Smoking's Impact on the Lungs


8:21 PM - Dec 10, 2008 #1

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 lung 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 John R. Polito on May 28, 2007

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Joined: 2:04 PM - Nov 13, 2008

3:07 PM - Mar 03, 2009 #2

[font='NOTO SERIF', GEORGIA, 'TIMES NEW ROMAN', TIMES, SERIF]I went back to smoking while in the hospital with pneumonia[/font]
[font='NOTO SERIF', GEORGIA, 'TIMES NEW ROMAN', TIMES, SERIF]Feel what it is like to breathe with emphysema[/font]
[font='NOTO SERIF', GEORGIA, 'TIMES NEW ROMAN', TIMES, SERIF]Learning how to inhale[/font]
[font='NOTO SERIF', GEORGIA, 'TIMES NEW ROMAN', TIMES, SERIF]See how smoking destroys the lungs[/font]
[font='NOTO SERIF', GEORGIA, 'TIMES NEW ROMAN', TIMES, SERIF]Getting colds and flus after quitting[/font]
[font='NOTO SERIF', GEORGIA, 'TIMES NEW ROMAN', TIMES, SERIF]"What's the use in quitting now?"[/font]
[font='NOTO SERIF', GEORGIA, 'TIMES NEW ROMAN', TIMES, SERIF]So I can’t run marathons…[/font]
[font='NOTO SERIF', GEORGIA, 'TIMES NEW ROMAN', TIMES, SERIF]Why many people cough more after quitting[/font]
[font='NOTO SERIF', GEORGIA, 'TIMES NEW ROMAN', TIMES, SERIF]"My smoking helps me to breathe better"[/font]
[font='NOTO SERIF', GEORGIA, 'TIMES NEW ROMAN', TIMES, SERIF]Lung cancer: Isn't there a cure just around the corner?[/font]
[font='NOTO SERIF', GEORGIA, 'TIMES NEW ROMAN', TIMES, SERIF]Should smokers feel "safer" because some non-smokers get lung cancer?[/font]
[font='NOTO SERIF', GEORGIA, 'TIMES NEW ROMAN', TIMES, SERIF]Finding out you have lung cancer after you quit smoking[/font]
Last edited by Joel Spitzer on 5:55 PM - Mar 29, 2017, edited 1 time in total.


3:38 PM - Sep 11, 2009 #3



5:34 PM - Jan 09, 2010 #4

Study Title: Pack-years of cigarette smoking
as a prognostic factor in patients with
stage IIIB/IV nonsmall cell lung cancer
Journal: Cancer, December 22, 2009 [Epub ahead of print]
Study Authors: Janjigian YY, McDonnell K, Kris MG,
Shen R, Sima CS, Bach PB, Rizvi NA, Riely GJ.
Study Abstract (Summary)

BACKGROUND: This study was undertaken to characterize the relation between the survival of patients with stage IIIB/IV nonsmall cell lung cancer (NSCLC) and pack-years of cigarette smoking (graded according to the American Joint Committee on Cancer staging system).

METHODS:: Data were analyzed from patients with stage IIIB/IV NSCLC who had completed a prospective smoking questionnaire. The impact of pack-years of cigarette smoking, age, sex, Karnofsky performance status (KPS), and the presence of weight loss >5% was evaluated on overall survival using univariate and multivariate analyses.

RESULTS:: Smoking history and clinical data were available for 2010 patients with stage IIIB/IV NSCLC (1004 women and 1006 men). Approximately 70% of patients (1409 patients) had smoked >15 pack-years, 13% (270) were former and current smokers who had smoked </=15 pack-years, and 16% (331) were never-smokers (<100 lifetime cigarettes). Never-smokers had a longer median survival compared with former or current smokers (17.8 months vs 11.3 months; log-rank P < .001). Among smokers, patients with a </=15 pack-year history of smoking had a longer median survival than patients who had smoked >15 pack-years (14.6 months vs 10.8 months; log-rank P = .03). As the number of pack-years increased, the median overall survival decreased (log-rank P < .001). Multivariate analysis indicated that a history of smoking was an independent prognostic factor (hazard ratio, 1.36; P < .001).

CONCLUSIONS:: More cigarette smoking, measured in pack-years, was associated with decreased survival after a diagnosis of stage IIIB/IV NSCLC. Trials assessing survival in patients with stage IIIB/IV NSCLC should report a detailed cigarette smoking history for all patients. ... 8/abstract

Joined: 2:04 PM - Nov 13, 2008

3:48 PM - Oct 30, 2011 #5

Last edited by Joel Spitzer on 5:32 PM - Oct 30, 2011, edited 1 time in total.

