Cigarette smoking and the allergic reaction of the body. Episode 53

Monika Rachtan
Hi, Monika Rachtan. I would like to welcome you very warmly to the next episode of the programme "First Patient". On 31 May, we celebrate World No Tobacco Day. And just today a little bit about smoking, but also about cigarette allergy, because I believe that many of you may have this allergy. I will be talking to Professor Rafal Pawliczak. Good morning, Professor, and welcome.

Rafał Pawliczak
Good morning, Monika, good morning to you.

Monika Rachtan
The professor is a specialist in allergology and he is about to prove to us here scientifically that it is possible to be allergic to cigarettes, not just the kind: "I don't like cigarettes, I'm allergic to cigarettes, I'm annoyed by people who smoke", but the kind that can be demonstrated by diagnostic tests. Is that right?

Rafał Pawliczak
Well I don't think we can quite talk about an allergy to cigarettes. First of all, cigarettes are harmful. I will even go a little further, ladies and gentlemen, whatever you light or strongly heat in your mouth, it really does cause very serious harm. Of course, exposure to tobacco smoke increases the risk of allergic diseases, worsens their control and definitely leads to disability. And we are talking here not only about asthma, but also about allergic rhinitis, where exposure to second-hand smoke significantly worsens the control of allergic rhinitis, but above all cigarettes, let us not hide it, Monika, are a poison. I realise that you are saying: 'Well, I smoke, I smoke, I cannot wean myself off it'. It is an addiction, but to wean oneself off tobacco is relatively simple.

Monika Rachtan
I'll ask you how to do that in a moment, but we've talked many times in this programme, the Patient First programme, about people who smoke cigarettes and who themselves, consciously or unconsciously, expose themselves to this toxin. But today I would perhaps like to talk a little more about people who do not put cigarettes in their mouths at all, but who are exposed to tobacco smoke that harms them. Passive smoking - 8% of smoking deaths are caused by passive smoking. Why is this passive smoking so harmful?

Rafał Pawliczak
Ladies and gentlemen, tobacco smoke contains just over 5000 different substances. And it does not matter which side of the cigarette we are on. These 5000 substances are in the vicinity of the smoker in the same room, in the same car, in the same premises, in very close proximity. Of these, a few hundred substances have cancer-causing properties, and all the rest cause an inflammatory process. An inflammatory process that affects not only the respiratory tract, but also the skin and, above all, the blood vessels. That is to say, when you inhale tobacco smoke, no matter from which side of the cigarette - I will say it again - you cause yourself quite intense vascular inflammation. If you imagine a mother taking her child to nursery school ...
Monika Rachtan
The same image, I had in my head exactly.

Rafał Pawliczak
And he corrects his cap while smoking a cigarette held in his mouth. Or two dads on a walk with their children, who hold their cigarettes right at nose and mouth level of the little ones. So you already know what this exposure looks like. Add to that what cardiologists say. The atherosclerotic plaque builds up over several decades, so several decades of exposure to second-hand smoke means not only damage to the respiratory system, but also a dramatic increase in the risk of atherosclerosis, heart attacks, strokes, peripheral vascular disease and, of course, cancer. And it makes absolutely no difference whether it is passive or active smoking. I would even hazard a guess that passive smoking is more harmful.

Monika Rachtan
Why?

Rafał Pawliczak
Because we don't have a filter and because the temperature on the side of the cigarette that you don't hold in your mouth is many times higher. So the generation of free radicals of all those substances that are oxidised at high temperatures increases them.

Monika Rachtan
As the professor said about the situation when a mother drives in the car with her child and smokes a cigarette. It would seem that such images are images from the 1990s, that the widespread ban on smoking in public places has meant that, if we do smoke, we hide with the cigarette in our own home and are unlikely to do so in front of others. My observations, on the other hand, are dramatic and surprisingly different. I very often look at people who, just when they are driving, have their window open, elbow out, and a cigarette in their hand, and fellow passengers. These co-passengers are often 2, 3, 4, 5. However, I wonder whether such an image is also common in the eyes of the professor. Because it seems to me that we have somewhat forgotten that people smoke in Poland.

