Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in this country, behind only heart disease and cancer. The primary cause of COPD is cumulative, chronic (long-term) exposure to cigarette smoking. The American Lung Association estimates that as many as 85% to 90% of those diagnosed are long-term smokers.[1] COPD can also be caused by pipe, cigar and other types of tobacco smoke, especially if it is inhaled.[2]

What’s in Tobacco Smoke?

When a cigarette burns, it creates more than 7,000 chemicals. At least 69 of these are carcinogenic (known to cause cancer). Many are poisonous. To follow is a list of some of the chemicals found in cigarettes and other places where these chemicals can be found:[3]

Acetone – an ingredient found in nail polish remover

Acetic acid – an ingredient found in hair dye

Ammonia – found in many common household cleaners

Arsenic – found in rat poison

Benzene – an ingredient found in rubber cement

Butane – an ingredient found in lighter fluid

Cadmium – an active ingredient in battery acid

Carbon monoxide – a chemical released in the air by car exhaust fumes

Formaldehyde – an ingredient found in embalming fluid

Hexamine – an ingredient found in barbecue lighter fluid

Lead – an ingredient used in batteries

Napthalene – an ingredient found in mothballs

Methanol – a primary component of rocket fuel

Nicotine – an ingredient used in insecticide

Tar – an ingredient used for paving roads

Toluene – an ingredient used to manufacture paint

How Does Cigarette Smoke Cause COPD?

It is widely recognized that chronic inflammation plays a major role in the development of COPD. The poison in tobacco smoke causes neutrophils, T-lymphocytes and other inflammatory cells to accumulate in the air passages. Once these inflammatory cells are activated, they trigger what’s known as the inflammatory response in which an influx of molecules known as inflammatory mediators navigate to the site in an attempt to destroy and remove the inhaled foreign debris.

As the inflammatory process continues, the air passages in the lungs constrict, becoming excessively narrow and swollen. This leads to excess mucus production and poorly functioning cilia (hair-like structures that sweep inhaled pollutants trapped in mucus out of the lungs), a combination that makes clearing the airways particularly difficult. When people with COPD can’t clear mucus out of their air passages, they develop classic symptoms of COPD, including shortness of breath and a chronic, productive cough. Over time, the buildup of mucus in the air passages attracts bacteria that thrive and multiply in the warm, moist environment of the lungs. This process results in further inflammation, the formation of tiny pouch-like sacs called diverticuli in the air passages and bacterial lung infection, a common cause of COPD flare-ups.

Under normal circumstances, the inflammatory response is a necessary and useful part of normal healing. Without it, a cut on your finger would never heal. In COPD, however, repeated exposure to airway irritants like tobacco smoke perpetuates an ongoing inflammatory response that over time, causes structural and physiological changes in the lungs that get progressively worse.

Quitting Smoking: The Best Treatment for COPD

No other factor carries more weight in slowing the progression of COPD than smoking cessation. In fact, studies show that lung function decline in COPD after quitting smoking actually normalizes, meaning that it declines at the same rate of anyone else of the same age, sex, height and weight.[4] What’s the best way to quit? The following treatments are proven to be effective for smokers who have a desire to quit:[5]

Nicotine replacement products including over-the-counter nicotine patches, gum or lozenges or prescription nicotine patches, inhalers or nasal spray.

including over-the-counter nicotine patches, gum or lozenges or prescription nicotine patches, inhalers or nasal spray. Brief help by a doctor such as when a doctor takes time to provide advice and assistance about quitting.

such as when a doctor takes time to provide advice and assistance about quitting. Counseling , either individual, group or telephone.

, either individual, group or telephone. Other prescription, quit smoking medication such as buproprion SR (Zyban®) and varenicline tartrate (Chantix®).

Used in combination, counseling and medication is more effective than using either method alone.4 For more information about quitting, call 1-800-QUIT-NOW, a free telephone support service that can help you quit smoking.

[1] American Lung Association. “What Causes COPD?” Accessed online March 3, 2016.

[2] National Heart, Lung and Blood Institute. “What Causes COPD?” Updated July 31, 2013.

[3] American Lung Association. “What’s in a Cigarette?” Accessed online March 3, 2016.

[4] B.W.M. Willemse, D.S. Postma, W. Timens, and N.H.T. ten Hacken. “The impact of smoking cessation on respiratory symptoms, lung function, airway hyper-responsiveness and inflammation.” ERJ March 1, 2004 Vol. 23 No. 3 464-476.

[5] Centers for Disease Control and Prevention. “What You Need to Know About Quitting Smoking”. Last updated May 21, 2015.

By Deborah Leader RN, BSN, PHN