Every year on the last day in May, World No Tobacco Day is observed as an occasion to take action against tobacco.

Every year, the WHO leads the selection of a new theme for the day’s campaigns to keep the messaging fresh and to demonstrate the breadth of issues that get swept up into the fight against tobacco, something the Tobacco Atlas team knows a thing or two about!

This year’s theme is lung health. It is a foundational subject in the tobacco control world and worth delving into a bit.

For starters, when we examine the health effects of tobacco on lung health, one characteristic really jumps out from the data. While tobacco is responsible for some harm to every major organ system, the proportion of lung-related deaths that are attributable to tobacco use is gigantic.

While tobacco might kill more people through ischemic heart disease (3.4% of all global deaths are tobacco-caused ischemic heart disease) than through chronic obstructive pulmonary disease (COPD) (2.5% of all global deaths and tobacco-caused COPD), the proportion of COPD attributable to tobacco use is far greater than in ischemic heart disease (44% versus 22%). For lung cancer, which causes 3.4% of global deaths, an astounding 65% is attributable to tobacco use.

Treeplot of Tobacco’s Global Harms by Disease, Global Burden of Disease Project 2017

Lung Cancer

Tobacco causes 65% of all lung cancer deaths. That rate is higher still in areas without serious ambient air pollution problems and is lower where air pollution is more severe.

By itself, lung cancer is responsible for one in five cancer deaths around the world and is the leading cause of deaths from cancer among men in 87 countries and for women in 26 countries. Even in the most advanced medical systems, survival rates for those diagnosed with lung cancer are among the lowest of any cancer site, contributing heavily to its place as a leader in deaths caused.

The good news about lung cancer though is that unlike many other cancers, an individual’s risk for contracting the disease is heavily modifiable through making one change in their life. Quitting smoking. Prior to the rise of cigarette smoking, lung cancer was an unfamiliar condition to most physicians. Recognizing that there are still lung cancers completely unrelated to tobacco use, eliminating smoking will go a long way to making lung cancer a much less common disease.

Chronic Obstructive Pulmonary Disorder (COPD)

COPD is made up of a series of diseases including chronic bronchitis and emphysema, which are caused by chronic irritation and inflammation of the airways that make up the lungs. Over time, COPD makes it more and more difficult for a person to breathe. The pain and discomfort caused by COPD needs to be communicated in the words of those afflicted with the condition. Qualitative studies on the subject are extensive, as this meta-analysis of 82 such papers shows.

“I’m afraid to go out. The last time I went out I thought, oh my God, is this it? I’m going to die (laughs) … Couldn’t get any air. You don’t get … cramp but you become completely … How can I describe it … Anxious // When it passes I take Ventolin and wait. Yes then everything’s fine again … for a while.” – A 70 Year Old Female with COPD in Sweden

“I can face the fact that, when the end comes, I’ll be gasping for air. That’s my life, I’m always out of breath. So when the time comes I know for sure that I’ll be gasping for air.” –A Woman with COPD in Canada

The toll of COPD is consequently enormous.

Tuberculosis and Lower Respiratory Infections

Tobacco is a perfidious disease vector because it does not stop at harming the tobacco user alone over the decades in a chronic fashion. It also contributes to the burden of communicable disease.

Tobacco use weakens the human immune systems’ ability to fight off infection. Smoking increases the likelihood that someone will contract tuberculosis and decreases the effectiveness of treatment. If tobacco use were eliminated globally, the prevalence of tuberculosis would fall by a fifth.

The Bottom Line

Tobacco use damages lungs in myriad ways. But luckily for us, most of the damage is preventable. Utilizing strong tobacco control policy tools will bring down the burden on lung health and help us all breathe a bit more easily.

By Alex Liber