Tobacco Documents Online

Smoking and Mucous Gland Abnormalities ..................... Abnormalities of the Small Airways.........: ............. EXPERIMENTAL STUDIES Studies in Brctmans........................................ Studies in Animals..........~..... 111 Tll 112'. ., ........................ 116 CYTOLOGIC AND HISTOLOGIC STUDIES,....., ........................ 118 SUPfMARY OF RECENT NON-NEOPLASTIC BRONCPHOPUIMONARY FINDINGS... BRONCYiOPULMONARY REFERENCES,.......... 120 ........ 121 BRONCHOPUIiMONARYDISEASE SUPPLEM',ENTAL -FEFERENCES....,.......... List' of Figures 128 Figure l.--Prevalence of chronic nonspecific respiratory disease by cigarette smoking habits and traffic exposure........... 92 Figure 2.--Relationship between."'closing volume"'and age in 39 smokers ................................................. 94 Figure 3.--PYevalence of abnormal closing,voSumeJvital capacity ratios in nonsmokers, cigarette smokers, and. ex-smokersby age decades.............. .................. . 96 Figure4.--Comparison.of the.prevalence.o.f respiratory symptoms and pulmonary function abnormalities in male smokers according to their daily cigarette consumption......... 97 Figure5.--Comparison of the prevalence of respiratory symptomsandl pulmonary functlion,abnormalities in female smokers according,to their daily ciga~retteconsumption.......... 9'8 Figure 6.--The distribution of smokingg histories 'in men with bronchitis and/or emphysema ...................,.......... 100 Figure 7. -Chronic bronchitis in female'wool and cotton textile workers......., ............................................ 106 Figure~ 8.--Chronic bronchitis in male wool and cotton textile workers......................,...............,............. Il07 82

In a separate publication, McCarthy and Craig (BP 60)) reported that 15'.percent of. a groupp of 91 asymptomatic female smokers in.Manitoba, had abnormally high closing voIlumes (CU),, in contrast to the 72' percent of 46 male smokers in London (BP 8) who had abnormally high closing voliumes. None of the female nonsmokers had any CV'abnormalities,. The authors suggested that differencesin.pollution exposureofe theLondom and Manitoba study groupsi mi'ght„ in.part,, account for the differences in prevalence of the Ch abnormalities. Iir.a, study ofpulmonaryfuneti'on of subjects voluntarily reporting to an emphysema screening center, Buist, et al. (BP 116) reported that 6 percent of the nonsmokers, 35 percent of the current cigarette smokers, and23.percent of the ex-smokerss hadab..normall.CV/VC ratios.. In each decade from age 20 to 79', more smokers andlex-smokers had abnormal CV/VC ratios than nonsmokers (fig.ure. 3):. The daily consumption of. cigarettes: was relatedito. CV abnormalities in.a.dose-responser.elation- shi.p for men: (figure 4). Among the women, those.with a daily cons.ump:- tion of less than 10 cigarettes per day had significantly lower CV'/VC rati.oss than those smok:ing,more than this amount (P'a.05);.but overall,, noo doserresp.onserelationshipwas demonstrated (figure 5).

<.l0:cig4cettes/dayn:=.19 10-20.cig;trettes/dry n~=75100 . 20-40 dgaretteslday n,=77 80. >40 cigarettes/day m= 3 66.7 4 synptolmat e cc/ric% cvlvck FEV1 Figure 5.--Cbmparison.ofthaprevalence of respiratory symptoms and pulmonary functioniabnormali'ties in.female smokerss according.to.theirdaily cig:arettee consumptioa. CC - Closing capacity TLC - To.tal.lung capacity CV' - Closing volume VC - Vital capacity FEVI Cne:-s:econd f.orcedlexpiratory volume O E.: ~. la SOURCE: Bui'st A. S et al (BP 116). , ,. ., . CJ 9'8

Table 3.--Prevalence (percent) of cough day or night in both sexes in winter by air pollution index, social class, cigarette smoking, and history of chest illness under two years of age.* (Figures in parentheses are population.) Air pollution index History of Chest illness under cigarette 2 years of age smoking Never smoked No chest illness One or more chest illnesses P_re_s_e_n__t_ smoker No chest illness one or more chest illnesses 7-17 18-28 Social class Social class i+ 2 3+ 4 1+ 2 3+ 4 4.7 (344) 5.7 (369) 4.7 (277) 6.6 (212) 12.3 (57) 8.3 (108) 8.3 (84) 10.8 (102) 11.2 (214) 12.6 (325) 14.1 (192) 15.7 (261) 16.4 (55) 11.8 (102) 12.3 (73) 22.2 (144) *Excluding 980 persons--that is, ex-smokers and those whose history of cigarette smoking, social class, , air pollution index, chest illness under 2 years of age, and history of cough day or night not k.novn.. SOURCE: Colley, J. R. T., et al. (BP 213). G`101•94-C0

