Table Of ContentTobacco or Health?
Knut-Olaf Haustein† • David Groneberg
Tobacco or Health?
Second Edition
Prof. Dr. Knut-Olaf Haustein† Prof. Dr. Dr. h.c. mult. David Groneberg
Fritz-Lickint-Institut für Charité - Universitätsmedizin Berlin
Nikotinforschung und Institut für Arbeitsmedizin
Raucherentwöhnung Thielallee 73
Johannes Str. 85–87 14195 Berlin
99084 Erfurt Germany
Germany [email protected]
ISBN: 978-3-540-87576-5 e-ISBN: 978-3-540-87577-2
DOI: 10.1007/978-3-540-87577-2
Springer Heidelberg Dordrecht London New York
Library of Congress Control Number: 2009931695
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Dedication
This book is dedicated to all the unborn who suffer from the negative effects of tobacco.
They cannot protect themselves, and often, they suffer a lifetime.
v
Preface
This book comprehensively summarizes the adverse effects of tobacco smoking on human
health. The current second edition has integrated a large set of new data that have been
published in numerous scientific studies and meta-analyses over the past few years.
Unfortunately, the harmful sequelae of tobacco smoking are played down by the indus-
try and politicians in many industrialized countries. However, about 800,000 people/year
in the EU die from the immediate consequences of smoking. The particularly insidious
feature of tobacco consumption is that smoking-attributable harmful effects on health do
not generally become apparent until three or four decades after smoking initiation.
Although some positive changes in the legislative handling of tobacco have appeared in
the past five years, we still need to form a pact, sealed by politicians, the medical profes-
sionals, teachers and the media, to target the problem across nations. In this respect, a
minority of countries, including the US and the UK, have given positive examples.
There are four areas that need to be improved in future: (1) strict bans on tobacco adver-
tisement on a global level, (2) better measures to protect against side-stream (passive) smoke
exposure, (3) establishment of prevention programs, especially for children and (4) treat-
ment of tobacco addiction.
While preparing the second edition of the German version of this book, the founding
author Knut-Olaf Haustein deceased. After the fall of the Berlin wall, he was one of the first
Germans to take an active part in the battle against tobacco in the united Germany and it is
the author’s hope that the present edition continues the thoughts of Knut-Olaf Haustein on
how to approach the numerous problems. As a comprehensive work, the book is intended
to meet the needs of a large readership, including all medical professionals and scientists,
as well as teachers, sociologists, the media and politicians.
First and foremost, I am grateful to all the scientists who provided the data. I also gladly
acknowledge the help of Springer, Heidelberg, and the assistance of Dr. Carolin Kreiter,
Dr. Julia-Anik Börger, Dr. David Quarcoo, Dr. Alexander Gerber, Bianca Kusma, Stefania
Mache, Karin Vitzthum and Silvana Kölzow. Without the help of my family and the family
of Knut-Olaf Haustein, this book could not have been realized.
I trust that this book will meet with a good reception both within and outside the field of
medicine.
Berlin, Germany
Prof. Dr. David Groneberg
vii
Contents
1. History of Tobacco ............................................................................................. 1
1.1 Tobacco Plants and Their Origin ............................................................. 1
1.2 Use of Tobacco for Religious Purposes ................................................... 1
1.3 The Appropriation of Tobacco by Europeans .......................................... 2
1.4 Worldwide Spread of Tobacco ................................................................. 3
1.4.1 Development of the Cigar ........................................................................ 5
1.4.2 Development of the Cigarette .................................................................. 5
1.5 Objections to Smoking on Health Grounds ............................................. 7
1.6 Women Won Over by the Cigarette ......................................................... 8
1.7 The Medical Use of Tobacco in the Nineteenth Century ......................... 12
1.8 Tobacco Research in the Twentieth Century............................................ 12
1.9 Concluding Remarks ................................................................................ 14
2. Epidemiology of Tobacco Dependence ............................................................. 17
2.1 Tobacco Consumption in the Twentieth Century ..................................... 18
2.2 Cigarette Smoking in the USA since 1965 .............................................. 19
2.3 Smoking Habits in Germany .................................................................... 20
2.4 Cigarette-Related Mortality in Different Countries ................................. 22
2.5 Other Forms of Tobacco Use ................................................................... 25
2.6 Smokers and Other Risk Factors ............................................................. 27
2.7 Smoking Behaviour and Educational Level in the EU ............................ 28
2.8 Concluding Remarks ................................................................................ 30
3. Tobacco Constituents and Additives ................................................................ 35
3.1 Non-Disclosure of Findings by the Tobacco Industry ............................. 35
3.2 Constituents of Tobacco ........................................................................... 36
3.3 Nicotine and Dependence ........................................................................ 40
3.3.1 The Cigarette as a Vehicle for Nicotine Release ...................................... 41
3.3.2 Modifications of Nicotine Release ........................................................... 41
3.3.3 Maintaining Nicotine Dependence .......................................................... 42
3.3.4 Marketing of Cigarettes with a “Reduced” Health Risk .......................... 43
3.3.5 Compensatory Behaviour by Smokers .................................................... 43
3.3.6 Optimising Nicotine Release ................................................................... 44
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3.3.7 Importance of Absorption Rate ................................................................ 45
