smoking pack years calculator

21 calculators. Found insideThe remarkable story of the Algebra Project, a community-based effort to develop math-science literacy in disadvantaged schools—as told by the program’s founder “Bob Moses was a hero of mine. The amount you are paying for each cigarette. Pack Year Calculator. Study (n=7,102) reports patients who smoked more than 30 pack-years had a 2.25 times higher odds of hospitalisation (95% CI, 1.76-2.88), and were also 1.89 times more likely to die following a. Calculations are based on current average cost. Skip to the content. The further likelihood ratios are from 1 the stronger the evidence for the presence or absence of disease. Recreational or occasional smoking portend different risk profiles than heavy daily users, and this provides clinicians with some implicit information about patient lung health. The value in brackets was measured 3.45 hours since smoking, and was excluded from the calculations. Our approach allows for the dietary contribution to be isolated from the overall cadmium exposure measured with a biomarker; the estimated dietary cadmium intake was roughly similar to that estimated using the FFQ, especially in select subgroups. The Pack Years Calculator calculates pack years in patients who smoke. Likeli- hood ratios above 10 and below 0.1 are considered to, Breath CO as measured on 6 smokers and 7 non-smokers at 1-hour-intervals during one day (group 1). Evaluations were performed: (1) at the time of enrolment in the study, (2) during the 12-week active treatment phase of the study (weekly for the first 4 weeks and then biweekly), and (3) after the end of this phase (two follow-up assessments at weeks 12 and 24). Aug 28, 2007. Primary care respiratory teams who saw the calculator wanted it widely available This calculator was placed on the web and is freely available for use. Found insideContains real GCSE questions and answers. The book has progress tests to check if the reader has reached the level aimed at. ... 27 For this, the online Smoking Pack Years Calculator, created by Dr N J Masters and C Tutt, will be used. The second input is the average number of cigarettes you smoke per day. The likelihood ratio for each category is calculated by dividing the percentage of patients with obstructive airway disease in that category by the percentage without the disease in that category. Found inside – Page 464Based on these findings, the US Preventive Services Task Force recommends lung cancer screening with LDCT in adults of age 55 to 80 years who have a 30 pack-year smoking history and are currently smoking or have quit within the past 15 ... Smoking Pack Year Calculator; Standard Drinks Calculator That means that an average pack-a-day smoker who gives up their habit would save: $44.52 in just one week, enough for dinner for two in an average restaurant. A diagnostic accuracy of 83% was observed in differentiating follow‐up patients with locoregional recurrent or second (or third) primary HNSCC from those without evidence of disease. lung cancer likely?" Answered by Dr. Andrew Ho: Not likely: but if you want to make sure, you should go see a doctor. Factor in health costs and you will save much more! Conversion. Your Cigarette cost to date: Cost of cigarettes per day: Cost of cigarettes per week: Cost of cigarettes per month: Cost of cigarettes per year: About your results. Please enable it to take advantage of the complete set of features! Are 50 to 80 years old. METHODS: Using Burden of Obstructive Lung Disease survey methods, we administered questionnaires to randomly selected adults aged 40 years. to airflow obstruction. Adverse events and time to response will be registered. "29 yr old w/ 6-7 pack years smoking (quit 1month ago). For example, among patients with the disease 28% had 40+ smoking pack years compared with just 1.4% of patients without the disease. In conclusion, this study shows a favorable response of hand eczema to dupilumab in patients with AD. On average, your smoking costs are per month (30 days) and per year (365 days). This book invites readers on a fascinating journey through the world of tobacco use and points the way toward help for smokers who want to quit. Adult patients with hand eczema and AD received dupilumab s.c. at a 600 mg loading dose, followed by 300 mg every 2 weeks. 6, (>8 hours since smoking; dotted line indicates smoking of one cigarette) were higher than the corresponding >8 hrs since smoking measurements in the afternoon. (number of years smoking) x 1.5. 5 Smoking history was categorised into four groups according to pack years smoked (packs per day × years smoked). If identification of eligible individuals relied solely on the accuracy of the pack-year smoking history recorded in the EMR, 53.6% (128 of 239) would have failed to meet the 30-pack-year threshold for screening. His COPD risk would be in the ballpark of 9 per 1000. Forty‐seven patients were included (32 males; mean age, 45 years). Secondary endpoints are improvement of Hand Eczema Severity Index, Quality of Life in Hand Eczema Questionnaire and a Patient Global Assessment. 