Smoking and lung copd asthma bronchial bronchus carcinoma etc

Smoking and lung – connection with COPD, bronchial asthma, bronchus carcinoma etc.

On the topic of smoking and the lungs, every physician should know their patients' smoking habits and suggest appropriate smoking cessation therapy.

Smoking and lung are strongly related not only in COPD, bronchial asthma and lung cancer, where every physician should know the smoking habits of his patients and suggest an appropriate smoking cessation therapy. In addition, he should perform or arrange for a pulmonary function analysis.

The smoke of a burning cigarette, cigar or pipe can lead to a number of cardiovascular, gastrointestinal, metabolic, immunological and central nervous disorders. However, the most important damage at the entry point of the disease – in the bronchopulmonary system – will be briefly outlined here.

As with all environmental chronic diseases, a genetically determined susceptibility -sensitivity- mediates the dose-response relationship of inhaled tobacco smoke as well (pack years). While clear statistical results are available for active smoking and are not disputed, the waves go up again and again because of the massive differences in the concentrations of pollutants to which the passive smoker is exposed.

On the one hand, it is therefore only a question of dose, with which probability a non-smoker becomes ill by passive smoke. On the other hand, there is increasing evidence of higher toxicity of sidestream smoke due to lower temperature during tobacco combustion.

Smoking and COPD as a disease of the lungs

About 30% of all smokers suffer from chronic obstructive pulmonary disease (COPD) – usually with emphysema. Because the disease begins in the bronchioles, where the airflow is already slow, the symptoms – besides the cough from smoking, especially dyspnea from exertion – develop gradually and only when considerable damage has already been done. Lung function analysis is the most important diagnostic measure. Has to be performed routinely in every smoker over 40. It has been proven that after 15 to 20 py the probability of suffering a relevant COPD increases by leaps and bounds.

COPD can be treated well, but early diagnosis and smoking cessation are prerequisites.

Smoking and the lungs: the problem of bronchial asthma

While two thirds of smokers with low bronchial reactivity may be lucky not to develop relevant COPD, an asthmatic – i.e. a patient with increased bronchial sensitivity – does not escape the fate of relevant lung function deterioration.

Despite this, patients who are asthmatic and also suffer from nicotine addiction are found repeatedly. These have a particularly poor prognosis. Early disability is the consequence.

Smoking and lung: risk of bronchial carcinoma

Cigarette smoke induces changes in the bronchial epithelium that lead to bronchial carcinoma via metaplasia. While this was still a rarity at the beginning of the last century, it has been the most frequent carcinoma leading to death in men for years.

But women are catching up. Currently, lung cancer ranks third in mortality statistics for women. But it is foreseeable when it will become the second most frequent cancer in women after breast cancer. Especially among younger women, a tripling of the mortality rate has been observed in the last decades.

In any case, smoking is considered the number one risk factor for cancer mortality, with 15 to 20% of heavy smokers developing lung cancer.

Other diseases associated with smoking and lungs

However, in addition to the common tobacco smoke-associated diseases – bronchial carcinoma, COPD, and chronic bronchial asthma – there are a number of other diseases of the lung that would be much less common without cigarette smoking.

Pneumonia acquired outside the hospital is significantly more likely to lead to hospitalization in smokers than in nonsmokers.

Respiratory bronchiolitis with bronchiolitis associated interstitial lung disease, desquamative interstitial pneumonia eosinophilic granuloma and also idiopathic pulmonary fibrosis are smoke associated.

Smokers – especially those also taking oral contraceptives – are much more likely to suffer from pulmonary thromboembolism than non-smokers.


The bottom line is that primary prevention with health policy measures on smoking and lung and smoking cessation are the most essential pneumological measures against COPD. bronchial asthma, bronchial carcinoma, and many other lung diseases. However, it is necessary for each physician to know the smoking habits of each patient, to inform smokers of the risk they are taking, to suggest smoking cessation therapy, and, if necessary, to perform lung function analysis or. Initiates.


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Lutter JI, Jorres RA, Welte T, Watz H, Waschki B, Alter P, Trudzinski FC, Ohlander J, Behr J, Bals R, Studnicka M, Holle R, Vogelmeier CF, Kahnert K. Impact of Education on COPD Severity and All-Cause Mortality in Lifetime Never-Smokers and Longtime Ex-Smokers. Results of the COSYCONET Cohort. Int J Chron Obstruct Pulmon Dis. 2020 Nov 5;15:2787-2798. doi: 10.2147/COPD.S273839. PMID: 33177816; PMCID: PMC7652228.

Bhore SJ. World No Tobacco Day: Tobacco is a Threat to the One Health and Sustainability. Cien Saude Colet. 2020 Nov;25(11):4347-4350. doi: 10.1590/1413-812320202511.33622018. Epub 2019 Mar 27. PMID: 33175043.

Allen Widysanto; Felton E. Combest; Abdolreza Saadabadi. Nicotine Addiction. StatPearls [Internet]. Last Update: August 12, 2020.

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