Joined: 2:04 PM - Nov 13, 2008

3:49 PM - Oct 30, 2011 #6


Joined: 2:04 PM - Nov 13, 2008

3:50 PM - Oct 30, 2011 #7


Joined: 2:04 PM - Nov 13, 2008

3:51 PM - Oct 30, 2011 #8


Joined: 2:04 PM - Nov 13, 2008

4:01 PM - Oct 30, 2011 #9


Joined: 7:22 PM - Nov 11, 2008

11:06 PM - May 31, 2013 #10

Will the gradual destruction of your lungs end in time to comfortably breathe the balance of life?  If the damage done is already being lived, will you gift yourself an end to further needless damage?  We certainly hope so!  Baby steps, just here and now, yes you can!!

Joined: 7:22 PM - Nov 11, 2008

1:11 PM - Dec 02, 2013 #11

This is one of the most tragic smoker lung stories imaginable.  :(

  Woman dies after receiving
 smoker's lungs in transplant

Dec. 19, 2012  ABC News

Jennifer Wederell, a 27-year-old British woman with cystic fibrosis, died of lung cancer after she received the lungs of a heavy smoker in an organ transplant.

According to BBC News, Wederell had been on the waiting list for a lung transplant for 18 months when in April 2011, she was told there was finally a match. She received the transplant, apparently not knowing the donor had been a smoker. In February 2012 a malignant mass was found in her lungs. She died less than 16 months after the transplant.

Her father, Colin Grannell, said he believed his daughter had died a death meant for someone else. "The shock immediately turned to anger insofar as all the risks were explained in the hour before her transplant," he told the BBC, "and not once was the fact smoker's lungs would be used mentioned."

Donor Dilemma

Wederell's case raises difficult issues regarding organ transplants. She was diagnosed with cystic fibrosis, a progressive and debilitating lung disease that affects more than 70,000 people worldwide, at the age of two. By her mid-20s, she relied on an oxygen tank 24 hours a day to survive.

Would she have been better off refusing the transplant, and hoping another set of organs became available that matched her blood type and came from a non-smoker?

"Probably not," said Dr. G. Alexander Patterson, surgical director of lung transplants at the Washington University and Barnes-Jewish transplant center in St. Louis, one of the largest organ transplant programs in the nation. "If she was critically ill and had poor chance of short-term survival, she was better off accepting the transplant."

Patterson said most hospitals, including those in the U.S., also transplant the lungs of smokers if they are of otherwise good quality.

"This is a necessity because there are far fewer donors than there are recipients and most patients who are on a waiting list would gladly accept a set of smoker's lungs in exchange for the ones they have, which usually have little chance of carrying them through to long-term survival."

Patterson said that his program would be likely to turn down an organ from a donor if smoking history was too extreme -- say, three packs a day for twenty years -- or if the donor had been known to engage in other risky lifestyle behaviors such as unprotected sex with multiple partners or intravenous drug use. Even those organs might still be used as part of an "extended criteria" donation, which utilizes organs that don't meet the usual criteria for transplant, but are still healthy enough for a successful procedure if a patient needs it quickly.

About 17,000 Americans receive a transplant each year, and more than 4,600 die waiting for one, according to United Network for Organ Sharing, the organization charged with allocating the nation's organs. If surgeons do not accept less-than-perfect organs, Patterson said that the numbers might be much worse.

Don't Ask, Don't Tell

Harefield Hospital in London, where Wederell was treated, has since apologized to her family for not revealing all the information about her donor's medical history. But Patterson said most transplant surgeons don't share details about the smoking history of the donor with their patients unless they are asked directly.

Arthur Caplan, director of the division of medical ethics at NYU Langone Medical Center in New York City said he believed this was a mistake.

"They absolutely should have told her. When you have reasons to think a donor organ is suboptimal in some way, you must disclose it and allow a person to make their own decision. People have to know the risks they face," Caplan said.

Caplin said he thought surgeons might not review such risks in order to avoid having a difficult conversation -- and they may sometimes also feel they are the experts who know what is best for the patient.

"They should do it anyway. Reasonable people can deal with major sources of risk and are exceedingly unlikely to say no to a donation anyway because waiting lists are long and they know they might not get another donation in time," he said.

Patterson said that he understood why Wederell's family was upset, but that it's impossible to know why she developed cancer. Lung transplant recipients receive a great deal more immunosuppressant therapy than other organ recipients to stop the body from rejecting the organ. This may have encouraged the cancer to grow.

"It's plausible that she would have succumbed to some type of cancer no matter what, but there's no way to know for sure," Patterson said.

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Last edited by JohnPolito on 1:15 PM - Dec 02, 2013, edited 1 time in total.