DINAS KESEHATAN KABUPATEN PATI Dampak Nikotin Ditinjau dari Sisi Kesehatan Tubuh Oleh : Dr. B Mariyani,MKes DINAS KESEHATAN KABUPATEN PATI 1

Sulit Berhenti Merokok?

Permasalahan Rokok di Dunia Merupakan penyebab kematian terbesar di dunia yang dapat dicegah ±4.9 juta orang meninggal akibat rokok di th 2000 (50% di negara berkembang); dan akan meningkat 2 x lipat di th 2020 (70% di negara berkembang) Di seluruh dunia terdapat kurang lebih 1.25 miliar perokok, 800 juta ada di negara berkembang (Bettcher, FCTC – WHO, Dec 2003) 3

Data Rokok di Indonesia Hampir 70% pria Indonesia merokok1 Total perokok di Indonesia berjumlah 62.800.0002 70% perokok mulai merokok sebelum usia 19 tahun3,4 12,77 % sudah merokok sejak SD3,4 1. WHO 2002 2. http://www.depkes.go.id/index.php?option=news&task=viewarticle&sid=476&Itemid=2 4 3. http://www.pdpersi.co.id/?show=detailnews&kode=957&tbl=artikel 4. http://www.tempointeraktif.com/hg/nasional/2007/05/30/brk,20070530-100967,id.html

Rokok… 1/NTP/p. 1/col2/¶4,5 Tembakau yang dihisap: 4000 zat kimia, 250 racun atau bersifat karsinogenik1 2/Mackay/p34/”Deadly Chemicals” Zat kimia pada tembakau2 Juga ditemukan di… Hidrogen Sianida Gas Beracun Acetone Cat Butane Bahan bakar pemantik Arsenic Racun Cadmium Aki mobil Carbon monoxide Asap knalpot Amonia Pembersih lantai DDT Insektisida Metanol Bensin roket Naftalen Kamper Vinil Klorida Plastik Toluene Pelarut industri 3/Harvard/p.2/¶3/figure 4/SGR/p. 25/col2/¶2 Key Point Tobacco smoke exposes the body to 250 toxic or carcinogenic chemicals. Vinil klorida – plastik Background Tobacco and tobacco smoke are known to be carcinogenic in humans.Tobacco smoke contains at least 4000 chemicals, at least 250 of which are toxic or carcinogenic.1 For example, tobacco smoke contains irritants, such as acetone, ammonia, and toluene, found in paint stripper, cleaners, and solvents respectively; toxic heavy metals, such as cadmium, used in car batteries, and arsenic, used in poisons; and carbon monoxide, which is a hazardous component of exhaust fumes.2 Although it is addictive, the nicotine found in tobacco is not a known carcinogen.3 All cigarettes are toxic: the US Surgeon General’s report noted that smoking cigarettes with lower yields of tar and nicotine provides no health benefit.4 References 1. National Toxicology Program. 11th Report on Carcinogens; 2005. Available at: www.cdc.gov/tobacco/ets. 2. Mackay J, Eriksen M. The Tobacco Atlas. Second Ed. Geneva, Switzerland: World Health Organization; 2006. 3. Harvard Health Letter. May 2005. 4. US Department of Health and Human Services. The Health Consequences of Smoking. A Report of the Surgeon General. Atlanta, Georgia: Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2004. 1/NTP/p. 1/col 2/¶4,5; p. 3/col 1/¶3; p. 4/col 2/¶2; p. 5/col 2/¶4 1. National Toxicology Program. 11th Report on Carcinogens; 2005. Available at: http://ntp-server.niehs.nih.gov. 2. Mackay J, Eriksen M. The Tobacco Atlas. World Health Organization; 2006. 3. Harvard Health Letter. May 2005. 2/Mackay/ p. 34/ “Deadly Chemicals” 3/Harvard/ p.2/¶3/ figure 4/SGR /p. 25/ col2/¶2

