Bronchitis and Pneumonia ebooksclub.org Tobacco or Health Physiological and Social Damages Caused by Tobacco Smoking Second Edition

5.6 Other Lung Diseases Influenced by Cigarette Smoking

This฀category฀principally฀includes฀a฀respiratory฀bronchiolitis-associated฀interstitial฀lung฀dis- ease฀ [207] ฀and฀pulmonary฀Langerhans฀cell฀granulomatosis฀ [208,฀209] .฀Pulmonary฀haemor- rhage฀ associated฀ with฀ Goodpasture’s฀ syndrome฀ type฀ is฀ also฀ signiicantly฀ associated฀ with฀ cigarette฀smoking฀ [50] .฀Women฀with฀breast฀cancer฀who฀smoke฀tend฀to฀develop฀lung฀metas- tases฀more฀frequently฀than฀non-smokers฀ [210] .฀In฀contrast,฀sarcoidosis฀ [211] ฀and฀allergic฀ pneumonitis฀occur฀more฀rarely฀in฀smokers฀than฀in฀non-smokers.฀Idiopathic฀pulmonary฀ibro- sis฀is฀common฀among฀heavy฀smokers฀than฀former฀smokers฀OR฀=฀−2.3;฀CI:฀1.3–3.8฀vs.฀1.9฀ CI:฀1.3–2.9,฀and฀the฀disease฀may฀even฀have฀its฀onset฀after฀sudden฀smoking฀cessation฀ [73] .฀ Obviously,฀explanations฀for฀the฀various฀diseases฀are฀to฀be฀sought฀in฀the฀effects฀of฀smoking฀on฀ the฀inlammatory฀processes฀in฀the฀lung,฀on฀immune฀function฀and฀on฀vascular฀permeability. Smokers฀are฀presumed฀to฀have฀a฀higher฀risk฀than฀non-smokers฀for฀developing-varicella฀ pneumonia฀ [110,฀212] .฀Radiologically,฀pneumonia฀can฀be฀detected฀on฀the฀basis฀of฀diffuse฀ interstitial฀or฀patchy฀iniltrates฀in฀up฀to฀20฀of฀adult฀cases฀ [213] ,฀though฀often฀without฀ clinical฀symptoms.฀The฀pulmonary฀symptoms฀usually฀set฀in฀during฀the฀irst฀days฀after฀the฀ onset฀of฀rash,฀and฀consist฀of฀cough,฀dyspnoea฀and฀varying฀degrees฀of฀hypoxaemia฀caused฀ by฀inlammation฀and฀swelling฀of฀the฀bronchial฀epithelium฀ [206,฀214] .฀In฀untreated฀adults,฀ the฀mortality฀rate฀from฀varicella฀pneumonia฀is฀approximately฀10,฀but฀may฀be฀as฀high฀as฀ 50฀where฀there฀is฀severe฀pulmonary฀involvement฀leading฀to฀pulmonary฀failure฀ [206] .

