

If you have asthma and are gutsy enough to smoke yourself, my lecture to scare you into quitting will come soon. So stay tuned.

No smoking, and no smelling like smoke!!!

I thought it was interesting a few months back when the administrators at Shoreline decided this hospital was going to go smoke free. Not only are employees no longer allowed to smoke on campus, they cannot leave and come back smelling of smoke.

My dad told me when grandpa was on his death bed in a hospital just after I was born in 1970 grandpa wanted a cigarette real bad and no one would give him one. So dad gave him one of his cigarettes. Grandpa would take a puff every few hours, and one smoke would last a long time.

In the 1980s hospitals started to crack down on smoking. And, about the same time nurses were allowed to wear more creative clothing than those prototypical white nursing uniforms and caps, smoking disappeared from hospitals.

When I was hired here in 1997 there was still yellowed tile in the nurses report rooms from when they used to smoke there. The elder nurses here have told me of how they used to sit and smoke at the nurses station while they charted. Patients used to smoke in their rooms.

They have finally disappeared, but we used to have little red magnets that said, "No Smoking" plastered on the file cabinets in the RT Cave. I never once used one, but these were supposed to be stuck onto the doors of rooms where oxygen was in use.

The policy eventually was changes so that if you wanted to smoke you had to go out to your car. However, I remember several nights the nurses would poke their heads out the door and puff. This habit was ended, however, when one summer many patent's had their windows open, and the smoke wafted in. Many patent's complained, and the practice was put to a sudden end.

So up until a few months ago my co-workers who smoked were allowed to do so with restrictions. However, that has come to an end. No person who works here is allowed to smoke on campus. Not only that, no person who works here can smell of smoke. Not following this policy is grounds to be sent home. And, if it is evident someone is not willing to comply, this is grounds for dismissal.

At first I thought this was quite harsh, but after further thinking about it I think this is pretty good, especially since this is a hospital, and many of our patients are Asthma and COPD patients who can have an attack just smelling smoke on someone.

I know this is true because just tonight I had to give a breathing treatment to an asthmatic kid, and both his parents reeked of smoke and filth. When I walked out of that room I had to use my inhaler, and I have controlled and mild asthma.

If it were a factory making a policy like this, I think I'd feel this policy is going too far. I think it's fine for a business to tell someone they can't smoke on campus, but to say they can't come in smelling of smoke is a bit overboard. Yet this is perhaps for the best for a hospital.

Now we have e-smoking

We already have e-mail, e-bay and e-magazines. Coming soon to an atmosphere near you may be e-cigarettes. Imagine a future of e-cars filled with people e-smoking.

Anyway, I found this ad while searching for something completely unrelated to this and thought it was a joke at first.