TABLE 14–2 Relative Risk (RR) for Smoking-Attributable Mortality and Average Annual Smoking-Attributable Respiratory Disease Mortality (SAM) Among Current and Former Smokers, by Sex and Disease, United States, 1990–1994

 

Men

Women

 

Respiratory Disease

Current Smokers RR

Former Smokers RR

SAM

Current Smokers RR

Former Smokers RR

SAM

Total SAM

Pneumonia, influenza

2.0

1.6

11,267

2.2

1.4

8,060

19,327

Bronchitis, Emphysema

9.7

8.8

9,642

10.5

7.0

6,475

16,117

Chronic airway obstruction

9.7

8.8

32,132

10.5

7.0

21,893

54,025

Other respiratory diseases

2.0

1.6

776

2.2

1.4

721

1,497

Total

 

53,817

 

37,149

90,966

 

SOURCE: Reprinted with modifications and permission from Novotny and Giovino, 1998. Copyright (1998) by the American Public Health Association.

ratory disease has been identified. The processes involved, such as inflammation and increased levels of oxidants, are not unique to tobacco-related respiratory diseases. Identifying unique biomarkers is further confounded by the heterogeneous nature of these diseases, the complex mixture that makes up tobacco smoke, and the range of individual susceptibilities to the harmful effects of tobacco smoke among users (see Chapter 11). In COPD, for example, the majority of smokers develop abnormal lung function (Camilli et al., 1987), but only 15–20% will develop symptomatic COPD (Fletcher and Peto, 1977). There appears to be no specific clinical or physiological feature to predict which smokers exhibit a rapid decline in lung function (Habib et al., 1987). The most widely used markers of tobacco-related respiratory diseases in population studies are symptom questionnaires and pulmonary function testing. These have well-known limitations of specificity and sensitivity, particularly for detecting the early effects of tobacco smoke on lungs (U.S. DHHS, 1989). Subtle effects of tobacco smoke exposure on the lung can be detected by sampling fluid in



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