Rafał Pawliczak
About 30% women smoke cigarettes a little more, even according to age. About a quarter of men smoke cigarettes. In general, cigarettes, ladies and gentlemen, are smoked by young people. We once did a large study. We looked at students at the Medical University of Lodz and studied when and what they smoke. Imagine that as many as 80% first-year students at the Faculty of Medicine and the Faculty of Military Medicine smoke cigarettes and start smoking from the first day of their studies and smoke for at least the first three or four years.

Monika Rachtan
A few weeks ago, we broadcast an episode just with a representative of the young generation of doctors, whom I asked directly if young doctors smoke cigarettes. And he admitted that they do. He also said that young doctors are also using alcohol more and more, and that this is a very big problem related to professional burnout. We often say that we smoke because we're stressed, I'm stressed, I'll have a cigarette, it'll make me feel better.

Rafał Pawliczak
I think there are two things. Here, undoubtedly, smoking is an addiction, it is an addiction in the same way as addiction to alcohol, to food, all the same, to drugs. All the same, whatever you come up with here. We also have good data that there are some genes for addiction. But, ladies and gentlemen, please note that smoking is a situational addiction, which is precisely stress, coffee, pleasant moments, also leisure. These are situations in which we very often reach for a cigarette. But pay attention to teenagers, who are increasingly reaching culturally for so-called disposable cigarettes. This is a real drama that is completely unnoticed by decision-makers.

Monika Rachtan
I will return once again to the streets of Polish cities and tell you, Professor, about what I am seeing today as I walk around my home town, the city in which I live, namely Wrocław. There are young people walking along the streets of the city very quickly, holding something in their hands, and you cannot even see what they have there. It is absolutely not the kind of cigarette they light up with a lighter. Absolutely it's not something that requires some kind of major commitment on their part to use it. They hold it in their hand and I go with such a young man for 20 minutes and he uses it for 20 minutes. Non-stop, non-stop, non-stop, non-stop. He doesn't hide it at all. I get the impression that when we are developing somewhere, he has this device in his hand all the time. What is it, Professor?

Rafał Pawliczak
These are disposable cigarettes, i.e. nicotine solution applicators costing £20, £30, with a non-replaceable battery that cannot be recharged. You cannot replace this container, which are available in many shops, including chain shops, the most popular ones, with dozens of flavours. The most popular flavours are sweet, so peach, pineapple, citrus, but also mint. And these are disposable electronic cigarettes that can be bought in Poland and are registered on a notification basis. Most of them, that is, we report to the relevant office that we want to sell such cigarettes and the office has a certain time to say no, if it doesn't say no within this time, then the cigarette goes on sale. So it is completely different. This is a product which is registered in a completely different way to a classic tobacco product.

Monika Rachtan
That is, it is much more accessible.

Rafał Pawliczak
Yes, it is much more readily available. Many countries around the world, including, for example, China, which, as you may have guessed, is a major producer of disposable cigarettes, have banned the sale. China banned the sale of single-use cigarettes in 2022. In Poland, we also have legislative attempts. Here, the Minister for Health has shown great legislative initiative, and I hope that we will soon reach a ban on the sale of disposable cigarettes. I would say that this is the modern equivalent of the chewing gum you used to chew. Chewing gum, apart from sometimes pulling fillings out of your teeth, was generally not very harmful. Unlike those disposable cigarettes, which provide nicotine, glycol and dozens of very harmful substances. But from my perspective, there is one other thing that is important, and that is the habit of snorting some tasty smoke. It will very quickly lead to young people who start with disposable cigarettes to start smoking vintage cigarettes.

