Respiratory care in the alternative setting/tobacco cessation

Respiratory care in the alternative setting/tobacco cessation

Introduction

Tobacco has an ancient history throughout the Americas as a shamanic inebriant. European settlers found tobacco use to be nearly universal among Native American tribes. Routes employed for this use include smoking, chewing, use as a snuff, and oral consumption. Tobacco is one of the most common additions to ayahuasca, a sacramental hallucinatory admixture common to many indigenous cultures in South America, consisting of at least one plant containing the hallucinogen dimethyltryptamine, another plant containing a monoamine oxidase inhibitor that allows the dimethyltryptamine to become orally active, and often other plants (including tobacco).

The doses of nicotine, the primary psychoactive agent intobacco, in these methods aimed at hallucinatory or visionary experience are much higher than those typically experienced by modern day cigarette smokers. European settlers in the Americas soon adopted the practice of tobacco smoking and introduced it to Europe in the 1500s and 1600s. From there, the practice of smoking tobacco eventually spread to the rest of the world. There have been many efforts by nations and municipalities to ban smoking, but such efforts have largely failed, and tobacco smoking is legal for adults in nearly the entire world.

Case Summary (findings)

The patient is a 58 yr old male who has a historyof diabetes mellitus type 2, coronary artery disease status post left anterior descending (LAD) artery, atrial fibrillation, systolic congestive heart failure, morbid obesity, hypertension, dilated cardiomyopathy, depression, obstructive sleep apnea, gastroesphageal reflux disease, He smoked 1 pack of cigarettes a day for 35 years. I have to explain in the paper how a tobacco cessation program would have helped this patient quit. For example how it could have prevented many of his illnesses. He presented to the emergency room department with shortness of breath and chest pain. He was then admitted and scheduled for a cardiac catherization/possible angioplasty. During the procedure he went into respiratory failure and coded. His respiratory failure was secondary to cardiogenic shock and pulmonary edema.

Discussion (Summary)

Nicotine is the main psychoactive and addictive component of cigarettes and other tobacco products. When tobacco is smoked, nicotine is absorbed through the alveoli in the lungs, and when it is chewed or used as a snuff, it is absorbed through the mucosal membranes into the bloodstream. Nicotine has direct effects on nicotinic acetylcholine receptors, but also activates dopamine in the mesolimbic (“rewards center”) of the brain, although to a lesser extent than some drugs such as cocaine. Although nicotine can cause some improvement in domains such as attention, memory, and motor ability in nonsmokers, much of the improvement in such domains in smokers are the result of alleviation of nicotine withdrawal symptoms rather than a substantial net benefit of nicotine.

Nicotine has been shown to increase the reinforcing value of other stimuli in the environment during the course of drug action. This is consistent with the observation that smokers usually do not experience the euphoria associated with many addictive drugs, but sometimes report that smoking increases ...