5.7 Concluding Remarks

• ฀ Current฀knowledge฀indicates฀that฀there฀is฀an฀established฀association฀between฀smoking฀and฀ various฀forms฀of฀lung฀cancer.฀Exposure฀over฀months฀and฀years฀to฀the฀various฀inhalational฀ products฀of฀tobacco,฀such฀as฀benzo[a]pyrene,฀nitrosamines฀NNK,฀NNN,฀solvents฀ben- zene,฀crotonaldehyde,฀formaldehyde฀and฀ 210 polonium,฀is฀an฀important฀aetiological฀factor.฀ The฀organic฀compounds฀are฀metabolised฀activated฀by฀various฀enzymes฀in฀the฀CYP฀sys- tem฀and฀then฀form฀adducts฀with฀DNA฀in฀lung฀tissue฀and฀with฀leucocytes.฀In฀addition,฀the฀ activity฀of฀the฀GST฀system฀plays฀an฀important฀role฀in฀the฀detoxiication฀elimination฀of฀ carcinogens. • ฀ A฀signiicant฀risk฀for฀the฀development฀of฀lung฀cancer฀has฀been฀identiied฀in฀individuals฀ with฀ high฀ inducibility฀ of฀ CYP1A1฀ and฀ reduced฀ activity฀ of฀ glutathione฀ S-reductase฀ GSTM1฀00.฀The฀risk฀for฀bronchial฀carcinoma฀is฀particularly฀increased฀in฀carriers฀of฀the฀ GSTM1฀00฀system.฀Bronchial฀carcinoma฀is฀commonly฀encountered฀and฀some฀90฀of฀ cases฀are฀smoking-related;฀worldwide,฀its฀prevalence฀is฀increasing฀more฀among฀women฀ than฀men. • ฀ As฀the฀practice฀of฀smoking฀light฀cigarettes฀has฀become฀more฀widespread,฀there฀has฀been฀ an฀increase฀in฀the฀prevalence฀of฀AC,฀a฀form฀of฀lung฀cancer฀that฀is฀less฀amenable฀to฀treat- ment฀than฀SCC. • ฀ In฀addition,฀COPD฀often฀sustained฀by฀years฀of฀smoking฀activity฀is฀gaining฀importance฀ because฀it฀is฀complex฀to฀treat฀and฀is฀even฀more฀common฀than฀bronchial฀carcinoma.฀In฀ the฀near฀future,฀COPD฀will฀be฀the฀third฀most฀common฀disease฀worldwide. • ฀ If฀they฀are฀exposed฀to฀environmental฀tobacco฀smoke฀ETS,฀children฀are฀a฀target฀group฀ for฀the฀development฀of฀lung฀diseases.฀Asthmatic฀diseases,฀especially฀among฀children,฀ are฀not฀caused฀by฀passive฀smoking,฀but฀are฀sustained฀and฀accelerated฀in฀their฀progres- sion฀by฀smoke฀inhalation. References ฀ 1.฀U.S.฀Department฀of฀Health฀and฀Human฀Services;฀Public฀Health฀Services,฀Centres฀for฀Disease฀ Control฀1996฀PHS฀document฀no.46-1123 ฀ 2.฀Centres฀for฀Disease฀Control.฀1993฀Mortality฀trends฀for฀selected฀smoking-related฀cancers฀and฀ breast฀cancer฀--฀United฀States,฀1550-1990.฀Morb฀Mortal฀Wkly฀Rep42:฀857;฀863–866 ฀ 3.฀American฀ Thoracic฀ Society฀ 1995฀ Standards฀ for฀ the฀ diagnosis฀ and฀ care฀ of฀ patients฀ with฀ chronic฀obstructive฀pulmonary฀disease.฀Am฀Rev฀Respir฀Crit฀Care฀152:77–121 ฀ 4.฀Environmental฀Protection฀Agency฀1992฀Respiratory฀health฀effects฀of฀passive฀smoking:฀lung฀ cancer฀ and฀ other฀ disorders.฀ Ofice฀ of฀ Research฀ and฀ Development,฀ Ofice฀ of฀ Health฀ and฀ Environmental฀Assessment,฀Washington,฀DC.฀US_EPA,฀Report-No.EPA6006–90006F ฀ 5.฀BAl฀Steering฀Committee฀1990฀Bronchoalveolar฀lavage฀constituents฀in฀healthy฀individuals,฀ idiopathic฀pulmonary฀ibrosis,฀and฀selected฀comparison฀groups.฀The฀BAl฀Cooperative฀Group฀ Steering฀Committee.฀Am฀Rev฀Respir฀Dis฀141:169–202 ฀ 6.฀Laughter฀AH,฀Martin฀RR,฀Twomey฀JJ฀1977฀Lymphoproliferative฀responses฀to฀antigens฀medi- ated฀by฀human฀pulmonary฀alveolar฀macrophages.฀J฀Lab฀Clin฀Med฀896:1326–1332 ฀ 7.฀Iribarren฀C,฀Tekawa฀IS,฀Sidney฀S,฀Friedman฀GD฀1999฀Effect฀of฀cigar฀smoking฀on฀the฀risk฀of฀ cardiovascular฀disease,฀chronic฀obstructive฀pulmonary฀disease,฀and฀cancer฀in฀men.฀N฀Engl฀ J฀Med฀34023:1773–1780 ฀ 8.฀Brown฀GP,฀Iwamoto฀GK,฀Monick฀MM,฀Hunninghake฀GW฀1989฀Cigarette฀smoking฀decreases฀ interleukin฀1฀release฀by฀human฀alveolar฀macrophages.฀Am฀J฀Physiol฀2562฀Pt฀1:C260–C264 ฀ 9.฀Kline฀JN,฀Schwartz฀DA,฀Monick฀MM,฀Floerchinger฀CS,฀Hunninghake฀GW฀1993฀Relative฀ release฀of฀interleukin-1฀beta฀and฀interleukin-1฀receptor฀antagonist฀by฀alveolar฀macrophages.฀A฀ study฀in฀asbestos-induced฀lung฀disease,฀sarcoidosis,฀and฀idiopathic฀pulmonary฀ibrosis.฀Chest฀ 1041:47–53 10.฀Soliman฀DM,฀Twigg฀HL฀III฀1992฀Cigarette฀smoking฀decreases฀bioactive฀interleukin-6฀secre- tion฀by฀alveolar฀macrophages.฀Am฀J฀Physiol฀2634฀Pt฀1:L471–L478 11.฀Daniele฀RP,฀Dauber฀JH,฀Altose฀MD,฀Rowlands฀DT,฀Gorenberg฀DJ฀1977฀Lymphocyte฀studies฀ in฀asymptomatic฀cigarette฀smokers.฀A฀comparison฀between฀lung฀and฀peripheral฀blood.฀Am฀Rev฀ Respir฀Dis฀1166:997–1005 12.฀Tollerud฀DJ,฀Clark฀JW,฀Brown฀LM,฀Neuland฀CY,฀Mann฀DL,฀Pankiw-Trost฀LK฀et฀al฀1989฀The฀ effects฀of฀cigarette฀smoking฀on฀T฀cell฀subsets.฀A฀population-based฀survey฀of฀healthy฀Caucasians.฀ Am฀Rev฀Respir฀Dis฀1396:1446–1451 13.฀Meliska฀CJ,฀Stunkard฀ME,฀Gilbert฀DG,฀Jensen฀RA,฀Martinko฀JM฀1995฀Immune฀function฀in฀ cigarette฀smokers฀who฀quit฀smoking฀for฀31฀days.฀J฀Allergy฀Clin฀Immunol฀954:901–910 14.฀U.S.฀Department฀Health฀Human฀Services;฀Public฀Health฀Services,฀Centres฀for฀Disease฀Control฀ 1982฀The฀Health฀beneits฀of฀smoking฀cessation.฀A฀report฀of฀the฀Surgeon฀General.฀PHS฀docu- ment฀no.90-8416