Monika Rachtan
You said, Professor, that there are various substances in these disposable cigarettes, that among other things there is also nicotine. And I would like us to answer the question at this point whether it is the same nicotine as the nicotine in those stinky cigarettes that some of us hector and say that we would absolutely never put that in our mouth. But when our child walks around with a disposable cigarette like that, we absolutely refuse to allow ourselves to think that it is generally the same thing, just a little less smelly.

Rafał Pawliczak
Well we probably don't know that our children are walking around with this disposable cigarette, because they are probably bought on the way to school, but they deliver roughly six hundred doses of nicotine. That is to say, many times more than a packet of cigarettes and they probably end up in some kind of rubbish bin when they return from school. Consequently, we do not even know about it. On the other hand, the nicotine is exactly the same and the additives are just as harmful as in classic electronic cigarettes, let's call them reusable.

Monika Rachtan
Do we have any data or observations on how long such a disposable e-cigarette lasts for a young person?

Rafał Pawliczak
No, I have no such data. All I can say is that, from my own observations, in general young people buy up to two such cigarettes a day.

Monika Rachtan
That is if they burn like that, I think it is called. If they're consuming these two e-cigarettes a day, how would we be able to convert that way roughly how many packs of classic cigarettes?

Rafał Pawliczak
I would put it comfortably at somewhere up to ten packets of cigarettes or two cigars.

Monika Rachtan
Can you imagine smoking 10 packets of cigarettes a day? It comes out that we smoke 100 cigarettes a day, which means that we hardly ever take the cigarette out of our mouths. And it is my observation, as far as young people are concerned, that they do not take the e-cigarette out of their mouths. It is simply an interlude between one sentence and another, between one action of answering the phone or writing a message on Messenger. It doesn't disappear from their hands. We absolutely don't want to do any advertising here where you can buy such things, because that's not what we're about at all. But we would also like you, above all parents, because I know that this group, the age range 18-35, is our audience. We would like to warn you, to draw your attention, to watch your children, to check what they do on the way to school, but above all to check what they do on the Internet, because disposable e-cigarettes are mainly available on the Internet. They are also available in vending machines in supermarkets, where you can just click on them and no one will ask you Hey, child, do you have proof?

Monika Rachtan
It just falls out there. That's right, Professor, so what to look out for, maybe what children's behaviour? Which devices, which boxes? What to look for?

Rafał Pawliczak
I would say very simply. If you see, if you smell a strange, unusual smell from your children, just mint, citrus, sweet, then take an interest and investigate. It is not chewing gum, it is very likely that your 15, 16 year old or 15, 16 year old is just using cigarettes. Look at the pictures your children are posting on Facebook, Instagram or other social media.

Monika Rachtan
We know or have learned from today's programme that these classic cigarettes are very harmful, I suspect. However, these devices, e-cigarettes and everything that has appeared on the market in the last 15 years, are these things researched? Can the professor give me an answer as to whether such a thing is more harmful than a normal cigarette? Do we not have such studies today?

Rafał Pawliczak
We have, in fact, ladies and gentlemen. Three, four types of nicotine providers. These classic cigarettes are well known to you. Please bear in mind that these modern versions of the light type, slim cigarettes, etc., etc., etc., etc., etc., etc., etc. They are, of course, just as harmful as those classic cigarettes that your grandparents or parents smoked, but they cause slightly different diseases. Those classic cigarettes caused lung cancer in the first place. On the other hand, thin cigarettes or cigarettes with a lower tar content primarily cause cancers of the larynx, throat, tongue and bladder. It is also worth noting that in addition to cancer, cigarettes accelerate the development of atherosclerosis, and not only coronary or cerebral atherosclerosis, but also peripheral atherosclerosis. Because you will say well, a heart attack. Modern interventional cardiology is so well developed that it is relatively rare to die of a heart attack. This is true. However, we still do not have good management of peripheral vascular atherosclerosis, where at some point such a 60-year-old who has had a shorter or longer episode with cigarettes, but has some other factors in the development of atherosclerosis, at some point finds that he does not get out of bed due to the fact that his blood vessels are largely closed by atherosclerotic plaques.