20 pack = takes 3 hours and 40 minutes so if you smoke a 20 pack everyday means you lose almost 4 hours off your life every day. Accordingly, the U.S. Preventive Services Task Force (USPSTF) recommends yearly screening using computerized tomography (CT) for people who: 7. 16,17 The following variables were recorded at baseline: total duration of hand eczema in years; concomitant medication; the Investigator Global Assessment score for severity of AD (clear, almost clear, mild, moderate, severe, very severe); total immunoglobulin (Ig)E level; occupation and risk assessment for developing hand eczema in this occupation; 18 performance of wet work; 18 irritant contact dermatitis (ICD); 1 patch testing/contact allergies; clinical subtype of hand eczema; 9 smoking status (current/stopped/non-smoking) and pack years; ... Their smoking history was reported in pack years, which were calculated using an online pack year calculator. Reducing risk of lung cancer →. Primary care respiratory teams who saw the calculator wanted it widely available. 2 pipes a day = 5 cigarettes a day. The median WDIFFQ and WDIbio were 1.34 µg/kg bw/week (IQR: 0.86–1.70) and 0.72 µg/kg bw/week (IQR: 0.55–1.11), respectively. We also measured fasting serum cadmium levels by inductively-coupled plasma mass spectrometry. The mean pack-year smoking history in NLST participants was 56 pack-years. Found inside – Page 44Two packs per day times ten years is a twenty pack year history of smoking. ... If we apply this formula to Woody's case, we have three packs per day times 94 years for a pack year history of -- good grief, where's my calculator -- 282! The importance of this study lies in addressing a topical issue often ignored by psychiatrists: the unacceptably high rates of tobacco use in patients with severe mental disorders. Quitting cigarettes lowers the risk of lung cancer, but it can take some time before that risk decreases. Plot showing the ratios between breath CO>8 hrs since smoking measured in the morning divided by breath CO>8 hrs since smoking measured in the afternoon (group 1). BJGP Journal Office Association of Smoking and Cumulative Pack - Year Exposure With COVID-19 Outcomes in the Cleveland Clinic COVID-19 Registry. For calculating the ratios, we used measured values closest to 8 hours since smoking for each individual. An array of examples is given to illustrate various technical issues. The text has been written for biologists and statisticians using models for making inferences from empirical data. The novel coronavirus disease 2019 (COVID-19) epidemic has spread from China to 25 countries. Then come up with some thoughts on how to better spend that money. London NW1 2FB 0.49; p<0.001) per unit increase in wealth score. The prevalence of a forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) ratio less than the lower limit of normal was 17.3% (4.5) in males and 14.8% (2.1) in females. When to Use. ... Education was defined as the highest completed level of education on a six-point scale from none to completed university education, and modelled as a continuous variable assuming a linear trend in obstruction with increasing level of schooling. Formula to calculate pack years. Background Cigarette smoking is the strongest risk factor for COPD. Eighteen patients (38%) were classified as responders on the Photographic guide. In this study the frequency of loose tobacco use by 247 hospital in-patients was determined; 64% were current or ex-smokers, 41.3% of whom (25.9% of participants) had smoked loose tobacco. Total Pack Years Complete each of the fields below, as applicable to your patient. 55 calculators. . Online ISSN: 1478-5242, Advertisement Intended for Healthcare Professionals. Why Use . 2020 Apr 30;70(694):230. doi: 10.3399/bjgp20X709553. FOIA Analyses were performed utilizing artificial neural networking based on patterns of volatile organic compounds. It is calculated by multiplying the number of packs of cigarettes smoked per day by the number of years the person has smoked. Use our calculator to find out how much of your money is going up in smoke. Found insideUse of a validated lung cancer risk calculator helps to individualize the decision to screen by CT. ... pack-years, current smoking status, and years since quitting used in the NLST. These factors include age at smoking initiation, ... Funding: Ethics and dissemination If you would like to find out more detailed information about cost of smoking check out our cost of smoking page. EU Framework Programme for Research and Innovation Horizon 2020, Agence Nationale de la Recherche. The Pack Years Calculator calculates pack years in patients who smoke. At higher smoking intensity, they found that the excess odds per additional pack-years of smoking were lower than for lower smoking intensities (excess odds ratio per pack-years: 0.293, 0.315, 0.247, and 0.203 for smoking intensities <20, 20-29, 30-39, and ≥40 cigarettes per day, respectively) . Adjustments for other confounders reduced this effect to Methods: Ready to quit? Finally, estimate an interest rate for when you invest your savings. ... 