[conspire] A few words about smoking and death

[Rick Moen]

There were a number of things I admired about my friend, the late David
Fox, who most of you will have known as an active CABAL member.  One of
them is that he had, earlier this year, managed to quit a tobacco
smoking habit of many decades, something that undoubtedly takes a heroic
level of determination.

One of the many reasons to quit smoking, if you've started, is that
pretty much all of the damage it does to your lungs and
circulatorysystem heals within not too many months, if you're lucky.
Unfortunately, in that respect, David wasn't lucky:  I should hasten to
say that I carefully didn't pry into David's medical problems and have
no inside knowledge of what caused his death, but I do know that he'd
been diagnosed by prior doctors with chronic obstructive pulmonary
disease (COPD).  See:
http://en.wikipedia.org/wiki/Chronic_obstructive_pulmonary_disease

Because I don't know the other facts of David's case, I can't really
talk further about what killed him.  However, I can talk about smoking
and COPD.

If you're a non-smoker, you have an excellent shot at living to be a
healthy 80 year old.  In a 1993 study[1], almost 60% of non-smokers lived
to 80, and that's without taking particular care of yourself otherwise.
Smokers?  By contrast, not a good chance at all -- _three out of four_
are dead by 80.

If, like me, you'd like to live and be healthy for a long time, it might 
be interesting to read what, statistically speaking, kills us.  The
Centers of Disease Control and Prevention, among other groups, keep
track of American statistics, and it's been pretty consistent for some
years.  The 2006 summary[2] says:

#1  Heart disease, 631,636 deaths - 29%
#2  Cancer, 559,888 deaths - 23%
#3  Stroke, 137,119 deaths - 7%
#4  Chronic obstructive pulmonary disease, 124,583 deaths - 5%
#5  Unintentional (non-homocide) injuries from all causes, 121,599 deaths - 4%
#6  Diabetes, 72,449 deaths - 3%
#7  Alzheimers, 72,432 - 3%
#8  Influenza & pneumonia, 56,326 deaths - 2%
#9  Kidney disease (nephritis, nephrosis, etc.), 45,334 deaths - 2%
#10 Septicemia (death by systemic infection), 34,234 deaths - 1%

One commentator points out[3] that the CDC summary omits iatrogenic causes 
-- death through doctors' blunders -- and that it might be as high as #3 
on that list.  So, pick your doctors carefully.

(The notion of what is a "cause" is potentially somewhat misleading and
debatable.  Someone's heart attack may be a secondary effect of a more
fundamental failure, for example.)

Otherwise, COPD is the fourth leading cause of death.  80-90% of COPD is
proximately caused by long-term tobacco smoking that causes enough 
irritation of the lungs to tip the patient into either irreparable
chronic bronchitis (damage to the upper lung) or irreparable chronic 
emphysema (damage to the lower lung).  

Note that tobacco smoking also has major roles in death causes #1, 2, 
and 3.

10-20% of COPD worldwide might be caused in part by long-term exposure
to high levels of industrial pollutants/chemicals, or cotton-processing
particles in the air, coal-mining dust, Third World cities' smog,
unprotected use of welding gear over many years, and so on.  But mostly
it's just plain old smoking.

Advanced COPD can kill in a number of ways.  First, you're basically
dying of anoxia -- inability to breathe.  Some patients basically
suffocate, but this is rare.  The lung damage is irreversible:  All
the doctors can do is give you inhalers and oxygen therapy to let you
get more mileage over the air you can breathe in, and help you get over
any infections or allergies that could kill you sooner.

Advanced cases suffer serious levels of edema (swelling from fluid
retention) that affects the entire body including the brain.  At the
same time, the heart increases blood pressure, particularly in the
lungs (pulmonary blood pressure), to attempt to compensate for lower
oxygen levels - thus, hypertension and heart disease.  The patient might
suffer right-side heart failure, or stroke, or the systemwide edema may
cause the brain to swell to the point of permanent brain damage, with
death then proximately resulting from damage to the brain stem.

Are you ready to quit smoking, yet?


[1] _Addiction_ magazine, 97:15-28 (2002).
[2] http://www.cdc.gov/nchs/FASTATS/deaths.htm
[3] http://www.benbest.com/lifeext/causes.html