Rafał Pawliczak
So these are the classic cigarettes. In addition to that, we have electronic cigarettes, which are a nicotine solution. Once still available, but significantly reduced. We have these electronic cigarettes where there are replaceable tanks that can be refilled. We currently have a flood of disposable cigarettes. And then we have the last group. Sources of nicotine, or tobacco warmers. And here, of course, the tobacco is the same. However, the temperature in these electronic heaters is slightly lower than in a classic cigarette, even two or three times lower than in a classic cigarette. Consequently, the release of nicotine, tar and other harmful substances from these sources is somewhat less. Interesting fact ladies and gentlemen, these nicotine warmers have been in some countries since 2014, as for example in Japan, and a significant proportion of patients who started smoking these devices, using these warmers quit smoking sooner or later, but as many as a dozen percent of these patients quit smoking. So the US Food and Drug Administration, for example, considers this a method of reducing nicotine exposure, but also points out that tobacco warmers should only be sold to adults and people who have not started smoking.

Rafał Pawliczak
So if you are thinking of starting smoking, I strongly advise against anything. Please. On the other hand, if you happen to smoke cigarettes, whatever they are, and you intend to or are thinking of quitting, I would firstly suggest that you see a doctor.

Monika Rachtan
To which doctor?

Rafał Pawliczak
Go to a pulmonologist, to an allergologist even, to a family doctor, to an internist and say that you want to stop smoking. Your doctor will then be able to recommend a course of action for you and usually starts with nicotine replacement products, which provide you with specific doses of nicotine. These doses can be adjusted, reduced.

Monika Rachtan
That is to say, we then stay with the nicotine to which we are addicted, but we reject from ourselves all those harmful substances that are in traditional cigarettes. These cancer-causing substances are plaque-causing substances, which is already one such factor that we want to get rid of. I guess the most important one, because it's about our health, is taken care of.

Rafał Pawliczak
And we are still left with the maintenance or maintenance of a certain habit, which is the supply of nicotine. And then you have tablets, gums, sprays. There are many preparations of this type and usually these preparations help us to wean ourselves off smoking very significantly. If it is effective, you quit smoking very well. If this is ineffective, your GP is able to take you to the next step on the therapeutic ladder, which is, for example, to use drugs that reduce the desire to light up a cigarette. And there are several of these drugs on the market.

Monika Rachtan
Are they reimbursed?

Rafał Pawliczak
By contrast, they are not very effective.

Monika Rachtan
Cheaper than cigarettes?

Rafał Pawliczak
I think so. If you buy cigarettes legally, I think an eight-week dose of smoking cessation medication will be slightly cheaper than eight weeks of smoking classic, legally available cigarettes.

Monika Rachtan
And what's next on the therapeutic ladder?

Rafał Pawliczak
If you are successful, do you stop smoking? Then the subject is closed. If you are unsuccessful in quitting, you can talk to your doctor about using tobacco warmers. And here, of course, these tobacco warmers are not a cure. You should be aware that the tobacco is still being heated there, that they are still generating harmful substances, but there are fewer of these substances and we do not have long-term observations, especially oncological ones, because this is the most important thing we are waiting for. However, as I said, several percent of patients using tobacco warmers quit smoking within a year of starting to use them.

Monika Rachtan
Patients often come to your professor's office and say I want to stop smoking. How do I go about doing that? Can you help me with this?

Rafał Pawliczak
I usually, if I smell cigarettes from someone, it doesn't matter if it's the patient's parent or if it's the patient, I try to start a conversation about it and according to the therapeutic scheme. If the patient is interested in quitting smoking, it doesn't matter who is at the appointment, him or the child, we start the procedure of quitting. On the other hand, if the patient definitely avoids the topic, we end the conversation but return to it at the next visit. If we are being watched by doctors, which is probably the case Ms Monica.

