Structural Aspects of Cigarette Smoke-Induced Pulmonary Disease

  • P. K. Jefferey
  • D. F. Rogers
  • M. M. Ayers
  • P. A. Shields
Part of the Ettore Majorana International Science Series book series (PSLI)


Smoking is the most important cause of preventable early death and loss of working time in the United Kingdom. Two out of five heavy smokers die before they are 65 - double the proportion of non-smokers. The most serious risk of smoking is lung cancer which kills over 38,000 people each year in the United Kingdom 80% of them men. The association of lung cancer, particularly squamous cell carcinoma, and cigarette smoking is clear cut. The death rate from the disease in heavy smokers is 30 times that in non-smokers. Other smoking-related pulmonary diseases of major significance are chronic bronchitis and emphysema. Asthma is exacerbated by smoking but is not caused by it. The pathologist faces the difficulty of only seeing the later stages in the natural history of each disease but by careful comparison of clinical material and the use of experimental animal models correlations of structure and function can be made and pathogenesis established. The structural parameters and the diseases to which they relate which will be discussed herein are: (i) mucosal sensitivity (asthma and bronchitis); (ii) cilia and mucus (bronchitis); (iii) phagocytic cells (emphysema) and (iv) squamous metaplasia/atypia (carcinoma).


Tobacco Smoke Chronic Bronchitis Small Airway Mucous Cell Squamous Metaplasia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Ailsby, R.L., Ghadially, F.N. (1973). Atypical cilia in human bronchial mucosa. J. Pathol, 109, 75–77.CrossRefGoogle Scholar
  2. Ayers, M., Jeffery, P.K. (1982). Cell division and differentiation in bronchial epithelium. In: Cellular Biology of the Lung (ed: G. Cumming & G. Bonsignore). Vol. 10, of Life Science series (ed. A. Zichichi ). pp. 33–54. Plenum, New York.Google Scholar
  3. Bjelke, E. (1975). Dietary Vitamin A and human lung cancer. Intern. J. Cancer 15, 561.CrossRefGoogle Scholar
  4. Bolduc, P., Jones, R., Reid, L. (1981). Mitotic activity of airway epithelium after short exposure to tobacco smoke and the effect of the anti-inflammatory agent phenylmethyloxidiazole. Brit. J. Exp. Path., 62, 461–468.Google Scholar
  5. Boucher, R.C., Johnson, J., Inone, S. et al (1980), The effect of cigarette smoke on the permeability of guinea pig airways. Lab. Invest. 43, 94–100.Google Scholar
  6. Bowes, D., Corrin, B. (1977). Ultrastructural immunocytochemical localization of lysozyme in human bronchial glands. Thorax 32, 163–170.CrossRefGoogle Scholar
  7. Bowes, D., Clark, A.E., Corrin, B. (1981). Ultra-structural localization of lactoferrin and glycoprotein in human bronchial glands. Thorax, 36, 108–115.CrossRefGoogle Scholar
  8. Coggon, D., Acheson, E.D. (1983), Trends in lung cancer. Thorax 38, 721–723.CrossRefGoogle Scholar
  9. Cohen, G.M. (1982), The induction of cancer by chemicals. In: Cellular Biology of the Lung (ed: G. Cumming, G. Bonsignore), Vol. 10 of Life Sciences Series (ed: A. Zichichi ), pp. 425–432, Plenum, New York.Google Scholar
  10. Cosio, M.G., Hale, K.A., Niewoehner, D.E. (1980), Morphologic and morphometric effects of prolonged cigarette smoking on the small airways. Amer Rev. Resp. Dis., 122, 265–271.Google Scholar
  11. Ebert, R.V., Terracio, M.J. (1973), The bronchiolar epithelium in cigarette smokers: observations with the scanning electron microscope. Am. Rev. Resp. Dis., 111, 4–11.Google Scholar
