Experience with asbestos disease and its control in Great Britain's naval dockyards

Abstract

Cigarette smoking is the leading cause of preventable death in the United States.2 Smoking adversely affects many organ systems, but especially the lung. Carcinoma of the lung and chronic obstructive pulmonary disease account for most smoking-associated morbidity and mortality, and their association with smoking is both well established and widely recognized.2 In addition, smoking has a substantial and increasingly recognized adverse impact on the respiratory health of children.42Cigarette smoking also is associated with differences in the incidence, severity, or natural history of a broad array of other respiratory illnesses, ranging from the common cold to pneumothorax, pulmonary hemorrhage, and various interstitial lung diseases (Box 1).Interestingly, whereas the general effect of smoking on respiratory diseases is adverse, in the cases of sarcoidosis and hypersensitivity pneumonitis, smoking may actually be associated with a decrease in the incidence of disease. The strength of the association between smoking and specific diseases varies considerably, and there are limitations in the methods used to establish association and to control for potentially confounding factors such as socioeconomic status.The mechanisms by which smoking affects the incidence or severity of various lung diseases are not entirely clear. In this review, the authors briefly discuss some of the pulmonary and systemic effects of smoking that might mediate its effects on an array of lung diseases, then comprehensively review less common or less well-recognized smokingaffected lung diseases such as pulmonary infections, spontaneous pneumothorax, Goodpasture's syndrome, eosinophilic granuloma and other interstitial lung diseases, and pulmonary metastatic disease.