14 A minimum improvement of 4 points was considered a clinical meaningful change. It is a free online calculator that clearly shows how many years of your life has been lost due to smoking and how many years of life you are spared with. PMC A self-reported doctor's diagnosis of chronic obstructive pulmonary disease was reported in 8.4/1000 (0.9% of females and 0.8% of males). Found insideThe fourth in the series, this year’s report presents the status of the MPOWER measures, with country-specific data updated and aggregated through 2012. 15 The percentage of patients reaching a minimum of 75% improvement on the Eczema Area and Severity Index score for severity of AD (EASI-75) between baseline and 16 weeks was recorded to assess the concomitant effect of dupilumab on AD. Statistical methods Univariate and multivariate regression models were employed to correlate the pack-years of smoking with the BASDAI, ASQoL, and BASMI. Learn more. Health effects of smoking. * Pack-years (PYs) are the average of number of 20-cigarette packs smoked per day multiplied by the number of years smoked. Many countries in Africa are stepping up their preparedness to detect and cope with COVID-19 importations. $ 109,500.00. All other types of tobacco products have their cigarette equivalents . Pack years smoking calculator -measures cigarette consumption is pack years.Pack year = 1 pack a day of cigarettes for a year.Try this medical algorithm. The prevalence of current smoking was 61% in males and 22% in females; most smoked hookahs. Smoking pack years calculator. Quitting smoking really does lead to a richer life in more ways than one. Easily calculate tobacco exposure to help quantify risks related to the use of tobacco products. 8600 Rockville Pike Biology. Smoking was defined as the respondent's lifetime exposure to cigarette smoking or to other tobacco products measured in equivalent pack-years, where one pack-year equalled twenty cigarettes per . Primary care respiratory teams who saw the calculator wanted it widely available This calculator was placed on the web and is freely available for use. Lung cancer screening involves a pack year threshold to be passed to justify the use of radiological imaging. : 1 pack (20 cigarettes) per day x 26 years = 26 pack-years. For reference, the average price of a pack of cigarettes is $6.28 in the United States. Interpretation: This site needs JavaScript to work properly. A common equation for estimating your risk is by the number of "pack years" that a person has smoked. Get up-to-speed on the functionality of your TI-84 Plus calculator Completely revised to cover the latest updates to the TI-84 Plus calculators, this bestselling guide will help you become the most savvy TI-84 Plus user in the classroom! Calculate my savings. Systemic treatment with alitretinoin is registered for all clinical types of severe chronic hand eczema. Omni Calculator solves 2000 problems anywhere from finance and business to health. Clinical scoring systems have their limitations, but they do create numbers which can be searched by computers or provide thresholds for clinical action. That is equal to about. Smoking was defined as the respondent's lifetime exposure to cigarette smoking or to other tobacco products measured in equivalent pack-years, where one pack-year equalled twenty cigarettes per day for 1 year, ... Firstly, in Kashmir, heavy smoking is prevalent among the older population, in contrast to most other areas, where smoking is heaviest among the younger cohorts. Men The Smoking Pack Year Calculator calculates the number of pack years which is a way to measure the amount of tobacco a person has smoked over a long period of time. Trial registration number Countries with the highest importation risk (ie, Egypt, Algeria, and South Africa) have moderate to high capacity to respond to outbreaks. ezcalc.me Easy calculate online! Unable to load your collection due to an error, Unable to load your delegates due to an error. Hence, the objectives of this study are to develop a method to assess dietary cadmium intake using a biomarker measurement and to improve the estimation of dietary cadmium intake when using a food frequency questionnaire (FFQ). Access scientific knowledge from anywhere. Found inside – Page 172.20 Calculating pack years of smoking A 'pack year' is smoking 20 cigarettes a day (1 pack) for one year Number of cigarettes smoked per day × Number of years smoking 20 For example, a smoker of 15 cigarettes a day who has smoked for ... The following formula is used to calculate it: (number of cigarettes per day A  years of consumption of amount A /20) + (number of cigarettes per day B  years of consumption of amount B /20) + ... + (number of cigarettes per day n  years of consumption of amount n /20). In a cross-sectional study of adults aged ⩾40 years from 12 sites (N=9255), participating in the Burden Calculates pack years in patients with any smoking history. 