In summary, the majority of studies so far reported indicate that cigarette smokers run a higher risk of developing postopera- tive pulmonary complications than do nonsmokers, corroborating a long-held clinical impression. The risk of developing such com- plications appears to increase with increasing dosage of cigarette smoke. SUMMARY AND CONCLUSIONS 1. Cigarette smoking is the most important cause of chronic ob- structive bronchopulmonary disease in the United States. Ciga- rette smoking increases the risk of dying from pulmonary emphy- sema and chronic bronchitis. Cigarette smokers show an increased prevalence of respiratory symptoms, including cough, sputum pro- duction, and breathlessness, when compared with nonsmokers. Ventilatory function is de¢reased in smokers when compared with nonsmokers. 2. Cigarette smoking does not appear to be related to death from bronchial asthma although it may increase the frequency and se- verity of asthmatic attacks in patients already suffering from this disease. 8. The risk of developing or dying from COPD among pipe and/ or cigar smokers is probably higher than that among nonsmokers while clearly less than that among cigarette smokers. 4. Ex-cigarette smokers have lower death rates from COPD than do continuing smokers. The cessation of cigarette smoking is associated with improvement in ventilatory function and with a decrease in pulmonary symptom prevalence. 5. Young, relatively asymptomatic, cigarette smokers show measurably altered ventilatory function when compared with non- smokers of the same age. 6. For the bulk of the population of the United States, the im- portance of cigarette smoking as a cause of COPD is much greater than that of atmospheric pollution or occupational exposure. How- ever, exposure to excessive atmospheric pollution or dusty occupa- tional materials, and cigarette smoking may act jointly to produce greater COPD morbidity and mortality. 7. The results of experiments in both animals and humans have demonstrated that the inhalation of cigarette smoke is associated with acute and chronic changes in ventilatory function and pul- monary histology. Cigarette smoking has been shown to alter the mechanism of pulmonary clearance and adversely affect cillary function. 8. Pathological studies have shown that cigarette smokers who die of diseases other than COPD have histologic changes charac- 201 teristic of COPD in the bronchial tree and pulmonary parenchyma more frequently than do nonsmokers. 9. Respiratory infections are more prevalent and severe among cigarette smokers, particularly heavy smokers, than among nonsmokers. 10. Cigarette smokers appear to develop postoperative pulmo- nary complications more frequently than nonsmokers. CHRONIC OBSTRUCTIVE BRONCHOPULMONARY DISEASE REFERENCES (1) AssoTt, O. A., Hopkins, W. A., VAN FLEIT, W. E., Rosinson, J. S. A new approach to pulmonary emphysema. Thorax 8: 116-132, 1953. (2) ALBERT, R. E., LIPPMANN, M., Briscoe, W. The characteristics of bron- chial clearance in humans and the effects of cigarette smoking. Archives of Environmental Health 18(5) : 738-755, May 1969. ALBERT, R. E., SPIEGELMAN, J. R., SHATSKY, S., LIPPMANN, M. The effect of acute exposure to cigarette smoke on bronchial clearance in the miniature donkey. Archives of Environmental Health 18(1): 30-41, January 1969. (4) Anperson, A. E., Jr., FURLANETO, J. A.. Foraker, A. G. Bronchopul- monary derangements in nonsmokers. American Review of Respira- tory Diseases 101(4): 518-527, April 1970. (5) ANDERSON, A. E., Jn., HERNANDEZ, J. A., ECKERT, P., Foraker, A. G. Emphysema in lung macrosections correlated with smoking habits. Science 144(3621) : 1025-1026, May 22, 1964. (6) ANDERSON, A. E., JR., HERNANDEZ, J. A., Homes, W. L., Foraker, A. G. Pulmonary emphysema. Prevalence, severity, and anatomical patterns in macrosections, with respect to smoking habits. Archives of Environ- mental Health 12(5) : 569-577, May 1966. (7) ANbERSON, D. O. Observations on the classification and distribution of pulmonary emphysema in Canada. Canadian Medical Association Journal 89: 709-716, October 5, 1963. (8) ANDERSON, D. O., FERRIS, B. G., JR., ZICKMANTEL, R. The Chilliwack Respiratory Survey, 1963. Part IV. The effect of tobacco smoking on the prevalence of respiratory disease. Canadian Medical Association Journal 92(20): 1066-1076, May 15, 1965. (9) ANDERSON, W. H., WitiiaMs, J. B. Effects of cigarette smoke on dis- tribution of pulmonary perfusion. In: Current Research in Chronic Respiratory Diseases. Proceedings of the 11th Aspen Emphysema Conference, Aspen, Colo, U.S. Department of Health, Education, and Welfare, Public Health Service Publication No. 1879, 1969. pp. 75-79. (10) ANTHONISEN, N. R., Bass, H., Oriot, A., PLace, R. E. G., BATES, D. V. Regional lung function in patients with chronic bronchitis. Clinical Science 35: 495-511, December 1968. (11) Asurorp, J. R., Brown, S., DUFFIELD, Dp. P., Smitu, C. S., Fay, J.W. J. The relation between smoking habits and physique, respiratory symp- toms, ventilatory function, and radiological pneumoconiosis amongst coal workers at three Scottish collieries. British Journal of Preventive and Social Medicine 15: 106-117, 1961. ~ oa ~ 202 (12) (23) (14) (15) (16) (17) (18) (19) (20) (21) (23) (24) ASHLEY, D. J. B. Environmental factors in the aetiology of lung cancer and bronchitis. British Journal of Preventive and Social Medicine 23 (4) : 258-262, November 1969. ATTINGER, E. O., GotpsTern, M. M., Secan, M. S. Effects of smoking upon the mechanics of breathing. 1. In normal subjects. American Review of Tuberculosis and Pulmonary Diseases T7(1): 1-16, January 1958. AUERBACH, O., HAMMOND, B. C., GARFINKEL, L., Thickening of wails of arterioles and small arteries in relation to age and smoking habits. New England Journal of Medicine 278(18): 980-984, May 2, 1968. AUERBACH, O., HAMMOND, E. C., KIRMAN, D., GARFINKEL, L. Emphysema produced in dogs by cigarette smoking. Journal of the American Medical Association 199(4) : 241-246, January 23, 1967. AUERBACH, O., HAMMOND, E. C., KIRMAN, D., GARFINKEL, L. Emphysema produced in dogs by cigarette smoking. In: Hanna, M. G., Jr, Nettesheim, P., Gilbert, J. R. (Editors). Inhalation Carcinogenesis. Proceedings of a Biology Division, Oak Ridge National Laboratory Conference, Gatlinburg, Tennessee, October 8-11, 1969. U.S. Atomic Energy Commission Symposium Series 18, April 1970. pp. 375-387. AUERBACH, O., Stout, A. P., HAMMOND, E. C., GARFINKEL, L. Smoking habits and age in relation to pulmonary changes. Rupture of alveolar septums, fibrosis and thickening of walls of small arteries and arterioles. New England Journal of Medicine 269(20}: 1045-1054, November 14, 1963. Avrapo, D. M., Carritio, L. R. Hormones and pulmonary effects of tobacco. I. Corticosteroids and their antiasthmatie action. Archives of Environmental Health 18(6): 925-933, June 1969. Aviapo, D. M., PALECEK, F. Pulmonary effects of tobacco and related substances. I. Pulmonary compliance and resistance in the anesthetized dog. Archives of Environmental Health 15(2): 187-193, August 1967. Aviapo, D. M., SADAVONGVIVAD, C., Carricvo, L. R. Cigarette smoke and e of