Cigarette Smoke Toxicity

Linking Individual Chemicals to Human Diseases

David Bernhard

• Publisher: Wiley-VCH
• Year: 2011
• Print ISBN: 9783527326815
• eBook ISBN: 9783527635337
• Edition: 1
• Topic: Physical Sciences
• Subtopic: Industrial & Technical Chemistry

Smoking causes and contributes to a large number of human diseases, yet due to the large number of potentially hazardous compounds in cigarette smoke -- almost 5,000 chemicals have been identified, establishing the link between smoking and disease has often proved difficult.
This unbiased and scientifically accurate overview of current knowledge begins with an overview of the chemical constituents in cigarette smoke, their fate in the human body, and their documented toxic effects on various cells and tissues. Recent results detailing the many ways components of cigarette smoke adversely affect human health are also presented, highlighting the role of smoking in cardiovascular, respiratory, infectious and other diseases. A final chapter discusses current strategies for the treatment and prevention of smoking-induced illness.
Despite the obvious importance of the topic, this is the first comprehensive reference on tobacco smoke toxicity, making for essential reading for all toxicologists and healthcare professionals dealing with smoking-related diseases.

1

From Discarded Leaf to Global Scourge – The Extraordinary History of the Ascent of Tobacco and its Many Modes of Consumption

Barry A. Finegan and Garrett J. Finegan

1.1 Public Health Policy and Commercial Interest – An Uneasy Equilibrium

The World Health Organization, Framework Convention of Tobacco Control (FCTC), came into effect in February 2005 [1]. The objective of the FCTC is “to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke by providing a framework for tobacco control measures to be implemented … at the national, regional and international levels in order to reduce continually and substantially the prevalence of tobacco use and exposure to tobacco smoke.” Significantly, the FCTC includes a requirement of signatories to periodically report on their progress on implementing the Treaty, thereby ensuring an active and ongoing global tobacco control effort. The FCTC, currently ratified by over 160 countries, recognizes the global nature of the tobacco industry and the growth of tobacco consumption, particularly in the developing world in the last two decades.

The worldwide consensus on the FCTC objective should portend a bleak future for entities engaged in the manufacture and sale of tobacco-related products. However, even a cursory review of the growth projections of Philip Morris and British American Tobacco suggests otherwise. In November 2009, more than 5 years after the provisions of the FCTC became binding on governments representing more than 80% of the planet’s population, an ebullient Louis Camilleri, Chairman and Chief Executive Officer of Philip Morris International (PMI), confidently predicted mid- and long-term sales volume increases of 1–2% annually and an astonishing 10–12% yearly increase in earnings per share [2]. These projections were made at a time of global economic uncertainty and when much of the world was in or slowly emerging from a deep depression. He emphasized that the free cash flow as a percentage of net revenues of PMI was 29%, second only to Pfizer and more than twice that of “peer companies” such as Pepsi and Unilever. The market valuation of PMI is US$100 billion as of January 2010 (equivalent to the annual GDP of the 55th largest economy in the world). British American Tobacco (BAT), the second largest tobacco company in the world after PMI, likewise reported record results in 2009, with profit growth of 15% [3]. BAT management emphasized that opportunities for enhancing sales, though limited in Western Europe, existed in Asia, Eastern Europe, and Africa.

The foregoing clearly demonstrates a fundamental conflict in public policy; there is clear recognition of the detrimental health effects of tobacco by governments and an expressed agreement to take firm measures in an attempt to limit consumption of tobacco products by their respective populations; there also exists a legal and powerful transnational tobacco industry which exert great influence on local economic wellbeing and whose products are a easy and reliable source of taxation revenue. How the products derived from the leaves of Nicotiana tabacum and N. rustica, plants used initially by indigenous peoples of the Americas as entheogens, assumed such importance is an intriguing story of economics, ingenuity, pharmacology, marketing, and duplicity.