Monika Rachtan
I hope.

Rafał Pawliczak
This I would encourage everyone, all my colleagues, whether they are ophthalmologists, dermatologists or gynaecologists, to talk to every patient about tobacco addiction and advise them to try to quit.

Monika Rachtan
The doctors who come into contact with us are that one branch that can change this face. And I would remind you that over 25% of adult men in Poland smoke cigarettes over 30. Around 30% of women also smoke cigarettes in our country, so the problem is a serious one and it would probably be appropriate for decision-makers to address it. Of course, we here hear about many EU projects, about the aspiration for Poland to be a cigarette-free country, for the whole of the European Union to be cigarette-free, for there to be 5% smokers in the coming years. But when I look at the statistics of 25% men, 30% women and kids running around with e-cigarettes, it seems to me that this problem cannot be solved in 50 years. If we don't start to take serious systemic action like you have with the eye of a specialist, a doctor who treats patients very often whose illnesses are precisely due to smoking. I look at these actions of decision-makers and how do I assess them?

Rafał Pawliczak
My assessment of these measures is not too bad, Monika, namely that at least someone has started to take an interest. You see, you are practically not allowed to smoke in public places. You cannot smoke a cigarette in a café, in a restaurant, can you? So these are extremely positive things. I don't light a cigarette. You at the university are also slowly being eliminated smoking rooms. The consequence of this, of course, is that people are smoking outside in front of the buildings. However, I would like to appeal to decision-makers to do two things: stop legalising new cigarette grades, new products, in short, to close the market, so that no tobacco company can introduce a new grade, a new tobacco product. I am aware of the tax benefits, but please remember that the harm caused by smoking far outweighs the gain from VAT excise duty. All the more so as a significant proportion of tobacco products are sold in Poland outside of the official circuit, and we need to be aware of this. The border guards and customs services report this very well. The second thing that I think is very important is that Polish politicians should stop appearing in public with cigarettes.

Rafał Pawliczak
Yesterday you saw Minister Sienkiewicz leaving the ministry, sitting down in a public place and smoking a cigarette. Minister, I perfectly understand this context and I value you as an intellectual. It is clear to me, but I would very much like to appeal to you to declare, as part of your campaign for the European Parliament, that you will give up smoking.

Monika Rachtan
And Mr Professor is probably happy to help.

Rafał Pawliczak
I will be very happy to help you. And you also have a number of pneumunologist specialists in Warsaw who are also happy to help you, but you are more than welcome to see me.

Monika Rachtan
We have these actions that the Ministry of Health is trying to take, which you said, the Ministry of Health is trying to create some tools that will make there be fewer smokers in Poland. But there is consent. Well, because if the Minister allows himself to smoke in a public place, then generally speaking, we are all thinking, all right, many people smoke anyway. How does the professor view such situations, when, let's say, he is relaxing on a beach in Poland, at the Baltic Sea, on the Hel Peninsula, and a group of young people sits down next to him, spreads out a blanket, has no screen, because this is no longer fashionable, and starts smoking? What does the professor do in this situation?

Rafał Pawliczak
A very good question. The answer will be quite obvious. No, I will not enter into a discussion or debate with them. I would probably consider that this would be an action that violates their certain freedoms. That being said, I rather take the stand of popularising a tobacco-free life. And here, many people, including from the medical sector, have done a great deal in this area. Professor Zatonski has always been such an icon. What I really want, however, is for every doctor, whatever speciality he or she practises, and every nurse to tell all those patients who smell tobacco that they should give up smoking. That, in my opinion, is the only way.

Monika Rachtan
Do doctors have the time to do this?

Rafał Pawliczak
To ask two questions I think yes. I think yes. Surely nurses have the time to do that. Remember, after all, everyone accepts smoking cigarettes in front of hospitals for example, right? So the most important thing is to be aware of the fact that a cigarette does not taste good, that it is harmful and that you can effectively replace it with some other healthy habit.

