Tobacco use and other chronic respiratory disorders

Smoking and smokeless tobacco

Tobacco smoke contains more than 7000 chemicals. Of these, 250 are harmful, and at least 69 can cause cancer. It is estimated that 1 in 5 deaths is related to smoking. According to the Centers for Disease Control and Prevention (CDC), smokers are more likely to develop heart disease, lung cancer, and strokes. Smoking can cause the following effects:

• Respiratory system: Pneumonia, chronic obstructive pulmonary disease (COPD), tuberculosis, asthma, and cancer of the trachea, bronchus, and lung
• Nervous system: Stroke
• Cardiovascular system: Aortic aneurysm, early abdominal aortic atherosclerosis in young adults, coronary heart disease, atherosclerotic peripheral vascular disease, and acute myeloid leukemia
• Sensory system: Blindness, cataracts, and age-related macular degeneration
• Digestive system: Orofacial clefts (congenital defect from maternal smoking) and periodontitis; oropharynx, larynx, esophagus, stomach, liver, and colorectal cancers
• Endocrine system: Type 2 diabetes mellitus and pancreatic cancer
• Musculoskeletal system: Hip fractures and rheumatoid arthritis
• Urinary system: Cancer of the bladder, kidney, and ureters
• Immune system: Immune function issues
• Reproductive system: In females, reproductive effects (e.g., reduced fertility), ectopic pregnancy, and cervical cancer; in males, erectile dysfunction

Passive or secondhand smoke, which stays in the air and can be breathed in by others, causes lung cancer, strokes, low-birth-weight babies, and heart disease. Exposure to secondhand smoke increases a person’s risk for lung cancer by 20%. Children exposed to secondhand smoke have an increased risk of** sudden infant death syndrome (SIDS)**, ear infections, bronchitis, pneumonia, colds, and asthma. Secondhand smoke causes more than 53,000 deaths a year in the United States.

Thirdhand smoke is the residue or chemicals from the smoke that gets on skin, clothing, furniture, carpets, and so on. This can be harmful to little children and animals that spend time on the floor. Besides breathing in the residue, these chemicals can be ingested. They can transfer from the carpet, clothing, and so on to the hands and then into the person’s mouth.

The CDC reports that at least 28 cancer-causing chemicals have been found in smokeless tobacco (e.g., chew and dip). Smokeless tobacco can cause cancer of the mouth, pancreas, and esophagus.

E-cigarettes, which are used for vaping, are also considered tobacco products because they usually contain nicotine. E-cigarettes (also called e-cigs, vape pens, mods, or e-hookahs) are battery-operated devices that heat liquids to form an aerosol, which is then inhaled. The liquids typically contain nicotine, flavorings, and other additives. E-cigs can also be used for marijuana and other drugs. An e-cig may look like a cigarette, pipe, whiteout, marker, lipstick, pen, or USB (flash) drive. Compared to cigarettes, e-cigs are safer, but they still can be harmful. The aerosol can contain nicotine, heavy metals (e.g., lead), volatile organic compounds, and cancer-causing substances. One example of a health risk comes from diacetyl, which is found in many e-cigarette flavors. It has been known to cause bronchiolitis obliterans, commonly called “popcorn lung.” Diacetyl was an ingredient in microwave popcorn and food flavorings until it was linked to hundreds of cases of bronchiolitis obliterans. Like COPD, this disease can cause wheezing, persistent cough, shortness of breath, and death. The alveoli become scarred, and the airway becomes narrowed.

According to the CDC, the advantages of giving up the use of tobacco products include the following:

• Blood pressure and heart rate begin to return to normal.
• Within a few hours, carbon monoxide levels in the blood decline.
• Within a few weeks, circulation improves and abnormal respiratory symptoms (e.g., cough, wheezing) decrease.
• One year after quitting, the cardiovascular risks decrease sharply.
• Two to 5 years after quitting, the risk for stroke returns to a nonsmoker’s level.
• Five years after quitting, the risk of cancer of the esophagus, bladder, throat, and mouth is cut in half.
• Ten years after quitting, the lung cancer risk decreases by 50%.
• Local resources and prescriptive medications are available to assist people who want to quit using these products. Websites and quit lines are also available (e.g., National Cancer Institute Smoking Quitline: 1-877-44U-QUIT).

Cystic fibrosis

Cystic fibrosis (CF) is a life-threatening, congenital disease. Mucus builds up in the lungs, pancreas, and other organs. The mucus blocks the airways and increases the risk of infections. In the pancreas, the mucus interrupts the release of digestive enzymes used to break down food.

More than 30,000 people in the United States have cystic fibrosis. The majority of people with CF are diagnosed by age 2. All states require newborn screening tests for cystic fibrosis. With improvements in treatments, people with CF can live, work, and play with a much greater quality of life than in the past.

