Smokers' Lung - COPD and Pneumonia

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Are smokers with COPD predisposed to developing pneumonia?

The answer is yes. As previously mentioned, smoking increases mucus production and impairs the clearing action of the cilia in the airway. Also, the addition of bacteria, inflammatory cells, and damaged lung cells to the secretions in the airway and lung make the secretions especially thick, tenacious, and difficult to clear. Therefore, in such a stagnant and nutritious (the mucus) environment, bacteria can flourish and cause infection of the lung (pneumonia). Furthermore, even the inflammatory cells are damaged by tobacco smoke so that their ability to fight infection is diminished.

For all of these reasons, pneumonia is not only more common, but it is often also more severe in smokers with COPD (chronic obstructive pulmonary disease, that is, emphysema and/or chronic bronchitis) than in non-smokers without COPD. Moreover, the inflammatory cells that accumulate in the lung to fight off the infection can fill the alveolar spaces and thereby further limit diffusion of oxygen and carbon dioxide. Therefore, smokers with COPD, who already have impaired breathing (pulmonary function), often become much worse when there is a superimposed infection of the lung (pneumonia). Figure 7 is a microscopic section of a lung with pneumonia in a patient with COPD.

Picture of pneumonia in COPD
Picture of pneumonia in COPD

Notice that most of the alveoli are filled with inflammatory cells. Some alveoli, however, are unaffected and empty because the involvement of this lung with pneumonia is patchy.

Return to Smoker's Lung: Pathology Photo Essay

See what others are saying

Comment from: Jan, 55-64 Female (Patient) Published: March 13

I have pretty severe COPD now. I have been smoking and still do smoke 2 packs a day... for 40 years. In the last 21 years I've been sick 3 times with either the flu or a sinus infection that required me to go to the hospital. I never got pneumonia because I always got to the hospital early on. I take flu shots, stay out of crowds and away from children, use sanitizer for grocery carts and menus, and wash my hands often. I could get sick and die with little trouble, but I'm being as careful as I can to stay away from germs. Spiriva, Albuterol, and a humidifier, as well as guaifenesin for coughing all control the worst of it.

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Comment from: Tamm, 45-54 Female (Patient) Published: October 18

I am 47 years old. When I was 43 years old I was diagnosed with stage 2 throat cancer! I had 6 weeks radiation twice a day and that was in March! I had to wait 3 months after treatment to see if it cured the cancer and thankfully it was. Started having more problems and had PET scan. It showed 3 spots in my lungs and they did biopsies. While doing that my lung collapsed and I was on the breathing machine for 4 days before it sealed itself up. I went thought chemotherapy and radiation for that! That was in November/December. In January I was coughing up blood and it got so bad that I had to go to emergency room. They said I had pneumonia and was put in the hospital for 2 weeks on IV antibiotics and breathing treatments. It hurt to breathe, felt like I was being smothered and someone was stabbing me in my lung with a knife; not a good feeling. I was released with diagnosis of COPD on top of everything else. Thankfully I am a survivor from the cancer but on a daily basis I fight to breathe right. Daily activity is harder now. If I could go back I never would have taken and inhaled that first cigarette or worked with chemicals. Some aren't as lucky as I am and they don't make it!

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