September 8th, 2004, 8:51 am #11

Not everyone coughs more immediately and some people may never develop the cough that is often characteristic after quitting. But the cilia is regenerating and is going to be cleaning out your lungs, it just may be doing it at a pace which isn't overloading your airways and thus the mucous is quietly being swept out. Although some people will still develop the cough a few weeks into their quit as opposed to a few days as is experienced by many.

Joined: January 16th, 2003, 8:00 am

March 7th, 2006, 10:17 pm #12

Lungs don't make a distinction between whether you're a "social smoker" or not.
Never take another puff!


June 18th, 2006, 11:31 pm #13

At times when goes down the graphics on this page and a number of others also go down. I am attaching the article here in its entirety with alternate graphics that will work independent of
Joel's Reinforcement Library

Smoking's Impact on the Lungs

Ex-smokers are often tempted when watching others smoke. Spending time with a specific friend and watching them smoke may be a trigger especially if it was the most time you had spend with the friend since you quit smoking. The first time you have any new experiences, even if smoking is not part of the ritual, the thought for a cigarette will seem like a natural part of the ritual.

Another factor is when watching a person smoke, the natural tendency is for the ex-smoker to start to fantasize about how good a cigarette will be at that given moment. A more productive way to handle the situation though is to really watch the person smoke one, and then wait a few minutes as they light another and then another. Soon you will see that they are smoking in a way that you don't want to and probably in a way that they don't want to either. But they have no choice. You do. I am attaching a letter here that addresses this issue. It is a little harder to describe because it is based on a demonstration I do at live seminars.

One demonstration I do at all my live seminars is a little smoking contraption made out of a plastic Palmolive bottle with a mouth piece inserted to hold a cigarette. The simulation shows how much smoke comes in when a person inhales, and how much comes out when they exhale. Smokers often feel they take in smoke and then blow most of it out, when in actuality, a very small percent actually comes out (about 10%). I always use cigarettes given to me by people in the audience, if I used one I brought people would think I was using a loaded cigarette. Anyway, below is a letter I wrote for clinic graduates who have seen this demonstration but the concepts apply to those who haven't also. Viewing smoking as it really looks will minimize the temptation for even a puff.

The letter is as follows ...

Whenever you watch a person smoking, think of the Palmolive bottle demonstration you saw the first day of the Stop Smoking Clinic. Visualize all of the smoke that goes into the bottle that doesn't come out. Also, remember that the smoker is not only going to smoke that one cigarette. He will probably smoke another within a half-hour. Then another after that. In fact, he will probably smoke 20, 40, 60 or even more cigarettes by the end of the day. And tomorrow will be the same. After looking at cigarettes like this, you don't want to smoke a cigarette, do you?

I always suggest that clinic participants follow this simple visualization exercise to help them overcome the urge for a cigarette. When I suggested it to one participant who was off for three days she replied, "I see, you want me to brainwash myself so that I don't want a cigarette."

Somehow I don't consider this technique of visualizing smoking brainwashing. It is not like the ex-smoker is being asked to view smoking in an artificially horrible, nightmarish manner. To the contrary, I am only asking the ex-smoker to view cigarette smoking in its true light.

The Palmolive bottle demonstration accurately portrays the actual amount of smoke that goes in as compared to the small amount that you see the smoker blow out. Most smokers believe they exhale the majority of smoke they inhale into their lungs. But, as you saw by the demonstrations, most of the smoke remains in the lungs. When you visualize all the smoke that remains, it does not paint a pretty picture of what is happening in the smoker. Maybe not a pretty picture, but an accurate one.

When an ex-smoker watches a person smoke a cigarette, he often fantasizes about how much the smoker is enjoying it--how good it must taste and make him feel. It is true he may be enjoying that particular cigarette, but the odds are he is not.

