Damage to the respiratory system from cigarette smoking is slow, progressive, and deadly. A healthy respiratory system is continuously cleansed. The mucus produced by the respiratory tubules traps dirt and disease-causing organisms, which cilia sweep toward the mouth, where it can be eliminated. Smoking greatly impairs this housekeeping. With the very first inhalation of smoke, the beating of the cilia slows. With time, the cilia become paralyzed and, eventually, disappear altogether. The loss of cilia leads to the development of smoker's cough. The cilia no longer effectively remove mucus, so the individual must cough it up. Coughing is usually worse in the morning because mucus has accumulated during sleep.
To make matters worse, excess mucus is produced and accumulates, clogging the air passageways. Pathogenic organisms that are normally removed now have easier access to the respiratory surfaces and the resulting lung congestion favors their growth. This is why smokers are sick more often than nonsmokers. In addition, a lethal chain reaction begins. Smokerís cough leads to chronic bronchitis, caused by destroyed respiratory cilia. Mucus production increases and the lining of the bronchioles thickens, making breathing difficult. The bronchioles lose elasticity and are no longer able to absorb the pressure within the alveoli (microscopic air sacs) enough to rupture the delicate alveolar walls; this condition is the hallmark of smoking-induced emphysema. The burst alveoli cause worsening of the cough, fatigue, wheezing, and impaired breathing. Emphysema is fifteen times more common among individuals who smoke a pack of cigarettes a day than among nonsmokers.
Simultaneous with the structural changes progressing to emphysema may be cellular changes leading to lung cancer. First, cells in the outer border of the bronchial lining begin to divide more rapidly than usual. Eventually, these displace the ciliated cells. Their nuclei begin to resemble those of cancerous cells--large and distorted with abnormal numbers of chromosomes. Up to this point, the damage can be repaired if smoking ceases. However, if smoking continues, these cells may eventually break through the basement membrane and begin dividing within the lung tissue, forming a tumor with the potential of spreading throughout lung tissue. Eighty percent of lung cancer cases are due to cigarette smoking. Only 13% of lung cancer patients live as long as 5 years after the initial diagnosis.