bronchodilators and biogenic pulmonary emphysema. Influenc ts. Archives of Environmental amines in experimental induction in ra Health 20(4) : 483-487, April 1970. Aviapo, D. M., SAMANEK, M. Bronchopulmonary effects of tobacco and related substances. I. Bronchoconstriction and bronchodilatation: In- fluence of lung denervation. Archives of Environmental Health 11(2): 141-151, August 1965. Aviapbo, D. M., SAMANEK, M., Fouve, L. E. Cardiopulmonary effects of tobacco and related substances. I. The release of histamine during inhalation of cigarette smoke and anoxemia in the heart-lung and intact dog preparation. Archives of Environmental Health 12(6): 705-724, June 1966. Bair, W. J., Dirvey, J. V. Pulmonary clearance of SOFE,O, and 1CR,0, in rats and dogs exposed to cigarette smoke. In: Davies, C. N. (Edi- tor). Inhaled Particles and Vapors. II. Proceedings of an International Symposium. Cambridge, September 28 to October 1, 1965, Oxford, Pergamon Press, 1967. pp. 251-271. BaLcuum, O. J., Fecron, J. S., JAMISON, J. N., GAINES, R. S., CLARKE, D. R., Owan, D., THE INDUSTRIAL HEALTH COMMITTEE, THE TUBERCU- LOSIS AND HEALTH ASSOCIATION OF Los ANGELES CounTy. A Survey for chronic respiratory disease in an industrial city. Preliminary re- sults. American Review of Respiratory Diseases 86(5) :675-685, November 1962. 203 (25) (26) (28) (20) (31) (33) (34) (35) (36) (37) (38) (39) (40) 204 BALLENGER, J. J. Experimental effect of cigarette smoke on human respiratory cilia. New England Journal of Medicine 263 (17) ; 832-855, October 27, 1960. BALLENGER, J. J., Dawson, F. W., DERUYTER, M. G., Harpine, H. B. Effects of nicotine on ciliary activity im vitro. Annals of Otology, Rhinology and Laryngology 74(2): 303-311, June 1965. BATES, D. V., GORDON, C. A., Paur, G. I., PLACE, R. E. G., Snipat, D. P., Wootr, C. R. Chronic bronchitis. Report on the third and fourth stages of the coordinated study of chronic bronchitis in the Department of Veterans Affairs, Canada. Medical Services Journal, Canada 22(1): 1-59, January 1966. Battista, S. P., KENSLER, C. J. Use of the nonimmersed in vitro chicken tracheal preparation for the study of ciliary transport activity. Cigarette smoke and related components. Archives of Environmental Health 20(3): 318-325, March 1970. BattisTA, S. P., KENSLER, C. J, Mucus production and ciliary transport activity. In vivo studies using the chicken. Archives of Environmental Health 20(3) : 326-338, March 1970. Best, b. W. R.A Canadian Study of Smoking and Health. Ottawa, Department of National Health and Welfare, 1966. 137 pp. BICKERMAN, H. A., BARACH, A. L. The effect of cigarette smoking on ventilatory function in patients with bronchial asthma and obstructive pulmonary emphysema. Journal of Laboratory and Clinical Medicine 43 (3): 453-462, March 1954. Bra, W. H., HENRY, M. C., EHRLICH, R. Chronic toxicity of nitrogen dioxide. II. Effect on histopathology of lung tissue. Archives of En- vironmental Health 18(2) : 186-192, February 1969. Boake, W.C.A Study of iliness in a group of Cleveland families. XVIT. Tobacco smoking and respiratory infections. New England Journal of Medicine 259 (26) : 4245-1249, December 25, 1958. BonNELL, J. A. Emphysema and proteinuria in men casting copper- cadmium alloys. British Journal of Industrial Medicine 12: 181-195, July 1955. BonNeELL, J. A., KAZANTZIS, G., Kine, E. A follow-up study of men ex- posed to cadmium oxide fume. British Journal of Industrial Medicine 16: 135-147, 1959. Boucot, K. R., COOPER, D. A., WEIss, W. Smoking and the health of older men. I. Smoking and chronic cough. Archives of Environmental Health 4(1): 59-72, January 1962. _. Bounuys, A. Peters, J. M. Control of environmental lung disease. New England Journal of Medicine 283(11): 573-582, September 40, 1970. Bounuuys, A., SCHILLING, R. S. F., VAN DE WOESTIINE, K. P. Cigarette smoking, occupational dust exposure, and ventilatory capacity. Ar- chives of Environmental Health 19(6) : 793-7197, December 1969. Bounuys, A., WoLFSON, R. L., Horner, D. W., BRAIN, J. D., Zuskin, E. Byssinosis in cotton textile workers. Respiratory survey of a mill with rapid labor turnover. Annais of Internal Medicine 71(2): 257-269, August 1969. Bousny, S. F., HELGASON, A. HL, Buuic, D. M., Gyrorky, F. G. Clinical physiologic, and morphologic examination of the lung in patients with bronchogenic carcinoma and the relation of the findings to postopera- tive deaths. American Review of Respiratory Diseases 101(5): 685— 695, May 1970. . (45) (46) (47) (48) (49) (50) (51) (52) (53) (54) (55) (56) (57) Bower, G. Respiratory symptoms and ventilatory function in 172 adults employed in a bank. American Review of Respiratory Diseases 83: 684-689, 1961. BRINKMAN, G. L., Coates, E. O., Jn. The prevalence of chronic bronchitis in an industrial population. American Review of Respiratory Diseases 86: 47-34, 1962. Brown, K. E., CAMPBELL, A. H. Tobacco, alcohol and tuberculosis. British Journal of Diseases of the Chest 55(3): 150-158, 1961. Carson, §., GorDHAMER, R., CARPENTER, R. Responses of ciliated epithelium to irritants. Mucus transport in the respiratory tract. American Review of Respiratory Diseases 93 (3, Part 2): 86-92, March 1966. Ceper.or, R. Frreerc, L., HRUBEC, Z. Cardiovascular and respiratory symptoms in relation to tobacco smoking. Archives of Environmental Health 18(6) : 934-940, June 1969. Ceper.or, R., FRIBERG, L., JONSSON, E., Kai, L. Respiratory symptoms and “angina pectoris” in twins with reference to smoking habits. An epidemiological study with mailed questionnaire. Archives of Environ- mental Health 13 (6) : 726-737, December 1966. CHANG, S. C. Microscopic properties of whole mounts and sections of human bronchial epithelium of smokers and nonsmokers. Cancer 10 (6) : 1246-1262, November-December 1957. CHAPMAN, T. T. The acute effect of cigarette smoking on pulmonary function. Journal of the Irish Medical Association 56(333): 72-74, March 1965. Cuester, E. H., GILLesprs, D. G., KRAUSE, F. D. The prevalence of chronic obstructive pulmonary disease in chlorine gas workers. Amer- ican Review of Respiratory Diseases 99(3) : 365-373, March 1969. CHEVALIER, R. B., KRUMHOLZ, R. A., Ross, J. C, Reaction of nonsmokers to carbon monoxide inhalation. Cardiopulmonary responses at rest and during exercise. Journal of the American Medical Association 198(10) : 1061-1064, December 5, 1966. CHIANG, S. T., WANG., B. C. Acute effects of cigarette smoking on pul- monary function. American Review of Respiratory Diseases 101 (6): 860-868, June 1970. Curvers, C. P. Respiratory function and disease among workers in alka- line dusts. British Journal of Industrial Medicine 16: 51-60, 1959. Coates, E. O., Jn. Bower, G. C., REINSTEIN, N. Chronic respiratory disease in postal employees. Epidemiologic survey of a group em- ployed in one building. Journal of the American Medical Association 191(3) : 161-166, January 18, 1965. CoHEN, J. Chronic bronchitis and emphysema. Observations on trends and distribution according to death certificate data, Israel 1960 to 1964. Israel Journal of Medical Sciences 3(6): 885-889, November- December 1967. CoLLECE oF GENERAL Practitioners. Chronic bronchitis in Great Brit- ain. A national survey carried out by the respiratory diseases study group of the College of General Practitioners. British Medical Journal 2: 973-979, October 14, 1961. Comnor, J. H., Jn. Forster, R. E., If, DuBots, A. B., Briscos, W. A., CARLSEN, E. The Lung. Clinical Physiology and Pulmonary Function Tests. Chicago, Year Book Medical Publishers, Inc., 1963. 