3.3.8 Ammonium and pH Manipulation ........................................................... 45
3.4 Tobacco Additives ................................................................................... 46
3.5 Cigarettes with Reduced Tar Yield .......................................................... 48
3.6 Snuff Tobacco .......................................................................................... 50
3.7 Concluding Remarks ................................................................................ 55
4. Pharmacology and Pharmacokinetics of Nicotine .......................................... 61
4.1 The Nicotine Receptor ............................................................................. 61
4.2 Agonists and Antagonists of the nAChR and its Subtypes ...................... 65
4.3 Pharmacology .......................................................................................... 66
4.3.1 Effects of Nicotine on Receptors in Different Organs ............................. 66
4.3.2 Organ Effects and Toxicity ...................................................................... 67
4.3.3 Metabolic and Hormonal Effects of Nicotine .......................................... 68
4.3.4 Central Nervous System Effects of Nicotine ........................................... 68
4.4 Pharmacokinetics of Nicotine .................................................................. 69
4.5 Nicotine Dependence ............................................................................... 73
4.5.1 Types of Dependence ............................................................................... 73
4.5.2 Molecular Biological Aspects of Dependence ......................................... 75
4.5.3 Genetic Aspects ....................................................................................... 77
4.5.4 Withdrawal Symptoms ............................................................................. 79
4.6 Concluding Remarks ................................................................................ 80
5. Smoking and Lung Disease ............................................................................. 87
5.1 Immunological Reactions Caused by Cigarette Smoking ....................... 87
5.2 Cigarette Smoking and Lung Cancer ....................................................... 88
5.2.1 Association Between Smoking and Lung Cancer .................................... 90
5.2.2 Types of Lung Cancer .............................................................................. 91
5.2.3 Genetic Factors That Increase the Risk for Bronchial Carcinoma .......... 93
5.3 Cigarette Smoking and COPD ................................................................. 99
5.3.1 Pathophysiology of COPD ....................................................................... 100
5.3.2 Important Risk Factors for COPD ........................................................... 102
5.4 Cigarette Smoking and Bronchial Asthma .............................................. 103
5.4.1 Caveats Concerning the Informative Value of Studies ............................ 103
5.4.2 Cigarette Smoking and Bronchial Asthma in Adults ............................... 103
5.4.3 Bronchial Asthma in Children ................................................................. 104
5.5 Bronchitis and Pneumonia ....................................................................... 106
5.6 Other Lung Diseases Influenced by Cigarette Smoking .......................... 107
5.7 Concluding Remarks ................................................................................ 107
6. Cardiovascular Disease, Disturbances of Blood
Coagulation and Fibrinolysis ............................................................................ 119
6.1 Coronary Artery Disease and Myocardial Infarction............................... 119
6.2 Systemic Vascular Changes ..................................................................... 123
6.2.1 Regulation of Vascular Tone .................................................................... 125
Contents xi
6.2.2 Changes in Endothelial Function
and Microcirculation ................................................................................ 129
6.2.3 Microcirculation and O Supply .............................................................. 130
2
6.2.4 Arteriosclerotic and Inflammatory Vascular Reactions ........................... 134
6.3 Blood Coagulation and Fibrinolysis ........................................................ 135
6.3.1 Genetic Factors ........................................................................................ 136
6.3.2 Nicotine and Ischaemic Heart Disease .................................................... 136
6.4 Concluding Remarks ................................................................................ 137
7. Other Organ Systems ........................................................................................ 149
7.1 Central Nervous System .......................................................................... 149
7.1.1 Cognitive Impairment .............................................................................. 150
7.1.2 Influence on Cognitive Performance ....................................................... 151
7.1.3 Intellectual Impairment in Childhood ...................................................... 152
7.1.4 Smoker Personality Profiles and Genetic Inheritance of Smoking .......... 154
7.1.5 Depression ............................................................................................... 155
7.1.6 Schizophrenia ........................................................................................... 157
7.1.7 Effects of Smoking in Forms of Dementia .............................................. 159
7.1.8 Smoking and Parkinson’s Disease ........................................................... 160
7.2 Ocular Diseases ........................................................................................ 161
7.2.1 Diabetic Retinopathy ............................................................................... 161
7.2.2 Cataract and Lens Opacity ....................................................................... 162
7.2.3 Graves’ Ophthalmopathy ......................................................................... 163
7.2.4 Macular Degeneration .............................................................................. 163
7.2.5 Glaucoma ................................................................................................. 164
