chest diseaseA comparison of smoking habits in the United States in 1955 and in 1966 showed a drop in cigarette consumption in men under 55 years of age, but among women, there was an increase in cigarette consumption for every age group. Another survey in the spring of 1970 showed a much larger drop in cigarette consumption in the four years from 1966 to 1970 compared with the 11 years from 1955 to 1966. This drop was particularly noted in men under 64 years of age and, for the first time, the increase in cigarette consumption among women under 55 years of age leveled off. The increase among women over 55 years was of a lesser magnitude than previously. Similar results have been found in surveys by the Department of National Health and Welfare in Canada but of particular concern is the increase of regular smokers reported among girls 15 to 19 years of age, from 19 percent in 1965 to 25 percent in 1970. Recently, there has been increasing attention paid to women smokers because of the relationship between maternal smoking during pregnancy and harm to the unborn child. Protect yoursef in case of erectile dysfunction together with My Canadian Pharmacy –

The literature related to clinical chest disease, pulmonary function abnormalities and sputum cellular abnormalities in relationship to regular cigarette smoking in women has been reviewed previously. The present investigation confirms the impression that chronic cigarette smoking is harmful to women. As the number of cigarettes increases, there is a progressive increase in the prevalence of respiratory symptoms and almost half of the heavy smokers appear to have chronic bronchitis. Many of the smokers had an increase in sputum over five years and this suggests that the chronic bronchitis is probably progressive. Colds “go to the chest” more frequently in the moderate and heavy smokers than in the nonsmokers and this suggests that the protective mechanisms against infection in the respiratory system are somewhat impaired by cigarette smoking in women. Respiratory symptoms and abnormalities on physical examination were unusual in the exsmokers, suggesting that much of the functional impairment caused by cigarette smoking is reversible if the individual stops smoking.

The sputum examinations confirmed the irritating effects of inhaling cigarette smoke. There was an increase in macrophages in the smokers. Hyperactivity of epithelium with replacement and desquamation is suggested by the increase in columnar cells and there were also an increased number showing degenerative and irritative changes. However, the more advanced state of irritation involving epithelial squamous cells was not definitely present (metaplastic epithelial squamous cells and dyskaryotic cells were found more frequently in the smokers than the nonsmokers, but the differences did not reach statistical significance). The increase in Curschmann’s spirals suggests an increase of mucus and stasis of mucus in the small airways. The increase in lymphocytes indicates a chronic inflammatory response to irritation and the increase in giant cells corresponds with the macrophage response to irritation. The greater the deposition of foreign material, the greater the “macrophage-giant cell” response.

chronic hypoxemiaThe pulmonary function tests showed many differences between the smokers and nonsmokers. The smokers, especially the heavy smokers, showed evidence of decreased air flow compared with the nonsmokers, both on the simple breathing tests, such as FVC, FEVi and MMF, as well as in the body plethysmograph tests of airway resistance and specific conductance.

In the heavy smokers, there were indications of slightly impaired gas exchange, as compared with nonsmokers, and this was shown by the significantly lower Dlco and fractional carbon monoxide uptake during exercise. A recent study by Van Ganse, Ferris and Cotes® also showed a decrease in diffusing capacity in cigarette smokers and this was probably related to a lower pulmonary capillary blood volume in smokers compared with nonsmokers. The higher hematocrit in smokers compared with nonsmokers was possibly related to the higher carboxy-hemoglobin concentration in the blood of smokers and not due to any chronic hypoxemia as the arte-rialized blood oxygen tension and the fall of oxygen saturation on exercise were similar in all groups. Recent work has shown that smoking in primates produced an increase in hematocrit and this was similar to the findings in the present study.

It would appear that abnormalities of pulmonary function are probably reversible in that no differences could be shown between the women who had never smoked and those who had been smokers but had not smoked for over a year. There is some support for this in that smokers with early small airways disease, who have stopped smoking for only one to eight weeks have shown a return to normal of frequency dependent compliance. Frequency dependent compliance was not measured in the present study as the discomfort involved precluded its use in our volunteers.

The inhalation of large quantities of carbon dust made little difference to the airway resistance studies in any of the volunteers. This suggests that there is no altered reactivity of the bronchial tree to an inert dust in relationship to cigarette smoking and any adverse effect of air pollution is unlikely to be related to the inhalation of carbon particles.

Widdicome and co-workers have demonstrated a mean decrease of 41 percent in airway conductance in nine men following inhalation of charcoal dust (neither size nor number of particles is stated). It was considered that dust particles stimulate activity in tracheal afferent nerve fibers and cause reflex bronchoconstriction. The present investigation did not find similar effects.

There appears to be no investigation of men comparable to the present study of women. However, an attempt has been made to compare some of the clinical data in Table 7 and pulmonary function tests in Table 8. There appears to be little difference in the prevalence of cough, sputum and dyspnea among comparable smoking of men and women in some studies but, in others, the men have a higher prevalence of cough than the women.

Small differences in pulmonary function between men who were heavy smokers and nonsmokers have been described. The results are similar to those reported for the women who are heavy smokers compared with nonsmokers in the present study but there is an impression that FVC and FEVi are more abnormal in the men than in the women smokers; however, SGaw shows no such difference.

There are many good reasons to encourage women to stop smoking. There is a relationship between cigarette smoking and respiratory symptoms, and respiratory function is significantly different in smokers and nonsmokers. In addition, cigarette smoking during pregnancy has been reported to increase the late fetal plus neonatal mortality rate by 28 percent, and this can be altered if the smoking habit is changed by the end of the fourth month of pregnancy.

It is suggested that campaigns should be directed increasingly towards influencing women to give up cigarette smoking.

Table 7—Prevalence of Respiratory Symptom.t in Men Compared with Women

Men (Published Data) Women
COUGH Percent Percent
Nonsmokers 4 (13) 6
14-22 (14)
Light smokers 24 (15) 28
Moderate smokers 48-52 (15) 35
46-74 (14)
Heavy smokers 42 (13) 54
67-74 (14)
58-78 (15)
Heavy smokers 42 (13) 49
All smokers 21 (16) 27
Heavy smokers 33 (17) 33

Table 8

TEST Women Men (Present (Published Data) Investigation)
FVC, ml 170 (18) 660 (19) 140
FEVi, ml 90 (18) 380 (20) 340 (21) 230 (22) 320 (22) 160
MMF, liters/sec Raw, cm HjO/liters/sec 0.5 (20) 0.19 (23) 0.26 (24) 0.32
SGaw liters/sec/cm H20/ liters 0.02 (23) 0.032 (25) 0.028
PaOj, mm Hg, sitting position Dlco exercise, ml/min/ mm Hg 3 (26)
7 (19)
(Single breath technique)
(Steady state technique)

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