Kandungan Utama Nikotin – zat yang menyebabkan ketagihan Tar – tidak banyak berbeda dengan kandungan tar jalan raya Karbon monoksida – asap yang keluar dari knalpot mobil, mengurangi kandungan oksigen yang diambil Bahan karsinogenik – lebih 30 bahan telah dikenal pasti menyebabkan kanker Cigarette smoke is an aerosol composed of volatile agents in the vapor (gas) phase and of semi-volatiles and non-volatiles in the particulate (solid) phase. The volatile phase accounts for about 95% of the weight of the cigarette smoke and contains some 400–500 gaseous compounds, including nitrogen, CO, CO2, ammonia, hydrogen cyanide and benzene. There are about 3,500 compounds in the particulate phase – a major component is the alkaloid nicotine. The particulate matter without the alkaloids and the water is called tar. Cigarette tar contains polynuclear aromatic hydrocarbons, N-nitrosamines and aromatic amines, which have been identified as carcinogens.1,2 Many approaches can be used to reduce the concentrations of certain cigarette smoke constituents. These include filters, changes in paper porosity, and using different tobacco blends of reconstituted tobacco or expanded tobacco. Also, nicotine, tar and CO yields depend extensively on the way the smoker smokes, in particular, the volume of each puff and the interval between puffs. Yields of other smoke chemicals may also be influenced by smoking patterns.3 References: 1. Hoffmann D, Hoffmann I. The changing cigarette, 1950–1995. Journal of Toxicology and Environmental Health 1997; 50:307–364. 2. Nicotine addiction in Britain. A report of the Tobacco Advisory Group of the Royal College of Physicians. 2000; pp. 27–66. 3. Hoffmann D, Djordjevic MV & Brunnemann KD. Changes in cigarette design and composition over time and how they influence the yields of smoke constituents. In Monograph 7. The FTC cigarette test method for determining tar, nicotine, and carbon monoxide yields of US cigarettes. Report of the NCI Expert Committee 1996. Bethesda, MD: US Department of Health and Human Services, Public Health Service, National Institutes of Health. 6

Dampak Jangka Pendek Merokok Denyut nadi dan tekanan darah meningkat Peristaltik usus meningkat Nafsu makan menurun Sirkulasi darah kurang baik (efek vasokonstriksi) Suhu ujung-ujung jari (tangan dan kaki) menurun Berkurangnya rasa mengecap dan membau Mewarnai gigi dan jari (kuning sampai hitam)

Dampak Jangka Panjang Rokok Kanker Paru Laring Mulut/faring Usus Ginjal Mulut rahim Leukemia (AML, ALL, CLL)2-4 Esofagus Pankreas Kandung kemih Saluran Pernapasan PPOK Pneumonia Asthma yang tidak terkontrol Dampak Jangka Panjang Rokok Penyakit Lain Luka lama sembuh Fraktur pinggul Densitas tulang yang rendah Katarak Ulkus peptik† Kardiovaskuler Penyakit Jantung Iskemik Stroke-demensia vaskuler5 Penyakit pembuluh darah tepi6 Aneurisma Aorta Abdominal Alat Reproduksi Berat Badan Lahir Rendah Komplikasi kehamilan Infertilitas Impotensi Kematian Janin Mendadak †In patients who are Helicobacter pylori positive. AML = Acute myeloid leukemia; ALL = acute lymphocytic leukemia; CLL = chronic lymphocytic leukemia; COPD = chronic obstructive pulmonary disease. 1. Surgeon General’s Report. The Health Consequences of Smoking. 2004; 2. Sandler DP et al. J Natl Cancer Inst. 1993;85:1994-2003; 3. Crane MM et al. Cancer Epidemiol Biomarkers Prev. 1996;5:639-644; 4. Miligi L et al. Am J Ind Med. 1999;36(1):60-69; 5. Roman GC. Cerebrovasc Dis. 2005;20(Suppl 2):91-100; 6. Willigendael EM et al. J Vasc Surg. 2004;40:1158-1165. 8

Perbedaan Paru-paru Perokok vs Non-perokok Gambar Paru Perokok Gambar Paru Bukan Perokok

Gambar Paru Perokok

Kematian Pada Perokok…. 70% akibat penyakit paru kronik, bronkhitis kronik, dan emfisema 40% akibat stroke 90% akibat kanker paru Data WHO 2004 : Kematian akibat merokok sudah mendekati 5 juta kasus per tahun

