Smoking and tobacco use by U.S. military personnel

Findings regarding smoking behavior for the 1985 survey of military personnel were compared to findings from earlier surveys. A decline in the percentage of cigarette smokers was evident for all ranks and ages. Reported use of smokeless tobacco and cigar/pipe smoking indicated that one-fifth of the cigarette smokers also use smokeless tobacco and that two-fifths of the cigarette users smoke a pipe or cigar. Among non-smokers of cigarettes, about one-tenth of the respondents used smokeless tobacco and/or smoked a pipe or cigars. Using self-evaluation of health status, non-smokers reported "excellent" health significantly more than smokers.     

Mucociliary clearance mechanism in smoking and nonsmoking normal subjects

Mucociliary clearance mechanisms were evaluated in 17 normal subjects visually and qualitatively by radioaerosol inhalation cinescintigraphy of the lung, and quantitatively by calculating the following indices: (a) overall or regional lung retention ratio; (b) airway deposition ratio; (c) airway retention ratio; (d) airway clearance efficiency; and (e) alveolar deposition ratio. The inhaled aerosol deposited homogeneously throughout the lungs, and mucus transport was always cephalad in direction and constant in velocity, although a temporary stasis of mucus was seen in smokers. Overall lung retention ratio was significantly smaller and airway deposition ratio was significantly larger in the smokers than in nonsmokers, but there was no difference between the groups in airway retention ratio or airway clearance efficiency. There was an inverse relationship between alveolar deposition ratio and cigarette consumption. Mucociliary clearance mechanisms were well maintained in the normal subjects, but in the smokers inhaled aerosol tended to deposit more proximally.     

Cigar and pipe smoking in the U.S. military: prevalence, trends, and correlates

This article examines the prevalence, trends, and correlates in cigar/pipe smoking and their relation to cigarette smoking among active duty U.S. military personnel. An examination of the trends in cigar/pipe smoking was conducted with data from 1985 to 1998, and predictors of smoking were determined for 1998. Rates of cigar/pipe smoking declined from 1985 until about 1992 and then began to increase. From 1995 to 1998, there was a 75% increase in the prevalence of cigar/pipe smoking. Greater prevalence of cigar/pipe smoking was associated with male gender, younger age, relatively favorable beliefs and values toward smoking, and being a current cigarette smoker. Findings indicate a notable increase in past-year cigar/pipe smoking. These findings suggest that military tobacco prevention and early intervention programs would benefit from including components that deal specifically with cigar and pipe use in addition to cigarette smoking.     

Healthy passive cigarette smokers have increased pulmonary alveolar permeability

QUESTION: Does passive smoking have a measurable effect on lung function in otherwise healthy subjects? There is current interest concerning passive smoking but no objective evidence showing that it has any impact on lung function. METHODS: The pulmonary clearance rate of (99m)Tc-DTPA was measured in 21 healthy volunteers after inhalation as a radio-aerosol and compared between healthy cigarette smokers, passive smokers and non-smokers. All volunteers had normal lung function. RESULTS: Clearance half-times in healthy passive smokers (n=5) were longer than in healthy smokers (n=6) but clearly shorter compared with healthy non-smokers (n=10) with respective mean values of 45.2 (SD 8.3), 24.3 (8.6) and 80.3 (20) min. CONCLUSION: Passive smoking has a functional impact on the lung blood/gas barrier.     

Cigarette smoking and decompression illness severity: a retrospective study in recreational divers

BACKGROUND: Severe decompression illness (DCI) could be more likely in cigarette smokers because of airway obstruction or vascular disease. The present study evaluated the severity of DCI as a function of cigarette smoking in recreational divers. METHODS: We examined all DCI reports recorded in the Divers Alert Network (DAN) database from 1989 through 1997. Smoking history was quantified as heavy (>15 pack-years), light (0 to 15 pack-years), and never smoked. DCI symptoms were classified as severe (alteration in consciousness, balance or bladder/bowel control, motor weakness, visual symptoms, convulsions), moderate (other neurological symptoms), or mild (pain, skin, or nonspecific symptoms). The proportional odds model and generalized logits were used for the adjusted analysis when accounting for other covariates. RESULTS: There were 4,350 patients included in the analysis. After adjustment for confounding variables, heavy smokers were more likely to have severe vs. mild symptoms than nonsmokers (OR = 1.88) (95% CI 1.36, 2.60) or light smokers (OR = 1.56) (95% CI 1.09, 2.23). Heavy smokers and light smokers were more likely to have severe vs. moderate symptoms than nonsmokers (OR = 1.36) (95% CI 1.06, 1.74) and (1.22) (1.02, 1.46), respectively. Although these data do not reveal whether smoking predisposes to DCI, the results are consistent with a tendency, when DCI occurs, for cigarette smoking to trigger more severe symptoms. CONCLUSIONS: The data suggest that when DCI occurs in recreational divers, smoking is a risk factor for increased severity of symptoms.     