CHAPTER:3 NOM-NEOPLASTIC BRONCHOPUIk10NARY DISEASES INTRODUCT'ION.................................. .................... 84 EP'IDEMIOLOGIC STUDIES Smoking and COPD...................................... ....... 86 The Effects of Smoking:on Pulmonary FUnction in Patients~with COPD................................ ,.... 89 The Effects of Smokiag on Pulmonary Function i!n:Healthy Populations ........... ,...... ..., ................ 89 The Roles of'Smoking and Pollution in the Deve7opment of COPD.., ................................... ,,~ 90 The Relationship Between.Cigarette Smoking and Small Ai'rwavs D'isease ...... .............. ,............... ... 93 The Interactions Between Cigarette Smoking and the Genetic Susceptibility to the Development of COPD...:.... 99 The Effect of Smoking on the Development of Bulilous Disease of the Lungs .... ...., ......... ......„...,.... 103 Smoking and Post-Operative Complications............ The Influence ofC.igarette Smok.ing.on.theDevelopment of Pulmonary Disease Associatediwi'th Rheumatoid Arthritis........... ............. .,....... Occupational Diseases and Smoking Byssinosis..... . 104 . 104 . 105 Asbestosis................................................. . . . ... . .: 110 Chronic Bronchitis and Pulmonary Symptoms in Cement and Rubber Industry Workers.........,......,... 110 AUTOPSY STUDIES Ths. Effect of Smoking on the Prematurity o:f Q3rrs40r,tis Development.and. Seueratyof..COPD......................,,, 110 81

Figure 6.--The distribution of'smokiag histories in men with bronchitis and/or emphysema. Patients grouped by phenotype; Pi?M patients above, those with, intermediate AAT deficiency below. Each bar depicts the.fraction of patients reporting smoking histories Tn th.e ranges shown. SOURCE: Mittman, C'., Barbela, T., Lieberman, J. (BP 64).

Table 1.--Number, percentage., and age-standardized percentage of. chronic bronchiticsamong.5,438cigarette..smoking male volunteers for mass radiography, aged at least. 40, by amount and'methodiof smoking. C.igarettess per day D. Nunber of volunteers 60 Number of. chronic bronchitics 22' Percentage chronic bronchitics. 36.6 Age-s t anda.r diz ed''percentag.e of chronic bronchitics 33.9 1-9 10-19 20+ All N. D'. N. D. N.. D. N: 581 134 1,839 266 2„558' 460 4,978 150 56 552 113 9171 191 1,673 25.8 41.8' 30.0 42.4 37'.5' 41.5* 33.6* - 26.0 41.,1 32.1 44.1 41.1 41.6 35.1 *P <.001.D. = "drooping" cigarette smokers. N. = normal cigarette smokers. SOURCE: Rimington,, J. (SP 109). In an,analysisn of data from Bosnia and ISercegovina in Yngoslavia,.. Zarkovic (BP'214) reported.dose:-response relationships between depth of cigarexte smoke inhalation and prevalence rates for chronic bronchitis, pulmonaryemphysema., asthma, corpulmonale, and: clinical and.'lab.oratory signs of obstructive lung disease. .. Olziihutag„ et al. (BP 229)) studied the prevalence of chronicc bronchitis in Mongolia and found no association between cigarette smoking.a.nd chroniobronchitis in urban women, and'd a reverse association in.rural women. These authors found close associations between chronic bronchitis and smoking in men. The authors pointed.out that chronic bronch~itiss increased in frequency with age. 88

