Tobacco and Public Health - TCSC Indonesia

Introduction
Chapter 33
Chronic obstructive pulmonary
disease
David M. Burns
Tobacco use antedates the arrival of Columbus in the Americas, and tobacco leaf
became a mainstay of trade between America and Europe over the next several centuries.
However, use of tobacco as cigarettes is a behavior largely confined to the twentieth and
now the twenty-first century (USDHHS 2001). Milder blends of flue-cured tobaccos
are used for most cigarettes, and they produce a more acid smoke than the tobacco
used for pipes and cigars (IARC 1986). Nicotine, the addictive agent sought by the
smoker, is less readily absorbed across the oral mucosa from this more acid smoke;
and, to satisfy the smokers need for this drug, smoke must be inhaled into much larger
surface area of the lung to allow sufficient absorption. This obligatory inhalation of
cigarette smoke by the addicted smoker makes cigarette smoking the most hazardous
form of tobacco use, and the deposition and retention of tobacco smoke in the lung
causes chronic obstructive pulmonary disease (COPD). An extensive body of literature
has examined the relationship of tobacco smoke inhalation to chronic lung disease,
and that literature is reviewed elsewhere (USDHHS 1984, 1990, 2001, in press). This
chapter presents a synthesis of the available information, but it does not attempt to
provide an exhaustive set of references to this substantial body of literature.
Lung damage from tobacco smoke inhalation is described using a variety of terms
including chronic bronchitis, emphysema, chronic obstructive lung disease (COLD),
COPD, and chronic airflow obstruction. The pathophysiological pattern of this injury
is often separated into three overlapping pictures which are each present to a variable
extent in most long-term cigarette smokers. The first pattern consists of inflammatory
changes in the larger airways with hypertrophy of the airway lining and an increased
number of mucus-secreting glands, and it commonly presents with the clinical symptom
of a chronic cough productive of small amounts of sputum. This set of clinical
symptoms is technically defined as chronic bronchitis when it is present for three or
more months in two or more years. However, in common medical usage, the diagnosis
of chronic bronchitis sometimes also includes individuals with emphysema and airflow
limitation rather than just chronic cough. This overlapping usage of terms, which