Most smokers enjoy a very small percentage of the cigarettes they smoke. In fact, they are really unaware of most of the cigarettes they smoke. Some are smoked out of simple habit, but most are smoked in order to alleviate withdrawal symptoms experienced by all smokers whose nicotine levels have fallen below minimal requirements. The cigarette may taste horrible, but the smoker has to smoke it. And because the majority of smokers are such addicts, they must smoke many such cigarettes every single day in order to maintain a constant blood nicotine level.

Don't fantasize about cigarettes. Always keep a clear, objective perspective of what it would once again be like to be an addicted smoker. There is no doubt at all that if you relapse to smoking you will be under the control of a very powerful addiction. You will be spending hundreds of dollars a year for thousands of cigarettes. You will smell like cigarettes and be viewed as socially unacceptable in many circles. You will be inhaling thousands of poisons with every puff. These poisons will rob you of your endurance and your health. One day they may eventually rob you of your life.

Consider all these consequences of smoking. Then, when you watch a smoker you will feel pity for them, not envy. Consider the life he or she is living compared to the simpler, happier, and healthier life you have had since you broke free from your addiction. Consider all this and you will - NEVER TAKE ANOTHER PUFF!

A picture of the Palmolive Bottle Demonstration
This looks like it was an exhalation after about 10 previous exhalations, not that much is seen in this particular photo. I normally get a tremendous amount of smoke out of the bottle with every drag, normally we can smoke up a room with one cigarette. If you look at the mouthpiece of the bottle, it is almost solid brown with tar. It used to be clear. I have used this bottle with somewhere between 300 and 400 cigarettes. While that may sound like a lot, most people smokemore than that in any given month. Even the bottle is pretty yellow and I blow out almost all of the smoke used when it inhales. The bottle is dry allowing me to do this, your lungs are moist trapping most of the tars when inhaled. Literally over 90% of the tar that is inhaled stays in the lung, when you see a person exhale they are literally blowing out about 10% of the smoke.
You can see how the smoke had darkened the bottle after about a few hundred cigarettes. You can start to see how the smoker's lungs below became so discolored. Smokers don't just put a total of a few hundred cigarettes in their system; they literally deliver hundreds of thousands of cigarettes over their shortened lifetime. This discoloration effect is more than just aesthetically unpleasant--it is in fact deadly.
Above: Normal city dwellers lung.
Note black specks throughout indicative of carbon deposits from pollution.
Compare this to the lung below.
Smokers lung with cancer. White area on top is the cancer, this is what killed the person. The blackened area is just the deposit of tars that all smokers paint into their lungs with every puff they take.
To add a little more perspective to the demonstration, here is another way to see how much tar actually gets into the lungs from smoking. Below is the picture of a smoking machine.
This machine smokes 2,000 cigarettes a day, mimicking smokers puffing patterns to capture equivalent amounts of tar as would a smoker. In one day the machine captures the amount of smoke in the picture below.
The bottle above with the tar collected from 2,000 cigarettes. If a diluted form (diluted, not concentrated is as often done in animal experimentation to demostrate that chemicals are carcinogens) of this tar is painted on the skin of mice, 60% of the animals developed cancer of the skin within a year.
Many chemicals currently banned for human consumption were removed from usage if they even caused 5% or less cases of cancer in similar experiments. Cigarette tars contain some of the most carcinogenic chemicals known to man. Consider this when watching people smoking and exhaling only 10% of the tars they actually take in. Not only are these chemicals being painted into the lung, but smoker are also constantly painting them up on their lips, tongue, larynx, swallowing some and thus painting it in the esophagus and throughout the digestive tract. Smokers have increased incidents of cancer in all of these exposed sites.
Now that you know what it looks like on a large scale and feels like, lets take a look at the microscopic level of things that happen in the lung from smoking.

The following series of slides illustrate microscopic changes that happen when a person smokes. The first slide is showing an illustrated blow-up of the normal lining of the bronchus.
On the top we see the cilia, labeled (H). They are attached to columnar cells, labeled (I). The cilia sweep the mucous produced in the goblet cells, labeled (J) as well as mucous coming from deeper glands within the lungs and the particulate matter trapped in the mucous. The bottom layer of cells, labeled (L) are the basal cells.

