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Medical Author:

Michael C. Fishbein, MD

Michael C. Fishbein, MD

Dr. Fishbein received his undergraduate and medical degrees from the University of Illinois. He completed a residency in anatomic and clinical pathology at Harbor General Hospital/UCLA Medical Center. He is board certified in anatomic and clinical pathology.

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Medical Editor:

Jay W. Marks, MD

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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In this Article

• Smoker's lung introduction
• What is the structure of the normal lung?
• What processes determine normal function of the lung?
• What are the abnormalities (diseases) in smoker's lung?
• What happens to the lung in emphysema?
• How does emphysema come about?
• Why does smoker's lung look black?
• What happens to the airways in chronic bronchitis?
• Are smokers with COPD predisposed to developing pneumonia?
• What about lung cancer in smokers?
• Are any of the pulmonary consequences of smoking reversible?
• From what do smokers die?
• Patient Comments: Smokers' Lung - COPD
• Smoker's Lung: Pathology Photo Essay Index

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.

Figure 7: 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.