Effects of cigarette smoking on I-123 IMP clearance from the lung

N-isopropyl-p-I-123-iodoamphetamine (I-123 IMP), originally developed as a brain scanning agent, is also taken up by the lung. To evaluate the cigarette smoking on the uptake of IMP by the lung, we studied I-123 IMP clearance from the lung of 14 volunteers; 5 non-smokers and 9 smokers. After the injection of 111 MBq (3 mCi) of I-123 IMP into the medial cubital vein, the time-activity curve for 60 minutes and the regional activity using 1 frame per minute and a 64 x 64 matrix was obtained. I-123 IMP clearance curve was described as follows: C(t) = A1e-k1t + A2e-k2t (A1, A2: intercepts, and k1, k2: slopes of the exponential components). I-123 IMP clearance was delayed in smokers, and k2 was smaller in smokers. Also a significant correlations between k1, k2, and the number of cigarettes smoked per day were found. In conclusion, this study suggests that the delayed clearance and retention of I-123 IMP in the lung indicate the lung metabolic disorders due to cigarette smoking.     

Relapse to smoking after basic military training in the U.S. Air Force

This study examined predictors of smoking relapse in the year after the mandatory smoking ban during basic military training (BMT) in the U.S. Air Force. Participants were all smokers who completed BMT from August 1995 to August 1996 and relapsed to smoking in the subsequent year (N = 4,303). Results demonstrated that the vast majority of airmen (69.8%) returned to smoking within 1 month after BMT and that most (90%) were still in training status when they smoked their first cigarette after BMT. Relapsed smokers appeared more motivated to quit smoking at 1-year follow-up compared with when they were in BMT. Individuals making serious quit attempts after BMT were younger and had greater levels of physical activity, more confidence in quitting, and more favorable perceptions of the BMT ban than individuals not attempting to quit. Based on these findings, recommendations are discussed for improving abstinence rates after BMT.     

Reduction in cortical IMP-SPET tracer uptake with recent cigarette consumption in a young group of healthy males

Functional brain imaging techniques are being used increasingly to infer disturbances in brain function in various neuropsychiatric disorders, but the specificity of such findings is not always clear. We retrospectively examined the effects of one possible confound - cigarette smoking - on cortical uptake of iodine-123 iodo-amphetamine (IMP) using single-photon emission tomographic imaging in a young (mean age=35 years) healthy group of male controls divided according to their smoking history. Subjects who had never smoked (n=17), or those with a history of smoking but no recent smoking (n=8), had equivalent and significantly higher mean cortical uptake of IMP than subjects with a history of smoking and who were current smokers (n=8). There were no differences in the cortical distribution of IMP. Our results indicate that cigarette smoking has an acute effect on global cerebral blood flow. This potential confound must be considered before abnormalities in cortical tracer uptake are attributed to some neuropsychiatric disorder of interest.     

Effects of cigarette smoking on iodine 123 N-isopropyl-p-iodoamphetamine clearance from the lung.

Iodine 123 N-isopropyl-p-iodoamphetamine (123I-IMP), originally developed as a brain scanning agent, is also taken up by the lung. To evaluate the effects of cigarette smoking on the kinetics of IMP in the lung, we studied 123I-IMP clearance from the lung in 18 volunteers (8 non-smokers and 10 smokers). After the injection of 111 MBq of 123I-IMP into the medial cubital vein, the time-activity curve for 60 min and the regional activity using 1 frame per minute and a 64 x 64 matrix were obtained. The 123I-IMP clearance curve was described as follows: C(t) = A1e-k1t + A2e-k2t (A1, A2: intercepts, and k1, k2: slopes of the exponential components). 123I-IMP clearance was delayed in smokers, and k2 was smaller in smokers. Also, a correlation between k1, k2, and the number of cigarettes smoked per day was found (r = -0.65, r = -0.74, respectively, P less than 0.01). In conclusion, this study suggests that the delayed clearance and retention of 123I-IMP in the lung indicate lung metabolic disorders due to cigarette smoking.     

