The dangers of smoking that you don’t know

This is the 4401st article of Da Yi Xiao Hu

Dear friends, today I will talk to you about the dangers of smoking that you may not know.

Speaking of this, I remembered a patient I met some time ago. This is the cousin of a friend of mine, 53 years old. He came to see me because of blood in his sputum. At that time, a CT scan was done and a cavity with a diameter of about three centimeters in the right upper lung was found. Seeing this cavity really shocked people, because he is a senior smoker who has smoked 30 cigarettes a day for 30 years. For this kind of patient, lung tumor should be considered. After admission, he was immediately given a series of examinations. Fortunately, the results showed that this was not a tumor, but a lung abscess. Although he escaped the disaster of lung tumor, it took a long time for this lung abscess to slowly improve after anti-infection treatment. The smoke produced after tobacco is ignited contains various toxic particles, which can damage the ciliated cells of the respiratory epithelium, leading to a further decline in the defense function of the respiratory tract.

In fact, in addition to causing lung cancer and emphysema, smoking is also closely related to various infectious lung diseases. For example, common pneumonia is also closely related to smoking. For example, a two-year survey in Spain compared the conditions of patients with acquired pneumonia with healthy controls to determine the relationship between smoking and the development of acquired pneumonia. If you smoke at least one cigarette a day or have a smoking history of at least one year, your risk of pneumonia will be twice that of a non-smoker. If you smoke more than 20 cigarettes a day, your risk of acquired pneumonia will be three times that of a non-smoker. Compared with the control group (56.2%), most pneumonia patients (64.9%) smoke for a long time or occasionally smoke. The increase in the risk of pneumonia is positively correlated with the history of smoking and the amount of cigarettes smoked per day. This study also shows that quitting smoking and not smoking for 5 years can reduce the risk of pneumonia.

Tuberculosis is an ancient lung infectious disease that is prone to occur in smokers. Smoking accelerates the decline of the immunity of tuberculosis patients. Tuberculosis patients themselves have weak body resistance. Smoke entering the lungs can easily destroy the natural protective barrier of the lungs, allowing other bacteria to take advantage of the opportunity to enter and cause new secondary infections, which will combine with the original tuberculosis, aggravate the disease and increase the difficulty of treatment. The more you smoke, the higher the risk of illness and prognosis. Benzopyrene in tobacco can cause gene mutations and apoptosis in immune cells, thereby inhibiting cellular immune function and increasing the body's susceptibility to Mycobacterium tuberculosis.

Studies have shown that the greater the daily amount of smoking, the higher the risk of a positive tuberculosis skin test reaction. Studies have found that the more smokers smoke before treatment, the lower the rate of sputum bacteria turning negative. This may be because smoking causes lung damage and inhibits the phagocytic and bactericidal functions of lung macrophages, which reduces the body's cellular immune function and the efficacy of anti-tuberculosis drugs in the body; smoking affects the efficacy of anti-tuberculosis drugs. Studies have shown that smoking can accelerate the metabolism of anti-tuberculosis drugs in the liver. For example, the concentration of rifampicin in the blood circulation of smokers is 30% lower than that of non-smokers, thereby reducing the body's absorption and utilization of anti-tuberculosis drugs and affecting the treatment effect.

References:

Almirall J;González CA;Balanzó

Almirall J;Blanquer J;Bello S. Community-Acquired Pneumonia Among Smokers. Archivos de Bronconeumología, 2014,50(6), 250–254.

Maurya V;Vijayan VK;Shah A, Smoking and tuberculosis: an association overlooked. Int J Tuberc Lung Dis 2002 Nov;6(11):942-951

Kolappan C;Gopi PG. Tobacco smoking and pulmonary tuberculosis. Thorax, 2002, 57(11), 964–966.

Author: Shanghai Fengxian District Central Hospital

Liu HongweiChief Physician