By Tedler D. Depaynos, MD
Smoking is the consumption of tobacco by burning it in the mouth. In the Ilocos provinces where you could see some elderly ladies burning it in reverse where the lighted end is inside the mouth, the effect is the same. In both cases, the tobacco smoke is inhaled inside the lungs.
Primary smokers are those that burn tobacco. The secondary smokers or sometimes called passive smokers are those that are exposed to tobacco smoke because of their closeness to primary smokers or are in enclosed spaces where the smoke is confined. They also inhale the smoke. Many of the passive smokers with lung problems who seek consultations are the wives of primary smokers who smoke inside their bed room. According to a young pulmonologist who trained in the Lung Center, tertiary smokers are those who happen to be exposed to tobacco smelling environment like walls, curtains and clothes. This is a new finding and research is now being done on those individuals constantly exposed to these environments like cleaners, janitors, waiters, etc.
Heavy smokers are those that consume at least 40 sticks per day and moderate smokers are those that consume at least 20 sticks per day. Many of those “addicted” to smoking we are familiar with smoke even 3-4 packs per day making their mouth look like a chimney. Some do not agree that “addicts” cannot stop smoking. A cardiologist stopped smoking suddenly when a lady patient he was examining with a stethoscope unexpectedly had severe bouts of coughing after she inhaled the Marlboro smell accompanying his wide smile. Stopping it is just with severe determination.
Smoke could cause irritation in the bronchial tree leading to various ailments like chronic cough, allergic or asthmatic attacks with difficulty of breathing. It causes of course repulsive mouth aroma and stains previously presentable white dental assets with chronic use. The most dreadful however are the chemicals that it contains that could cause lung Ca.
Incidence of lung Ca to the primary smokers especially those with genetic history may reach up to 100%. With passive smokers, the incidence is to 17 – 20%. The incidence quoted did not mention the presence or absence of filters in the cigarettes consumed.
Other environmental hazards like hydrocarbons coming from vehicular exhausts may also contribute to lung cancer appearance so that those exposed daily to vehicular exhausts like the traffic enforcers have a higher chance of developing the disease later in life. They even double their chances when they take a break and relax by inhaling their cigarettes.
Asbestos may also cause the disease but studies reveal that the disease may appear 20 years after chronic exposure. It means that the individual will manifests the Ca when already retired. The findings made officials in a local city hall replace the ceiling with asbestos components of their offices. Likewise, the previous water supplier of Metro Manila made sure that their pipes are no longer with asbestos.
In almost all of the lung cancer patients we encountered in the hospital, however, the common denominator is smoking. The exceptions are rare. I could recall a late non-smoking lawyer friend who went into hands -on farming wondering with wet eyes how he ever got his lung malignant tumor.
There are many types of lung Ca but they are classified in general into two – small cell lung Ca (SCLCA) and non-small cell lung Ca (NSCLC). The former has a very rapid growth and metastasize early. Sometimes the metastasis is diagnosed first before the primary lesion. The latter may have a delayed growth and could be treated completely when diagnosed at Stage I or II. In both instances however, their early manifestations are non-specific and when confirmed that they are due to lung Ca, in almost all instances, they are already at a late stage. Hence early diagnosis is always attempted by practicing MDs.
A history of heavy smoking with genetic tendencies always make MDs suspicious and entertain the possibility of lung Ca when these patients seek consultations due to chronic respiratory problems like coughing, difficulty of breathing and even chest heaviness. After an extensive family history interview, a routine work-up like chest x-rays or chest UTZ are requested. Any suspicious lesions are biopsied. Many of our young pulmonologists are very familiar in doing these procedures. If the lesion is centrally located a bronchoscopy with biopsy is done and if it is at the lung periphery, an UTZ or CT Scan guided needle biopsy is recommended. An intrathoracic video assisted biopsy may also be done and if not feasible, an open thoracostomy maybe the alternative to be done by a thoracic surgeon.
Chemotheraphy and even radiotheraphy maybe prescribed to late stage patients in the hope of palliating and making them comfortable. Extending their life span however with these prescriptions may be futile. Hence early diagnosis is a must.
To answer the inquiry of a listener with regards to “asthma” and “pneumonia”, Dr. Cosme mentioned that Asthma is a form of allergy and smoking maybe the culprit while, pneumonia is a form of infection. Infection may be cured completely and no recurrence unless another infection occurs. Allergy on the other hand may be chronic or recurrent when re-exposed again and again to the things the patient is allergic to like cigarette smoke.**
