A pulmonologist called active smoking the main provocateur of COPD

Active smoking is the main provoker of chronic obstructive pulmonary disease (COPD). Lidiya Nikitina, a pulmonologist from the National Medical Research Center for Pulmonology at the I.M. Sechenov First Moscow State Medical University, told Izvestia about this on October 11.

According to her, the official statistics on COPD are just the tip of the iceberg. Rosstat reports 820,000 identified cases in 2024, but the real picture shown by Russian population screenings is much larger — functional signs of COPD are observed in about 11 million Russians, in fact, one in 10.

"The main instigator of the disease is active smoking. The risk directly depends on the length of service: 10 years of a pack a day is already enough to get tested. Passive smoking, occupational dust, and the smog of megacities pose a threat," the specialist noted.

Nikitina clarified that the progression of the disease can be stopped, but only at the start, when the patient may be bothered only by a slight cough, but there is no shortness of breath yet. According to her, if at this moment a person quits smoking, and the doctor connects inhalation therapy, only then there is a minimal chance that the disease will develop further.

At the moment, as the doctor clarifies, there are such effective means of control as modern aerosol and powder inhalers that deliver medicine to the bronchi and small airways of the bronchioles. Nikitina emphasized that they not only expand them by acting on the receptors, but also work against inflammation. The treatment regimen is selected individually, taking into account the severity of the condition and the frequency of exacerbations.

"And an exacerbation is a critical event in a patient's life. Each episode is a powerful impetus for the progress of the disease, narrowing the bronchial lumen irreversibly. The task of modern therapy is to prevent these attacks, reduce their number and thereby significantly prolong the life of our patients," said the pulmonologist.

She drew attention to the publication in The Washington Post of a study according to which the content of carbonaceous particles in the lungs of patients with COPD was three times higher than in smokers without a corresponding diagnosis.

The specialist suggested that the reason may be that their lungs are losing their ability to self-clean. According to her, pulmonary alveolar macrophages, which serve as protective cells that absorb and neutralize harmful particles, are responsible for this function. However, in patients with COPD, these "cleaners" are overloaded with carbon.

"It opens up a new perspective.: the higher the dose of particulate matter from tobacco smoke, the higher the risk of illness. Macrophage dysfunction exacerbates the course of COPD and leads to loss of lung function. Now we have a potential target for new therapies — the restoration of macrophage function. It is likely that this will affect the development of laboratory diagnostics," Nikitina added.

The doctor called it important for patients with chronic obstructive pulmonary disease to see a doctor regularly, check the function of organs and strictly follow prescriptions without skipping medications. As the specialist notes, in this case it is important to realize that continuing smoking is out of the question, since this is no longer a habit, but a drug problem. In case of a lack of willpower in the patient, she urged to contact the dispensary.

"Unfortunately, too often we see a person already in serious condition, when respiratory support is required. And only then does the real realization come: you need to quit smoking. But waiting for this moment is an unacceptable luxury," Nikitina concluded.

Earlier, on September 3, Academician of the Russian Academy of Sciences, chief pulmonologist of the Ministry of Health Sergey Avdeev urged Russians to get checked for COPD. According to him, smokers in the country were massively diagnosed with "chronic bronchitis", which turned out to be incorrect. The specialist emphasized that in order to identify the true clinical picture, spirometry should be performed, which reveals a violation of respiratory function — a clear sign of COPD.

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