Smoking lung (COPD) - symptoms, causes, therapy

Smoking lung (COPD) - symptoms, causes, therapy

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What is a smoking lung?

Shortness of breath, morning coughing fits, low resilience, shortness of breath - many smokers experience the consequences of long-term tobacco use firsthand. The lungs suffer the most from the toxic smoke inhalations. It is not unlikely that smoking will form a lung. The Robert Koch Institute (RKI) estimates that around six percent of the population in Germany are affected. From a medical point of view, the smoking lung is known as chronic obstructive pulmonary disease (COPD) and factors other than tobacco consumption can also lead to the symptoms. The most important things in brief:

  • definition: COPD is chronic obstructive bronchitis that occurs either with or without overexposure to the lungs (emphysema). Chronic bronchitis occurs when the symptoms persist for more than three months a year.
  • Symptoms: Seizure-like cough with expectoration of mucus (increased in the morning), shortness of breath, difficulty breathing when stressed (later also when at rest).
  • frequency: COPD is a common condition from middle adulthood. There is a high number of unreported cases among those affected. According to RKI projections, 5.8 percent of the German population are affected.
  • causes: Toxins in the lungs, mostly tobacco smoke, have increasingly damaged the natural defense mechanisms of the lungs over many years. Certain childhood diseases, genetic factors, and air pollution are also suspected of promoting COPD development.
  • therapy: In the advanced stage, the damage to the lungs is considered non-reversible. However, bronchodilators and cortisone, as well as smoking cessation, can improve the situation of those affected.

Three stages of the smoking lung

The World Health Organization WHO divides the smoking lung or COPD (from the English: Chronic Obstructive Pulmonary Disease) into three stages:

  • Stage I: The first stage is characterized by predominant bronchitis, but without further physical restrictions.
  • Stage II: At this stage, in addition to bronchitis, there is a reduction in performance.
  • Stage III: In the third stage, the symptoms are expanded by further impairments in the gas exchange. Pulmonary emphysema can develop, which has massive negative consequences for lung function and breathing.


In the respiratory tract there are the finest cilia and between them so-called goblet cells, which are responsible for the mucus production. The cilia move back and forth on the moist mucous membrane and use these movements to transport dust and dirt towards the nasopharynx. The ciliated epithelium (epithelium = cover tissue) is responsible for cleaning the inhaled air and moistening it.

Tasks of the bronchial mucosa

An intact bronchial mucosa has different tasks. It provides protection against foreign intruders and is involved in the production of various substances. These include immune messengers, growth factors and substances that can cause the blood vessels to constrict.

Smoke destroys the mucous membranes

Constant smoking is increasingly destroying the mucous membrane, including the cilia, whereby more and more goblet cells develop from the ciliated epithelium, which produce more mucus. As a result, mucus production increases throughout the bronchial tract. The amount of mucus can no longer be coughed up properly, and the backflow of bacteria makes it easier for them to colonize.

Inflammation occurs

Due to the constant penetration of pathogens, dust or dirt, the increased production of mucus and the lack of intact mucous membrane, there is recurrent inflammation in the bronchial walls, which causes the mucous membrane to swell. The bronchial walls are getting thicker, which leads to long-term obstruction (narrowing) of the airways. Breathing becomes more difficult, the gas exchange between blood and breathing air is increasingly impaired, and the oxygen content of the blood decreases.

Other causes

While 80 to 90 percent of COPD cases are caused by smoking, there are other factors that increase the risk of COPD:

  • Childhood diseases: Childhood illnesses such as asthma, bronchitis or pneumonia (pneumonia) are considered a risk factor.
  • Smoking parents: Smoking by parents has an impact on the development of later smoking cough in their children.
  • Genetic predisposition: The genes also play a role. In particular, people with the hereditary disease alpha-1-antitrypsin deficiency have an increased risk of developing COPD.
  • Air pollution: Fine dust is also suspected to trigger COPD. Certain professions, such as coal mining workers, are particularly at risk.