Below we start to see the changes that occur as people begin to smoke. You will see that the columnar cells are starting to be crowded out and displaced by additional layers of basal cells. Not only are fewer cilia present but the ones that are still functioning are doing so at a much lower level of efficiency. Many chemicals in tobacco smoke are toxic to cilia, first slowing them down, soon paralyzing them all together and then destroying them.
As you see with the cilia actions being diminished, mucous starts to build up in the small airways making it harder for the smoker to breathe and causing the characteristic smokers cough in order to clear out the airways.

Eventually though, the ciliated columnar cells are totally displaced. As can be seen below ominous changes have taken place. Not only is the smoker more prone to infection from the loss of the cleansing mechanism of the cilia, but these abnormal cells (O) are cancerous squamous cells. These cells will eventually break through the basement membrane wall and invade into underlying lung tissue and often spread throughout the body long before the person even knows they have the disease.
If a smoker quits before cancer actually starts, even if the cells are in a precancerous state, the process is highly reversible. Cilia regeneration starts in about 3 days once smoking stops. Even if cilia has been destroyed and not present for years, the lining tissue of the windpipe will start to repair. Even the precancerous cells will be sloughed off over time, reversing the cellular process to the point where the lining tissue goes back to normal. But if a smoker waits too long and cancer starts, it may be too late to save his or her life.

Following are actual pathological slides showing these same damaging effects.
The little pink hairlike projections on the top is the cilia and if you compare this image with the illustrations above you should be able to see the mucous secreting cells and the separation of the lining tissue from the underlying lung tissue.

Below you can see the same area of tissue from a smoker's lung who has totally destroyed the cilia in this tissue.
Again note, where there used to be two layers of well formed and orginized basal cells, now numerous layers of disorganized squamous cells has replaced the normal defensive tissue. These cells are precancerous and if the continued irritation (cigarette smoke) is not ceased can go to that final stage where they become malignant and invade into the underlying lunng tissue as seen below.
Then it is only a matter of time before it leaves the lung and spreads throughout the body. If the smoker quits smoking before this last cellular change occurs, before a cell turns malignant, the process seen in this last slide can be avoided. In fact much of the damage seen in the second picture here is highly reversible.

In three days cilia start to regenerate and usually within 6 months the normal cilia function is returned. Also over time, the extra layers of cells will be sloughed off and the lining tissue of the bronchus will return to normal.

Unfortunately, if a smoker waits until a malignancy has started, the outlook is grim. The overall 5 year survival rate for lung cancer is only 14%. Lung cancer, is a disease that while once uncommon, is now the leading cancer killer in both sexes.

Cancer is actually many different diseases with many different causes. If we look at cancer trends over the last century we see some amazing changes. While cancer was always around, it was different sites that were primary problems. Lung cancer, at the turn of the century was almost unheard of. If a doctor saw a case he would have easily gotten it printed up in a medical journal. Now, it is the major cause of cancer death in our society, killing more men and women than any other site. The primary difference between now and then is smoking. Before the turn of the century smoking was a limited practice. A very small percentage of people smoked and even the ones who did smoked many fewer cigarettes. Cigarettes were not even mass produced till the very end of the 1900's.

We always hear of a cancer epidemic, how more and more people die of cancer every year. Actually, if you pull the smoking related sites out of the equation, cancer deaths have been on a decline. Some sites, like stomach the incidence dropped dramatically, not fully understood as to why. Other sites, like breast, even though the morbidity rate (number of cases) didn't drop, because we now have better treatments and earlier detection, the mortality (death) rate has dropped.

