Smoking chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) affects over 5% of the adult population, is the fourth leading cause of death worldwide and is the only major cause of mortality that is increasing worldwide. It is an inflammatory disorder of the lungs, caused mainly, but not exclusively, by cigarette smoking. 15-20% of smokers develop COPD. 

In conditions that lead to chronic hypoxemia, such as smoking and chronic obstructive pulmonary disease, an increased concentration of BPG In the RBCs promotes O2 dissociation from hemoglobin in tissues to support cellular function. 

One should consider infiuenza- and pneumococcal-vaccination in patients with increased risk for lower RTI including patients with chronic obstructive pulmonary disease like chronic bronchitis or emphysema and cystic fibrosis patients. It should be considered for the elderly population in general. There is no role for prophylactic antibiotic therapy in patients with frequent RTI. Attempts should be made to have those patients that smoke stop doing so. 

Pauwels RA, Lofdahl CG, Laitinen LA, Schouten JP, Postma DS, Pride NB, Ohlsson SV. Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. N Engl J Med 1999 340 1948-53. 

Oosterhoff Y, de long W, lansen MA, Koeter GH, Postma DS (1993) Airway responsiveness to adenosine 5 -monophosphate in chronic obstructive pulmonary disease is determined by smoking. Am Rev Respir Dis 147(3) 553-558... 

Smoking leads to respiratory problems other than lung cancer. It causes chronic bronchitis, emphysema, and lower resistance to flu and pneumonia. It worsens asthma symptoms in adults and children. As these problems persist, chronic obstructive pulmonary disease (COPD, airway obstruction) develops. Eighty to 85% of deaths due to COPD are from smoking. The role of nicotine in chronic lung diseases such as COPD, emphysema, and asthma is uncertain. However it is known that nicotine can cause an enzyme to be released which is able to destroy parts of the lungs as is seen in emphysema. 

A major predisposing factor for developing chronic obstructive pulmonary disease is cigarette smoking. It now is believed that i-PI is inactivated either directly by oxidants in the smoke or by myeloperoxidase which is released from leukocytes (7). The interrelationship between i-PI, elastase, and emphysema is shown schematically in Figure 1. 

Nicotine and the other ingredients in tobacco have been cited as causing a variety of fatal illnesses. A study by the Centers for Disease Control and Prevention (CDC) in 1991 listed the causes of death related to smoking with annual death toll as follows (cardiovascular) heart disease, 150,000 stroke, 26,000 other, 24,000 (cancer) lung, 112,000 other, 31,000 (non-malignant pulmonary disease) chronic obstructive pulmonary disease, 62,000 other, including pneumonia and influenza, 21,000 for a total of 426,000 fatalities a year directly attributable to tobacco. Further, the CDC points out that tobacco is also responsible for an annual... 

Iribarren C, Tekawa IS, Sidney S, Friedman GD. Effect of cigar smoking on the risk of cardiovascular disease, chronic obstructive pulmonary disease, and cancer in men. N Engl J Med 1999 340(23) 1773-80. 

Chronic obstructive pulmonary disease is a respiratory condition characterized by irreversible airway obstruction caused by chronic bronchitis or emphysema. The major symptoms of COPD include chronic cough, increased sputum production, and dyspnea. The vast majority of patients with COPD are those who are current or former heavy smokers. Other risk factors for the development of COPD include occupational exposure (dusts, chemicals) and rare genetic disorders (a -antitrypsin deficiency). The medical management of COPD includes pharmacotherapy (bronchodilators, corticosteroids, and antibiotics) in combination with interventions to reduce risk factors for disease progression (e.g., smoking cessation). Some patients require long-term administration of supplemental oxygen. 

Cigarette smoking causes lung cancer, heart disease, chronic obstructive pulmonary disease, emphysema, and other serious diseases in smokers. Smokers are... 

Hu Y, Chen B, Yin Z, et al. Increased risk of chronic obstructive pulmonary diseases in coke oven workers Interaction between occupational exposure and smoking. Thorax 2006 61(4) 290 5. 

Coke oven workers are at risk for developing chronic obstructive pulmonary disease (COPD). There is a dose-dependent relationship between exposure to the benzene soluble fraction of coke oven emissions and COPD. Smoking in coke oven workers synergistically increases the incidence of COPD.1621 Though many of the compounds in cigarette smoke are identical to those in coke oven emissions, that alone cannot account for the observed synergism. 

Schapira RM, Reinke LF. The outpatient diagnosis and management of chronic obstructive pulmonary disease Pharmacotherapy, administration of supplemental oxygen, and smoking cessation techniques. J Gen Intern Med 1995 10 40-55. 

Alcohol, nicotine, and caffeine are considered by most to be socially acceptable drugs, yet they impose an enormous social and economic cost on our society. More than 440,000 deaths each year are attributable to tobacco use, making tobacco the number one preventable cause of death and disease in this country. Smoking is responsible for 85% of all lung cancer deaths, approximately 80% of aU chronic obstructive pulmonary disease deaths, and 30% of overall health disease deaths. ... 

---