Since there is no longer any cilia in a smoker's lung and mucus production increases more and more, there is a chronic cough, which is particularly severe in the morning. Due to the toxins in the lungs, the expectoration usually has a brownish color. Traces of blood are occasionally added to the sputum.

Smoking cough - the first warning sign

The smoker's cough does not develop overnight, but is a gradual process over years. Most of the time, a smoker's symptoms are downplayed by himself, while smoking destroys his lungs more and more. The first alarm sign is chronic cough with morning sputum.

Shortness of breath and reduced resilience

Over the years, those affected increasingly suffer from shortness of breath during physical exertion. This can be the case, for example, when simply climbing stairs. Overall, the general resilience due to the smoking lung continues to decrease.

Blue lips and finger ailments

Due to the progressive lack of oxygen, the lips turn blue. So-called drumstick fingers (swelling of the fingertips) and watch glass nails (large, curved nails) are also created.

Consequences of a smoking lung

Since a smoker's lung has already been damaged, very commonplace colds are usually much more difficult for those affected. Due to the lack of cilia and the enormous amount of mucus, the pathogens can not be easily banished from the body or coughed up. As a result, pneumonia occurs frequently.

Increased risk of heart failure

The increased performance of the lungs also increases the pressure in the pulmonary circulation (cor pulmonale), which in the long run favors the development of heart failure.

Chronic inflammation

The constant exposure to nicotine and other pollutants causes the cilia to die. The smallest inhaled dust particles and dirt remain in the body. This constant state of irritation causes chronic inflammation. The mucus production increases, the bronchial walls swell and there are breathing difficulties up to shortness of breath over the years.


In the advanced stage, the alveoli lose their stability and collapse on exhalation. The normal physiological structure of the lungs is increasingly destroyed and pulmonary emphysema can develop.


A smoking lung should not be taken lightly. According to the Lunge white paper, which is published by the German Society for Pneumology and Respiratory Medicine and the German Lung Foundation, around 15,000 men and 11,000 women in Germany died in 2011 from the consequences of COPD. Life expectancy due to a smoking lung is reduced by eight years on average.


Lighter course forms, without symptoms, are determined by a lung function measurement. Heavier forms are shown by shortness of breath, even at the slightest load. The diagnosis of COPD is usually only made in the fourth or fifth decade of life. In order to be able to assess exactly how far the disease has progressed, X-ray examination and / or computer tomography are carried out. Pulmonary function test, ECG, blood count and a sputum check (examination of the sputum) are also common methods of examination.


Of course, stopping smoking or avoiding pollutants plays an outstanding role here. A reduction in cigarette consumption is not enough. Lung function can normalize again here, but in advanced cases chronic bronchitis continues. Bronchodilating drugs are used to try to avoid further damage. In conventional medicine, cortisone is often used to combat the chronic inflammation of the bronchi. If those affected continue to smoke, the disease cannot be cured despite all medication.

Smoking cessation

The best preventive measure against a smoking lung is: quit smoking. Quitting smoking leads to many health benefits. Regeneration begins just a few minutes after the last cigarette:

  • 20 minutes later: pulse and blood pressure values ​​normalize.
  • 12 hours later: The oxygen supply to all organs increases. The general performance improves.
  • 2 weeks to 3 months later: The entire circulation and lung function show improvements.
  • 1 to 9 months Later: Typical symptoms such as coughing fits, shortness of breath and blocked sinuses progressively decrease. The stuck mucus in the lungs is gradually broken down. The increased risk of infection begins to decrease.
  • 1 year Later: The risk of developing coronary artery disease is halved compared to the risk of smokers.
  • 5 years later: The risk of cancer in the oral cavity, throat, esophagus and bladder is halved. The risk of developing cervical cancer is at the same level as a non-smoker.
  • ten years later: The risk of dying from lung cancer has halved. Other cancer risks on the larynx and pancreas also decrease.
  • 15 years Later: The risk of developing coronary artery disease reaches the level of a non-smoker.

(sw, vb)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Susanne Waschke, Barbara Schindewolf-Lensch


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ICD codes for this disease: J44ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.

Video: Smoking and COPD. Nucleus Health (August 2022).