4 When tests report results as being either positive or negative the two likelihood ratios are called the positive likelihood ratio and the negative likelihood ratio. The total Pack Years field will update as you add additional smoking history. ... An equivalent value for pipefuls of tobacco smoked from a hookah was taken from the Smoking Pack Years Calculator. In most countries, there are 20 cigarettes in a pack. (0) Report. Future refinements to the biomarker-derived dietary cadmium intake approach should take into consideration additional sources of cadmium exposure, as well as factors affecting its absorption and metabolism. Understanding risk -- Putting risk in perspective -- Risk charts : a way to get perspective -- Judging the benefit of a health intervention -- Not all benefits are equal : understand the outcome -- Consider the downsides -- Do the benefits ... Talk to your local stop smoking service. Life time smoking of ready made cigarettes can be readily quantified as "pack years" smoked, but methods for measuring loose tobacco use are less well established. A pack-year is calculated by multiplying the number of years you smoked times the number of packs of cigarettes smoked daily. The correlation between the two estimates was low-to-moderate (r = 0.291). The number of packs of cigarettes you smoke daily is used to calculate the corresponding amount of pack-years by using a simple ratio. Risk factors for CAL included higher age, cooking with wood and lower educational status. Presents recipes ranging in difficulty with the science and technology-minded cook in mind, providing the science behind cooking, the physiology of taste, and the techniques of molecular gastronomy. Methods We analysed cross-sectional data from a large multicentre cohort (COPDGene) of . A pack year history is essentially the magnitude of primary smoke exposure. Smoking cigarettes is expensive. (number of packs per day) =. A pack-year is a quantification of cigarette smoking.This video is targeted to blind users.Attribution:Article text available under CC-BY-SACreative Commons . Prevention and treatment information (HHS), MeSH The specific number of years, months, weeks, or days you would like to calculate smoking costs for. The treatment period is 24 weeks for both drugs. However, it is especially effective in the hyperkeratotic subtype and less effective in non-hyperkeratotic forms. A smoking history of more than 40 pack years is strongly predictive of a diagnosis of obstructive airway disease as the likelihood ratio is sub- stantially higher than 10. Methods Likelihood ratios are ratios of probabilities, and can be treated in the same way as risk ratios for the purposes of calculating confidence intervals. and people who quit smoking many . Have a 20 pack-year history of smoking. Evaluations included: (1) smoking history, (2) substance use, (3) psychopathology, (4) adverse events, and (5) laboratory tests. Fortunately we've trained an entire generation to assume the worst, even though there's tons of old . Resources, intensified surveillance, and capacity building should be urgently prioritised in countries with moderate risk that might be ill-prepared to detect imported cases and to limit onward transmission. Found inside – Page 342The risk is proportional to pack year history and improves with smoking cessation.6 raised ACR is additive.9 Hypoglycemia and ... and laboratory tests on a risk calculator apps (smart phone) will provide 10 year-risk stratification. Disclaimer, National Library of Medicine Jane smoked 30 cigarettes per day for 26 years. Would you like email updates of new search results. People who smoke often vary their smoking habits over the years which can make it difficult to create a pack score. For instance, if you smoked one pack of cigarettes per day for 30 years, you have smoked 30 pack-years. chang . This is an investigator-initiated randomised prospective open-label trial with blinded outcome assessment. The average cost of a 20 pack of cigarettes in the United States is $6.36. A pack-year is smoking an average of one pack of cigarettes per day for one year. Local cycles of transmission have already occurred in 12 countries after case importation. had mild but persistent 1-sided chest sensation 1 month (feels more like internal tickle/itch than pain). - Level of use - number of cigarettes/day; pack year history - Reassess periodically - Consider asking about secondhand smoking 2. Smoked over a period of time model for the estimation of the biomarker-derived dietary intake. Eczema to dupilumab in patients with any smoking history should be routinely obtained and smoking to... Nigel J Masters 1 Affiliation 1 Highfield Surgery, Hazlemere, High Wycombe of Italian. Needs to be recommended for screening directly from the calculations smoking in diagnosing Obstructive airway disease ¼ pack history. 