Particulate matter has no politics, as I frequently tell my patients. Recently in Oregon, we were all very concerned about the hazardous PM2.5 levels permeating our communities. As a lung and ICU doctor who works in the COVID19 pandemic, I also worried about the increased particulate matter making COVID19 more severe and potentially more contagious as well, particularly for our wildland firefighters and those fleeing fires who had to crowd into smoke shelters or move in with family and friends . One of the reasons I have that fear is because tobacco has taught us that smoke and lung infections are a deadly combination.
Another lung and ICU doctor who knows that well is Dr. Farzad Moazed, MD, who has studied the impacts of tobacco on the Acute Respiratory Distress Syndrome (ARDS), which is the dreaded fulminant respiratory failure that can be seen from severe viral illnesses like influenza and COVID19.
Dr. Moazed did his residency in internal medicine at Northwestern and completed his fellowship in pulmonary and critical care medicine at University California San Francisco, where he researched the interaction between acute lung injury and tobacco. He currently works at Highland Hospital in Oakland, CA. We talked on the podcast about the interaction between tobacco use and ARDS.
Tobacco use increases the risk of severe ARDS, and Dr. Moazed’s research has shows this may be because lungs of people who smoke become more “leaky” and have a more severe inflammatory response (marked by a chemical released in our body called Interleukin-8) when exposed to a typical protein in common lung infections (LPS).
We touch a little bit on the history of Big Tobacco and its obfuscation in general, which I have also covered on a previous post. At the time of our interview, we were in a slightly different place in COVID19 treatment, but the magnitude of taking someone from a smoker to a non-smoker to potentially prevent a severe case of COVID19 seems to be one of the best “therapies” out there, though we have to do it in advance. Anything we can do to help our country quit smoking will decrease the severity and likely death toll of COVID19, in addition to saving lives from Big Tobacco in general.
As always, we try to touch on the “wealth” we could be preserving if we could eliminate the scourge of tobacco from our communities. Take a moment, if you can, to work for a tobacco free community in your area.
TLDR= Don't Light Things on Fire and Breathe them into your Lungs
What Can you Do?
1- Support people to quit smoking and vaping- do this in every way you can. If you smoke, go to the Tobacco and Veterans post to learn more about how to quit. If you don’t, donate to the ALA or the Campaign for Tobacco Free kids (on Invest part of site). Wear a T-shirt telling people not to light things on fire and breathe them into their lungs.
2- Support tobacco taxes– honestly, I generally vote for tobacco taxes, even if I don’t like the design, because I will take anything that helps get this scourge out of people’s lives. The best ones go only to funding cessation programs and healthcare, and I think Measure 108 in Oregon fits that bill. Learn more about its design in my conversation with Cyreena Boston Ashby, and by going here. If nobody is working on one in your state or community, or if there is a carve-out for vaping, be the person in your community who works on it. We can stop when it is $16/pack or higher, or everyone just quits smoking.
Twitchy Airways Club Members-
1- if you smoke, please get help to quit. You can find resources here, and support and motivation from my conversation with veteran Brandy Carpenter. Also feel free to get in touch with me via the website or Instagram if you need more resources or have questions.
2- use your voice as someone with lung disease to talk about the importance of healthy air! You can learn more at the Tobacco & Vaping section.
3- Speak up for your own health- if someone is smoking or vaping around you, you can ask them to make choices that preserve healthy air for you. If you are willing to share that you have lung disease, you can, or you can just remind them that healthy air is good for everyone
References:
ARDS– general info from American Lung Association on Acute Respiratory Distress Syndrome
Moazed F et al. Cigarette Smoking and ARDS After Blunt Trauma: The Influence of Changing Smoking Patterns and Resuscitation Practices. Chest. June 2020.- showing active and passive smoking exposure increases ARDS risk.
Moazed F et al. Cigarette smokers have exaggerated alveolar barrier disruption in response to lipopolysaccharide inhalation. Thorax. 2016 Dec;71(12):1130-1136. – showing exaggerated response in smokers to an infection toxin (LPS)
COVID19 ARDS case– image from Radiopaedia
More references at prior posts listed above.
When smokers switched from traditional cigarettes to “heat-not-burn” devices, researchers didn’t find any evidence of improvements in lung function or reductions in inflammation that can signal tobacco-related blood vessel damage. “Even if a patient could switch completely from regular cigarettes to heat-not-burn products, Philip Morris International’s own data shows that there will continue to be significant health risks associated with these products,” said lead study author Dr. Farzad Moazed of the University of California, San Francisco.
Yes, I think there was a lot of hope that anything has to be better than traditional cigarettes. I shared that when my patients started bringing e-cigarettes to clinic, but the science has shown us a great deal of harm that is possible from them as well. Whether they will be as lethal over a lifetime as combustible cigarettes is not known. Best is to not inhale anything but good clean air! For more on vaping and non-combustible cigarettes, can look at post and podcast interview with Jeff Gotts here.