Cigarette smoking and

its long term side

effects
Pathophysiology Assignment

Prepared by: Zainab Ameer Ahmed 7/28/23 PHARM.D

 I. Introduction
Once regarded as socially acceptable , smoking is now counted as one of those habits
which are hazardous to life.
The worst part of smoking is that it not only causes harm to smoker’s health but also to
the surrounding people through passive smoking, which means to inhale cigarette
smoking present in the environment and it is equally harmful. Due to this smoking is
highly condemned. About half of the cigarette smokers die of tobacco-related diseases
and lose on average 14 years of life. Every year, tobacco cigarettes kill more than 8
million people worldwide, with 1.2 million of those being non-smokers dying as the
result of exposure to second-hand smoke. Second-hand smoke from cigarettes causes
many of the same health problems as smoking, including cancer, which has led to
legislation and policy that has prohibited smoking in many workplaces and public areas.

II. cigarette and its constituents

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There are more than 4,000 identified chemicals found in cigarette smoke, which has
various carcinogenic and mutagenic effects. The three most health damaging in tobacco
smoke are, nicotine, tar, carbon-monoxide.

The complex mixture of chemicals in tobacco smoke includes carbon monoxide,

hydrogen cyanide, benzene, formaldehyde, nicotine, phenol, polycyclic aromatic
hydrocarbons and tobacco specific nitrosamines ( TSNAs)

1. Nicotine
Nicotine is a chemical compound that naturally occurs in tobacco plants
(nicotiana tabacum) and some other plants in the solanaceae family. It is highly
addictive alkaloid, and when tobacco is burned, nicotine is released into the
smoke. This is why smoking tobacco products such as cigarettes, cigars, and
pipes, is a common way for people to consume nicotine.
When tobacco is burned and inhaled as smoke, nicotine is rapidly absorbed
through the lungs and into the bloodstream. From there it quickly reaches the
brain, where it exerts its psychoactive effects. These effects include increased
alertness, pleasure, and sense of relaxation or stress relief, which contribute to the
addictive nature of nicotine.
2. Carbon monoxide

Carbon monoxide is a poisonous gas which replaces oxygen in blood. In the context of
smoking, carbon monoxide is one of the harmful components present in tobacco smoke.
When a person inhales smoke from burning tobacco products, carbon monoxide is
absorbed into the bloodstream through the lungs. In the bloodstream, carbon monoxide
binds to haemoglobin, the protein responsible for transporting oxygen in the blood.
However, carbonmonoxide has a much stronger affinity for haemoglobin than oxygen
does. As a result, the presence of carbon monoxide reduces the blood’s ability to carry
oxygen to body tissues effectively

This forces your heart to work much harder and stops your lungs from working properly.

Your cells and tissues will be prevented from getting the oxygen they need. This can lead
to heart diseases and stroke.

If a person smokes during pregnancy, carbon monoxide prevents the baby from getting
the oxygen it needs.

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 3. Tar

Tar is a dark, sticky substances that is produced when tobacco is burned and smoke is
generated. It is a complex mixture of toxic and harmful chemicals that are released during
the combustion of tobacco.

When a person smokes a cigarette, the tobacco is ignited, and the smoke is inhaled into
the lungs. This smoke contains various harmful components, and tar is one of the most
concerning one. Tar contains a range of carcinogens( cancer-causing substances) and
other toxic compounds that have detrimental effects on the respiratory system and overall
health.

Tar has several harmful effects including :

I. Lung damage: The chemicals in tar can irritate and damage the lining of the lungs
leading to chronic respiratory issues, such as chronic bronchitis and emphysema.
II. Cancer risk: Tar contains carcinogens, which can cause changes in lung tissue that
lead to the development of lung cancer and other types of cancers, including oral,
throat, esophageal, and laryngeal cancer.
III. Respiratory problems: Inhaling tar can lead to the accumulation of mucus and
impairs the natural cleansing mechanism of the respiratory system, leading to
respiratory infections and breathing difficulties
IV. Cardiovascular issues: Smoking and tar exposure contribute to the narrowing and
hardening of blood vessels, increasing the risk of heart disease, heart attacks, and
strokes.
V. Staining and discoloration: Tar can stain the teeth, fingers, and nails of smokers,
leading to unsightly discoloration.

It’s important to note that tar is just one of the harmful components found in
cigarette smoke.

