SMOKING AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE

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The link between smoking and pulmonary diseases was first recognized in the 1870s, but it was not until 1964 that the US Surgeon General's report warned of a potential relationship between smoking and emphysema. By 1984, sufficient data had accrued from epidemiologic and animal studies to enable the Surgeon General to emphatically cite “cigarette smoking [as] the major cause of chronic obstructive lung disease,” with a “contribution… to chronic obstructive pulmonary disease morbidity and mortality [that] far outweighs other factors.”215 Presently, despite widespread public awareness of the health risks involved, an estimated 25% of Americans smoke tobacco.46 A fashionable addiction and a profitable industry together therefore promote the development of chronic obstructive pulmonary disease (COPD).

While asthma may be grouped among the chronic obstructive respiratory disorders, the unique inflammatory basis of asthma separates it from COPD.207 This review is confined to a discussion of the obstructive respiratory conditions associated most closely with cigarette consumption—chronic bronchitis and emphysema. Chronic bronchitis is defined clinically as “the presence of chronic productive cough for at least 3 months in two consecutive years, after excluding other causes of chronic cough.”206 Emphysema is defined as “a condition of the lung characterized by abnormal, permanent enlargement of airspaces distal to the terminal bronchiole, accompanied by the destruction of their walls, and without obvious fibrosis.”205 An estimated 14 million persons in the United States suffer from COPD—approximately 12.5 million from chronic bronchitis and about 1.65 million from emphysema.207 In 1991, COPD became the fourth leading cause of death in the United States.207 As such, cigarette smoking has the notorious distinction of being the “chief, single, avoidable cause of death” in the United States.215

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Address reprint requests to Carolyn L. Rochester, MD, Section of Pulmonary and Critical Care, Yale University School of Medicine, 333 Cedar Street, Bldg. LCI–105, New Haven, CT 06520