1.2 Blessed Offspring of an Uncouth Land

Prior to 1492, knowledge of tobacco was limited to the American continent. Tobacco was smoked, chewed, drunk, inhaled as snuff, or administered as an enema by the Amerindians, who used it extensively in ceremonial, social, and medicinal situations [4]. Tobacco was ubiquitous but greatly prized, as detailed by a puzzled Columbus in his journal outlining the events of 15 October 1492, as he sailed off the shore of what is now Cuba: “we met a man in a canoe … he had with him … some dried leaves which are in high value among them, for a quantity of it was brought to me at San Salvador” [5]. Ironically, given the future economic importance of tobacco, Columbus discarded the offering, being obsessively focused on discovering gold, silver, and spices, the key objective of his voyage. On his second expedition, in 1493, Columbus was accompanied by Ramon Pané, a friar who was charged with describing the legends, culture, religious beliefs, and daily life of the Amerindians. Pane’s writings provide the first detailed description of the use tobacco: “he [a shaman] must also purge himself just as the sick man does, by snuffing a powder called cohoba up his nose. This produces such intoxication that they do not know what they are doing” and how a chieftain “relates the vision he had while stupefied with the cohoba that he snuffed up his nose and that went to his head” [6].

The colonization of the Americas and the introduction of Iberian agricultural practices began immediately following these first encounters [7]. The numbers of emigrants, and with them, the contact between Europe and the Americas grew rapidly, with over 85 000 people departing from Seville alone between 1506 and 1560. (Norton) Not surprisingly, knowledge of the unique effects of tobacco ingestion, allied to the remarkable methods used to consume the drug (smoking being heretofore unheard of outside the Americas), piqued the interest of many in Europe. Detailed descriptions of tobacco use by Amerindians were published in the many writings of the adventurers and merchants who visited the new continent in the decades following Columbus’s initial voyages [8].

Initially, the export trade in tobacco was relatively limited and monopolized by Spain. Although the Spanish crown recognized the value of tobacco as a commodity that could be a stable and growing source of revenue, the main focus of Spanish activities in the Americas was the mining of precious metals (silver and gold) and the marshaling of sufficient labor to allow this activity to proceed unhindered. By 1560, tobacco seeds had been sent to Europe and plants were being grown in the Portuguese and Spanish palace gardens. The effects of tobacco, medicinal and otherwise, were subject to intense study by leading European scholars. In 1571, Nicolo Monardes, a prominent and, for the time, a widely read Spanish physician, cataloged in detail the putative benefits of tobacco in the treatment of multiple diseases, including cancer, asthma, cramps, worms, and toothache.(Norton) Monardes’ theories dovetailed neatly with the classical humoral medical philosophy still somewhat prevalent in the sixteenth century [9], and helped establish the ill-founded but tenacious belief that tobacco was a therapeutic plant.

The following year, 1572, the first monograph devoted solely to tobacco was published in France. Tellingly, the author, Jacques Gohory, refers to the plant as “l’herbe de la Royne” in honor of his patroness Catherine de’ Medici [10]. Gohory added to the luster of tobacco as a medicinal herb, suggesting that it was an effective remedy for chancrous ulcers, among other ailments. By the late sixteenth century, aided by familiarity, posited medicinal properties, and social cachet, tobacco cultivation and consumption, though limited, had spread throughout the known world. Portuguese traders brought Brazilian tobacco to India, Japan, Macao, China, and African ports. Spanish mariners introduced tobacco to the Philippines. In England, Raleigh and Drake had popularized pipe smoking, especially among the members of Elizabeth’s royal court [11], and the popularity of smoking among the general population widened. In 1602 an anonymous author composed and published The Metamorphosis of Tobacco which included the lines “A worthy plant, springing from Flora’s hand, the blessed offspring of an uncouth land.”