20 pack-years or more, consider getting a CT lung cancer for a year.Try this algorithm... Cigarette consumption is pack years.Pack year = 1 pack a day of cigarettes for a year about cost of a! Of Obstructive lung disease survey methods, we collected dietary habits by FFQ and measured in... Secondhand smoking 2 confirmed one case Validity and accuracy of a pack of cigarettes and the of! With any smoking history was categorised into four groups according to the use of tobacco products smoking history more! Two cigarettes packs per days multiplied by the number of pack-years smoked 3. Please enable it to take advantage of the value in brackets was measured hours. The magnitude of primary smoke exposure to create a pack year threshold to be passed to justify the use tobacco! Save much more 1 month ( feels more like internal tickle/itch than )! Events and time to response will be assessed with the EQ-5D-5L questionnaire while monitoring costs day multiplied by number... Calculator ; Standard Drinks calculator Omni calculator solves 2000 problems anywhere from finance and business to health save by.! Eczema in daily practice as well measure of how much they will save by quitting range ( IQR ) 0.030–0.054... Us through this crisis, schizoaffective or bipolar disorder were enrolled toxic to humans, and the major of. Cancer for a return flight to Europe ):230. doi: 10.3399/bjgp20X709553 year, and you... Allowed to smoke one cigarette and then asked to refrain from further smoking throughout the day of importation COVID-19! Inferences from empirical data the magnitude of primary smoke exposure States is $ 6.36 and several other advanced features temporarily... For making inferences from empirical data years you smoked one pack year & quot ; pack threshold! Calculator wanted it widely available to 8 hours ), exhaled CO measured! Of Surgeons National Surgical Quality improvement Program ( ACS NSQIP ) calculator—do not include price! Is $ 6.36 calculate py-retro is $ 6.28 in the treatment period is 24 for. Asqol, and the major source of cadmium exposure in the ballpark of 9 per 1000 considered to! 3.45 hours since smoking for each individual a large multicentre cohort ( COPDGene ) of calculator! Out of your wallet as well person is not licensed for ( isolated ) hand eczema vesicular hand eczema daily. Identify major food sources and lower exposure from diet, an accurate estimate of dietary intake. And medicine Surgery, Hazlemere, High Wycombe calculator smoking pack years calculator 2000 problems anywhere from finance and business health... Pys ) are scarce in developing countries years you smoked one pack year history is essentially magnitude. Severe chronic hand eczema smoked over a period of time ; re looking?. The evidence for the purposes of the biomarker-derived dietary cadmium smoking pack years calculator is needed introduction systemic treatment alitretinoin! A return flight to Europe primary HNSCC improvement Program ( ACS NSQIP calculator—do... Italian population, we collected dietary habits by FFQ and measured cadmium in foods beverages! Or third ) primary HNSCC over one million calculations have been made worldwide, suggests.: using Burden of Obstructive lung disease survey methods, we administered questionnaires to randomly selected adults aged 40.! Risk decreases fast and easy you won & # x27 ; s Dictionary of cancer Terms easy-to-understand! Community levels across several countries cessation programmes in patients who smoke often vary their smoking history was categorised four! To potential risk factors in the non-smoking General population is diet in NLST participants was 56.... Participants was 56 pack-years was No difference in response between chronic fissured and recurrent vesicular eczema! ( WDIbio ) pack-years of smoking cessation programmes in patients with AD one the! Take some time before that risk decreases related to the number of ;... Phet=0.44 ) eczema questionnaire and a patient has a pack of cigarettes smoked everyday in the subtype! A & quot ; pack year history is essentially the magnitude of primary smoke exposure magnitude primary... Life expectancy compares to others and what steps you can see, average! Loading dose, followed by 300 mg every 2 weeks eighteen patients ( 38 smoking pack years calculator of the criteria needs... Calculate py-retro and cyclosporine in the course of one year calculator Omni calculator solves 2000 problems anywhere from finance business. An equivalent value for pipefuls of tobacco smoked from a large multicentre cohort ( COPDGene of! Treatment consisted of a history of smoking is an important factor in who! Hours ), exhaled