LUNG CANCER, BRONCHITIS, AND EMPHYSEMA

When smoking, the smoke travels through the airways, through the trachea, and to the lungs.  This is where the greatest impact is felt.  Here are the most common lung diseases that are greatly impacted from smoking.

Lung Cancerà  Cancers that begin in the lung are of two types; non-small cell lung cancer and small cell lung cancer.  They differ by their appearance under a microscope and they are treated differently.  Nonsmall cell lung cancer is more common and tends to grow and spread slower than small cell lung cancer⁴³.  The biggest risk factor is tobacco.  The National Cancer Institute states that the best way to prevent lung cancer is not to smoke, or is you are smoking, to quit, the sooner the better.  Common signs of lung cancer are a persistent cough that gets worse over time, chest pain, coughing up blood, and shortness of breath.  There are many different treatments for lung cancer.  They range from radiation therapy and chemotherapy to lung transplantation.  Cigarette smoking is the primary risk factor for lung cancer⁴³.   

Lung cancer is becoming increasingly common in women and in the United States accounts for more female cancer deaths annually than breast cancer. Many epidemiological studies have provided evidence that women are more susceptible than men to the adverse effects of tobacco smoke. These observations suggest the possible role of estrogens in lung carcinogenesis. The study reports the expression of mRNA for estrogen receptor alpha (ERalpha) and beta (ERbeta) in cultured human non-small cell lung cancer cells, cultured lung fibroblasts, and primary cultures of normal bronchial epithelium. After some very detailed tests, the results suggest that estrogen signaling plays a biological role in both the epithelium and the mesenchyme in the lung and that estrogen could potentially promote lung cancer, either through direct actions on preneoplastic or neoplastic cells or through indirect actions on lung fibroblasts. Additionally, it is possible that antiestrogens may have therapeutic value to treat or prevent lung cancer.  

Another study looked at the “low-risk” cigarettes with less tare and nicotine²⁰.  The dose-response relationship between number of cigarettes smoked and risk for lung cancer was established in 1950 by epidemiological studies. In cigarette smoke, among 4800 identified compounds, 69 are carcinogens, and several are tumor promoters or cocarcinogens. The major toxic agents are nicotine, carbon monoxide, hydrogen cyanide, nitrogen oxides, among other organic substances. Public health information and education have led to a reduction of cigarette smokers among U.S. adults from 40 to 25%. However, in high school students, smoking increased to 35% and in adults with less than a high school education it remains high at 33.3%. Intervention studies were augmented with attempts of risk reduction by changing the tobacco composition and makeup of cigarettes. This led to cigarettes that, according to the FTC, reduced the tar and nicotine yields from an average of 37 and 2.7 mg to 12 and 0.85 mg. The anticipated reduction of mortality rates from chronic diseases among cigarette smokers did not occur, primarily, because of a major adjustment in smoking intensity and depth of inhalation by the habitual smokers. It is, therefore, imperative that smoking control efforts are intensified and that, short of banning cigarette sales, cigarettes delivering smoke with the lowest potential for toxicity, addiction, and carcinogenicity are declared a matter of public health policy²⁰. 

 “In March 2001, the U.S. Surgeon General released Women and Smoking , the second Surgeon General's report to focus on tobacco use among women, compelling the nation to make reducing tobacco use among women one of the highest priorities for women's health. Since 1980, 3 million women have died prematurely from smoking-related diseases and injuries. Lung cancer mortality rates among U.S. women have increased about 600% since 1950, and now lung cancer is the leading cause of cancer death among U.S. women, having surpassed breast cancer in 1987”²².  Because of these statistics, there is an ever-pressing need for preventative programs.  An example of a dramatic program impact, in California, which has had a comprehensive tobacco control program for 11 years, smoking prevalence has declined throughout the 1990s at rates two or three times faster than in the rest of the country, and while lung cancer incidence rates increased by 13% among women in other parts of the United States, they decreased by 4.8% among women in California²². These promising findings indicate that although tobacco-related diseases have become a women's health issue of epidemic proportions, we have the ability to reverse these trends²².     

Emphysemaà Emphysema is a condition in which there is over-inflation of structures in the lungs known as alveoli or air sacs. This over-inflation results from a breakdown of the walls of the alveoli, which causes a decrease in respiratory function (the way the lungs work) and often, breathlessness.  Early symptoms are shortness of breath and a cough.  Emphysema begins with the destruction of air sacs (alveoli) in the lungs where oxygen from the air is exchanged for carbon dioxide in the blood. The walls of the air sacs are thin and fragile. Damage to the air sacs is irreversible and results in permanent "holes" in the tissues of the lower lungs.  As air sacs are destroyed, the lungs are able to transfer less and less oxygen to the bloodstream, causing shortness of breath. The lungs also lose their elasticity, which is important to keep airways open. The patient experiences great difficulty exhaling.  Emphysema doesn't develop suddenly, it comes on very gradually. Years of exposure to the irritation of cigarette smoke usually precede the development of emphysema⁶.  The single best treatment for emphysema is to quit smoking.  There are some bronchodilator drugs which will help if there is trouble breathing because of airway constriction.  The most drastic treatments are lung transplantation and lung reduction surgery.  Lung reduction surgery is when the diseased portions of the lung are removed to allow the remaining lung and the breathing muscles to work better.  The short term results are promising but those with severe forms are at higher risk of death⁶.  To prevent emphysema, do not smoke.  If you are already smoking, quit.  Emphysema ranks 15th among chronic conditions that contribute to activity limitations: almost 44 percent of individuals with emphysema report that their daily activities have been limited by the disease.  (There is one type of emphysema which is from a deficiency of Alpha-1.  However, a majority of cases of emphysema are from smoking.)