Tobacco and COPD: presenting the World Health Organization (WHO) Tobacco Knowledge Summary

Abstract

The WHO recently published a Tobacco Knowledge Summary (TKS) synthesizing current evidence on tobacco and COPD, aiming to raise awareness among a broad audience of health care professionals. Furthermore, it can be used as an advocacy tool in the fight for tobacco control and prevention of tobacco-related disease. This article builds on the evidence presented in the TKS, with a greater level of detail intended for a lung-specialist audience. Pulmonologists have a vital role to play in advocating for the health of their patients and the wider population by sharing five key messages: (1) Smoking is the leading cause of COPD in high-income countries, contributing to approximately 70% of cases. Quitting tobacco is an essential step toward better lung health. (2) People with COPD face a significantly higher risk of developing lung cancer. Smoking cessation is a powerful measure to reduce cancer risk. (3) Cardiovascular disease, lung cancer and type-2 diabetes are common comorbidities in people with COPD. Quitting smoking not only improves COPD management, but also reduces the risk of developing these coexisting conditions. (4) Tobacco smoke also significantly impacts children's lung growth and development, increasing the risk of respiratory infections, asthma and up to ten other conditions, and COPD later in life. Governments should implement effective tobacco control measures to protect vulnerable populations. (5) The tobacco industry's aggressive strategies in the marketing of nicotine delivery systems and all tobacco products specifically target children, adolescents, and young adults. Protecting our youth from these harmful tactics is a top priority.

Keywords: Chronic obstructive pulmonary disease; Smoking; Smoking cessation; Tobacco control.

Fig. 1

Tobacco smoking and development of Chronic Obstructive Pulmonary Disease (COPD). There were 329 million cases of COPD globally in 2019, with high rates of mortality and morbidity. The leading risk factor for developing COPD is smoking, including early life exposure. The pathogenesis of COPD involves various factors such as airway inflammation, oxidative stress, genetic factors, epithelial-mesenchymal transition (EMT) mediated airway remodeling, and endothelial-mesenchymal transition (EndMT) mediated vascular remodeling. COPD often coexists with other conditions such as lung cancer, cardiovascular diseases, and pulmonary hypertension as common comorbidities

Fig. 2

Chronic obstructive pulmonary disease (COPD) and multimorbidity, and the management strategies. The most common comorbidities in COPD include cardiovascular diseases, lung cancer, gastro-oesophageal reflux disease (GERD), skeletal muscle wasting, osteoporosis, depression and anxiety, which normally affect COPD progression and management. Most COPD patients have three or more comorbidities. Multidisciplinary management strategies, including smoking cessation, weight management, dietary changes, exercise training, medication and psychological counselling, are essential for COPD patients with multimorbidity