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 III. Etiology of COPD
Chronic Obstructive Pulmonary Disease (COPD) is a chronic respiratory condition
characterized by persistent obstruction of airflow from the lungs. The development of
COPD is usually a result from long-term exposure to certain irritants that damage the
lungs and airways. The primary risk factor of COPD is cigarette smoking, accounting for
the vast majority of cases. However, other factors can also contribute to the development
of COPD. Here are some key etiological factors:

1. Smoking: cigarette smoking is the most significant risk factor for COPD. Tobacco
smoke contains harmful chemicals that irritate and inflame the airways, leading to
chronic bronchitis and emphysema, both of which are common components of
COPD.
2. Environmental exposure: Prolonged exposure to other harmful substances and
pollutants in the air can also contribute to COPD. This includes exposure to
secondhand smoke, air pollution, fumes, dust, and chemicals in the workplace or
home environment.
3. Genetic Factors: A small percentage of COPD cases may have a genetic
predisposition. Alpha-1 antitrypsin deficiency is a rare genetic condition that can
lead to early onset emphysema, especially in non-smokers
4. Respiratory infections: Frequent or severe respiratory infections, such as repeated
lung infections during childhood or adulthood, can cause damage to the lungs and
contribute to the development of COPD.
5. Asthma: Chronic asthma, if not well-controlled, can lead to airway remodeling
and contribute to the development of COPD over time.
6. Age: The risk of COPD increases with age, as the lungs naturally undergo
changes and lose some of their elasticity and function as people get older.

It’s important to note that COPD typically develops over many years of exposure to
these risk factors. Not everyone who smokes or is exposed to harmful substances will
develop COPD, but these factors significantly increase likelihood of the diseases.

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 Additionally, quitting smoking and avoiding exposure to harmful pollutants can slow
down the progression of COPD and improve overall lung health.

IV. Pathology

Smoking is
a major risk
factor for a wide
range of diseases,
and its detrimental effects on health have been extensively studied by medical
researchers. The pathology (The study of smoking is well documented and includes the
following.

A. Chronic obstructive pulmonary diseases (COPD):

chronic obstructive pulmonary disease is a progressive lung disease characterized by

chronic inflammation obstruction of airflow in the lungs. The primary risk factor for
COPD is smoking, but long-term exposure to other respiratory irritants such as air
pollution, occupational dust, and fumes can also contribute to its development.

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 Chronic inflammation: The inflammatory response is a central feature of COPD.
Inhaled irritants, particularly cigarette smoke, trigger an immune response in the
lungs. This inflammation leads to activation of immune cells, such as neutrophils,
macrophages, and T-lymphocytes, in the airways and lung tissue. Over time,
chronic inflammation damages the delicate structures of the lungs and leads to
structural changes.

 Airway remodeling: Chronic inflammation causes structural changes in the

airways, leading to airway remodeling. The airways become thickened and
narrowed, making it harder for air to flow in and out of the lung. This results in
airflow limitation, one of the hallmark features of COPD.
 Emphysema: emphysema is a component of COPD characterized by the
destruction of the alveoli, the tiny air sacs where gas exchange occurs. Chronic
inflammation in the lungs triggers the release of enzymes that break down the
walls of the alveoli. As a result, the alveoli lose their elasticity, and the surface
area available for gas exchange is reduced, leading to impaired oxygen uptake and
carbon dioxide elimination.

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 Mucus Hypersecretion: In response to chronic irritation, the airway lining
produces an excessive amount of mucus. This excess mucus clogs the airways,
further obstructing airflow and increasing the risk of respiratory infections.
 Exacerbations: COPD patient are prone to exacerbations, which are acute
worsening of symptoms. Exacerbations can be triggered by respiratory infections,
exposure to pollutants, or other factors. During exacerbations, inflammations
intensifies, and symptoms such as coughing, wheezing, and shortness of breath
become more severe
 Oxidative stress and inflammation: chronic exposure to cigarette smoke and other
lung irritants leads to increased oxidative stress in the lungs. Oxidative stress
occurs when there is an imbalance between the production of harmful reactive
oxygen species and the body’s ability to neutralize them with
antioxidants .Oxidative stress and inflammation play a key role in the progressive
damage to the lung tissue and contribute to the pathogenesis of COPD.

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  Pulmonary vascular changes: COPD can also affect the blood vessels in the lungs,
leading to pulmonary hypertension (high blood pressure in the pulmonary
arteries). Pulmonary hypertension occurs due to narrowing and remodeling of the
pulmonary arteries, making it harder for the blood to flow through the lungs and
causing increased pressure on the right side of the heart.

V.
VI.

Diagnosis of COPD

The diagnosis of Chronic Obstructive Pulmonary Disease (COPD) involves combination

of medical history, physical examination, lung function tests, and sometimes imaging

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studies. It’s essential for healthcare professionals to gather a comprehensive assessment
to confirm the diagnosis and determine the severity of the disease. Here’s an overview of
the diagnostic process for COPD :

