Tobacco cigarettes, smoking, smoking cessation, and chronic obstructive pulmonary disease

The case linking cigarette smoking to the development of COPD is now several decades old and provides overwhelming evidence that the most important risk factor for the development of COPD is cigarette smoking. Cigarette smokers have more cough and sputum production, a higher prevalence of abnormal pulmonary function, a higher rate of decline of pulmonary function, a higher prevalence of COPD, and higher rates of death from COPD. Cessation of smoking ameliorates all of these adverse effects. Pathophysiologically, smoking is associated with structural changes within the lung that explain the functional abnormalities of airflow obstruction, although the underlying mechanisms that unite these structural and functional abnormalities remain to be fully elucidated. There is no small irony that in our present consumer-oriented society, which demands the highest safety standards for products, that cigarettes are still legally purchased despite the crushing weight of the evidence indicting the inhalation of cigarette smoke. Surely, few other consumer products could withstand such an assault. It is unlikely that COPD would be eradicated if tobacco cigarettes were no longer available; however, it is certain the scope of this problem would be drastically reduced.