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Cigarette Smoking, Asthma, and Emphysema

The George Washington University Medical Center Washington, DC

Correspondence to: Tsung O. Cheng, MD, FCCP, Department of Medicine, Division of Cardiology, The George Washington University Medical Center, 2150 Pennsylvania Ave NW, Washington, DC 20037

To the Editor:

I read with interest the recent report of Silverman et al (May 2003)¹ about cigarette smoking among asthmatic adults. What impressed me most was their finding that, although 50% of current smokers admitted smoking worsens their asthma symptoms, only 4% stated that smoking was responsible for their current exacerbation.¹ A similar scenario exists in patients with pulmonary emphysema.

In my practice, I saw many patients with chronic cor pulmonale due to pulmonary emphysema who are invariably cigarette smokers. They continue to smoke, despite the obvious fact smoking made their cough worse. The invariable answer to my question why they continued to smoke if smoking made their cough worse was that cigarette-induced cough loosened their sputum. This seems to be a universal response of cigarette smokers, in both the United States and China where cigarette smoking is rampant.^{2 3}

In Chinese, xiao tan is the equivalent expression for loosening the phlegm. What I usually did for these patients in China was to ask them to perform a simple FVC test to measure the FEV₁ before and after they smoked a cigarette. I then showed how the FEV₁ fell instead of rising after they smoked a cigarette. Such a visual demonstration that cigarette smoking worsened instead of improving the airway obstruction usually did more good than my constant preaching of the harm of smoking. As they say in China, one picture is better than a thousand words.

References

1. Silverman, RA, Boudreaux, ED, Woodruff, PG, et al (2003) Cigarette smoking among asthmatic adults presenting to 64 emergency departments. Chest 123,1472-1479[Abstract/Free Full Text]
2. Cheng, TO Smoking and diabetes in Chinese men [letter]. Postgrad Med J 2001;77,551[Free Full Text]
3. Cheng, TO, Chen, TO Help with tobacco control [letter] [published correction in Lancet 2001; 358:766].Lancet 2001;358,511[Medline]

This article has been cited by other articles:

				T. O. Cheng Cigarette Smoking Can Kill You Real Fast Arch Intern Med, April 12, 2004; 164(7): 807 - 808. [Full Text] [PDF]

This Article Full Text (PDF) Free Erratum (v125,p1175) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (2) Citing Articles via Google Scholar Google Scholar Articles by Cheng, T. O. Search for Related Content PubMed PubMed Citation Articles by Cheng, T. O.