390 pp- Coon, W. A., Wess, W. R. Surfactant in chronic smokers. Annals of Thoracic Surgery 2(3) : 327-333, May 1966. 205 (58) (59) (60) (61) (62) (63) (64) (65) (66) (67) (68) (69) (70) (72) (72) (73) (74) (75) 206 Coovey, J. R. T., RED, D. D. Urban and social origins of childhood bron- chitis in England and Wales. British Medical Journal 2(5703) + 213- 217, April 25, 1970. DaLHaMNn, T. The effect of cigarette smoke on ciliary activity in the upper respiratory tract. A.M.A. Archives of Otolaryngology 70: 166- 168, 1959. DALHAMN, T. Effect of cigarette smoke on ciliary activity. American Review of Respiratory Diseases 93(3): 108-114, March 1966. DALHAMN, T., RYLANDER, R. Ciliastatic action of smoke from filter- tipped and non-tipped cigarettes. Nature 201 (4917) : 401-402, Janu- ary 25, 1964. DALHAMN, T., RYLANDER, R. Ciliastatic action of cigarette smoke. Vary- ing exposure times. Archives of Otolaryngology 81 (4) : 379-382, April 1965. DALHAMN, T., RYLANDER, R. Tar content and ciliotoxicity of cigarette smoke. Acta Pharmacologica et Toxicologica 25(3): 369-372, 1967. DALHAMN, T., RYLANDER, R. Ciliotoxicity of cigarette smoke and its volatile components. American Review of Respiratory Diseases 98(3): 509-511, September 1968. DALHAMN, T., RYLANDER, R. Ciliotoxicity of cigar and cigarette smoke. Archives of Environmental Health 20(2): 252-253, February 1970. Davis, T. R. A-, BATTISTA, S. P., KENSLER, C. J. Mechanism of respira- tory effects during exposure of guinea pigs to irritants. Archives of Environmental Health 15(4) : 412-419, October 1967. DEANE, M., GOLDSMITH, J. R., Tuma, D. Respiratory conditions in out- side workers. Report on outside plant telephone workers in San Fran- cisco and Los Angeles. Archives of Environmental Health 10(2): 323-331, February 1965. DENSEN, P. M., JONES, E. W., Bass, H. E., Breuer, J. A survey of respi- ratory disease among New York City postal and transit workers. 1. Prevalence of symptoms. Environmental Research 1: 262-286, 1967. DENSEN, P. M., JONES, E- W., Bass, H. E., BREUER, J., Reep, E. A survey of respiratory disease among New York City postal and transit work- ers. 2. Ventilatory function test results. Environmental Research 2(4): 277-296, July 1969. Doi, R., Hur, A. B. Mortality in relation to smoking: Ten years’ observations of British doctors. (Part I) British Medical Journal 1(5395) ; 1399-1410, May 30, 1964. Doi, R., Hitt, A. B. Mortality in relation to smoking: Ten years’ observations of British doctors. (Concluded) British Medical Journal 1(5396) : 1460-1467, June 6, 1964. _ Dow1inc, H. F., JACKSON, G. G., INouYE T. Transmission of the experi- mental common cold in volunteers. IL. The effect of certain host factors upon susceptibility. Journal of Laboratory and Clinical Medicine 50(4) : 516-525, October 1957. Everman, N. H.. MittMan, C., Norris, A: H., ConEen, B. H., SHOCK, N. W. The effects of cigarette smoking upon spirometric performance of community dwelling men. American Review of Respiratory Diseases 94(3) : 421-429, September 1966. Epwarps, F., McKeown, T., Wuitrtevp, A. G. W. Association between smoking and disease in men over sixty. Lancet 1: 196-200, January 24, 1959. Enrcicy, R., Henry, M. C., FENTERS, J. Influence of nitrogen dioxide on resistance to respiratory infections. In: Hanna, M. G., Jr., Nette- (76) (77) (78) (79) (80) (81) (52) (88) (84) (85) (86) (87) (88) (89) (90) (91) sheim, P., Gilbert, J.-R. (Editors). Inhalation Carcinogenesis. Pro- ceedings of a Biology Division, Oak Ridge National Laboratory Con- ference, Gatlinburg, Tennessee, October 8-11, 1969. U.S. Atomic Energy Commission Symposium Series 18, April 1970. pp. 243-257. EicH, R. H., Girpert, R., AUCHINCLGSS, J. H., Jz. The acute effects of smoking on the mechanics of respiration in chronic obstructive pul- monary emphysema. American Review of Tuberculosis 76: 22-32, 1957. Er.woop, P. C., PEMBERTON, J., Merrett, J. D., Carey, G. C. R., Mcautay, I. R. Byssinosis and other respiratory symptoms in flax workers in Northern Ireland. British Journal of Industrial Medicine 22-27-37, 1965. Eriksson, S. Studies in Alpha,-antitrypsin Deficiency. Acta Medica Scandinavica 177 (Supplementum 432): 1965. 85 pp. Fak, G. A., BRISCOE, W. A. Chronic obstructive pulmonary disease and heterozygous alpha,-antitrypsin deficiency. Annals of Internal Medi- cine 72(4): 595-596, April 1970. Fak, H. L., TREMER, H. M., KoTin, P. Effect of cigarette smoke and its constituents on ciliated mucus-secreting epithelium. Journal of the National Cancer Institute 93(5): 999-1012, November 1959. Ferris, B. G., JR., ANDERSON, D. O. The prevalence of chronic respiratory disease in a New Hampshire town. American Review of Respiratory Diseases 86(2): 165-177, August 1962. Ferris, B. G., JR., ANDERSON, D. O., Burcess, W. A. Prevalence of respiratory disease in a flax mill in the United States. British Journal of Industrial Medicine 19: 180-185, 1962. FINKLEA, J. F., SANDIFER, S. H., SmMiTH, D. D. Cigarette smoking and epidemic influenza. American Journal of Epidemiology 90(5): 3890- 399, November 1969. FLETCHER, C. M., HORN, D. Smoking and health. WHO Chronicle 24(8) : 345-370, August 1970. Frercuer, C. M., TINKER, C. M. Chronic bronchitis. A further study of simple diagnostic methods in a working population. British Medical Journal 1; 1491-1498, May 27, 1961. Frick, A. L., PATON, R. R. Obstructive emphysema in cigarette smokers. A.M.A. Archives of Internal Medicine 104: 518-526, 1959. FRANKLIN, W., LOWELL, F. C. Unrecognized airway obstruction associ- ated with smoking. A probable forerunner of obstructive pulmonary emphysema. Annals of Internal Medicine 54(3) :379-386, March 1961. Frasca, J. M., AUERBACH, O., Parks, V. R., JAMIESON, J. D. Electron microscopic observations of the bronchial epithelium of dogs. If. Smok- ing dogs. Experimental and Molecular Pathology 9 (3) : 380-399. December 1968. FREEMAN, G., CRANE, S.C. STEPHENS, R. J., Furiost, N. J. Pathogenesis of the nitrogen djoxide-induced lesion in the rat lung: A review and presentation of new observations. American Review of Respiratory Diseases 98(3) : 429-443, September 1968. FREEMAN, G., HaYDON, G. B. Emphysema after low-level exposure to NO.. Archives of Environmental Health 8(1) : 125-128, January 1964. FREEMAN, G., STEPHENS, R. J., CRANE, S. C., Furtost, N. J. Lesion of the lung in rats continuously exposed to two parts per million of nitrogen dioxide. Archives of Environmental Health 17(2): 181-192, August 1968. 