The number of smokers has gone up again. Chia Hui Jun reports
The smoking rate has been falling for years but it is now back up again. The culprits are a stagnant cigarette tax and cheaper alternatives to cigarettes like loose tobacco leaves, beedies (thin cigarettes filled with tobacco flakes) and smokeless tobacco, respiratory physicians said. For instance, a bundle of 25 beedies costs $3 while a pack of 20 cigarettes costs $12.
Concerted efforts including prohibitive cigarette taxes and strict anti-smoking laws and campaigns cut the proportion of smokers here from 14 per cent in 2001, to 12.6 in 2006. Now it is back up to 14.3 per cent, with increases in almost all age groups, but especially those aged 30 to 39. In February, taxes for non-cigarette tobacco products were raised by 5 to 10 per cent while taxes for cigarettes have remained at $352 for every 1,000 sticks imported since 2005.
Dr Ong Kian Chung, president of the Chronic Obstructive Pulmonary Disease (COPD) Association Singapore, argues it is time to raise the tax again, as it has been shown to be effective in discouraging smokers. A study by the World Health Organisation has shown a 4 per cent drop in tobacco consumption in high-income countries for every 10 per cent increase in price. But a tax increase may mean people are more likely to smuggle illegal tobacco products.
Another strategy would be to rope in primary doctors, said Dr Ong, who is also a respiratory physician at Mount Elizabeth Medical Centre. He said financial incentives such as subsidies for medications to help people quit smoking should be given to general practitioners and specialists in private practice to encourage doctors to counsel patients to quit smoking. Smokers face raised risks of many diseases. For example, heavy smokers are 30 per cent more likely to develop COPD compared to non-smokers, said Dr Chew Huck Chin, a respiratory physician at Singapore General Hospital.
COPD is an umbrella term for chronic respiratory diseases like emphysema and bronchitis, both usually caused by smoking. Smoking has also been linked to ischaemic heart disease, stroke and cancer of the lung, bladder, pancreas, kidney and oesophagus. A study published in the Singapore Medical Journal in 2002 showed that the social cost of smoking to Singapore in 1997 was between $674 million and $839 million. The number of people with COPD is expected to increase by at least 20 per cent by 2020, up from the 60,000 cases diagnosed in 2008, Dr Ong said.
Poisonous chemicals build up in the lungs after prolonged smoking. These toxins cause the smoker’s bronchi (tubes that carry air into the lungs) and alveoli (air sacs in the lungs) to become inflamed. That causes the bronchioles (branches of the bronchi) to become narrower. This is known as chronic bronchitis. A smoker may also suffer from emphysema, in which damaged alveoli reduce the surface area for the exchange of oxygen and carbon dioxide, thereby weakening the lung structure and destroying the lungs.
The longer and more one smokes, the worse the damage to the lungs, said Associate Professor Philip Eng, consultant respiratory physician at Mount Elizabeth Hospital. This is why COPD usually strikes chronic smokers who are 50 years and older. It is estimated that 20 per cent of chronic smokers ultimately develop COPD, said Prof Eng. Patients with severe COPD may be bedridden and unable to perform everyday activities, said Dr Ong.
Mr Teo Eng Teng (inset), 83, was diagnosed with COPD in his 40s, after 20 years of smoking 40 to 50 cigarettes daily. He suffered often from asthma attacks, which worsened because of his smoking, said Dr Jim Teo, a respiratory physician at Mount Alvernia Hospital. It took a few severe and increasingly frequent attacks for him to decide to quit in 1960. “I was so breathless that I couldn’t speak,” Mr Teo recalled. His lung function has declined in recent years, due to age and smoking in those two decades. At least his asthma is under control now. He said. “I get an asthma attack once every few months now, instead of two to three times a month.”
FREE LUNG FUNCTION TEST
Smokers who are over the age of 40, become breathless easily and cough a lot, should take a spirometry or lung function test, said Dr Jim Teo, a respiratory doctor at Mount Alvernia Hospital. The five-minute breathing test assesses lung function and confirms if the airway is obstructed. The test is required to diagnose chronic obstructive pulmonary disease (COPD). COPD symptoms include coughing, sputum and shortness of breath.
Several hospitals are offering free tests in conjunction with World No Tobacco Day, which is on May 31.
SATURDAY, MAY 21
Say Yes To Quitting! Public forum on quitting smoking.
SGH Deck on 9, Block 6, Level 9. 1 to 5pm. Free. Call 6321 4685 or e-mail email@example.com or firstname.lastname@example.org
SATURDAY, MAY 28
Take A Breath: A public forum and spirometry tests by Dr Jim Teo and oncologist Elaine Ng.
Ngee Ann Kongsi Auditorium, Singapore Management University School of Accountancy. Free. 2pm to 5pm. No registration required.
Spirometry tests: By Jurong General Hospital and National University Hospital.
Clementi Community Centre. 11am to 3pm. Free.
SATURDAY, JUNE 4
Spirometry tests: By Khoo Teck Puat Hospital and National Healthcare Group.
Khoo Teck Puat Hospital. 8.30am to 3pm. Free