Palenie bierne – czy na pewno wiemy jak bardzo jest szkodliwe?

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bierne palenieJak bardzo szkodliwe dla zdrowia jest palenie tytoniu nie trzeba przekonywać nikogo. Nawet zatwardziali palacze najczęściej zdają sobie sprawę, że ich nałóg zwiększa częstość zachorowań na liczne nowotwory, nieodwracalnie uszkadza płuca i zwiększa ryzyko chorób sercowo-naczyniowych. Co gorsza, równie złe skutki przynosi tzw. bierne palenie, czyli przebywanie w towarzystwie osób palących, które nieuchronnie prowadzi do wdychania dymu unoszącego się w powietrzu. Do ograniczenia tego szczególnie groźnego zjawiska miały prowadzić, wprowadzone także w Polsce, obostrzenia prawne dotyczące używania tytoniu w miejscach publicznych. O wpływie nowych regulacji na zdrowie populacji możemy się przekonać na przykładzie krajów, które te zmiany wprowadziły wcześniej.
Naukowcy z Niemiec, gdzie zakaz palenia w miejscach publicznych obowiązuje od początku 2008 roku, zaprezentowali podczas ostatniego kongresu ESC analizę zmiany częstości zawałów serca z uniesieniem odcinka ST (STEMI), którą obserwowali po wejściu w życie nowego prawa. Analizując wszystkie przypadki STEMI w latach 2006-2007 oraz 2008-2010 zauważyli, że, porównując oba okresy, ich ogólna ilość spadła o 16 %. Jednak, co zastanawiające, nałogowi palacze zupełnie nie skorzystali z prozdrowotnego ustawodawstwa, a wręcz przeciwnie – wśród nich częstość STEMI wzrosła (o 4 %). Zupełnie inaczej miała się natomiast sytuacja osób niepalących. W ich przypadku ilość odnotowanych zawałów serca z uniesieniem odcinka ST spadła z 39 miesięcznie w latach 2006-2007, do 29 przypadków miesięcznie w kolejnym badanym okresie, co oznacza zniżkę o 26 %. Takie wyniki sugerują jednoznacznie, że o ile zakaz palenia w miejscach publicznych nie pomaga osobom uzależnionym w pozbyciu się nałogu, o tyle osoby niepalące, mające do tej pory bierny kontakt z dymem tytoniowym, odnoszą bezpośrednią korzyść zdrowotną.
Toksyczność składników papierosa dobrze obrazują wyniki innego ciekawego badania prezentowanego w ramach monachijskiego kongresu ESC. W ramach eksperymentu zespół z Grecji poddał zdrowych ochotników godzinnej ekspozycji na dym tytoniowy. Przed wejściem i po wyjściu z palarni pobrano ich krew by ocenić średnią objętość płytek krwi (MPV), której wzrost, jak wcześniej wykazano, jest dobrym wskaźnikiem aktywacji płytek. Jednocześnie oznaczano także stężenie karboksyhemoglobiny (COHb) oraz poziom mleczanów, jako markerów zatrucia tlenkiem węgla i wyindukowanej w ten sposób hipoksji. Zgodnie z oczekiwaniami naukowców odnotowano istotny statystycznie wzrost wszystkich wymienionych parametrów – MPV z 7,8±0,4 fL do 8,5±0,6 fL; COHb z 0,8±0,5% do poziomu 1,2±0,4% oraz stężenie mleczanów z 0,7±0,2 mmol/L na początku do 2,2±0,9 mmol/L. Pamiętając, że były to efekty jedynie godzinnego palenia biernego, łatwo sobie wyobrazić, jakie są skutki wieloletniego przebywania w zadymionych pomieszczeniach.
W świetle tych i wielu innych dotychczas przeprowadzonych badań nikt nie może mieć wątpliwości, że walka z nikotynizmem powinna być jednym z priorytetów służby zdrowia. Z powodu tego niezwykle rozpowszechnionego nałogu ciepią nie tylko same osoby uzależnione, ale także ich rodziny, czy współpracownicy. Jako lekarze powinniśmy pamiętać, jak ważna jest tu nasza rola i przy okazji każdej wizyty konsekwentnie informować pacjentów o zagrożeniach związanych z nałogowym paleniem tytoniu, namawiać do jego zaprzestania i wskazywać metody pomocne w osiągnięciu tego celu.


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