The adverse effects of cigarette smoke on the lungs may be separated into two distinct conditions.
• Chronic mucus hypersecretion, which causes persistent cough with sputum and fits with the original definition of simple chronic bronchitis. This condition arises chiefly in the large airways, usually clears up when the subject stops smoking and does not on its own carry any substantial risk of death.
• Chronic obstructive lung disease, which causes difficulty in breathing due to narrowing of the air passages in the lungs. This condition originates chiefly in the small airways, includes a variable element of destruction of peripheral lung units (emphysema), is progressive and largely irreversible and may ultimately lead to disability and death.
Both conditions can coexist in one person and they predispose to recurrent acute infective illnesses.
The obstructive syndrome is as specifically related to smoking as is lung cancer. Despite this, in discussing the health effects of tobacco, there has generally been far more emphasis on lung cancer than on this more disabling, but equally fatal disorder.
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