A pulmonologist named smoking as the main cause of COPD » Medvestnik


“When a patient with COPD comes to a pulmonologist, most often it is a person over 40 years of age who smokes or has smoked in the past,” he noted. — The main symptoms of the disease are shortness of breath, cough and sputum discharge; sometimes the patient may experience wheezing and a feeling of tightness in the chest. In addition, the typical COPD patient often has high fatigue, decreased appetite, and decreased body weight. Gradually, his lung function decreases until the person is unable to climb the stairs to the second floor without shortness of breath. The insidiousness of the disease also lies in the fact that its symptoms are invisible at an early stage and obvious signs may appear many years after the onset of COPD. Therefore, patients often find out about their diagnosis after hospitalization due to a severe exacerbation.”

As the doctor explained, respiratory infections and inhalation of polluted air can trigger the disease. COPD often occurs as an occupational disease, during activities related, for example, to coal mining. “Among the risk factors for COPD there are those that we cannot influence in any way, for example, natural aging of the body and a genetic predisposition to deficiency of alpha-1-antitrypsin (a protein that leads to accelerated destruction of lung tissue), the specialist added. “In addition, important risk factors include the patient’s socioeconomic status. This is supported by statistics showing that almost 90% of deaths from COPD among people under 70 years of age occur in low- and middle-income countries.”

However, the most important cause of COPD is smoking, Denis Ilyushin emphasized. As the pulmonologist explained, cigarette smoke contains about 7 thousand chemical compounds that enter the body along with tobacco smoke. These include free radicals and peroxide compounds, which cause oxidative stress in the body and can cause the development of not only COPD, but also cancer and atherosclerosis. In addition, cigarette smoke contains acrolein and formaldehyde, which can trigger the development of asthma and a number of malignant neoplasms.

Despite a steady decline in tobacco smoking prevalence since the 1970s, global population growth has increased the number of global smokers since 1990 to approximately 1 billion in 2020. More than 60% of adult smokers would like to quit smoking and more than 40% have tried to do so in the past year. At the same time, 28% of adult smokers quit smoking for more than six months, but then started again.

“It is vitally important for patients with COPD to give up this bad habit,” Denis Ilyushin emphasized. “However, there are people with severe tobacco addiction who are not motivated to quit smoking, even knowing the high health risks. To help this cohort of patients, switching to smokeless tobacco products, such as electronic heated tobacco systems, could be considered as part of a harm reduction approach. Of course, this product cannot be called completely harmless. However, the impact of harmful components on the body when using smokeless nicotine-containing products is reduced by 90-95% compared to conventional cigarettes.”

Favorable changes in the body after switching to smoke-free products are confirmed by a 90-day study in Japan, the pulmonologist said. In this study, two groups of smokers used cigarettes or electronic heated tobacco systems ad libitum, while a third, control group, quit smoking. As a result, the levels of the 15 biomarkers studied among those who switched to the use of electronic systems were comparable to the levels of those who quit smoking during the study. A three-year observation of smokers with COPD, in turn, showed that the use of electronic tobacco heating systems can reduce the number of severe exacerbations of this disease.

“The unofficial name for COPD is “a disease of the second half of life,” said Denis Ilyushin. “This means that at the time of seeking medical help, a patient with COPD may have a number of concomitant diseases – hypertension, coronary heart disease, diabetes, asthma, thrombosis, etc.”

As the pulmonologist noted, severe exacerbations of COPD are the main cause of death for patients, as they lead to decompensation of concomitant chronic diseases: for example, in the first five days from the onset of an exacerbation, the risk of developing acute myocardial infarction more than doubles.

An exacerbation is the most unfavorable event in the life of a COPD patient. There are statistics that indicate that approximately 25% of patients die within a year after a severe exacerbation. Over time, the frequency of exacerbations only increases, increasing the risk of death, the specialist stated.

“Any possible method of reducing the number of exacerbations contributes to a more favorable prognosis for the patient, therefore, foreign guidelines and domestic clinical recommendations set similar goals for the treatment of COPD: reduce symptoms of the disease, improve exercise tolerance and general health, and also reduce possible risks, paying special attention to prevention progression of the disease,” summed up Denis Ilyushin.



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