207 (92) (93) (94) (95) (96) (97) (98) (99) (100) (101) (102) (103) (104) (105) 208 Freour, P., CouDRAY, P., RouSSEL, A. Serise, A. Les bronchites ‘chroni- ques et Vinsuffisance respiratorie dans Vagglomeration de Bordeaux. (Chronic bronchitis and respiratory insufficiency in Bordeaux). Journal de Medecine de Bordeaux 143 (2): 1865-1879, December 1966. GANDEVIA, B. A productive cough upon request a5 an index of chronic bronchitis: The effects of age, S€X, smoking habit, and environment upon prevalence in Australian general practice. Medical Journal of Australia 1(1): 16-20, January 4, 1969. GIAMMONA, S- T. Effects of cigarette smoke and plant smoke on pulmo- nary surfactant. American Review of Respiratory Diseases 96(3): 539-541, September 1967. GoipsMITH, J- R., HECHTER, H. H., PERKINS, WN. M. BoRHANT, N. O. Pulmonary function and respiratory findings among longshoremen. American Review of Respiratory Diseases 86 (6) ;867-874, December 1962. GREEN, G. M., Caron, D. The depressant effect of cigarette smoke on the in vitro antibacterial activity of alveolar macrophages. New Eng- land Journal of Medicine 276(8) : 421-427, February 23, 1967. GREENBERG, M., MILNE, J. F., Watt, A. Survey of workers exposed to dusts containing derivatives of Bacillus subtilis. British Medical Journal 2: 629-633, June 13, 1970. Guenter, C. A. WercH, M. H., Russetr, T. Ro Hype, R. M., HAMMAR: sten, J. F. The pattern of lung disease associated with alpha-1 anti- trypsin deficiency. Archives of Internal Medicine 122 (3): 954-257, September 1968. GuILLERM, R., SAINDELLE, A. Fatot, P., HEE, J. Action de la fumee de cigarette et de quelquesuns de ses constituants sur les resistances ventilatoires chez le cobaye. (Action of cigarette smoke and some of its constituents on ventilatory resistance In the guinea pig-) Archives Internationales de Pharmacodynamie et de Therapie 167 (1): 101- 114, May 1967. Guyatt, A. R., Berry, G., ALPERS, J. H., BRAMLEY, A. C., FLETCHER, Cc. M. Relationship of airway conductance and its immediate change on smoking to smoking habits and symptoms of chronic bronchitis. Amer- ican Review of Respiratory Diseases 101(1): 44-54, January 1970. YIAMMARSTEN, J. F., WELCH, M. H., RICHARDSON, R. H., PATTERSON, C. D., GUENTER, C. A. Familial alpha,-antitrypsin deficiency and pul- monary emphysema. Transactions of the American Clinical and Clima- tological Association go(1): 7-14, 1968. HAMMOND, E. C. Evidence on the effects of giving up cigarette smoking. American Journal of Public Health and the Nation’s Health 55(5): 682-691, May 1965. HAMMOND, E. C. Smoking in relation to the death rates of 1 million men and women. In: Haenszel, Ww. (Editor). Epidemiological Approaches to the Study of Cancer and Other Chronic Diseases. Bethesda, U-S. Public Health Service, National Cancer Institute Monograph No. 19, January 1966. pPp- 127-204. Hammond, E. C., AUERBACH, O., Kirman, D., GARFINKEL, L. Effects of cigarette smoking on dogs. 1. Design of experiment, mortality, and findings in lung parenchyma. Archives of Environmental Health 21(6): 740-153, December 1970. HamMOonp, E. C., HoRN, D. Smoking and death rates—report on forty- four months of follow-up of 187,783 men. IJ. Death rates by cause. (106) (107) (108) (109) (110) (111) (112) (113) (114) (115) (116) (117) (118) (119) Journal of the American Medical Association 166(11): 1294-1308, March 15, 1958. Hayvon, G. B., Davipson, J. T., LILLincton, G. A., WASSERMAN, K. Nitrogen dioxide-induced emphysema in rabbits. American Review of Respiratory Diseases 95(5): 797-805, May 1967. Hayrpon, G. B., Freeman, G., Furioss, N. J. Covert pathogenesis of NO., induced emphysema in the rat. Archives of Environmental Health 11(6) : 776-783, December 1965. HAYNES, W. F., JR., Krstuxovic, V. J., Betz, A. L. L., Jk. Smoking habit and incidence of respiratory tract infections in a group of adolescent males. American Review of Respiratory Diseases 93(5): 730-735, May 1966. HENRY, M. C., Frnpvay, J., SPANGLER, J., EHRLICH, R. Chronic toxicity of NO, in squirrel monkeys. III. Effect on resistance to bacterial and viral infection. Archives of Environmental Health 20(5): 566-570, May 1970. Heprer, N. G., Hyatr, R. E., Fowrer, W. S. Detection of chronic obstructive lung disease. An evaluation of the medical history and physical examination. Archives of Environmental Health 19 (6): 806— 813, December 1969. HERNANDEZ, J. A., ANDERSON, A, E., Jz., HOLMES, W. L., FORAKER, A. G. Pulmonary parenchymal defects in dogs following prolonged cigarette smoke exposure. American Review of Respiratory Diseases 93 (1) : 78- 83, January 1966. Hicerns, I. T. T. Respiratory symptoms, bronchitis and ventilatory capacity in random sample of an agricultural population. British Medical Journal 2: 1198-1203, November 23, 1957. Hiceins, 1. T. T. Tobacco smoking, respiratory symptoms, and ventila- tory capacity. Studies in random samples of the population. British Medical Journal 1: 325-329, February 7, 1959. Hicorns, I. T. T., Cocuran, J. B. Respiratory symptoms, bronchitis and disability in a random sample of an agricultural community in Dumfriesshire. Tubercle 39: 296-301, 1958. Hiceins, I. T. T., CocHrane, A. L. Chronic respiratory disease in a random sample of men and women in the Rhondda Fach in 1958. British Journal of Industria] Medicine 18: 93-102, 1961. Hicorns, I. T. T.. Cocurane, A. L., Gitson, J. C., Woop, C. H. Popula- tion studies of chronic respiratory disease. A comparison of miners, foundryworkers, and others in Staveley, Derbyshire. British Journal of Industrial Medicine 16: 255-268, 1959. Hicoins, I. T. T., Girson, J. C., Ferris, B. G., Jn, Waters, M. E., CAMPBELL, H., HicGins, M. W. Chronic respiratory disease in an industrial town: A nine-year follow-up study. Preliminary report. American Journal of Public Health and the Nation’s Health 58(9): 1667-1676, September 1968. Hiccins, I. T. T., Hiccrns, M. W., LocKsHin, M. D., CANALE, N. Chronic respiratory diséase in mining communities in Marion.County, West Virginia. British Journal of Industrial Medicine 25(3): 165-175, July 1968. Hicerns, 1. T. T., OrDHAM, P. D., CocHRANE, A. L., GILSON, J. C. Res- piratory symptoms and pulmonary disability in an industrial town. Survey of a random sample of the population. British Medical Journal 2: 904-909, October 20, 1956. 209 (120) HIDING, A. C. On cigarette smoking, bronchial carcinoma and ciliary action. I]. Experimental study on the filtering action of cow’s lungs, the deposition of tar in the bronchial tree and removal by ciliary action. New England Journal of Medicine 254(25): 1155-1160, June 21, 1956. (121) HOLLAND, W. W., Ecuiott, A. Cigarette smoking, respiratory symptoms and anti-smoking propaganda. An experiment. Lancet 1 (7532) : 41-43, January 6, 1968. (122) HOLLAND, WwW. W., Hau, T., BENNETT, A. E., Evuiorr, A. Indications for measures to be taken in childhood to prevent chronic respiratory disease. Milbank, Memorial Fund Quarterly 47 (3, part 2): 215-227, July 1969. (125) HOLLAND, R. H., Koztowskl, E. J., Booker, L. The effect of cigarette smoke on the respiratory system of the rabbit. A final report. Cancer 16(5): 612-615, May 1963. (124) HOLLAND, W. W., Rew, D. D. The urban factor in chronic bronchitis. Lancet 1(7383) : 445-448, February 27, 1965. (125) Horma, B. The acute effect of cigarette smoke on the initial course of lung clearance in rabbits. Archives of Environmental Health 18(2): 171-173, February 1969. (126) HunxTt, E. Prevalence of Respiratory Symptoms, Chronic Bronchitis and Pulmonary Emphysema in a Finnish Rural Population. Field survey of age group 40-64 in the Harjavaita area. Acta Tuberculosea et Pneumologica Scandinavica (Supplementum 61): 1965. 