Nicotine and cotinine in infants dying from sudden infant death syndrome

The aim of this component of the German Study on Sudden Infant Death was to determine (1) nicotine concentrations in hair (NCH), as a marker of long standing exposure to tobacco, (2) cotinine concentrations in pericardial fluid (CCP) and (3) cotinine concentrations in liquor cerebrospinalis (CCL), the latter measures being markers of recent exposure to tobacco in the last few hours of life. The results obtained were compared with data on parental smoking revealed from interviews. In 100 cases of sudden infant death syndrome, material was taken at autopsy to determine NCH. In 41 cases, NCH and CCP, and in 70 cases, NCH and CCL were determined. Infants of mothers who stated having smoked during pregnancy had higher NCH than infants of non-smoking mothers (p = 0.008). Furthermore, there was a weak but statistically significant relationship between NCH's and the daily cigarette consumption of the mother during pregnancy (n = 64, r = 0.24, p = 0.05). In 43% of infants, nicotine could be detected in their hair, although the mothers had said at the interview that they did not smoke during pregnancy. On the other hand, in 33% of infants whose mother stated they had smoked during pregnancy nicotine was not detectable in the infant's hair. CCP's were strongly correlated with CCL's (r = 0.62, p = 0.0027). For this reason, both parameters were treated as equivalent for the detection of tobacco smoke exposure in the last hours before death. The influence of breast-feeding was evaluated by comparison of the nicotine concentrations in breast fed and non-breast-fed infants from smokers and non-smokers. Fivefold higher nicotine concentrations were determined in non-breast-fed infants of parents who smoked as compared to all other groups. It can be concluded that nicotine intake by passive smoking is much more important than by breast-feeding. We conclude that both interview data and biochemical measures should be sought to understand the true exposure to tobacco smoke.     

Tri-service Health Questionnaire-1989

An anonymous, self administered health questionnaire survey of the habits and attitudes of servicemen in the 3 Services was conducted. The overall response rate was 75%. This paper reports the results of questions on smoking. The Army had the greatest percentage of smokers, smoked most heavily and had the worst attitude to smoking of the 3 Services. The RAF had the best results in these fields. There was a higher percentage of smoker, who smoke more heavily in Germany/seadraft than UK/shoredraft. There was a rank gradient in percentage smokers, with the lowest ranks smoking the most. A sizeable proportion of the smoking population wish to give up, have tried to do so and feel their Medical Officer should be interested in their smoking habits. A reduction in prevalence of cigarette smoking to less than 30% within 5 years is recommended as a Tri-service Health Policy Goal, with the Army, Tri-Service 16-20 year olds and Private-Corporal rank equivalents and recruits, as specific target groups for intervention. The health promotion strategy should include concerted anti-smoking advice from Medical Officers.     

Multi-detector computed tomography demonstrates smoke inhalation injury at early stage

A multitrauma victim was transported to our trauma centre. Smoke inhalation injury was suspected based on trauma history and clinical examination. The first trauma computer tomography (CT) obtained 2.8 h after the injury revealed subtle ground-glass opacifications with mainly peribronchial distribution and patchy peribronchial consolidations centrally in the left lung. A repeated scan showed a more distinctive demarcation of the peribronchial opacities, further substantiating the clinically verified smoke inhalation injury. The golden standard for diagnosing smoke inhalation injury still is fibroptic bronchoscopy examination. This paper shows that lesions typical to smoke inhalation injury appear much earlier than previously reported. Whether assessment of smoke inhalation injury severity using CT could clinically benefit patients is controversial and still requires further research. Multi-detector computed tomography is readily available in trauma centres and to simply neglect its potential as a diagnostic tool in some inhalation injury would be unwise.     

Respiratory bronchiolitis, respiratory bronchiolitis-associated interstitial lung disease, and desquamative interstitial pneumonia: different entities or part of the spectrum of the same disease process?

