Mechanisms of chronic airway obstruction in smokers
Mechanisms of chronic airway obstruction in smokers
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DOI：
10.1016/j.rmed.2003.09.005
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发表时间：
2004-02-01
影响因子：
4.3
通讯作者：
Martinet, Y
中科院分区：
文献类型：
--
作者：
Bohadana, A;Teculescu, D;Martinet, Y
过去几十年的研究表明，吸烟与慢性气道阻塞的发展之间存在明确的联系。然而，只有少数吸烟者受到影响，因此在许多吸烟者中，即使是重度吸烟者，肺功能也保持在正常范围内。虽然致癌物已得到很好的表征，但有关香烟烟雾中引起慢性气道阻塞的成分的信息有限。此外，吸烟者气道阻塞的相关危险因素尚未完全确定。本文综述了近年来有关香烟烟雾在大、小气道和肺实质水平上的密切作用。经典的炎症细胞，如中性粒细胞和肺泡巨噬细胞的作用进行了审查，但重点放在最近的证据表明，参与的CD8+ T淋巴细胞和可能的嗜酸性粒细胞的结构变化，导致气道阻塞的成因。气道炎症和重塑引起气道狭窄和气流限制的机制进行了讨论，沿着相关的折腾肺弹性继发于破坏性肺气肿。其他生物学，流行病学，病理生理学和临床方面进行了分析，强调这些基本方面的防御机制，形态功能的相关性，识别易感吸烟者，并在专门的实验室和初级保健气道阻塞的早期检测。(C)2003爱思唯尔有限公司。保留所有权利。
Studies over the past few decades have showed a clear association between cigarette smoking and the development of chronic airway obstruction. Yet, only a minority of smokers is affected so that in many, even heavy, smokers, pulmonary function remains within normal limits. While carcinogens have been well characterized, there is only limited information about the constituents of cigarette smoke responsible for inducing chronic airway obstruction. In addition, the associated risks factors for airway obstruction in smokers have not been totally identified. The present paper is a review of the recently accumulated facts concerning the intimate action of cigarette smoke at the Level of large and small airways and lung parenchyma. The role of classical inflammatory cells such as neutrophils and alveolar macrophages is reviewed, but emphasis is put on recent evidence indicating the involvement of CD8+ T-lymphocytes and possibly eosinophils in the genesis of the structural changes leading to airways obstruction. The mechanisms by which airway inflammation and remodelling cause airway narrowing and airflow limitation are discussed, along with the associated toss of lung elasticity secondary to destructive emphysema. Other biological, epidemiological, physiopathological, and clinical aspects are analyzed, stressing such fundamental aspects as the defence mechanisms, the morpho-functional correlations, the identification of susceptible smokers, and the early detection of airway obstruction, both in specialized laboratories and in primary care. (C) 2003 Elsevier Ltd. All rights reserved.