But the smoking cancers; lung, mouth, lip, tongue, throat, larynx, pancreas, esophagus, pharynx, urinary bladder have all seen marked increases over the 20th century. These cancers have gone from obscurity to some of the major causes of death in our country. Actually, for the first time in a hundred years we are starting to see an early decline of morbidity and mortality because we are seeing fewer smokers now with the drop in the percentages of adult smokers.


You see a dramatic difference in men and women, especially in lung cancer rates. The reason is women started smoking much later than men, about a 30 year time delay before it became socially acceptable for women to smoke. Male smoking rate jumped dramatically between World War I and another big boost during World War II. Free distribution of cigarettes to soldiers was a big factor. Women smoking rates happened much later and the time delay is reflected in the time delay in cancer and otehr diseases going up too.
The above pictures were primarily about how smoking causes cancer of the lung and other sites. But the assault on the lungs from the tars in tobacco are not just limited to causing cancer. Other lung diseases are directly caused by smoking, the most well known are the chronic obstructive lung diseases.
The most well known smoking induced COPD is emphysema. This is another one of those diseases that primarily happen to smokers. Over 90% of the cases are smoking induced. There are cases in some families where there does seem to be a genetic predisposition, where non-smokers get it too. This is from a rare condition, a lack of a blood enzyme called alpha1antitrypsin. This again is rare, but if you do have family members who never smoked a day in their life get emphysema there may be a genetic tendency. But again, over 90% of emphysema cases are simply caused by smoking. Eradicate smoking and you eradicate the risk of the disease.
To get a sense of how a long is altered by smoking to cause emphsema look at the pictures below. The first is a picture of an inflated non-smoker city dweller's lung.
As in the normal picture of a lung above, you can see carbon deposits collected throughout from pollution effects. But when contrasted with a smoker's lung with emphysema...
...there is a very dramatic visible difference. Not only is the discoloration the issue, but the lungs have literally been ripped out of shape making breathing extremely difficult and eventually impossible. To get a sense of what it feels like to breathe with emphysema take a deep breath and hold it. Without letting out any air, take another deep breath. Hold that one too. One more time, take one more breath. Okay let it all out.
That second or third breath is what it feels like to breathe when you have advanced emphysema. Emphysema is a disease where you cannot exhale air. Everyone thinks that it is a disease where you cannot inhale but in fact it is the opposite. When you smoke you destroy the lungs elasticity by destroying the tissue that pulls your lung back together after using muscles that allow us to inhale air. So when it comes time to take your next breath it is that much more difficult, for your lungs could not get back to their original shape.

Imagine going through life having to struggle to breathe like those last two breaths I had you take. Unfortunately, millions of people don't have to imagine it, they live it daily. It is a miserable way to live and a slow painful way to die.

Hopefully when you breathe normally today you are not in pain and you are not on oxygen. If you don't smoke you will continue to give yourself the ability to breathe longer and feel better. Never lose sight of this fact. To keep your ability to breathe better for the rest of your life always remember to - NEVER TAKE ANOTHER PUFF!


© Joel Spitzer 2001
Page last updated by Joel Spitzer on August 25, 2003

See also how smoking impacts circulation


October 12th, 2006, 6:08 pm #14

Video's showing the Palmolive Bottle Demonstration:

Lower resolution version for Dial Up Connections: .

Higher resolution version for DSL/Cable connections:

Joe D0
Joe D0

October 14th, 2006, 1:28 am #15


(Pulmonary Function Test)