  12. Fletcher, C.M. (1975), The natural history of chronic bronchitis. Community Health, 7, 70–78.Google Scholar
  13. Gadek, J.E., Hunninghake, G.W., Fells, G.A., Zimmerman, R.L. Keogh, B.A., Crustal, R.G. (1980), Evaluation of the protease-antiprotease theory of human destructive lung disease. Bull. Europ. Physiopath. Resp, 16 (suppl), 27–40.Google Scholar
  14. Harris, J.O., Swenson, E.W., Johnson, J.E. (1970), Human alveolar macrophages: comparison of phagocytic ability, glucose utilization and ultrastructure in smokers and non-smokers. J. Clin. Invest, 49, 2086–2096.CrossRefGoogle Scholar
  15. Hinman, L.M., Stevens, C.A., Matthay, R.A., Gee, J.B.L. (1980), Elastase and lysozyme activities in human alveolar macrophages: effects of cigarette smoking. Amer. Rev. Resp. Dis., 121, 263–272.Google Scholar
  16. Hopkin, J.M., Tomlinson, V.S., Jenkins, R.M. (1981), Variations in response to cytotoxicity of cigarette smoke. Brit. Med. J., 283, 1209–1211.CrossRefGoogle Scholar
  17. Hutchinson, D.C.S. (1973), Alpha-l-antitrypsin deficiency and pulmonary emphysema: the role of proteolytic enzymes and their inhibitors. Brit. J. Dis. Chest, 67, 171–196.CrossRefGoogle Scholar
  18. Janof, A., Sloan, B., Weinbaum, G., Daminao, V., Sandhaus, R.A., Elias, J., Kimbel, P. (1977). Experimental emphysema induced with purified human neutrophil elastase. Tissue localisation of the instilled protease. Amer. Rev. Resp. Dis., 115, 461–478.Google Scholar
  19. Jeffery, P.K., Reid, L. (1975), New observations of rat airway epithelium: a quantitative electron microscopic study. J. Anat. 120, 295–320.Google Scholar
  20. Jeffery, P.K., Reid, L. (1981), The effect of tobacco smoke, with or without phenylmethyloxadiazole (PMO), on rat bronchial epithelium: a light and electron microscopic study. J. Pathol. 133, 341–359.CrossRefGoogle Scholar
  21. Jeffery, P.K. (1982), The innervation of bronchial mucosa. In: Cellular Biology of the Lung (ed: G. Cumming & G. Bonsignore), Vol. 10 of Life Science series, (ed. A. Zichichi ), pp 1–32, Plenum, New York.Google Scholar
  22. Jeffery, P.K., Romano, H., Hutchison, D., Baum, H. (1983), Effect of the water soluble gaceous fraction of tobacco smoke on phagocytosis and morphology of human peripheral blood neutrophils: comparison of normal and emphysematous subjects. Proc. Brit. Thoracic Soc. Thorax 38, 229.Google Scholar
  23. Jeffery, P.K., Romano, H., Hutchison, D., Baum, H. (1983), Effect of the water soluble gaceous fraction of tobacco smoke on phagocytosis and morphology of human peripheral blood neutrophils: comparison of normal and emphysematous subjects. Proc. Brit. Thoracic Soc. Thorax 38, 229.Google Scholar
  24. Jones, R., Bolduc, P., Reidl L. (1972), Protection of rat bronchial epithelium against tobacco smoke. Brit. Med. J., 2, 142–144.CrossRefGoogle Scholar
  25. Karlinsky, J.B., Snider, G.L. (1978), State of the art. Animal models of emphysema. Amer. Rev. Resp. Dis., 117, 1109–1133.Google Scholar
  26. Kent, J.F. (1966), Distribution and fine structure of globular leukocytes in respiratory and digestive tracts of the laboratory rat.Google Scholar
  27. Kollerstrom, N., Lord, P.W., Whimster, W.F. (1977), A difference in the composition of bronchial mucus between smokers and non-smokers. Thorax, 32, 155–159.CrossRefGoogle Scholar
  28. Lamb, D., Reid, L. (1968), Mitotic rates, goblet cell increase and histochemical changes in mucus in rat bronchial epithelium during exposure to sulphur dioxide. J. Path. Bac. 96, 97–111.CrossRefGoogle Scholar