7.2.6 Strabismus ................................................................................................ 164
7.2.7 Ocular Tumours ....................................................................................... 164
7.2.8 Retinal Detachment .................................................................................. 165
7.3 Ears, Oral Cavity and Larynx .................................................................. 165
7.3.1 Harmful Effects on the Ears ..................................................................... 165
7.3.2 Changes in the Oral Cavity ...................................................................... 165
7.3.3 Oral and Laryngeal Cancer ...................................................................... 166
7.4 Disorders of Lipid and Glucose Metabolism ........................................... 167
7.4.1 Lipid and Cholesterol Metabolism .......................................................... 167
7.4.2 Diabetes and Smoking ............................................................................. 169
7.5 Gastrointestinal Tract ............................................................................... 173
7.5.1 Oesophageal Cancer................................................................................. 173
7.5.2 Gastrointestinal Ulcers ............................................................................. 174
7.5.3 Cancers of the Gastrointestinal Tract ....................................................... 175
7.5.4 Pancreatic Cancer..................................................................................... 175
7.6 Urinary Tract Diseases ............................................................................. 176
7.6.1 Toxic Substances and Inducers ................................................................ 177
7.6.2 Kidney Cancer ......................................................................................... 178
7.6.3 Bladder Cancer ........................................................................................ 179
7.6.4 Cancer of the Cervix ................................................................................ 179
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7.6.5 Prostatic Hyperplasia and Prostatic Cancer ............................................. 180
7.6.6 Fertility Disorders .................................................................................... 181
7.7 Disorders of Mineral Metabolism and Bone ............................................ 182
7.7.1 Vitamin D and Oestrogen Metabolism .................................................... 182
7.7.2 Osteoporosis ............................................................................................. 183
7.7.3 Hip Fractures ............................................................................................ 185
7.8 Skin and Mucosa ...................................................................................... 185
7.8.1 Skin Changes ........................................................................................... 186
7.8.2 Psoriasis ................................................................................................... 187
7.8.3 Skin Tumours ........................................................................................... 188
7.8.4 Breast Cancer ........................................................................................... 188
7.9 Haematopoietic System ........................................................................... 189
7.10 Concluding Remarks ................................................................................ 191
8. Smoking and Pregnancy ................................................................................... 221
8.1 Effects of Smoking on the Placenta ......................................................... 222
8.2 Complications of Pregnancy .................................................................... 224
8.3 Malformations Possibly Caused by Smoking .......................................... 227
8.4 Smoking and Sudden Infant
Death Syndrome (SIDS) .......................................................................... 230
8.5 Foetotoxic Effects of CO ......................................................................... 232
8.6 Effects of Nicotine on the Foetus ............................................................. 233
8.7 Smoking and Breast-feeding .................................................................... 234
8.8 Medical Care Costs Attributable
to Smoking During Pregnancy ................................................................. 236
8.9 Concluding Remarks ................................................................................ 236
9. Passive Smoking ................................................................................................. 247
9.1 ETS in the Workplace and at Home ......................................................... 250
9.2 Changes at the Molecular and Cellular Level .......................................... 252
9.2.1 Fibrinogen ................................................................................................ 253
9.2.2 Cholesterol ............................................................................................... 253
9.2.3 Endothelium and Platelets ....................................................................... 253
9.2.4 Markers of Inflammation ......................................................................... 254
9.2.5 ETS and Drug Metabolism ...................................................................... 256
9.3 Passive Smoking During
and After Pregnancy ................................................................................ 256
9.4 Cardiovascular Disease ............................................................................ 258
9.4.1 Coronary Heart Disease ........................................................................... 258
9.4.2 Arteriosclerosis ........................................................................................ 260
9.4.3 Stroke and Subarachnoid Haemorrhage................................................... 262
9.5 Respiratory Tract...................................................................................... 263
9.5.1 Respiratory Tract in Children and Teenagers .......................................... 263
9.5.2 Bronchial Carcinoma ............................................................................... 267
9.6 Complications of Anaesthesia ................................................................. 270