111 pp. (127) Hurst, A. Familial emphysema. American Review of Respiratory Dis- eases 80: 179-180, 1959. (128) Hyatt, R. E., Kistin, A. D., MAHAN, T. K. Respiratory disease in Southern West Virginia coal miners. American Review of Respiratory Diseases 89 (3): 387-401, March 1964. (129) IDE, G., SUNTZEFF, v., Cowpry, E.V.A comparison of the histopathology of tracheal and bronchial epithelium of smokers and nonsmokers. Cancer 12(3) : 473-484, May-June, 1959. (130) Iro, H., AvIADO, D. M. Pulmonary emphysema and cigarette smoke. Experimental induction and use of bronchodilators in rats. Archives of Environmental Health 16(6): 865-870, June 1968. (131) James, R. H. Prior smoking as a determinant of the distribution of pulmonary ventilation. American Review of Respiratory Diseases 1O1(1) : 105-107, January 1970. (132) Kaun, H. A. The Dorn study of smoking and mortality among U.S: veterans: Report on 8% years of observation. In: Haenzel, W. (Edi- tor). Epidemiological Approaches to the Study of Cancer and Other Chronic Diseases. Bethesda, U.S. Public Health Service, National Cancer. Institute Monograph No. 19, January 1966, pp. 1-125. (183) KAMINSKI, E. J., FANCHER, O. E., CALANDRA, J. C. In vivo studies of the ciliastatic effects of tobacco smoke. Absorption of ciliastatic compo- nents by wet surfaces. Archives of Environmental Health 16(2) : 188— 193, February 1968. (184) KEeNNeEbY, J. R., ELLIOTT, A. M. Cigarette smoke: The effect of residue on mitochondrial structure. Science 168(3935) : 1097-1098, May 29, 1970. (135) KENSLER, C. J., BATTISTA, S. P. Chemical and physical factors affecting mammalian ciliary activity. American Review of Respiratory Diseases 93(3, Part 2): 93-102, March 1966. : 210 (136) (137) (133) (139) (140) (141) (146) {147) (148) (149) (156) (151) (152) KLeEtNepMaN. J. Effects of NO: in hamsters: Autoradiograpnic ana electron microscopic aspects. In: Hanna, M. G., Jr., Nettesheim, P., Gilbert. J. R. (Editors). Inhalation Carcinogenesis. Proceedings of a Biology Division, Oak Ridge National Laboratory Conference, Gatlin- burz, Tennessee, October 8-11, 1969. U.S. Atomic Energy Commission Symposium Series 18, April 1970. pp. 271-281. KorDIk, P., BULERING, E., Burn, J. H. Ciliary movement and acetyl- choline. British Journal of Pharmacology and Chemotherapy 7: 67- 79, 1952. Kran, V. E., BULMASH, M. H. Studies on living ciliated epithelium. American Review of Respiratory Diseases 99(5) : 711-718, May 1969. keucer, 3A. P., SMiru, R. F. Effects of gaseous ions on tracheal ciliary rate. Proceedings of the Society for Experimental Biology and Medi- cine G8: 412-414, 1958. KeumHowz, R. A., CHEVALIER, R. B., Ross, J. C. Cardiopulmonary func- tion in young smokers. A comparison of pulmonary function measure- ments and some cardiopulmonary responses to exercise between a group of young smokers and a comparable group of nonsmokers. ‘Annals of Internal Medicine 60(4) : 603-610, April 1964. Krumpouz. R. A., CHEVALIER, R. B., Ross, J. C. Changes in cardiopul- monary functions related to abstinence from smoking. Studies in yourg cigarette smokers at rest and exercise at 3 and 6 weeks of ab- stinence. Annals of Internal Medicine 62 (2) 2197-207, February 1965. Krumuorz, R. A., CHEVALIER, R. B., Ross, J. C. A comparison of pul- monary compliance in young smokers and nonsmokers. American Review or Respiratory Diseases 92(1): 102-107, July 1965. Kueppers, F. Identification of the heterozygous state for the alpha,-anti- in ceficiency gene in man. Biochemical Genetics 3(3): 283-238, 19698. Kueprers. F., FALLAT, R., LARSON, R. K. Obstructive lung disease and alpha,-enuitrypsin deficiency gene heterozygosity. Science 165 (3896) : §99-401, August 29, 1969 LABELLE, C. W., BEVILACQUA, D. M., Brrecer, H. The influence of ciga~ rette smoke on lung clearance. An experimental approach. Archives of Environmental Health 12(5): 588-596, May 1966. LAMBERT, P. M., Rew, D. D. Smoking, air pollution, and bronchitis in Britain. Lancet 1(7652) : 853-857, April 25, 1970. Larson, R. K., BARMAN, M. L. The familial occurrence of chronic ob- structive pulmonary disease. Annals of Internal Medicine 63(6): 1001-1003, December 1965. Larsox, R. K., BARMAN, M. L., KUEPPERS, F., FUDENBERG, H. H. Genetic and environmental determinants of chronic obstructive pulmonary disease. Annals of Internal Medicine 72(5) : 627-632, May 1970. LatRenzi, G. A., GUARNERI, J. J., Exprica, R. B., Carey, J. P. Clear- ance of bacteria by the lower respiratory tract. Science 142: 1572- 1573, December 20, 1963. Lrese. W. L. B. An investigation into bronchitis. Lancet 2: 762-765, October 13, 1956. LEFCOE, N. M., Wonwnacort, T. H. The prevalence of chronic respiratory disease in the male physicians of London, Ontario. Canadian Medical Association Journal 102(9) ; 381-385, February 28, 1970. LEUCHTENBERGER, C., LEUCHTENBERGER, R., ZEBRUN, W., SHAFFER, P. A correlated histological, cytological, and cytochemical study of the tracheobronchial tree and lungs of mice exposed to cigarette smoke. 211 (153) (154) (155) (156) (157) (158) (159) (160) (161) (162) (163) (164) (165) (166) (167) (168) 212 If. Varying responses of major bronchi to cigarette smoke, absence of bronchogenic carcinoma after prolonged exposure, and disappearance of bronchial lesions after cessation of exposure, Cancer 13(4): 721- 732, July-August 1960. Lewis, G. P., Lyte, H., Mitrer, S. Association between elevated hepatic water-soluble protein-bound cadmium levels and chronic bronchitis and/or emphysema. Lancet 2(7634) : 1330-1333, December 20, 1969. LIEBERMAN, J. Heterozygous and homozygous alpha,-antitrypsin defi- ciency in patients with pulmonary emphysema. New England Journal of Medicine 281 (6): 279-284, August 7, 1969. LIEBERMAN, J., MITTMAN, C., SCHNEWER, A. S. Screening for homo- zygous and heterozygous alpha,-antitrypsin deficiency. Protein elec- trophoresis on cellulose acetate membranes. Journal of the American Medical Association 210(11) : 2055-2060, December 15, 1969. LiEBESCHUETZ, H. J. Respiratory signs and symptoms in young soldiers and their relationship to smoking. Journal of the Royal Army Medical Corps 105: 76-81, 1959. Lowe, C. R. An association between smoking and respiratory tubercu- losis. British Medical Journal 2: 1081-1086, November 10, 1956. Lowe, C. R. Chronic bronchitis and occupation. Joint meeting No. 1. Section of Occupational Medicine with Section of Epidemiology and Preventive Medicine. Proceedings of the Royal Society of Medicine 61(1)-: 98-102, January 1968. LUNDMAN, T. Smoking in Relation to Coronary Heart Disease and Lung Function in Twins. A Co-twin Study. Acta Medica Scandinavica 180 (Supplement 455) : 4966. 