smoking seems to have an important pathogenetic role, although to a lesser extent than in the first group
acute eosinophilic pneumonia and
pulmonary hemorrhage syndrome,
Group 3
, diseases in which smoking creates an increased risk for developing
Idiopathic pulmonary fibrosis (IPF) UIP. The combination of lower lung fibrosis and upper lung emphysema is being increasingly recognized as a distinct clinical entity in smokers. High-resolution computed t
diseases that are actually less likely to develop in smokers . The protective effect of smoking in these diseases may result from suppression of T-helper cell (Th)1 immunity
Smoking in Two Puff Harmony From the series “People of Israel” Ashley Davidoff MD TheCommonVein.net Generation Gap Enjoying a Cigarette Together From the series “People of Israel” Ashley Davidoff MD TheCommonVein.net An Advert in Toronto Newspaper 1977 Cigars are not as carcinogenic as cigarettes probably due to the fact that cigar smoke is not usually inhaled. In the early 1900?s cigar smoking was associated with elegance and currently portrays a sense of bravado as demonstrated in this image. Courtesy Ashley Davidoff MD 13021g TheCommonVein.net Empty Promises Collage of cigarette advertisements of the early 20th century revealing a portrayal of elegance, feminism, and manhood. The advertising campaigns worked well for the cigarette companies but had a dismal result on health. The third image from the left in the top row shows a physician who states that ?Luckies are less irritating? The world war brought free cigarettes to the soldiers from the tobacco companies. The effect on the soldiers and the culture was a devastating rise in carcinoma 20 years after the event, with peaks in the incidence of carcinoma in the 1940’s and then in the 1960’s. 54458 code historical Ashley Davidoff MD The CommonVein.net Smog in the Alveolus These diseases are all about cigarettes and the garbage that they deposit in our lungs. Courtesy Ashley Davidoff MD. 32646d The CommonVein.net Smog Filled Alveolus An alveolus subjected day and night for 20 years to black smog from a human chimney. It had no choice but to react. Courtesy Ashley Davidoff MD. 32166f The CommonVein.net By products of Nicotine Polycyclic Aromatic Hydrocarbons (PAH’s) are by products of nicotine and are flat compounds that are similar to benzene in structure. Liver enzymes oxidize the PAH’s making their incorporation into DNA possible. The change in DNA structure leads to interference in function and a predisposition to carcinogenesis. Image modified by Ashley Davidoff MD. 54460 The CommonVein.net
Emphysema The flattened diaphragms in a are a clue to the hyperinflated lungs, confirmed by the architectural distortion, loss of structural integrity, and large bullous spaces particularly in the right upper lobe.(b,c,) The cachexia characterized by loss of the subcutaneous fat and muscle is also characteristic of the disease(d). Ashley Davidoff MD 41860c Copyright 2010 TheCommonVein.net Normal and Emphysema November is COPD Awareness Month Ashley Davidoff MD TheCommonVeein.net
Emphysema
NORMAL VS CENTRILOBULAR EMPHYSEMA STARTING AT THE RESPIRATORY BRONCHIOLE Ashley Davidoff MD TheCommonVein.net Normal Acinus and Emphysema Image on the left shows normal size and appearance of terminal bronchioles and alveoli. On the right the image shows the effects on the respiratory bronchioles and when severe, on the alveoli as well Ashley Davidoff MD TheCommonVein.net Langerhans Dendritic Macrophage Ashley Davidoff MD TheCommonVein.net
The Cause and the Effect in one Image The CT scan through the chest of an 80 year old male shows a large lung mass in the posterior aspect of the right upper lobe (overlaid in green) and3 small nodules in the left upper lobe (overlaid in green). The patient is obviously a smoker and the incriminating pack of cigarettes is identified in his right shirt pocket containing 9 cigarettes. The lung cancer was shown to be an adenocarcinoma The pathology of the nodules may either represent metastatic disease or multicentric foci of bronchioloalveolar cell carcinoma. Associated finding of a thinned anterior junction line suggests hyperinflation and emphysema, and the thickened bronchial walls noted in the right lung suggest chronic bronchitis. Saber shaped trachea is also reminiscent of emphysema. The patient is emaciated, a finding that relates both to his chronic lung disease and his cancer. Ashley Davidoff MD 87831c01b.8s TheCommonVein.net
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