Monika Rachtan
You mentioned that many countries have put in place measures that erase all those e-cigarettes, disposable e-cigarettes, but also that result in fewer of those people smoking traditional cigarettes in society. Do we have a country here that we could point to our policymakers as a model? Well, since they have already taken on the task, why not give them a good example?

Rafał Pawliczak
The UK, for example, intends to ban the sale of cigarettes to people born after a certain calendar year. I am not entirely convinced that banning methods are that effective. You know very well that a Pole can circumvent any ban. I would therefore rather suggest discouragement. If you look at the sales curve for cigarettes, the advertising ban has had some effect in reducing cigarette sales. The fiscal measures, i.e. the increase in tobacco taxes, has reduced sales very significantly, at least the official sales. It has also reduced consumption a little bit, but it really seems to me that education and education not only on the part of doctors, but on the part of policy makers. If, ladies and gentlemen, a politician is running, skiing, playing with his dog, well, that somehow also influences your behaviour. I would expect exactly the same from actors or, more broadly, people in the arts. I would also prefer not to see any public person smoking cigarettes. I would love to hear more from these people that they don't smoke or that they used to smoke, that they don't smoke, because I would love to hear how they feel about it.

Monika Rachtan
So what, social media, actors, influencers that will be, is that just the way to do a modern social campaign today? So we don't do some marketing plan, we don't do billboards, we just show good, cool examples, educating. Well, probably on the Internet, because that's where most people are. And there we talk about the benefits of quitting smoking.

Rafał Pawliczak
The benefits of not starting smoking. I would even say yes. If you look, on all cigarette packets, classic and otherwise, on all cigarettes containing tobacco, you have warnings, usually in the form of drastic images. Our assessments show that the effectiveness of these pictures is low.

Monika Rachtan
Well we get a bit used to them looking at them every day, 10 times a day I think it stops working a bit.

Rafał Pawliczak
Reducing the number of places where cigarettes can be bought seems to me not to be a bad solution either. I look with interest at the activity of the present government, which is concerned with attempts to restrict the sale of alcohol at filling stations. I would very much like to add cigarettes to that.

Monika Rachtan
Yes, that would be a very big breakthrough. And that's exactly what I'm thinking about, if we have the power to say Poles, there's not going to be beer at the petrol station, why do cigarettes have to be there? But I'm thinking about this because it's World No Cigarette Day on 31 May. What benefit will a person who has been smoking for, say, 20 years experience? If she manages on that 31st of May, to say to herself okay, I'm getting up today, I'm not picking up cigarettes. What will happen after nine hours? What will happen after one day? What will happen after 30 days? And what will the health benefits be after 15? Because that's what we wish for our audiences, that they last those 15 years from 31 May without a cigarette.

Rafał Pawliczak
Firstly, Mrs Monica, dear readers, we will have more money left over. Whatever cigarettes you buy. They are all expensive. Therefore, you can spend it on something else entirely, on whatever you want. The second thing I think is that after about three or four days your taste and appetite will improve. Therefore, there is a good chance that you will feel like eating something. Here I recommend carrots. Carrots are really very good. Tasty and healthy. Yes, and I am keeping my hands busy. Therefore, more or less after another two weeks of eating carrots. It seems that such a situational habit of having to occupy one's hands with something will disappear after another few weeks. Of course, they cough all the time. A person who has stopped smoking, especially classic cigarettes, clears the bronchi, but starts to breathe freely. I think that after two months you will observe a better physical capacity. And we are not talking about running marathons, but we are talking about climbing the second floor. You will stop having breathlessness. I am not mentioning that your skin will become prettier and your hair shinier.

Rafał Pawliczak
Please remember that free radicals actually damage the skin very significantly, and not only the skin on the hands, but especially the skin on the face. Here, too, a special appeal to young women. Really, if you ladies stop smoking, your skin will become velvety.

