Restrictive Pulmonary Disorders

In restrictive pulmonary disorders, vital capacity is reduced because the lungs have lost their elasticity. Inhaling particles such as silica (sand), coal dust, asbestos, and, now it seems, fiberglass can lead to pulmonary fibrosis, a condition in which fibrous connective tissue builds up in the lungs. The lungs cannot inflate properly and are always tending toward deflation. Breathing asbestos is also associated with the development of cancer. Because asbestos was formerly used widely as a fireproofing and insulating agent, unwarranted exposure has occurred. It has been projected that two million deaths caused by asbestos exposure-mostly in the workplace-will occur in the United States between 1990 and 2020.

Obstructive Pulmonary Disorders

In obstructive pulmonary disorders, air does not flow freely in the airways, and the time it takes to inhale or exhale maximally is greatly increased. Several disorders, including chronic bronchitis, emphysema, and asthma, are referred to as chronic obstructive pulmonary disorders (COPD) because they tend to recur.

     In chronic bronchitis, the airways are inflamed and filled with mucus. A cough that brings up mucus is common. The bronchi have undergone degenerative changes, including the loss of cilia and their normal cleansing action. Under these conditions, an infection is more likely to occur. Smoking cigarettes and cigars is the most frequent cause of chronic bronchitis. Exposure to other pollutants can also cause chronic bronchitis.
     Emphysema is a chronic and incurable disorder in which the alveoli are distended and their walls damaged so that the surface area available for gas exchange is reduced. Emphysema is often preceded by chronic bronchitis. Air trapped in the lungs leads to alveolar damage and a noticeable ballooning of the chest. The elastic recoil of the lungs is reduced, so not only are the airways narrowed, but the driving force behind expiration is also reduced. The victim is breathless and may have a cough. Because the surface area for gas exchange is reduced, less oxygen reaches the heart and the brain. Even so, the heart works furiously to force more blood through the lungs, and an increased workload on the heart can result. Lack of oxygen to the brain can make the person feel depressed, sluggish, and irritable. Before therapy can begin, the patient must stop smoking. Then, exercise, drug therapy, supplemental oxygen, and surgery may relieve the symptoms and possibly slow the progression of emphysema.

     Asthma is a disease of the bronchi and bronchioles that is marked by wheezing, breathlessness, and sometimes a cough and expectoration of mucus. The airways are unusually sensitive to specific irritants, which can include a wide range of allergens such as pollen, animal dander, dust, cigarette smoke, and industrial fumes. Even cold air can be an irritant. When exposed to the irritant, the smooth muscle in the bronchioles undergoes spasms. It now appears that chemical mediators given off by immune cells in the bronchioles cause the spasms. Most asthma patients have some degree of bronchial inflammation that reduces the diameter of the airways and contributes to the seriousness of an attack. Asthma is not curable, but it is treatable. Special inhalers can control the inflammation and hopefully prevent an attack, while other types of inhalers can stop the muscle spasms should an attack occur.

Lung Cancer

Lung cancer used to be more prevalent in men than in women, but recently it has surpassed breast cancer as a cause of death in women. The recent increase in the incidence of lung cancer in women is directly correlated to increased numbers of women who smoke. Autopsies on smokers have revealed the progressive steps by which the most common form of lung cancer develops. The first event appears to be thickening and callusing of the cells lining the primary bronchi. (Callusing occurs whenever cells are exposed to irritants.) Then cilia are lost, making it impossible to prevent dust and dirt from settling in the lungs. Following this, cells with atypical nuclei appear in the callused lining. A tumor consisting of disordered cells with atypical nuclei is considered cancer in situ (at one location) (Fig. 14.11). A final step occurs when some of these cells break loose and penetrate other tissues, a process called metastasis. Now the cancer has spread. The original tumor may grow until a bronchus is blocked, cutting off the supply of air to that lung. The entire lung then collapses, the secretions trapped in the lung spaces become infected, and pneumonia or a lung abscess (localized area of pus) results. The only treatment that offers a possibility of cure is to remove a lobe or the whole lung before metastasis has had time to occur. This operation is called pneumonectomy. If the cancer has spread, chemotherapy and radiation are also required. Current research indicates that passive smoking-exposure to smoke created by others who are smoking-can also cause lung cancer and other illnesses associated with smoking. If a person stops voluntary smoking and avoids passive smoking, and if the body tissues are not already cancerous, they may return to normal over time.