75 pp. MCDERMOTT, M., COLLINS, M. M. Acute effects of smoking on lung air- ways resistance in norma! and bronchitic subjects. Thorax 20: 562- 569, 1965. Martt, J. M. Pulmonary diffusing capacity in cigarette smokers. An- nals of Internal Medicine 56(1): 39-45, January 1962. Masin, F., Masin, M. Frequencies of alveolar cells in concentrated sputum specimens related to cytologic classes. Acta Cytologica 10(5): 362-367, September—October 1966. MEGAHED, G. E., SENNA, G. A., Eissa, M. H., SALEH, S. Z., Erssa, H. A. Smoking versus infection as the aetiology of bronchial mucous gland hypertrophy in chronic bronchitis. Thorax 22(3) : 271-278, May 1967. MENDENHALL, W. L., SHREEVE, K. E. The effect of cigarette smoke on the tracheal cilia. (Abstract) 28th Annual Meeting, April 21-24, 1937, Memphis, Tennessee. The Scientific Proceedings of the American So- ciety for Pharmacology and Experimental Therapeutics, Inc. Journal of Pharmacology and Experimental Therapeutics 60: 111-112, 1937. MILLer, D., BONDURANT, S. Effects of cigarette smoke on the surface characteristics of lung extracts. American Review of Respiratory Diseases 85(5) : 692-696, May 1962. Mirrer, J. M., SPROULE, B. J. Acute effects of inhalation of cigarette smoke on mechanical properties of the lungs. American Review of Respiratory Diseases 94(5): 721-726, November 1966. Miis, C. A. Tobacco smoking: Some hints of its biologic hazards. Ohio State Medical Journal 46(12): 1163-1170, December 1950. Mircue er, R. S., WEBB, N. C., Fitcey, G. F. Chronic obstructive bron- chopulmonary disease. III. Factors influencing prognosis. American Review of Respiratory Diseases 89(6): 878-896, June 1964. (169) (170) (171) (£72) (173) (173) (175) (177) (178) (179) (180) (181) (182) (183) (185) (185) MITCHELL, R. S., Sirvers, G. W., Dart, G. A., Petry, T. L., VINCENT, T. N., Ryan, S. F., Furey, G. F. Clinical and morphologic correla- tions in chronic airway obstruction. American Review of Respiratory Diseases 97({1): 54-61, January 1968. MorrrvaMa, I. M., Dawper, T. R., Kannet, W. B. Evaluation of diag- nostic information supporting medical certification of deaths from cardiovascular disease. In: Haenszel, W. (Editor). Epidemiological Approaches to the Study of Cancer and Other Chronic Diseases. Bethesda, U.S. Public Health Service, National Cancer Institute Mon- ograph No. 19, January 1966. pp. 405-419. Mork, T. A Comparative Study of Respiratory Disease in England and Wales and Norway. Acta Medica Scandinavica 172 (Supplementum 384), 1962. 100 pp. Morron, A. Postoperative hypoxaemia. Medical Journal of Austraha 2(7) : 341-342, August 16, 1969. Morton, H. J. V. Tobacco smoking and pulmonary complications after operation. Lancet 1: 368-370, March 18, 1944. Motvey, H. L., KuZMAN, W. J. Cigarette smoke. Its effect on pulmonary function measurements. California Medicine 88(3): 211-220, March 1958. Myrvik, Q. N., Evans, D. G. Metabolic and immunologic activities of alveolar macrophages. Archives of Environmental Health 14(1) : 92- 96, January 1967. NADEL, J. A., COMROE, J. H., JR. Acute effects of inhalation of cigarette smoke on airway conductance. Journal of Applied Physiology i6: 713- 716, 1961. NANDI, M., Jick, H., SLONE, D., SHAPIRO, S., Lewis, G. P. Cadmium con- tent of cigarettes. Lancet 2(7634) : 1329-1330, December 20, 1969. Oswa_p, N. C., Mepvet, V. C. Chronic bronchitis; the effect of cigarette- smoking. Lancet 2: 843-844, October 22, 1955. PALECEK, F., Aviapo, D. M. Pulmonary effects of tobacco and related sub- stances. Il. Comparative effects of cigarette smoke, nicotine, and his- tamine on the anesthetized cat. Archives of Environmental Health 15 (2) : 194-203, August 1967. Paecek, F., OsKour, M., Aviapbo, D. M. Pulmonary effects of tobacce and related substances. III. Inhibition of synthesis of histamine in various species. Archives of Environmental Health 15(2): 204-213, August 1967. PARNELL, J. L., ANDERSON, D. O., KINNIS, C. Cigarette smoking and respiratory infections in a class of student nurses. New England Journal of Medicine 274(8) : 979-984, May 5, 1966. Peters, J. M., Ferris, B. G., JR. Smoking, pulmonary functions and respiratory symptoms in a college-age group. American Review of Respiratory Diseases 95(5) : 774-782, May 1967. Peters, J. M., Ferris, B. G., Jn. Smoking and morbidity in a college-age group. American Review of Respiratory Diseases 95(5): 783-789, May 1967. PETERSON, D. I., LONERGAN, L. H., HARDINGE, M. G. Smoking and pul- monary function. Archives of Environmental Health 16(2): 215-218, February 1968. Puitiirs, A. M., PHiciips, R. W., THompson, J. L. Chronie cough. Analysis of etiologic factors in a survey of 1,274 men. Annals of In- ternal Medicine 45(2) : 216-231, August 1956. 213 (186) Prrer, D. W. Respiratory complications in the postoperative period. Scottish Medical Journal 3(5): 193-198, May 1958. (187) Pratt, 5S. A., FINLEY, T. N., SMITH, M. H., Lapman, A.J. A comparison of alveolar macrophages and pulmonary surfactant(?) obtained from the lungs of human smokers and nonsmokers by endobronchial lavage- Anatomical Record 163(4): 497-508, April 1969. (188) RakIeTEN, N., RAKIETEN, M. L., FELDMAN, D., Boykin, M. J., Jz. Mam- malian ciliated respiratory epithelium. Studies with particular refer- ence to effects of menthol, nicotine, and smoke of mentholated and nonmentholated cigarettes. A.M.A. Archives of Otolaryngology 56: 494-503, 1942. (189) RANKIN, J., GEE., J. B., CHosy, L. W. The influence of age and smoking on pulmonary diffusing capacity in healthy subjects. Medicina Thora- calis 22(3) : 366-374, 1969. (190) RANKIN, J. G., Hare, G. S., WILKINSON, Pp., O'Day, D. M., SANTAMARIA, J. N., BABARCZY, G. Relationship between smoking and pulmonary dis- ease in alcoholism. Medical Journal of Australia 1(14): 730-733, April 5, 1969. (191) Reap, J., Setey, T. Tobacco smoking and ventilatory function of the lungs. British Medical Journal 2: 1104-1108, October 28, 1961. (192) Revorsxiz, N., KANNEL, W., GocosmiTH, J. R., Dawer, T. R. Pul- monary function in a community sample. American Review of Respi- ratory Diseases 86(6): 907-911, December 1962. (193) RIMINGTON, J. Chronic bronchitis, smoking and social class. A study among working people in the towns of Mid and East Cheshire. British Journal of Diseases of the Chest 63(4): 193-205, 1969. (194) ROBERTSON, D. G., WaARRELL, D. A., NewtTon-Howes, J. S., FLETCHER, C. M. Bronchial reactivity to cigarette and cigar smoke. British Med- ical Journal 3(5665) : 269-271, August 2, 1969. (195) Rogue, A. L., Pickren, J. W. Enzymatic changes in fluorescent alveolar macrophages of the lungs of cigarette smokers. Acta Cytologica 12 (6) : 420-429, November—December 1968. (196) ROSENKRANTZ, H., Esper, H. J., SPRAGUE, R. Lung hydroxyproline lev- els in mice exposed to cigarette smoke. Life Sciences 8(11, Part 1): 571-576, June 1, 1969. (197) ROSENKRANTZ, H., SPRAGUE, R. Biochemical screen to investigate whole smoke and vapor phase effects in mice. Archives of Environmental Health 18(6) ; 917-924, June 1969. (198) Ross, J. C., Ley, G. D., Krumuowz, R. A., RAHBARI, H. A technique for evaluation of gas mixing in the lung: Studies in cigarette smokers and nonsmokers. American Review of Respiratory Diseases 9543): 447-453, March 1967. (199) SAMANEK, M., Aviapo, D. M. Bronchopulmonary effects of tobacco and related substances. II. Bronchial arterial injections of nicotine and histamine. Archives of Environmental Health 11(2): 152-159, Au- gust 1965. (200) SAMANEK, M., Aviapo, D. M. Bronchopulmonary effects of tobacco and related substances. IV. Bronchial vascular and bronchomotor re- sponses; their suggested defense function. Archives of Environmental Health 11(2) : 167-176, August 1965. (201) SAMANEK, M., Avrapo, D. M. Cardiopulmonary effects of tobacco and related substances. III. Pulmonary vascular effects of cigarette smoke and nicotine. Archives of Environmental Health 12(6) : 717-724, June 1966. : 214 (202) (£03) (204) (205) (206) (207) (208) (209) (210) (211) (213) (214) (215) (216) (217) (218) SAMANEK, M., Avrabo, D. M., PEsKin, G. W. Bronchopulmonary effects of tobacco and related substances. III. Axon reflexes elicited fram the visceral pleura. Archives of Environmental Health 11(2): 160-166, August 1965. SCARPELLI, E. M. The Surfactant System of the Lung. Philadelphia, Lea & Febiger, 1968. 