Monika Rachtan
That is, saving not only on cigarettes, but also on the creams that we women love to use and put on ourselves in large quantities. Just stop smoking and that skin will be more beautiful. But you mentioned that a little bit of stress comes up. When you quit smoking, you start eating a little bit, you start hanging around that fridge a little bit.

Rafał Pawliczak
First of all, ladies and gentlemen. Quitting any addiction is fraught with stress, because something that was important and enjoyable to you disappears from your life. Therefore, Monika, you will not hear from me that a senior citizen has to give up smoking. You will not hear that from me. I would very much like senior citizens to stop smoking.

Monika Rachtan
But it is difficult.

Rafał Pawliczak
In contrast, the benefits to a person aged 75 80 of quitting smoking, given their life expectancy, will probably not be great, and the negative emotions may be. Although I have patients among my patients who have quit smoking at 75 80 and they say it has prolonged their life significantly. I will say one thing that is very important, because we are talking a little bit about the profit and loss account. This calculation is, ladies and gentlemen, very simple. A person who smokes cigarettes lives 14 years less than a person who does not smoke. 14 years. And that is the basic benefit that we see. On the other hand, if you put on a bit of weight, if you start controlling what you eat, there is a good chance that you will maintain that weight.

Monika Rachtan
But it also improves fitness. It's a great opportunity to start moving a bit, not to say run marathons, but at least go for a walk once a day, for those 20 minutes, to breathe fresh air. And I think that this quality of life will totally change. Quitting smoking, moving a little bit, wow, great opportunity to change your lifestyle a little bit.

Rafał Pawliczak
If you go on this walk with your partner and children, for example, you will still be assembling family ties.

Monika Rachtan
And speaking of partners, how do you put up with a husband who quits smoking? Well, because it's the atmosphere, the atmosphere in the whole house. He's stressed, he's 40, not 70, he's 40. He decides to change for his 40th birthday. He quits smoking and a stressful situation arises. What to do here? How do you prepare for it?

Rafał Pawliczak
I think it is very simple. These are certain things that are beyond your control. Therefore, if a stressful situation arises with your partner or partner, the answer here is quite trivial. Is it worth worrying about something over which you have no control? You can ask her or him. In my opinion, this is the best way to deal with stress. Life is hard. There is no doubt about that. We have seen historically that tobacco consumption increases dramatically during wars. We saw it during the Second World War. We saw it during the Vietnam War and the Korean War. We are seeing exactly the same thing at the moment. Yes, but please remember that these are things over which you have absolutely no influence. Therefore, is it worth worrying about? In my opinion, no.

Monika Rachtan
However, we do have an influence on whether we smoke or not, and making this choice is very important today, because as we speak, it is World No Tobacco Day, but it does not matter whether it is 31 May, 5 June or 24 December. We would like this percentage of smokers in our country to be significantly reduced, both of classic cigarettes, e-cigarettes and everything else that provides us with nicotine. In three sentences, Professor, in three points. What can be done to quit?

Rafał Pawliczak
Make a decision, plan, quit and don't get frustrated if you keep coming back. It rarely happens the first time. Roughly 60% patients need at least two or three attempts to quit smoking. But the most important thing is to make a decision, be motivated and set yourself a reward.

Monika Rachtan
I now appeal to you, ladies and gentlemen, not only to remember on 31 May, but also throughout the year, that nicotine and cigarettes are not just the ordinary, classic cigarettes we remember from the 1990s, the 2000s, when there was a lot of smoking. But they are also modern devices which, despite being modern, are not at all good for our health. I would appeal to all those who do not smoke to watch their children, their relatives and to notice just such devices, because they, too, can harm our children's health, our relatives' health and our own health. This was the 'Patient First' programme. My guest, but above all your guest, was Professor Rafał Pawliczak. Thank you very much, Professor, for our conversation today.