The link between smoking and pulmonary diseases was first recognized in the 1870s, but it was not until 1964 that the US Surgeon General's report warned of a potential relationship between smoking and emphysema. By 1984, sufficient data had accrued from epidemiologic and animal studies to enable the Surgeon General to emphatically cite “cigarette smoking [as] the major cause of chronic obstructive lung disease,” with a “contribution… to chronic obstructive pulmonary disease morbidity and mortality [that] far outweighs other factors.”<sup>215 US Surgeon-General The Health Consequences of Smoking: Chronic Obstructive Lung Disease   Washington DC: US Department of Health and Human Services (1984). 

Cliccare qui per andare alla sezione Riferimenti</sup> Presently, despite widespread public awareness of the health risks involved, an estimated 25% of Americans smoke tobacco.<sup>46 Centers for Disease Control and Prevention Cigarette smoking among adults-United States, 1997 MMWR 1999 ;  48 (43) : 994-996

Cliccare qui per andare alla sezione Riferimenti</sup> A fashionable addiction and a profitable industry together therefore promote the development of chronic obstructive pulmonary disease (COPD).

While asthma may be grouped among the chronic obstructive respiratory disorders, the unique inflammatory basis of asthma separates it from COPD.<sup>207 Sorlie P.D., Kannel W.B., O'Connor G. Mortality associated with respiratory function and symptoms in advanced age. The Framingham Study Am Rev Respir Dis 1989 ;  140 : 379-384  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> This review is confined to a discussion of the obstructive respiratory conditions associated most closely with cigarette consumption—chronic bronchitis and emphysema. Chronic bronchitis is defined clinically as “the presence of chronic productive cough for at least 3 months in two consecutive years, after excluding other causes of chronic cough.”<sup>206 Sommerhoff C.P., Nadel J.A., Basbaum C.B. , e al. Neutrophil elastase and cathepsin G stimulate secretion from cultured bovine airway gland serous cells J Clin Invest 1990 ;  85 : 682-689  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Emphysema is defined as “a condition of the lung characterized by abnormal, permanent enlargement of airspaces distal to the terminal bronchiole, accompanied by the destruction of their walls, and without obvious fibrosis.”<sup>205 Snider G.L., Kleinerman J.E., Thurlbeck W.M. , e al. The definition of emphysema: Report of a National Heart, Lung, and Blood Institute, Division of Lung Diseases Workshop Am Rev Respir Dis 1985 ;  132 : 182-185

Cliccare qui per andare alla sezione Riferimenti</sup> An estimated 14 million persons in the United States suffer from COPD—approximately 12.5 million from chronic bronchitis and about 1.65 million from emphysema.<sup>207 Sorlie P.D., Kannel W.B., O'Connor G. Mortality associated with respiratory function and symptoms in advanced age. The Framingham Study Am Rev Respir Dis 1989 ;  140 : 379-384  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> In 1991, COPD became the fourth leading cause of death in the United States.<sup>207 Sorlie P.D., Kannel W.B., O'Connor G. Mortality associated with respiratory function and symptoms in advanced age. The Framingham Study Am Rev Respir Dis 1989 ;  140 : 379-384  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> As such, cigarette smoking has the notorious distinction of being the “chief, single, avoidable cause of death” in the United States.<sup>215 US Surgeon-General The Health Consequences of Smoking: Chronic Obstructive Lung Disease   Washington DC: US Department of Health and Human Services (1984). 

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