This is a test used to determine how much lung capacity a person who is afflicted with a respiratory disease has left. It is administered to those who have asthma, chronic bronchitis, chronic obstructive pulmonary disease (COPD), Lung Cancer, and or emphysema; I am sure there are other diseases it is used for as well. I have taken this test many times and in many different forms. There are field tests, home tests and professionally monitored tests which are conducted in a physician's office or in the hospital. The latter test; at the hospital, is taken inside a closed Plexiglas booth, monitored with various machines and always under the supervision of a respiratory nurse or physician. This test is usually the toughest for me to take because medications are administered during the test and I tend to try my best while exhaling. This test tries to identify which medication works best for the particular patient; it has also brought on a seizure more than once.
Please understand, this little post is actually a good post, it is not morbid, or depressing it is a positive move from deterioration to becoming all I can be. Let me explain: I have a home PFT device which pretty much measures lung capacity. It is not very sophisticated but does give the user an indication as to what is going on with breathing ability/capacity.
That first day when I knew I had to stop smoking, I had collapsed but prior to that, I took a shot on my little home model PFT device; I "blew" a resounding score of 90. This was a little more than two months ago. Let me interpret this for you. On this particular device, a healthy man of my age, weight, and height, should be registering around 600. I had been afraid to try the test prior to that as I knew I was already in trouble. To make a long story short, I saw my score and told myself; "I gotta quit smoking." I went to the computer, lit up, fell down, got scared, my wife freaked out and the rest is history. Here I am a couple of days short of double green and never prouder of what we have accomplished. I say "we" because without all of you and the education found here at whyquit I would not be able to give this next report.
I just tried the home model PFT device, Thank God I'm Free! I just "blew" 425….Prior to this, for years, my best score was 350. Less than 2 months of not smoking, my lungs are purging rapidly and I am becoming healthier. I know that I will never run like I used to or swim as long or as strenuous as I once did but I know with time, my lungs will be as clean as they can be and I will become as healthy as I can as well. One day at a time I will NEVER TAKE ANOTHER PUFF. I'm FREE! In a way I guess I am lucky as I can actually gauge my progress at will using this home device but I do not wish this on anybody. I am happy for all of you who have not allowed this addiction progress to the point which I have allowed it to. If you are clean of nicotine, stay that way I KNOW that I am lucky or … yes, I am blessed not to have contracted one of the immediate killers. I may be ill but it is controllable - if I smoke then all bets are off.
Joe Do - Free and Healing for One Month, Twenty Nine Days, 4 Hours and 59 Minutes, while extending my life expectancy 8 Days and 5 Hours, by avoiding the use of 2368 nicotine delivery devices that would have cost me $593.52.

John (Gold)
John (Gold)

December 19th, 2006, 5:31 am #16

Study Abstract:
A new method for estimating the retention of selected smoke constituents in the respiratory tract of smokers during cigarette smoking.
Journal: Inhalation Toxicology, February 2007, Volume 19(2), Pages 169-179
Authors: Feng S, Plunkett SE, Lam K, Kapur S, Muhammad R, Jin Y, Zimmermann M, Mendes P, Kinser R, Roethig HJ. Philip Morris USA, Research Center, Richmond, Virginia 23234, USA. [][/url]

This report describes a new method for estimating the retention of selected mainstream smoke constituents in the respiratory tract of adult smokers during cigarette smoking. Both particulate-phase (PP) constituents including nicotine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), and N'-nitrosonornicotine (NNN), two tobacco-specific nitrosamines (TSNA), and gas-vapor-phase (GVP) constituents including carbon monoxide (CO), isoprene (IP), acetaldehyde (AA), and ethylene, were studied.

To estimate the amounts of smoke constituents delivered during smoking, we used predetermined linear relationships between the measured cigarette filter solanesol content and machine-generated mainstream deliveries of these selected compounds. To determine the amounts of smoke constituents exhaled, the expired breath was directed through a Cambridge filter pad (CFP) attached to an infrared spectrometer. PP compounds were trapped on the CFP for later analysis and GVP compounds were analyzed in near real time. The smokers' respiratory parameters during smoking, such as inhalation/exhalation volume and time, were monitored using LifeShirt(R), a respiratory inductive plethysmography (RIP) device. The retention of each smoke constituent, expressed as a percentage, was then calculated as the difference between the amount delivered (estimated) and the amount exhaled relative to the amount delivered. We studied 16 adult male smokers who smoked cigarettes according to 3 predefined smoking patterns: no inhalation (pattern A), normal inhalation (pattern B), and deep inhalation (pattern C).