Resiko bagi Perokok Pasif Asap Samping (asap dari pembakaran ujung rokok) Perokok pasif → Resiko terkena kanker paru dan penyakit jantung bertambah 20-30% Ibu hamil → Resiko mengalami proses kelahiran yang bermasalah (bayi lahir dengan berat badan rendah, lahir mati dan cacat lahir) Anak – anak → Lebih mudah terkena infeksi saluran pernafasan

Efek Rokok Pada Perokok Pasif… Asap yang dihirup 2 kali lebih banyak Kadar bahan berbahaya yang dihisap, lebih tinggi : > CO, 2-4 kali lebih tinggi > Nikotin, 2-3 kali lebih tinggi > Nitrosamin, 50 kali lebih tinggi Kemungkinan terkena kanker paru 30% lebih tinggi Kanker paru pada istri perokok 20-50% lebih tinggi Kematian istri perokok akibat penyakit jantung koroner lebih tinggi Batuk pilek pada anak perokok 20-80% lebih sering Bronkhitis pada anak perokok 2 kali lebih sering

Bahaya Asap Rokok Terhadap anak-anak Merokok berdekatan dengan kanak-kanak meningkatkan risiko anak-anak mengalami: Asma Sering pilek Radang telinga Bronkitis Kerap Ke Klinik Menjadi perokok

Efek Rokok Pada Wanita… Efek Kosmetika : Kulit keriput, rambut kaku, mata merah, bau tidak sedap, gigi berwarna kuning, suara serak. Kesuburan berkurang, menopause dini, kalsium tulang menurun menyebabkan tulang keropos dan mudah patah Merokok pada kehamilan : menyebabkan keguguran, bayi lahir mati atau lahir cacat.

Dampak Asap Rokok bagi Orang Lain 84% perokok dewasa merokok di rumah (2004) Dari 48.9% penduduk semua umur yang terpapar asap rokok orang lain di rumah (Susenas 2001):  66% (65 juta) PEREMPUAN  70% populasi (43 juta) ANAK-ANAK 0-14 th 81% remaja 13-15 th terpapar di tempat2 umum 64% di dalam rumah (GYTS, 2006) 17

Perbandingan Bahan dalam Asap Aliran Utama dan Asap Aliran Sampingan Asap Aliran Utama vs Asap Aliran Sampingan Nikotin Aseton Tar Hidrogen sianid Karbon monoksida Toluen Benzen Anilin Nitrosamin (bahan karsinogen) 2 kali ganda 2-5 kali ganda 3 kali ganda 4-6 kali ganda 5 kali ganda 6-8 kali ganda 10 kali ganda 30 kali ganda 50 kali ganda

Paru Umur 42 th. Merokok 20 btg/hr Paru Umur 82 th. Tidak Merokok.

Kanker Bibir

Kandungan Asap Rokok 4000 bahan kimia beracun, 69 penyebab kanker PADAT: √ NIKOTIN (ZAT ADIKTIF) √ TAR(kumpulan partikel pdt penyebab kanker) GAS: √ CO (mengikat sel darah merah mengganti O2) √ Gas-gas berbahaya lain 22

Sulit Berhenti Merokok : Karena Ketergantungan Nikotin 23

Bagaimana Nikotin Bekerja di Otak?

Efek Yang Ditimbulkan Karena pengaruh nicotine di keseimbangan sistem syaraf, merokok atau mengunyah tembakau mengecilkan pembuluh darah, menaikkan detak jantung dan tekanan darah, menurunkan nafsu makan, meningkatkan kewaspadaan, menghasilkan euphoria yang sangat ringan, setengah mengurangi indera perasa dan penciuman, dan mengganggu paru-paru. Penggunaan tembakau yang berlangsung lama dapat mengakibatkan paru-paru, jantung dan pembuluh darah menjadi rusak, dan kanker. Penyakit-penyakit yang ditimbulkan dari merokok seperti kanker paru-paru, emphysema (penyakit bengkak pada paru-paru karena pembuluh darah yang kemasukan udara), serangan jantung, stroke.