1. Medical history: The first step is to obtain a detailed medical history, including
information about the patient’s smoking history, exposure to risk factors eg;
(occupational pollutants), respiratory symptoms (e.g; cough, shortness of breath,
sputum production), and any relevant family history of respiratory conditions.
2. Physical Examination: A physical examination helps the healthcare provider
assess to patient’s overall health and respiratory status. They may listen to the
lungs using a stethoscope to check for abnormal breath sounds and signs of
respiratory distress.
3. Spirometry: spirometry is the primary test used to diagnose and assess the severity
of COPD. It measures lung function by evaluating how much air a person can
inhale and exhale and how quickly they can do it. The two key measurements
obtained from spirometry are:
a) Forced expiratory volume in 1 second (FEV1): The amount of air a person can
forcefully exhale in one second.
b) Forced Vital Capacity( FVC): The total amount of air a person can forcefully
exhale after a full inhalation. The FEV1/FVC ratio is used to determine if there is
an obstruction in the airways. A lower FEV1/FVC ratio indicates airflow
limitation, which is characteristic of COPD.
4. Post-Bronchodilators Testing: To confirm the diagnosis of COPD and
differentiate it from other respiratory conditions, a post-bronchodilator spirometry
maybe performed. This involves administering a bronchodilator medication ( such
as albuterol) and then repeating the spirometry to see if there is a significant
improvement in lung function, which is typical in asthma but no in COPD.
5. Imaging Studies: In some cases, chest X-rays or computed tomography ( CT)
scans may be ordered to rule out other lung conditions and assess the extent of
lung damage in advanced cases of COPD.

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6. Arterial Blood Gas (ABG) Test: In severe cases of COPD, an arterial blood gas
test maybe performed to evaluate the levels of oxygen and carbon dioxide in the
blood. ABG testing helps assess the effectiveness of breathing and the need for
oxygen therapy.
7. Other Tests: Additional tests, such as exercise testing, may be used to evaluate
exercise capacity and oxygen use during physical activity.

It’s important to note that the diagnosis of COPD should be made by a qualified
healthcare professional, typically a pulmonologist or a respiratory specialist, based
ona thorough evaluation of the patient’s medical history, symptoms, and test results.
Early diagnosis and management of COPD are crucial in slowing disease progression
and improving quality of life.

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 VII. Signs and symptoms of COPD

Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory condtion

that can cause various signs and symptoms. The symptoms of COPD usually develop
slowly and worsen over time. The most common signs and symptoms of COPD include:

1. Chronic cough: A persistant cough that lasts for atleast three months in two
consecutive years is common early symptom of COPD. The cough is often
productive, meaning it produces mucus or phlegm.
2. Shortness of Breath: Also known as dyspnea, shortness of breath is another
hallmark symptom of COPD. Initially, it may occur due to physical activities or
exercises, but as the disease progresses, it can happen during minimal exertion or
even at rest.
3. Wheezing: Wheezing is a high-pitched whistling sound that occurs during
breathing due to narrowed airways. It can be more noticeable during exhalation in
individuals with COPD.
4. Chest tightness: people with COPD may experience a feeling of tightness or
heaviness in the chest, which can be distressing and uncomfortable.
5. Increased Mucus Production: As COPD progresses, there may be an increase in
the production of mucus in the airways, leading to a chronic cough and sputum
production.
6. Frequent Respiratory infections: COPD weakens the lungs ability to fight off
infections, making individuals more susceptible to respiratory infections such as
bronchitis and pneumonia.
7. Fatigue: reduced lung function and the effort required to breathe can lead to
fatigue and a decreased ability to perform everyday activities.
8. Unintended Weight Loss: As the condition worsens , individuals with COPD may
experience unintended weight loss, which can be related to the increased energy
expenditure of breathing.

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 VIII. Preventing COPD by Quitting Smoking:
Cigarette smoking is the leading cause of COPD , accounting for approximately 80-90%
of all cases. The harmful chemicals in tobacco smoke cause irritation and inflammation in
the airways and lung tissue, leading to chronic bronchitis and emphysema, which are
main components of COPD. S moking damages the small air sacs in the lungs (alveoli)
and weakens the walls of the airways, causing them to collapse and narrow. Overtime,
this damage reduces the lung function.

 Preventing COPD by Quitting smoking:

The single most effective way to prevent COPD or slow its progression is to quit
smoking. When someone quits smoking, their lungs start to heal and respiratory
symptoms often improve. Even in individuals who already have COPD, quitting
smoking can slow down the decline in the lung function and improve their overall
health and quality of life. It is never too late to quit smoking, and the benefits of
quitting are substantial regardless of age or how long one has been smoking.

progression of COPD varies from person to person, but it generally leads to a gradual
decline in lung function, increasing disability, and reduced quality of life. Smoking
cessation and avoiding exposure to respiratory irritants are crucial in managing COPD
and slowing down its progression. Medical treatments, such as bronchodilators, anti-
inflammatory medications, oxygen therapy, can help relieve symptoms and improve lung
function in COPD patients. Regular medical follow-up and adopting a healthy lifestyle
are essential aspects of COPD management.

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 IX. References:
https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/
effects_cig_smoking/index.htm

https://www.cancer.org/cancer/cervical-cancer/prevention-and-early-detection/cervical-
cancer-prevention.html

https://www.who.int/health-topics/tobacco#tab=tab_1

https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/cessation-fact-sheet

https://goldcopd.org/:

https://www.cdc.gov/

https://www.mayoclinic.org/

https://www.thoracic.org/

https://www.lung.org/

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