OBJECTIVE: Our objective was to assess high-resolution CT findings of respiratory bronchiolitis, respiratory bronchiolitis-associated interstitial lung disease, and desquamative interstitial pneumonia and to determine whether these three entities could be reliably differentiated by radiologic criteria. MATERIALS AND METHODS: CT scans (1- to 3-mm collimation) were reviewed in 40 patients with pathologically proven respiratory bronchiolitis (n = 16), respiratory bronchiolitis-associated interstitial lung disease (n = 8), or desquamative interstitial pneumonia (n = 16). All patients with respiratory bronchiolitis and respiratory bronchiolitis-associated interstitial lung disease were cigarette smokers, and 85% of the patients with desquamative interstitial pneumonia had a history of smoking. CT scans were independently reviewed by two radiologists who assessed the pattern and distribution of abnormalities. RESULTS: The predominant abnormalities in respiratory bronchiolitis were centrilobular nodules (12 [75%] of 16 patients) and ground-glass attenuation (six [38%] of 16). No single abnormality predominated in the respiratory bronchiolitis-associated interstitial lung disease group; findings included ground-glass attenuation (four [50%] of eight), centrilobular nodules (three [38%] of eight), and mild fibrosis (two [25%] of eight). All patients with desquamative interstitial pneumonia showed ground-glass attenuation, and 10 (63%) of the 16 showed evidence of fibrosis. CONCLUSION: The significant overlap between the CT findings of respiratory bronchiolitis, respiratory bronchiolitis-associated interstitial lung disease, and desquamative interstitial pneumonia is consistent with the concept that they represent different degrees of severity of small airway and parenchymal reaction to cigarette smoke.     

Continuous aerosol inhalation scintigraphy in the evaluation of early and advanced airways obstruction

By means of continuous lung imaging, regional mucociliary removal rates of inhaled ^99mTc-labeled human serum albumin minimicrospheres were determined over upper, middle, lower, central, and peripheral anterior lung areas. Additionally, an index was employed for analysis of initial pulmonary radioaerosol distribution in order to quantify the site of particle deposition in various degrees of airways obstruction.The study involved 15 volunteer healthy subjects, 20 asymptomatic smokers with early small airways obstruction, and 30 patients with advanced chronic obstruction of large airways. The healthy group showed evenly distributed lung activity and (normal) clearance rates consistent with data from earlier work. While most uneven lung aerosol distribution was seen in the patients with large airways obstruction, slowest mucociliary clearance velocity was encountered in the smokers with small airways dysfunction.The aerosol technique, if carefully controlled, can be a useful supplement to pulmonary ventilatory function testing, showing reduction of bronchial mucous velocity to be one of the earliest signs of functional impairment in asymptomatic cigarette smokers.     

Does cigarette smoking affect the fitness of young adults? Rationale and protocol for future research.

While there is considerable evidence of the direct effects of cigarette smoking upon the cardiovascular and respiratory systems, one result of impaired function, that is how cigarette smoking affects fitness and athletic performance, has not been well documented. Because of the potential impact that exercise might have as a substitute for smoking, it is important to delineate relationships, particularly for those who are just beginning to smoke. Literature is presented as a rationale for research in this area and results of a pilot study on smokers and non-smokers are reported. A number of trends in the fitness and pulmonary function tests emerged, suggesting this line of research be pursued.     

硫化氢吸入干预大鼠棉花烟雾吸入性肺损伤中的氧化应激

目的：探讨吸入硫化氢（ hydrogen sulfide , H2 S）干预大鼠棉花烟雾吸入性肺损伤的氧化应激反应机制。方法24只雄性SD大鼠随机分成对照组、H2 S组、烟雾组、烟雾＋H2 S组,每组6只。复制大鼠棉花烟雾吸入性损伤模型,在烟雾吸入或模拟烟雾吸入后,H2 S组、烟雾＋H2 S组大鼠予以持续吸入H2 S 80 ppm＋30％氧气6 h,对照组、烟雾组予以吸入30％氧气6 h,ELISA法检测肺组织匀浆中MDA、NO、iNOS、NF-κB p65浓度,免疫组化检测肺组织NF-κB p65并进行半定量分析,荧光定量PCR法行肺组织iNOS mRNA定量。结果烟雾组大鼠肺组织匀浆中MDA、NO、iNOS、NF-κB p65浓度和肺组织中NF-κB p65的累积光密度、iNOS mRNA的相对表达量均明显高于对照组,而烟雾＋H2 S组的上述指标较烟雾组均明显降低,如肺组织匀浆中NF-κB p65浓度（8123．51±2095．33） pg/ml vs （13803．19±2196．37） pg/ml,P＜0．001;肺组织中iNOS mRNA的相对表达量（1．04±0．24） vs （2．20±0．21）,差异有统计学意义（P＜0．001）;H2S组iNOS浓度、iNOS mRNA的相对表达量、NF-κB p65的累积光密度高于对照组,但MDA、NO、iNOS、NF-κB p65浓度与对照组比较无明显差别。结论吸入H2 S的干预机制可能是吸入H2 S可抑制NF-κB p65的激活,使iNOS mRNA的转录合成减少,从而减少iNOS、NO生成,减轻氧化应激反应和减轻大鼠肺损伤。     