  29. Lamb, D., Reid, L. (1969), Goblet cell increase in rat bronchial epithelium after exposure to cigarette and cigar tobacco smoke.Google Scholar
  30. Lamb, D., Lumsden, A. (1982), Intra-epithelial mast cells in human airway epithelium: evidence for smoking-induced changes in their frequency. Thorax, 37, 334–342.CrossRefGoogle Scholar
  31. Lieberman, J. (1976), Elastase, collagenase, emphysema and alpha-l-antitrypsin deficiency. Chest 70, 62–67.CrossRefGoogle Scholar
  32. Macklem, P.T., Proctor, D.F., Hogg, J.C. (1970), The stability of peripheral airways. Resp. Physiol. 8, 191–203.CrossRefGoogle Scholar
  33. McDermott, M.R., Befus, A.D., Bienenstock, J. (1982), The structural basis for immunity in the respiratory tract. Intern. Rev. Exp. Pathol., 23, 47–112.Google Scholar
  34. McDowell, E.M., Combs, J.W., Newkirk C. (1983), Changes in secretory cells of hamster tracheal epithelium in response to acute sublethal injury: a quantitative study. Exp. Lung Res. 4, 227–243.CrossRefGoogle Scholar
  35. Minty, A.D., Jordan, C., Jones, J.G. (1981), Rapid improvement in abnormal pulmonary epithelial permeability after stopping cigarettes. Brit. Med. J., 282, 1183–1186.CrossRefGoogle Scholar
  36. Mooren, H.W.D., Kramps, J.A., Franken, C., Meijer, C.J.L.M., Dijkman, J.A. (1983), Localisation of a low-molecular-weight bronchial protease inhibitor in the peripheral human lung. Thorax 38, 180–183.CrossRefGoogle Scholar
  37. Niden, A.H. (1967), Bronchiolar and large alveolar cell in pulmonary phospholipid metabolism. Science, 158, 1323–1324.ADSCrossRefGoogle Scholar
  38. Niewoehner, D.E., Kleinerman, J., Rice, D.B. (1974), Pathologic changes in the peripheral airways of young cigarette smokers. New. Eng. J. Med., 291, 755–758.CrossRefGoogle Scholar
  39. Reid, L. (1954), Pathology of chronic bronchitis. Lancet 1, 275–279.CrossRefGoogle Scholar
  40. Richardson, J.B., Bouchard, T., Ferguson, C.C. (1976), Uptake and transport of exogenous proteins by respiratory epithelium. Lab. Invest. 35, 307–314.Google Scholar
  41. Senior, R.M., Tegner, H., Kuhn, C., Ohlsson, K., Starcher, B.C., Pierce, J.A. (1977), The induction of pulmonary emphysema with human leukocyte elastase. Amer. Rev. Resp. Dis., 116, 469–475.Google Scholar
  42. Senior, R.M., Tegner, H., Kuhn, C., Ohlsson, K., Starcher, B.C., Pierce, J.A. (1977), The induction of pulmonary emphysema with human leukocyte elastase. Amer. Rev. Resp. Dis., 116, 469–475.Google Scholar
  43. Stedman, R.L. (1968), The chemical composition of tobacco and tobacco smoke. Chem. Rev. 68, 153–207.CrossRefGoogle Scholar
  44. Turner, N.C., Marriott, C., Machling, R. (1983), An evaluation of an in vivo model of tracheobronchial glycoprotein secretion. In: Glycoconjugates (eds. M. A. Chester et al. pp. 574–575.Google Scholar
  45. Wald, N., Idle, M., Boreham, J. (1980), Low serum Vitamin A and subsequent risk of cancer: preliminary results of a prospective study. Lancet 2, 813–815.CrossRefGoogle Scholar
  46. Warr, G.A., Martin, R.R. (1974), Chemotactic responsiveness of human alveolar macrophages: effects of smoking. Infect. & Immunity 2, 769–771.Google Scholar
  47. Wells, A.B., Lamerton, L.F. (1975), Regenerative responses of rat tracheal epithelium after acute exposure to tobacco smoke: a quantitative study. J. Natl. Conc. Inst. 55, 887–891.Google Scholar

Copyright information

© Plenum Press, New York 1984

Authors and Affiliations

  • P. K. Jefferey
    • 1
  • D. F. Rogers
    • 1
  • M. M. Ayers
    • 1
  • P. A. Shields
    • 1
  1. 1.Department of Lung PathologyBrompton HospitalLondonEngland

Personalised recommendations