For the three PP constituents, the mean retentions for pattern A ranged between 10 and 20%; and while the mean retentions of the two TSNAs were significantly higher for pattern C (84% for NNK and 97% for NNN) than those for pattern B (63% for NNK and 84% for NNN), the mean retentions of nicotine were basically the same between patterns B and C, which were both greater than 98%. For the GVP constituents, the retentions were similar between pattern B and pattern C, although different constituents were retained to different degrees (average values of 33%, 52%, 79%, and 99% for ethylene, IP, CO, and AA, respectively).
The differences in the retention between different constituents could be interpreted in terms of each constituent's physical properties such as volatility and solubility. In conclusion, the method described is suitable for studying the retention of selected mainstream smoke constituents in the respiratory tract of smokers.
PMID: 17169864 [PubMed - in process] ... s=17169864

What's most interesting about this study, aside from it being conducted by Philip Morris USA, the maker of Marlboro, is that 98% of inhaled nicotine does not get expelled but remains in the lungs.

NNK is a tobacco-specific nitrosamine that induces primarily lung tumors, which are assumed to derive from malignant transformation of alveolar type II (AII) cells within the lung.

NNN was the first tobacco-specific nitrosamine (TSNA) identified as carcinogen in tobacco smoke

Kristen Goldx3
Kristen Goldx3

December 20th, 2006, 5:41 am #17

From above:

Don't fantasize about cigarettes. Always keep a clear, objective perspective of what it would once again be like to be an addicted smoker. There is no doubt at all that if you relapse to smoking you will be under the control of a very powerful addiction. You will be spending hundreds of dollars a year for thousands of cigarettes. You will smell like cigarettes and be viewed as socially unacceptable in many circles. You will be inhaling thousands of poisons with every puff. These poisons will rob you of your endurance and your health. One day they may eventually rob you of your life.

All are excellent reasons to embrace and rejoice in your Freedom!


January 15th, 2007, 7:34 am #18

The following question was posted in the cilia string:
From: tcouch0 Sent: 1/14/2007 4:05 PM
I have seen the pictures of the smokers blackened (tar) lungs and the neveer-smokers pink lungs. I was wondering (can't find info on topic) if after quitting smoking the smokers lungs return to a pink color?
Teresa - Free and Healing for Twenty Nine Days, 18 Hours and 4 Minutes, while extending my life expectancy 1 Day and 13 Hours, by avoiding the use of 446 nicotine delivery devices that would have cost me $83.78.

For some reason I cannot get a reply to post there. I am going to try to attach the reply here:

I had a similar question posed at the AskJoel board. Here is my answer from there:
Much of the discoloration of the lung will remain, although the chemicals deposited do start to lose their potency. Where the real benefit of quitting can be seen is at the cellular level. While the underlying tissue remains discolored and destroyed, the lining tissue of the bronchus does in fact return to normal and is cleared out. While this may not look impressive to the naked eye, it is of great importance--for this is the tissue where the vast majority of lung cancers actually occur. That is why quitting smoking and allowing this tissue to regenerate plays such a paramount factor in reducing the risks of developing lung cancer.
The article Smoking's Impact on the Lungs explores this issue--again at a macro and microscopic level.
Read that article and if you then have any follow-up questions feel free to get back in touch.
Videos to watch giving full understanding of what happens to the cilia and the lungs in general and why:
Title Dial Up High Speed Length Date added
The Palmolive bottle demonstration 2.84mb 19.1mb 07:45 10/11/06
Lung cancer 3.04mb 6.55mb 18:48 11/05/06
See how smoking destroys the lungs 1.55mb 4.59mb 04:13 11/27/06

John (Gold)
John (Gold)