CF is a genetic disease. Each parent gives one copy of a specific gene to the child. As a result, the child gets two copies of a specific gene. If one of the copies is defective, the person will be a carrier of that disease. If both copies are defective, the person will have the disease. CF can cause the following conditions:

• Higher than normal levels of salt in the sweat and electrolyte imbalances
• A persistent cough that produces a thick, sticky sputum
• Breathlessness, shortness of breath, wheezing, and frequent lung infections
• Poor growth and weight gain
• Intestinal blockage, severe constipation, and foul-smelling, greasy stools

One of the following tests can be done to diagnose CF:

• Two positive sweat tests (the tests must be performed on different days)

• Genetic testing, to detect two defective genes (for CF), and one positive sweat test There is no cure for CF. Treatment centers on reducing the complications and symptoms. Treatment can include the following:

• Antibiotics for lung infections and anti-inflammatory medications can reduce the swelling in the lungs.

• Bronchodilators and mucus-thinning medication can help clear the lungs of mucus.

• Oral pancreatic enzymes are used to help with digestion.

• Chest physical therapy, vest therapy (vibrating vest), and O2 therapy can be initiated.

• Surgical options for CF complications include lung transplantation and bowel surgery for obstructions.

Sleep apnea

Sleep apnea occurs when a person stops breathing, or the breathing becomes very shallow. Breathing pauses may last a few seconds to minutes and can occur 30 or more times an hour. The cause of sleep apnea depends on the type:

• Obstructive sleep apnea (OSA): The most common type of sleep apnea; it causes breathing to pause during sleep. OSA results from a blockage or narrowing of the airway when the throat muscles relax. It can be caused by excessive weight, a thicker neck circumference, a narrowed airway, smoking, and nasal congestion. Males are twice as likely to have it, and age increases the risk.
• Central sleep apnea: The breathing repeatedly stops during sleep. The brain temporarily stops sending signals to the muscles that control breathing. This condition can be caused by brainstem injuries (including infections and stroke), congestive heart disease, and narcotic analgesics.
• Complex sleep apnea syndrome: Occurs when a person has both obstructive and central sleep apnea.

The most common signs and symptoms of these conditions include loud snoring, breathing cessation during sleep, dry mouth, sore throat, morning headache, difficulty staying asleep, excessive daytime sleepiness, irritability, and attention problems.

After an examination, the provider may refer the patient to a sleep specialist or order a sleep study. Treatments may include weight loss or stopping the use of alcohol or medications that may be causing the condition. Continuous positive airway pressure (CPAP) therapy is the most common treatment for OSA. It uses mild air pressure to keep the airway open. Image 057 Image of CPAP machine

Respiratory system cancers

Laryngeal and lung cancers are the most common cancers that impact the respiratory system. It is estimated that more than 12,000 people are diagnosed with laryngeal cancer yearly, and more than 3700 Americans die of it yearly. More than half a million Americans have lung cancer. Lung cancer is one of the most common cancers in the United States.

Laryngeal Cancer

Laryngeal cancer is throat cancer that affects the vocal cords and larynx (voice box). In most cases, laryngeal cancer develops in adults older than 50, and males are more likely to get it than females. The causes of laryngeal cancer include tobacco and alcohol use. Laryngeal cancer can cause the following conditions:

• A constant sore throat and painful swallowing
• Ear pain and a lump in the neck or throat
• Hoarseness

After a physical exam, the provider may order a biopsy with laryngoscopy or endoscopy, a CT scan, magnetic resonance imaging (MRI), a positron emission tomography (PET) scan, a bone scan, and a barium swallow (or upper gastrointestinal series). Treatment consists of surgery, chemotherapy, and radiation therapy.

Lung cancer

There are two main types of lung cancer: non–small cell and small cell. Non–small cell lung cancer is more prevalent. Lung cancer is the leading cause of cancer-related deaths in the United States.

The leading cause of lung cancer is cigarette smoking. The longer a person has smoked and the more a person has smoked, the more likely it is that the individual will contract lung cancer. High exposure levels of asbestos, radiation, and pollution can also increase a person’s risk for lung cancer. Lung cancer can cause the following:

• A chronic, worsening cough with hemoptysis and constant chest pain
• Wheezing, breathlessness, shortness of breath, clubbing, and more frequent respiratory infections
• Fatigue, loss of appetite, weight loss, and swelling of the face and hands

Chest x-rays and CT scans, sputum cytology, bronchoscopy, and lung tissue biopsy are used to diagnose lung cancer. Treatment for lung cancer is based on the person’s health, the stage of the disease, and the person’s preferences. Treatments can include chemotherapy, radiation therapy, targeted drug therapy, and surgery.

Here are some common surgical options for lung cancer:

• Wedge resection: Removal of a small portion of the lung tissue. It includes the tumor and the healthy tissue on the edge of the tumor.
• Segmental resection: Removal of a larger portion or segment of the lung.
• Lobectomy: Removal of a lobe of the lung.
• Pneumonectomy: Removal of the entire lung.