269 pp. ScHOETTLIN, C. E. The health effect of air pollution on elderly males. American Review of Respiratory Diseases 86(6): 878-897, December 1962. Suan, J. R., WarawavekKar, M. S., DESHMUKH, P. A., PHUTANE, P.N. Institutional survey of pulmonary tuberculosis with special reference to smoking habits. Indian Journal of Medical Sciences 13(5): 381- 392, May 1959. Suort, J. J., Jounson, H. J., Ley, H. A., Jr. The effects of tobacco smoking on health. A study of 2,031 medical records. Journal of Laboratory and Clinical Medicine 24: 586-589, 1939. Simonsson, B. Effect of cigarette smoking on the forced expiratory flow rate. American Review of Respiratory Diseases 85: 534-539, 1962. S.Luis-Cremer, G. K., SICHEL, H. S. Ventilatory functions in males in a Wit-watersrand town. Comparison between smokers and nonsmokers. American Review of Respiratory Diseases 98(2): 229-239, August 1968. SLuis-CrReMeER, G. K., WALTERS, L. G., SicHer, H. S. Chronic bronchitis in miners and nonminers: An epidemiological survey of a community in the gold-mining area in the Transvaal. British Journal of Indus- rial Medicine 24(1): 1-12, January 1967. Smit, J. P., Smitu, J. C., McCarr, A. J. Chronic poisoning from cad- mium fume. Journal of Pathology and Bacteriology 80: 287-296, 1960. SpurRGASH, A., EHRLICH, R., Perzorp, R. Effect of cigarette smoke on resistance to respiratory infection. Archives of Environmental Health 16(3) : 3885-391, March 1968. . STANESCU, D. C., Tecurescu, D. B., Pacuraru, R., GAVRILESCU, N. Chronic effect of smoking upon pulmonary distribution of ventilation in healthy males. Respiration 25(6) : 497-504, 1968. STERLING, G. M. Mechanism of bronchoconstriction caused by cigarette smoking. British Medical Journal 3: 275-277, July 29, 1967. Srriever, D. J., Murpuy, R., Kazemi, H. Mechanism of postural hy- poxemia in asymptomatic smokers. American Review of Respiratory Diseases 99(5): 760-766, May 1969. TALAMO, R. C., ALLEN, J. D., KAHAN, M. G., AUSTEN, K. F. Hereditary alpha,-antitrypsin deficiency. New England Journal of Medicine 278 (7) : 345-351, February 15, 1968. TARKOFF, M. P., KUEPPERS, F., MILLER, W. F. Pulmonary emphysema and alpha,-antitrypsin deficiency. American Journal of Medicine 45 (2) : 220-228, August 1968. THURLBECK, W. M., HENDERSON, J. A., FRASER, R. G., BATEs, D. V- Chronic obstructive lung disease. A comparison between clinical roent- genologic, functional and morphologic criteria in chronic bronchitis, emphysema, asthma and bronchiectasis. Medicine 49(2): 81-145, March 1970. Tokuuata, G. K., DESSAUER, P., PENDERGRASS, E. P., HARTMAN, T., DIGON, E., MiLLer, W. Pneumoconiosis among anthracite coal miners in Pennsylvania. American Journal of Public Health and the Nation’s Health 60(3): 441-451, March 1970. 215 (219) (221) (222) (228) (229) (250) (281) (282) (233) (254) 216 U.S. Pusptic HEALTH Service. The Health Consequences of Smoking. 1968 Supplement to the 1967 Public Health Review. Washington, U.S. Department of Health, Education, and Welfare. Public Health Service Publication No. 1696, 1968. 117 pp. U.S. Pusric HEALTH SERVICE. NATIONAL CENTER FOR HEALTH STATISTICS. Cigarette smoking and health characteristics, United States, July 1964_June 1965. Washington, U.S. Department of Health, Education, and Welfare, Vital and Health Statistics Series 10, No. 34, Public Health Service Publication No. 1000, May 1967. 64 pp. U.S. Pusiic HEALTH SERVICE. NATIONAL CENTER FOR HEALTH STATISTICS. Vital Statistics of the United States—1967. Vol. 1]—Mortality, Part A. Washington, U.S. Department of Health, Education, and Welfare, Public Health Service Publication, 1969. U.S. PUBLIC HEALTH SERVICE. NATIONAL CENTER FOR HEALTH STATISTICS. Vital Statistics Rates in the United States 1940-1960. Washington, U.S. Department of Health, Education and Welfare, Public Health Service Publication No. 1677, 1968. 881 pp. U.S. Pusiic HEALTH SERVICE. Smoking and Health. Report of the Ad- visory Committee to the Surgeon General of the Public Health Serv- ice. Washington, U.S. Department of Health, Education, and Welfare, Public Health Service Publication No. 1103, 1964. 387 pp. Wess, W. R., Coox, W. A., LANIUS, J. W., SHaw, R. R. Cigarette smoke and surfactant. American Review of Respiratory Diseases 95(2): 244-247, February 1967. Weir, J. M., Dunn, J. E., Jr. Smoking and mortality: A prospective study. Cancer 25(1): 105-112, January 1970. WELCH, M. H., REINECKE, M. E., HAMMARSTEN, J. F., GuENTER, C. A. Antitrypsin deficiency in pulmonary disease: The significance of in- termediate levels. Annals of Internal Medicine 71(3) : 533-542, Sep- tember 1969. Wicken, A. d. Environmental and personal factors in lung cancer and bronchitis mortality in Northern Ireland, 1960-62. Tobacco Research Coucil, Research Paper No. 9, 1966. 84 pp. WicHtTman, J. A.K.A prospective survey of the incidence of postopera- tive pulmonary complications. British Journal of Surgery 55 (2): 85- 91, February 1968. WIKLANDER, O., NORLIN, U. Effect of physiotherapy on post-operative pulmonary complications: A clinical and roentgenographic study of 200 cases. Acta Chirurgica Scandinavica 112: 246-254, 1957. WILHELMSEN, L. Effects on bronchopulmonary symptoms, ventilation, lung mechanics of abstinence from tobacco smoking. Scandinavian Journal of Respiratory Diseases 48(3/4) : 407-414, 1967. WILHELMSEN, L., OHRA, I., Tipaiin, G. Decrease in ventilatory capacity between ages of 50 and 54 in representative sample of Swedish men. British Medical Journal 3(5670) : 553-556, September 6, 1969. WItson, R. H., MEADOR, R. S., Jay, B. E., HiccIns, E. The pulmonary pathologic physiology of persons who smoke cigarettes. New England Journal of Medicine 262(19) : 956-961, May 12, 1960. WINKELSTEIN, W., KANTOR, S. Respiratory symptoms and air pollution in an urban population of Northeastern United States. Archives of Environmental Health 18(5) : 760-7177, May 1969. Woo.cock, A. J., Vincent, N. J., MAcKLEM, P. T. Frequency depend- ence of compliance as a test for obstruction in the small airways. Journal of Clinical Investigation 48: 1097-1105, 1969. 