1.3 A Valuable Poison

Acceptance of tobacco was far from universal, however. Tobacco was linked to heathen rituals and savage practises, issues of grave concern to those sworn to uphold Christian principles [8]. Bartolome de las Casas, a priest and the first bishop of Chiapas, who initially visited the Americas in 1502, considered smoking a vice and reprimanded his fellow Spanish colonists for their habit, urging them to cease the activity without success [12]. Girolamo Benzoni, a traveler and controversial author of History of the New World, published in 1565, considered tobacco a “pestiferous and wicked poison from the devil” [13]. The introduction of tobacco into the Ottoman Empire fomented considerable debate among religious scholars and in some cases violent opposition [14]. Elizabeth’s successor, James I was a vehement opponent of tobacco, describing it as a “vile barbarous custome” and shortly after assuming the throne in 1604, he imposed a punitive duty on tobacco imports. In part, his opposition was due to the Spanish monopoly on tobacco production that required England to trade with its traditional enemy and exchange gold for a substance of no enduring value – a product that would be burned by the purchaser [15]. Furthermore, Monardes had included scrofula (ulcerous tuberculosis of the cervical lymph glands) in the pantheon of maladies that could be cured by tobacco-containing salves. Scrofula, otherwise known as the “King’s Evil,” was thought at the time to be curable only by the “royal touch,” that is by touch of the king of England or France. That tobacco should intrude into this unique prerogative of royalty was no doubt anathema to James. His autocratic royal contemporaries appear to have had similar concerns: rulers as disparate as the Ottoman Sultan Ahmed I and the last Ming Emperor of China proclaimed smoking a capital offense [16].

Despite these actions, tobacco use did not diminish. Official attitudes of detestation toward tobacco and smokers, changed to acceptance, if not encouragement, with the realization that sanctions on the import and sale of tobacco encouraged an illicit trade in the product and that tobacco import duties could be a new and potentially valuable source of revenue [17]. James I typified this trend, being forced in 1607 to reduce the duty on tobacco imports in an effort to hinder the volume of contraband trade. In 1615, he ordered the resumption of the royal monopoly over the importation of tobacco, and in 1617 sold that right for a substantial sum to a group of private individuals.

Before the establishment of Jamestown settlement in Virginia in 1607, England, unlike the France, Holland, and Spain, had not been successful in maintaining a permanent colony on the North America continent. Initially, the Jamestown enterprise almost foundered – the settlers being wracked by disease and starvation – and the London Company, which had financed the venture, teetered close to bankruptcy. Tobacco, introduced by John Rolfe, the husband of the famed Pocahontas, saved the colony from ruin. Thereafter, almost all aspects of life in the colony were subordinated to the cultivation and exportation of tobacco. Such was the importance of tobacco to the colony that for much of the seventeenth century, sterling was supplanted by pounds of tobacco as the unit of currency in Virginia (200 lb = 1£ sterling) [18].

The colonists were a unique breed, willing to accept great risk in return for the promise of transport to the New World and an eventual grant of land, capitalistic by nature and circumstance, and forced into self-reliance by extraordinarily difficult living conditions [19]. These characteristics were essential for the success of the tobacco industry in North America. Most had arrived in Virginia from England as indentured laborers, initially working off the cost of their passage by toiling in the fields, performing the many manual activities required to cultivate and process tobacco efficiently. The indentured labor system operating in Virginia presaged the introduction of slavery, which occurred in Virginia towards the end of the seventeenth century when tobacco prices fell and white labor became too scarce and expensive to employ, even on an indentured basis [20].

In 1634, the Maryland colony was established, further expanding tobacco production in British North America (BNA). In concert with the tenets of mercantilism, all tobacco leaf grown in BNA was packed in barrels and shipped on British ships to England and Scotland.

Production and export of tobacco from BNA soared during the seventeenth century, rising from 60 000 lb in 1622 to 30 000 000 lb in 1698 [21]. The increase in production in BNA was matched in mainland Europe by Dutch and German growers [21]. Inevitably, the price for the raw product, which was 96 pennies per l b in 1622 at its zenith, fell dramatically, averaging less than 2 pennies per lb between 1632 and 1770 [22]. During the late seventeenth and throughout the course of the eighteenth century, tobacco, once a luxury product, became inexpensive and available to all, and consumption of tobacco increased worldwide.

Britain and Holland became major centers for the manufacture of tobacco products, exporting to countries as diverse as France, Russia, and even Spain, and tobacco cultivation flourished throughout the Ottoman Empire, the expanding colonies of European powers and in Asia [22].

