Tobacco and Public Health - TCSC Indonesia

586
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Excess Death Rate per 100,000
1200
1000
800
600
400
200
Lung Cancer
CHD
COPD
0
35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79
CPS II Data (Thun et al. 1997)
Age Group
Fig. 33.2 Male excess death rates* from smoking-caused diseases (*rates in smokers minus
the rate in never smokers). Excess rates are calculated by subtracting the age-specific death
rate for a given disease experienced by smokers from that for never smokers in the American
Cancer Society Cancer Prevention Study II as published by Thun et al. (1997). Rates are
presented for male smokers.
COPD to decline following cessation, and the death rate remains substantially elevated
in former smokers even after 20 years of abstinence.
As described above, lung function may improve slightly following cessation probably
due to a decrease in airway inflammation once the exposure to the irritants in tobacco
smoke ceases. The rate of lung function decline with advancing age also slows following
cessation and returns to that of the never smoker (Anthonisen et al. 1994; Scanlon
et al. 2000). However, the emphysema present in the lung at the time of cessation does
not repair, and lung function rarely returns to normal among smokers with substantial
lung injury at the time of cessation.
Respiratory symptoms, most notably a chronic productive cough, often improve
following cessation and may disappear altogether.
Pipe and cigar smoking
Cigarette smokers are much more likely to inhale tobacco smoke than are those who
have only smoked pipes and cigars, and this distinction is evident in the pattern of
disease risks found among smokers of different forms of tobacco. Pipe and cigar smokers
have risks similar to those of cigarette smokers for cancers of the oral cavity where