Cigarettes and cigarette smoking.

Tobacco use was widespread in the New World by the time of the first voyage of Columbus; however, it is only in the last century that the use of tobacco as cigarettes has been prevalent. The milder tobacco and more acidic smoke of cigarettes lead to the deeper inhalation of tobacco into the lung with resultant deposition and absorption of the addicting, toxic, and carcinogenic components of the smoke. More than 4000 individual constituents have been identified in cigarette smoke, and the relative concentrations of these constituents vary widely between brands of cigarettes. Tar yield, a measure of the total particulate matter of the smoke, varies markedly with the characteristics of the cigarette manufacture and with the pattern of inhalation. As a result, tar is not a good measure of the dose of toxic or carcinogenic agents received by the individual smoker. The particle size of cigarette smoke is in the range that will lead to deposition in the airways and alveoli of the lung, and many of the gas-phase constituents are absorbed across the alveolar capillary membrane. The irritant agents in the smoke cause acute and chronic changes in lung structure and function that may result in greater retention of carcinogens within the lung and increased vulnerability of the lung to the effects of these carcinogens. Carcinogens and other constituents of cigarette smoke are also absorbed into the blood and metabolized to active forms through microsomal enzyme systems induced by cigarette smoke. The cellular influx of neutrophils and alveolar macrophages that is part of the inflammatory response may be the precursor of the alveolar wall destruction that results in emphysema. The prevalence of smoking is not uniformly distributed across the population. Men began smoking in large numbers very early in the century, but women began to smoke in large number only at the time of the Second World War. Men born after 1930 have been less likely to take up smoking than their older counterparts. The prevalence of smoking is currently declining in both men and women.