Akibat Nikotin… Peningkatan Denyut Jantung Nikotin Penyempitan Pembuluh Darah Pengerasan Pembuluh Darah Penggumpalan & Peningkatan Kolesterol

Merokok Mengakibatkan..... * 25% kematian akibat jantung koroner * Serangan jantung 3 kali lebih sering * Serangan jantung di usia < 50 tahun

Berhenti merokok itu sulit Gejala Putus Nikotin biasa disertai dengan 4 atau lebih tanda-tanda seperti: Dysphoric / mood yang jelek Insomnia Frustasi Mudah Marah & Cemas Sulit Berkonsentrasi Kurang Sabar Tidak Tenang Denyut nadi meningkat Nafsu makan/ berat badan yang bertambah • Women may have greater withdrawal symptoms. • More than 90% of young people who use tobacco daily experience at least one symptom of withdrawal. • Smoking cessation (nicotine cessation) produces a well-defined withdrawal syndrome characterized by four or more of the following signs: • dysphoric or depressed mood • insomnia • irritability, frustration, or anger • anxiety • difficulty concentrating • restlessness or impatience • decreased heart rate • increased appetite or weight gain American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)TM. 4th ed. 1994.

HANYA 5%-10% yang dapat melakukannya tanpa bantuan Faktanya… 70 % perokok ingin berhenti merokok tetapi…. HANYA 5%-10% yang dapat melakukannya tanpa bantuan Hughes JR. New treatments for smoking cessation. CA Cancer J Clin. 2000;50:143-151 FoulisJ, Burke M, Steinberg M, William JM, Ziedonis DM. Advances in pharmacotherapy for tobacco dependence. Expert Opin Emerg Drugs. 2004;9:39-53 Department of Health. Smoking kills: a White Paper on Tobacco. London, England: Stationery Office; 1998

Gejala-gejala yang mungkin muncul bila seseorang berhenti merokok1,2 1/DSM IV-TR p 1 of printout, table 292.0 2/West/ p 37/Table;p. 39, ¶2 Tidak sabar (<4 minggu)2 Meningkatnya nafsu makan atau berat badan (>10 minggu)2 Gejala Ketagihan Anxiety (rasa cemas)1,2 Dysphoric atau depresi Mudah tersinggung, frustrasi, atau marah Sulitnya berkonsentrasi Insomnia/gangguan tidur Sulitnya berhenti merokok tanpa bantuan Key Point Nicotine withdrawal syndrome is characterized by a combination of physical and psychological conditions, which make smoking difficult to treat. Background Recognizing that nicotine withdrawal results in clinically significant impairment in a person’s ability to function, the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) classifies these symptoms as a distinct condition: nicotine withdrawal syndrome. The symptoms of nicotine withdrawal syndrome can develop rapidly after a smoker tries to quit, and characteristics include the psychological symptoms of dysphoric or depressed mood; anxiety; irritability, frustration, or anger; and restlessness or impatience and the physical symptoms of insomnia, increased appetite/weight gain, and difficulty concentrating. Although present in those who use other nicotine-containing products, the manifestations of nicotine withdrawal syndrome are more intense in individuals who smoke compared with those who use other forms of tobacco. The rapidity of onset and intensity of withdrawal syndrome in smokers may suggest a greater dependence on tobacco.1 The typical duration of most of these symptoms is <4 weeks. Increased appetite is an exception, often lasting for >10 weeks. Although anxiety is listed as a classic symptom of nicotine withdrawal in the DSM, additional information is available about the relationship between anxiety and smoking. Some evidence suggests that while smokers increase their smoking when stressed, smoking does not help relieve the stress. As smokers stop smoking, levels of stress and anxiety actually decrease.2 References 1. Diagnostic and Statistical Manual of Mental Disorders, IV-TR. Washington, DC: APA; 2006: Available at http://psychiatryonline.com. Accessed November 7, 2006. 2. West R, Shiffman S. Fast Facts: Smoking Cessation. 1st ed. Oxford, United Kingdom. Health Press Limited. 2004. 1/DSM IV-TR p 1 of printout, table 292.0, 2/West/ p 37/Table3p. 39, ¶2 1. Diagnostic and Statistical Manual of Mental Disorders, IV-TR. Washington, DC: APA; 2006: Available at http://psychiatryonline.com. Accessed November 7, 2006. 2. West RW, et al. Fast Facts: Smoking Cessation. 1st ed. Oxford, United Kingdom. Health Press Limited. 2004.

Sekarang ada terobosan TERBARU, solusi berhenti merokok PERTAMA di Indonesia: Varenicline Tartrate 31

Mari Hidup Sehat Tanpa Rokok! TERIMA KASIH 32 32