Figure 14.11 Normal lung versus cancerous lung. a. Normal lung with heart in place. Note the healthy red color. b. Lungs of a heavy smoker. Notice how black the lungs are except where cancerous tumors have formed.

The Most Often Asked Questions About Tobacco and Health

Is there a safe way to smoke?
No. All forms of tobacco can cause damage, and smoking even a small amount is dangerous. Tobacco is perhaps the only legal product whose advertised and intended use-that is, smoking it-will hurt the body.
Does smoking cause cancer?
Yes, and not only lung cancer. Besides lung cancer, smoking a pipe, cigarettes, or cigars is also a major cause of cancers of the mouth, larynx (voice box), and esophagus. In addition, smoking increases the risk of cancer of the bladder, kidney, pancreas, stomach, and uterine cervix.
What are the chances of being cured of lung cancer?
Very low; the five-year survival rate is only 13%. Fortunately, lung cancer is a largely preventable disease. In other words, by not smoking, it can probably be prevented.
Does smoking cause other lung diseases?
Yes. Smoking leads to chronic bronchitis, a disease in which the airways produce excess mucus, forcing the smoker to cough frequently. Smoking is also the major cause of emphysema, a disease that slowly destroys a person’s ability to breathe. Chronic bronchitis and pulmonary emphysema are higher in smokers than in nonsmokers.
Why do smokers have “smoker’s cough”?
Normally, cilia (tiny, hairlike formations that line the airways) beat outward and “sweep” harmful material out of the lungs. Smoke, however, decreases this sweeping action, so some of the poisons in the smoke remain in the lungs.
If you smoke but don’t inhale, is there any danger?
Yes. Wherever smoke touches living cells, it does harm. So, even if smokers of pipes, cigarettes, and cigars don’t inhale, they are at an increased risk for lip, mouth, and tongue cancer.
Does smoking affect the heart?
Yes. Smoking increases the risk of heart disease, which is the number one killer in the United States. Smoking, high blood pressure, high cholesterol, and lack of exercise are all risk factors for heart disease. Smoking alone doubles the risk of heart disease.
Is there any risk for pregnant women and their babies?
Pregnant women who smoke endanger the health and lives of their unborn babies. When a pregnant woman smokes, she really is smoking for two because the nicotine, carbon monoxide, and other dangerous chemicals in smoke enter her bloodstream and then pass into the baby’s body. Smoking mothers have more stillbirths and babies of low birthweight than nonsmoking mothers.
Does smoking cause any special health problems for women?
Yes. Women who smoke and use the birth control pill have an increased risk of stroke and blood clots in the legs. In addition, women who smoke increase their chances of getting cancer of the uterine cervix.
What are some of the short-term effects of smoking cigarettes?
Almost immediately, smoking can make it hard to breathe. Within a short time, it can also worsen asthma and allergies. Only seven seconds after a smoker takes a puff, nicotine reaches the brain, where it produces a morphinelike effect.
Are there any other risks to the smoker?
Yes, there are many more risks. Smoking is a cause of stroke, which is the third leading cause of death in the United States. Smokers are more likely to have and die from stomach ulcers than nonsmokers. Smokers have a higher incidence of cancer in general. If a person smokes and is exposed to radon or asbestos, the risk for lung cancer increases dramatically.
What are the dangers of passive smoking?
Passive smoking causes lung cancer in healthy nonsmokers. Children whose parents smoke are more likely to suffer from pneumonia or bronchitis in the first two years of life than children who come from smoke-free households. Passive smokers have a 30% greater risk of developing lung cancer than do nonsmokers who live in a smoke-free house.
Are chewing tobacco and snuff safe alternatives to cigarette smoking?
No, they are not. Many people who use chewing tobacco or snuff believe it can’t harm them because there is no smoke. Wrong. Smokeless tobacco contains nicotine, the same addicting drug found in cigarettes and cigars. Although not inhaled through the lungs, the juice from smokeless tobacco is absorbed through the lining of the mouth. There it can cause sores and white patches, which often lead to cancer of the mouth. Snuff dippers actually take in an average of over ten times more cancer-causing substances than cigarette smokers.