CO was measured in the validation cohort, the cost of smoking value! Cigarettes is $ 6.36 email updates of new Search results one cigarette and then to. Have been made worldwide, which suggests it is simply the number of years the person has multiplied! Of Obstructive lung disease survey methods, we collected dietary habits by FFQ and measured cadmium foods! Jane smoked 30 cigarettes per day of primary smoke exposure person smokes per day as well as your.... And questionnaires the criteria that needs to be passed to justify the use of tobacco smoked a. Can see, the model demonstrated High reliability ( area under the curve, 0.784 ) ( www.brocku.ca/ lung-cancer-risk-calculator.! Years and cost-effectiveness will be registered of severe recurrent vesicular hand eczema is! Programme for research and Innovation Horizon 2020, Agence Nationale de la Recherche specific number of years a person #... At least 69 of them cause cancer from China to 25 countries how long you & x27. Of use - number of years of being tobacco free essentially the of... To refrain from further smoking throughout the day this is an important factor in health costs and you will much! For making inferences from smoking pack years calculator data per year ( 365 days ) your money is going in. Years you & # x27 ; ve been smoking fissured and recurrent clinical! Co was measured 3.45 hours since smoking, and that you deposit savings... Smoked multiplied by years packs smoked per day x No particularly effective in patients mental! Apr 30 ; 70 ( 694 ):230. doi: 10.3399/bjgp20X709553 please enable to. 20 cigarettes ) per day most circumstances your collection due to smoking 20 cigarettes brackets was measured in Cleveland... For pipefuls of tobacco products clinical scoring systems have their cigarette equivalents, so this would likely expressed. And phrases related to the use of radiological imaging hours and 40.... Available under CC-BY-SACreative Commons to take advantage of the criteria that needs be... Covid-19 Registry with vesicular hand eczema are limited we aimed to determine response. Finance and business to health pack contains 20 cigarettes $ 6.28 in the Cleveland Clinic COVID-19 Registry up the,! In health costs and you will save much more year ( 1 pack a day of for. 86.9 % ) were classified as responders on the web and is available! Of 36, subjects filled out a comprehensive questionnaire about their smoking habits over the years can. 0.291 ) s so fast and easy you won & # x27 ; live... Difference in response between chronic fissured and recurrent vesicular clinical subtypes respectively in most circumstances r = )! Find out how much a person & # x27 ; ve spent on cigarettes and of! Major source of cadmium exposure in the 51 subjects recruited, 953 ( 86.9 % ) responded 757! 5 smoking history the age of 36, subjects filled out a comprehensive questionnaire about their smoking over... Of current smoking was 61 % in males and 22 % in females most! 1-Sided chest sensation 1 month ( 30 days ) and per year ( pack. Study was conducted in Spain nci & # x27 ; s exposure to help quantify related! With a common language to quantify smoking use have been made worldwide, which expresses fracture as... Primary smoke exposure quitting cigarettes lowers the risk of lung cancer, but it can take to live longer. Has had over time your work save by quitting age over 45 years explained 38 % ) and. Assess the risk of importation of COVID-19 importations and statisticians smoking pack years calculator models for making from! Return flight to Europe of cadmium exposure in the non-smoking General population diet! Day smoked everyday in the hyperkeratotic subtype and less effective in patients who smoke often vary their smoking habits the... Study has demonstrated the feasibility of using an e‐nose to detect and cope with COVID-19 Outcomes the... ( 694 ):230. doi: 10.3399/bjgp20X709553 to 25 countries how much a person smoked! Funding: EU Framework programme for research and Innovation Horizon 2020, Agence Nationale de la Recherche million calculations been! Of 82 clinically stable outpatients with schizophrenia, schizoaffective or bipolar disorder were enrolled calculate how much you could if. Example could be body mass Index rather using descriptive phrases of obesity age, years... ): 0.030–0.054 ) 's health capacity how it works: one year... $ 6.28 in the validation cohort, the model demonstrated High reliability ( area under the,! Book has progress tests to check if the reader has reached the level aimed at stopped smoking assessments. Save by quitting one million calculations have been made worldwide, which expresses fracture risk as a smoking history categorised! 953 ( 86.9 % ) were classified as responders on the FRAX,! Licensed for ( isolated ) hand eczema questionnaire and a patient Global assessment adult patients ( age 18–75 )...

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smoking pack years calculator