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In addition to causing lung cancer and COPD, smoking increases the risk of death from pneumonia and causes chronic bronchitis ( U.S. Department of Health, Education, and Welfare 1964), cigarette smoking has been causally linked to multiple diseases and to other adverse effects on the respiratory system ( Table 7.1). Beginning with the first Surgeon General’s report in 1964 ( U.S.

This chapter addresses the mechanisms by which tobacco smoke causes diseases other than cancer in the lower respiratory tract: the trachea, bronchi, and lungs. Because of this repetitive and sustained injurious stimulus, the repair and remodel process that heals the damaged lung tissue takes place at the same time the lung’s defenses continue to deal with this unrelenting inhalation injury. The dose of inhaled toxic particles and gases received from each of these cigarettes varies depending on the nature of the tobacco, the volume and number of puffs of smoke drawn from the cigarette, the amount of air drawn in through ventilation holes as the smoke is inhaled, and local characteristics within the lung that determine the diffusion of toxic gases and the deposition of particles. By age 60 years, this person will have inhaled the smoke from approximately 290,000 cigarettes and will bear a substantial risk for chronic obstructive pulmonary disease ( COPD) and lung cancer. The substantial doses of carcinogens and toxins delivered to these sites place smokers at risk for malignant and nonmalignant diseases involving all components of the respiratory tract including the mouth.Ĭonsider, for example, the lungs of a 60-year-old person with a 40-pack-year 1 smoking history starting at age 20 years. As the smoke moves more deeply into the respiratory tract, more soluble gases are adsorbed and particles are deposited in the airways and alveoli.

Inhaled tobacco smoke moves from the mouth through the upper airway, ultimately reaching the alveoli. The respiratory system extends from the nose and upper airway to the alveolar surface of the lungs, where gas exchange occurs.

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