Lung infections in smokers

By: Ayman Fatima

 Objectives
• Introduction to smoking and listing the various disease
caused
• Pathological changes
• Lung diseases seen in smokers:
1.Pneumonia
2. Influenza
3. Tuberculosis
4. Covid 19
• Conclusion
• Bibliography
 Introduction to smoking
• Approximately, 120 million smokers in world.
• India accounts for 12 % (Ac. to WHO)
• Around 1 million deaths occur due to tobacco
consumption.
• Some infectious diseases which are associated with
smoking are in the following slide:
• Pneumonia, pneumococcal and
meningococcal infections
• Tuberculosis
• Influenza
• HIV and its complications
• Periodontitis
• Reproductive tract infections
• surgical infections
• Corona virus and SARS
How does smoking predispose to infections

• Mechanisms are multifactorial and interactive

in their effects.
• Structural mechanisms
• peribronchiolar inflammation and fibrosis
• increased mucosal permeability
• impairment of the mucociliary clearance
• changes in pathogen adherence
• disruption of the respiratory epithelium
Immunological changes:
• elevated peripheral white blood cell count (30%)
• increase in band cell counts, higher levels of L-
selectin, and increased myeloperoxidase content.
• Decreased CD+4 and increased CD+8
• higher % of macrophages in BAL
• depressed migration and chemotaxis of PMN
• decreased IL-1, IL-6 and TNF alpha
• Decreased NK cell activity
• Antigen mediated signaling of T cells
• lower serum Ig (A,G,M) levels (10 -30%)
• IgG content 2 times higher
• resolve in 6 weeks after cessation.
• A chemically diverse mixture of pro-
inflammatory, oxidative and carcinogenic
factors found in tobacco smoke has a number
of different, sometimes contradictory effects
 Pneumonia and Smoking

• substantial risk factor for pneumococcal pneumonia,

especially in COPD patients
• nearly 2-fold risk of community-acquired pneumonia
• strongest independent risk factor for invasive
pneumococcal disease among immunocompetent adults.
• risk of pneumococcal disease declined to nonsmoker
levels 10 years after cessation
• In vitro adherence of Streptococcus pneumoniae to
buccal epithelial cells has been shown to be increased in
cigarette smokers. May persist for up to 3 years after
smoking cessation.
 Legionnaires disease
• Independent risk factor
• Seen  1% to 3% of CAP
• risk of legionnaires disease was increased
121% per cigarette pack consumed daily in
smokers
 Meningococcal disease
• associated with meningococcal colonization of the
nasopharynx.
•  55% of active smokers were carriers compared with
36% of nonsmokers and 76% of those exposed to
secondhand tobacco smoke.
•  tobacco smoke is a risk factor for meningococcal
nasopharyngeal carriage,
• preceding viral infection, which is more frequent in
smokers, can act as a cofactor for meningococcal disease
•  ineffective humoral immunity against the Neisseria
meningitidis polysaccharide capsule is a well-recognized
risk factor for invasive meningococcal disease.
 Influneza
• more severe, with more cough, acute and chronic
phlegm production, breathlessness, and wheezing
in smokers  
•  Influenza was more severe among smokers, with a
dose-related increase in rate: 30% in nonsmokers,
43% in light smokers, and 54% in heavy smokers
• Enhanced bacterial adherence (superinfection)
• decreased antibody production and rapid waning
of the antibodies
•
 Tuberculosis
• smoking is a risk factor for tuberculin skin test reactivity, skin
test conversion, and the development of active tuberculosis.
• smokers of 20 years’ or greater duration had 2.6 times the
risk of nonsmokers for tuberculosis.
• duration of smoking was more important than the number of
cigarettes smoked daily.
• the smoking-attributable fraction of deaths from tuberculosis
was 61%, greater than the fraction of smoking-attributable
deaths from vascular disease or cancer. (India)
•  decrease in immune response, mechanical disruption of cilia
function, defects in macrophage immune responses, and/or
CD4+ lymphopenia, increasing the susceptibility to pulmonary
tuberculosis.
 Covid 19 Pandemic
•
  Summary
• smokers incur a 2- to 4-fold increased risk of
invasive pneumococcal disease
• Influenza risk is severalfold higher and much
more severe in smokers compared with
nonsmokers.
• smoking contributes substantially to the
worldwide disease burden of tuberculosis.
•
• Smoking cessation should be part of the therapeutic
plan for people with any serious infectious disease,
periodontitis, or positive results of tuberculin skin
tests.
• Secondhand smoke exposure should be controlled in
children to reduce the risks of meningococcal
disease and otitis media and in adults to reduce the
risks of influenza and meningococcal disease.
• Pneumococcal and influenza vaccine in all smokers
• Acyclovir treatment for varicella in smokers
• Yearly Papanicolaou smears in women who smoke.
 Bibliography
• Tobacco Smoke Induces and Alters Immune
Responses in the Lung Triggering Inflammation,
Allergy, Asthma and Other Lung Diseases: A
Mechanistic Review Agnieszka Strzelak ID ,
Aleksandra Ratajczak, Aleksander Adamiec and
Wojciech Feleszko
• Cigarette Smoking and Infection Lidia Arcavi,
Neal L. Benowitz
•