1.4 Sniffing, Chewing, and Smoking

Difficult as it is to believe today, for much of the eighteenth and nineteen centuries, in many areas of the world tobacco was not smoked but inhaled or chewed. Nasal inhalation of ground tobacco (snuff) was especially popular among elites, devotees including such luminaries as Catherine de’ Medici, George III’s wife Charlotte (known as Snuffy Charlotte), and Admiral Lord Nelson [23]. In Austria, Italy, and particularly in France, snuff consumption became widespread. Snuff was introduced into China by the Jesuits at a time when smoking tobacco was illegal and rapidly gained acceptance among courtiers and wealthy merchants. Both in Asia and Europe, snuff containers (boxes and bottles) were popular gifts and frequently were objects of elaborate decoration and value. Interest in snuff waned in most of Europe in the early nineteenth century with the widespread availability of cigars, which had been a product confined to Spanish and Portuguese territories. A number of factors combined to facilitate the widespread adoption of cigars in Europe, including the introduction of an official tobacco grading system and standardized guidelines for cigar manufacture in the Spanish colonies (the primary location for cigar production), the establishment of large cigar manufacturing facilities, and alterations to the taxation structure that encouraged production, particularly in Cuba. The French, Swedish and Austrian tobacco industry were all offering cigars by 1845 [24].

By 1880, sales of snuff had fallen in all European countries except Sweden, where oral moist snuff (snus) was the most popular tobacco product, a unique regional preference that is still apparent today. Chew tobacco was consumed by the less privileged members of society. Chew was produced by spinning tobacco leaves into rolls, which were then pressed and cut into “plugs” that were placed in the mouth, allowing the nicotine to be absorbed and the flavor tasted. Excess juice was expectorated, hence the colloquial term “spit tobacco.” In the USA, chew tobacco outsold any other manufactured tobacco product throughout the nineteenth and into the early part of the twentieth century. Elsewhere in the world, chewing tobacco was never as popular as snuff or smoked tobacco products.

1.5 The Development of the Cigarette – A Perfect Nicotine Delivery System

Graphic illustrations of cigarette-like objects (papalete) being smoked appear in the late eighteenth century in paintings and drawings by Goya. Cigarettes were initially the preserve of the poor and indigent, being self-rolled in paper from waste tobacco, but by the mid-nineteenth century they were being sold by some European tobacco monopolies, though in very limited quantities. Sales statistics from 1868 for the French state tobacco monopoly are illustrative; they indicate that cut tobacco (used in pipe smoking) and snuff were by far the most popular tobacco products and that cigarette sales accounted for only 0.02% of total sales. The Austrian and Italian tobacco monopolies only started offering cigarettes for sale in 1875 and 1884, respectively, a clear indication of the weak consumer demand in this part of Europe for this “new” tobacco product. During the Crimean War (1853–1856) and US Civil War (1861–1865), smoking tobacco in the form of self-rolled cigarettes was relatively commonplace among soldiers, fueling a small but growing demand for cigarettes in Britain and United States in the aftermath of the conflicts. Cigarettes might well have remained a marginal tobacco product were it not for the occurrence of a number of unrelated developments.

Prior to the advent of chemical fertilizers, land used for tobacco cultivation rapidly became depleted of nutrients, needing to lie fallow for many years if crop quality and yield were to be maintained. With growth in demand, tobacco cultivation spread westward in Virginia and into the neighboring lands of Ohio, Pennsylvania, Maryland, North Carolina, and Kentucky. Unlike the Tidewater district of Virginia, whi...

Table of contents

• Cover
• Related Titles
• Title page
• Copyright page
• Preface
• List of Contributors
• 1 From Discarded Leaf to Global Scourge – The Extraordinary History of the Ascent of Tobacco and its Many Modes of Consumption
• Part I: Cigarette Smoking
• Part II: Linking Cigarette Smoke Chemicals to Human Diseases and Pathophysiology
• Part III: Prevention and Treatment of Smoking–Induced Diseases
• Part IV: Summary
• Index