235) Wynoper, E. L., GoooMan, D. A., HOFFMANN, D. Ciliatoxic components in cigarette smoke. Ii. Carboxytic acids and aldehydes. Cancer 18¢4): 505-509, April 1965. '236) WYNDER, E. L., KAISER, H. E., GoopMaN, D. A., HOFFMANN, D. A method for determining ciliastatic components in cigarette smoke. Cancer 16 (9) : 1222-1225, September 1963. (287) WYNDER, E. L., KAUFMAN, P. L., Lesser, R. L.A short-term follow-up study on ex-cigarette smokers. With special emphasis on persistent cough and weight gain. American Review of Respiratory Diseases 96(4) : 645-655, October 1967. (238) WYNDER, E. L., Lemon, F. R., MANTEL, N. Epidemiology of persistent cough. American Review of Respiratory Diseases 91(5): 679-700, May 1960. (239) YEAGER, H., Jr. Alveolar cells: Depressant effect of cigarette smoke on protein synthesis. Proceedings of the Society for Experimental Bi- ology and Medicine 131{1): 247-250, May 1969. (240) ZaMEL, N., YOUSSEF, H. H., Prime, F. J. Airway resistance and peak expiratory flow-rate in smokers and nonsmokers. Lancet 1: 1237-1238, June 8, 1963. (241) Zw, S., GorpmMaNn, H. I. Levin, A. Cigarette smoking and pulmonary function in healthy young adults. American Review of Respiratory Dis- eases 89(1): 73-81, January 1964. 217 BRONCHOPULMONARY APPENDIX TABLES 219 Tez TABLE A2.,—Smoking and chronic obstructive pulmonary disease symptoms'—percent prevalence (Numbers in parentheses represent total number of individuals in particular smoking group) SM = Smokera. NS = Nonsmokers. EX <= Ex-smokers, Author, year, Number and Breathlessness . country, type of Cough Sputum production or dyspnea Chest illnesses Other Cominents reference Population Short 2,031 male and NS....... 16 (496) NS .........10,9 Chest ilincases etal, female ineurance SM ....... 6.4(1,293) SM o..e. ee 18.0 ay yepre- 1939, policy holders, sented by USA, frequent (£06), colds, Oswald 3,602 male and Chronic Bronchitts Chronic and 2,242 female Malces brunchitis Medvei, clerical NS .......16.8 (474) defined ly 1956, workers 40-65 SM .......18.4 (1,940) habitual England years of age. Females cough and (178). NS ..,.,..121 (619) aputunt SM .......18.8 (879) production. Phillips 1,274 male NS....... 2,0 (461) etal, factory workers SM .......61.0 (823) 1956, without overt U.S.A. pulmonary (185), disenge or heart failure. Higgins 301 male and Cough and aputum Chronic Bronchitis 1957, 280 female Malee Males Males Males England rural dwellers NS vw, TL (28) NS vice eeeeee TE NS oo. 86 NS ciseeee 26 (212). 25-74 years of SM .4.......63.9 (222) SM ......0..-998 SM... WL SMM 6... 99 age, Females Females Females Females NS ....ece.. 4B C176) ONS cee 216 NS occa BT ONS cecsees 34 SM ow. ce ee kT (93) SM eee OT SM rece ae 15.2 SMM ......, 8.6 CCS TABLE A2,—Smoking and chronic obstructive pu (Numbers in parentheses represent total nu SM = Smokers. NS = Nonsmokers. bnonary, discase symiptonis'—percent prevalence (cont.) mber of individuals in particular smoking group) EX = Ex-smokers. Author, Number and Breathiesaness contr, type of Cough Sputum production or dyspnea Chest illnesses Other Comments reference population Higgins 94 males and Females Males Males Chronic bronchitis and 92 females Cough and aputum NS .cccc coe ee 893 NS... 0.0 Mates Cochran, randomly chosen NS vo. cee ee (6) SM vice eee ee 293 SM ...., 16.0 NS visee es 0.0 1958, (members of an SM .........24.0 (75) Females Fematea SM ....--- 67 England agricultural NS occccceas Gl (64) NS. vee eee ABB NSO. 10,9 Females (1th). community.} SM occ cc cee BO (20) SM Lecce ce ee 2000 SM ..... 10.0 NS .,..... 0.0 SM ....e- 60 Edwards 1,737 male out= Chronic bronchitis etal., patients on NS ..c0ee-16.6 (181) 1959, lists of Cigarettes 29.7 (779) England general prac- i- 9 2.23.4 (236) (74). titionera >60 10-19 31.2 (969) years of age. >20 . 33.7 (175) Pipe . 18.5 (349) Flick 222 male NS ....5.510,0 (61) NS....... 28.0 (49) NS ..... 30.0 (47) and patients not SM .,...,-56.0 (157) SM........,66.0 (166) SM ...,.,. 60.0(13B) Paton, suffering from 1959, overt cardiae ULS.A, pulmonary (86). didease, 20-90 yenra of age. Wigwins 716 males in Cough and aputum Chronie bronchitis etal, various SM visveaeee Ti (8B) NS... ee cesses DA NS weeee Td SM weeee 143 1968, occupations NS o0.00255.36,8 (B75) SM vce ee eee 248 SM voce. 20.2 NS ...... 35 England 25-64 years (116), of age. ce TAULE A2.—Smoking and chronic obstructive pulmonary disease symplons'—percent prevalence (cont.) (Numbers in parentheses represent totel number of individuals in particular smoking group) SM = Smokers. NS = Nunsmokers. EX =: Ex-smokers. Author, year, Number and Breathlessness country, tyne of Cough Sputum production or dyspnea Chest illnesses Other Comments refrrence population Higgins, 393 males in Cough and sputum Chronic bronchitia Chronic 1959, Vurious NS ........ 62 (33) NS .......6.6. 18.2 NS eee 30 NS ...... 0.0 bronchitis Englond occupations \+14g./day 9.7 (173) \-14g./day 30.1 l-ld4g./day 23.7 1-14 g./day 13.9 defined as (113). 65-64 years >15 wees 42,3 (142) Dis ......... 338 15 ........,23.9 DIB ..... 17.6 persistent of age. sputum and at tenst ] chest Hinesy in past d yours. Tobneco ram equivalents. are: Lcigarette rz. ld ywram, Locigar cs 2-0 Krams, lpipen 1-05 grams, Liebeschuetz,147 male NS ...... (52) 1053, soldiers SM oo... (83) England 20~30 years (1568), of age. Ashford eee a vere Respiratory symptoms Respiratory 1801, ' NS cere 103 (677) Bymptuma— ‘England EX ....6.19.8 9 (123) “bronchitis Un), Cigarettes 21.1 (1,504) and/or Pipeonly 36.1 (202) asthma’. No Cigarettes doge rela- and pipe 37,1 (90) tionship —— ANSM .. 21.7 (8,214) found. 720 TABLE AZ.—Smoking and chronte obstructive pulmonary disease aymptoms'—-percent prevalence (curt.) (Numbers in parentheses represent total numbe r of judividualy in particular smoking group) SM = Smokera. NS = Nonamokers. VX cz Ex-amokers. Author, yeur, Number and Breathlessness country, type of Cough Sputum production or dyapnea Chest illnesses Other Comments reference population Bower, 96 male and NS .....0. 4b (49) NS vices 204 NS ....6 OAT Chest inese— 1961, 71 female SM vcccee 27.6 (16) SM eee 34.2 SM ......88.2 chent colda U.S.A. bank employees Pipe, cigar =.. (18) Pipe, elgar 16.4 Pipe, elgor during cach (41). 40-70 yonrs 62.9 of Inst & of ue. wihrtess. Fietchor and 863 mate London NS cscveeee ae (80) NS viceeceees OF NS p.cceeeree 8 NS ..ceee 48 Tinker, transport l-la4g./dny 16.8 (106) t-l4g-/day ..20.9 Ieldg./doy .. 8.2 1-14 g./day 1061, employees DIB cures 27.8 (116) Pls rene BOD DIG ...ee reer 86 8.2 England 40-00 years DIB 4.6 107 (85), ofuge. Read 170 male and Males and 132 female NS v..caeee 44 Selby, individuals SM .......,.28.1 1961, interviewed EX woe... 21.2 Australia in an out- Femalca (191), patient NS ...-.0-- 49 clinic (not SM... 18.6 all patients), Balebum 1,451 male NS ........40,.2 (268) NS wccee eee » 14.0 NS vciceeee ee 9.8 etal, Ught SM ....,...,23.3 (1,198) SM oo... 804 SM voc eevee AAS 1062, industry <1 packs 20 3.1132) 60.0 (4) Ferris 542 male and Chronic bronchitis Age-specific and 625 female Males rates. Andergon, residents of NS ...se. 13.8 (125) 1962, New Hampshire EX .......11,9 (77) ULS.A. town chosen Cigarettes 40.9 (340) (81). by randum 1-10 ..,..29.8 sumpling of 11-20 .,..,.34.2 census. 21-30 ..,.,.42.3 31-40 .0.. 62.1 Dal ow.’ 76.3 Females NS vi.eee GA (878) EX .....,.10,8 (37) Cigarettes 19.8 (208) 1-10 .....43,1 11-20 .....22.2 21-30 vo... 6. 31-40 .....27.3 >4l