Hutchison,et al. (BP' 23) studied 28 patients with pulmonary emphysema„ 8 of whom.were homozygous deficient for alpha1-antitrypsin. Althoughth:e annual consuuption of tobacco up to the age of onset of dyspnea was equal in the deficient and nondeficient group of patients, total lifetime tobacco consaanption was significantly less among the AeYT deficient patients than az¢ong:the nondeficients (P <.01). All 8.AAT deficient patients were smokers. Although there was no significant difference in.the incidence or age of onset of chronic bronchitis between the two groups,, the A[iT deficient group of patients developedi exertional dyspnea 12 years earlier than the nondeficients(P <.00.1)... Thes.e data suggest a synergistic effect of cigarette smoking on the development of pulmonary emphysema in those patients with homozygous deficiency of alphal-antitrypsin. clolley„ et al. (BP 213) ) analyzed a cohort of. 3,899 persons born in the last week of March 1946 in England, Scotland, and Wales and found that irrespective of a~hilstory of lower respiratory tract illness before the age of two, the smokers had a greater prevalence of symptoms of' winter coughh at age 20 than th,enonsmokers (tab:le. 3). . Thee authors argued that cigarette smoking,, by age 20, is a far more important factor iin the development of'respiiratory disease than is a history of lower respiratory tract.illness. The results of this study are evidence against the hypothesis of a purely constitutional susceptibility to the development of respiratory: diseases independent of tobacco exposure. 101

CHAPTER 3 NON-NEOPLASTIC ERONCHOPUIt10NARY DISEASES IN2'RODUCTION. Chronic obstructive pulmonary disease (COPD) (defined here as chronic bronchitis and emphysema) accounted for approximately 2'5,000 deaths in.the United States in 1969.. In 1970, in the U.S., the combined preva~lence.ofe chronic bronchdtisfor members. of both sexess over age17'was29.5 per 1,000.population., and for emphysema: was 9.8 per 1„000'0 population. In: 1970,,persons with chronir br:onchitis lost, on the average, 1'.4,workdaysper year,, andl those with emphysema lost greater: than 5 workdhys,per year due to disability from these diseas:es. Epid'emiologSc., autopsy, and experimental data, presen~ted.in previous editions of this report (1964, 1967', 1968s 1969, '. 1971, 1972,. 1973): indicate that:ciga:rette smoking:g is.s the.pri'mary cause of chronic bronchitis and emphysema.. A summary of'that evidence is presented below: 1. Results from.numerous.prospective studiesshow a markedly increased mortality from COPD:for male smokers compared to:n:onsmokers... There is a limited'amount of data dealing with the relationship between cigarettesmoking and COPD.mortality in women. 2.. Dose-responserela.tionships between cigarette smoking' and mortality from chronic bronchitis and emphysema were demonstrated in all studies in which dose-specific mortality rates were evaluated. Heavy cigarette smokers ran relative riskss of mortality from chronic bronchitis rangi.ng.from.3'..6 to 21.2'timesthose of nonsmokers, and'' relative risks of mortality from emphysema ranging from 6.9 to 25.3. times those of nonsmokers. 3. Data from~many studies demonstrate that male and female smokers suffer fromsymptoms of COPD' (including cough,, sputum;production, and dyspnea) more frequently than do nonsmokers. 4.. Of the studies in which dose-specific.prevalence rates.were examined„ strong.doae-response relationshipsbetween cigarette smoking and symptoms of COMweregenera~lly demonstrated.. 5.. The relationship.between cigarette.smoking.and COPDmortality hasbeen demonstrated in theUnited.States, Canada, Great Britain, and!Ireland;:strong as.soci'ati.onsbetween cigarette smoking.and COPD morbidity have been shown in.the United.S!tates, Canada., England:,, Australia,,= . Finland, Sweden,, France, Belgium, Hungary, and Japan. W. Cn ~C+ C 84

and cigarette consumption ass risk factors in the development ofchronicf nonspecific respiratorydis.eases. In.an.analysisof the initial data from.a prospective stud'yof. Boston policemen, Speizer and Ferris (BP 159) found that a higher percentage of men in three of four smoking categories who worked in areas of heavy traffic had chronic nonspecific respiratory d'iseasecompared with men who worked in the, outskirtss ofBostom (figure 1)'.3 In general„ for each of the four traffic exposure categories, the prevalence of CNRD was greater among ex-smokers than nonsmokers,. and greater among curr.entt cigarette smokerss than among either ex-smo'kerss or nonsmokers (table 2). Conversely,, the prevalence of CNRD in current smokers appeared to be related to the number oflf years of traffic exposure; th~ose men with few yearss of'such exposureh~ad approximately the, same. incidence:as,those who worked in the outskiYts. In the analysis of thiss relatively homogenous group of men, it appears that "traffic polluti.on" and' cigarette.smoking may beacting,in.concert too ihcreas:ee the risk of developing chronic respiratory disease.. Criteriafor diagnosis of CNADiwer:e those established by the British Medical Research Council Bronchitis Committee (1955)., 91