Smoking-induced elevations in blood carboxyhaemoglobin levels. Effect on maximal oxygen uptake.

Many people engage in physical activity to reduce their cardiovascular risk associated with smoking. These people should be made aware of the metabolic and cardiorespiratory changes induced by chronic and acute smoking and, in particular, the exercise ramifications of increased levels of blood carbon monoxide (CO). Smoking-induced elevations in the CO content of the blood can reduce exercise tolerance and maximal aerobic capacity. Smoking also increases the reliance upon glycolytic metabolism during exercise. Together, these factors contribute to earlier fatigue in smokers compared with nonsmokers who exercise. Similar effects upon exercise tolerance are noted in those who inhale environmental tobacco smoke.     

吸烟导致闭合性损伤手指发生动脉危象的诊断及救治

目的探讨吸烟所致闭合性手指损伤后发生动脉危象的早期诊断及救治措施。方法2005年1月—2008年12月,接诊闭合性手指损伤患者56例(70指)吸烟后出现伤指疼痛加剧、麻木、指腹张力低下、颜色苍白,利用高频脉冲超声多普勒血流仪(PUDVP)观察伤指血流灌注情况,并与同期未吸烟患者伤指血流灌注进行了比较。结果32例36指被诊断发生动脉危象,动脉危象发生率吸烟组明显高于未吸烟组,伤指动脉血流最大速度、指动脉血流量及手指末节温度吸烟组明显低于未吸烟组,动脉危象非手术方法治疗有效率吸烟组明显低于未吸烟组,手术探查指动脉血栓发生率吸烟组明显高于未吸烟组,指动脉痉挛发生率未吸烟组高于吸烟组。结论对吸烟的闭合性手指损伤患者应密切观察伤指的血运及感觉变化,指动脉危象发生后应采取积极救治措施。     

Difference in inhaled aerosol deposition patterns in the lungs due to three different sized aerosols.

Deposition patterns of inhaled aerosol in the lungs were studied in five normal subjects and 20 patients with lung disease by inhaling radioaerosols with three different particle size distributions. These aerosols were generated from BARC, UltraVent, and Mistogen-EN-142. Particle size distributions generated by these three nebulizers were 0.84, 1.04 and 1.93 microns in activity median aerodynamic diameter (AMAD) with its geometric standard deviation (sigma g) of 1.73, 1.71 and 1.52, respectively. Deposition patterns of inhaled aerosols were compared qualitatively and quantitatively by studying six different parameters: alveolar deposition ratio (ALDR), Xmax, Xmean, standard deviation (S.D.), skewness and kurtosis of the radioactive distribution in the lungs following inhalation. It has been found that aerosol deposition patterns varied with particle size. The unevenness of aerosol deposition, Xmax, Xmean and the number of 'hot spots' became more prominent with the increase in particle size, whereas values of ALDR and S.D. decreased as particle size increased. Knowing these deposition characteristics would facilitate a judicious application of aerosol inhalation to medical use.     

106例吸烟健康老年人胸部X线分析

本文对200名健康男性老年人的胸部X线片进行了测量分析。其中包括94名不吸烟和106名吸烟者。测量结果:吸烟组的肺长度(L)、肺宽度(W)的均值随吸烟而增高。右膈弓高(BD)随吸烟而下降。且吸烟量与肺长度(L)呈正相关,与右膈弓高(BD)呈负相关。结果表明:长期大量吸烟会导致肺体积增大,其中以肺长度(L)的增加和右膈弓高(BD)的减少最为明显。