November 30th, 2007, 9:37 pm #19

Patterns of airway inflammation and MMP-12 expression in smokers and ex-smokers with COPD
Respir Res. 2007 Nov 14;8(1):81 [Epub ahead of print]
Babusyte A, Stravinskaite K, Jeroch J, Lotvall J, Sakalauskas R, Sitkauskiene B.
BACKGROUND: Smoking activates and recruits inflammatory cells and proteases to the airways. Matrix metalloproteinase (MMP)-12 may be a key mediator in smoke induced emphysema. However, the influence of smoking and its cessation on airway inflammation and MMP-12 expression during COPD is still unknown. We aimed to analyse airway inflammatory cell patterns in induced sputum (IS) and bronchoalveolar lavage (BAL) from COPD patients who are active smokers and who have ceased smoking >2 years ago.
METHODS: 39 COPD outpatients - smokers (n=22) and ex-smokers (n=17) were studied. 8 'healthy' smokers and 11 healthy never-smokers were tested as the control groups. IS and BAL samples were obtained for differential and MMP-12+-macrophages count analysis.
RESULTS: The number of IS neutrophils was higher in both COPD groups compared to both controls. The amount of BAL neutrophils was higher in COPD smokers compared to healthy never-smokers. The number of BAL MMP-12+-macrophages was higher in COPD smokers (1.60.3x106/ml) compared to COPD ex-smokers, 'healthy' smokers and healthy never-smokers (0.90.4, 0.40.2, 0.20.1x106/ml respectively, p<0.05).
CONCLUSIONS: The lower amount of BAL neutrophils in COPD ex-smokers, compared to COPD smokers, suggests positive alterations in alveolar compartment after smoking cessation. Smoking and disease itself may stimulate MMP-12 expression in airway compartments (IS and BAL) from COPD patients. ... 1-8-81.pdf
Note: Full text PDF freely available from link immediately above.

John (Gold)
John (Gold)

December 7th, 2007, 11:17 pm #20

Smoking makes asthma expensive:
a register-based study in Finland
The International Journal of Tuberculosis and Lung Disease, Volume 11, Number 12, December 2007 , pp. 1358-1365(8)

Ikäheimo, P.1; Tuuponen, T.2; Kiuttu, J.2; Hakko, H.3; Hartikainen, S.4; Klaukka, T.5


SETTING: Chronic bronchitis and chronic obstructive pulmonary disease (COPD)/emphysema occur frequently among middle-aged and elderly asthma patients who smoke.

OBJECTIVE: To test how much this comorbidity increases the use and costs of health services in comparison with asthma alone.

DESIGN: A sample of 6000 adults with a clinical diagnosis of asthma was extracted from a nationwide health insurance register for a postal inquiry. Comorbidity and the use of health services were measured using a questionnaire. Data on medication expenses were obtained from the national prescription register.

RESULTS: Altogether 4956 individuals replied, of whom 3160 asthma patients aged ≥40 years (response rate 85%) were chosen for this investigation. Asthma patients with COPD/emphysema (12% of the series) accounted for 21% of all doctor consultations, 39% of the total number of hospital in-patient days and 27% of the total expenses, of which one third were medication costs. The mean annual gross expenditure on treatment services and anti-asthma medications was €754 per patient for those with asthma alone and €2107 for those with concurrent COPD/emphysema. Current smoking further increased costs among COPD patients.

CONCLUSION: To prevent pulmonary comorbidity and the related high costs, cessation of smoking should be an integral part of the treatment provided for asthma patients.

Keywords: asthma; COPD; costs; health care utilisation; smoking

Document Type: Regular paper

Affiliations: 1: Department of Public Health Science and General Practice, University of Oulu, Oulu, Finland 2: Social Insurance Institution, Regional Office for Northern Finland, Oulu, Finland 3: Department of Psychiatry, Oulu University Hospital, Oulu, Finland 4: Leppävista Health Centre, Leppävista, Finland; and Faculty of Pharmacy, University of Kuopio, Kuopio, Finland 5: Research Department of the Social Insurance Institution, Helsinki, Finland ... 2/art00016