The George Washington University Medical Center Washington, DC
Correspondence to: Tsung O. Cheng, MD, FCCP, Department of Medicine, Division of Cardiology, The George Washington University Medical Center, 2150 Pennsylvania Ave NW, Washington, DC 20037
To the Editor:
I read with interest the recent report of Silverman et al (May 2003)1
about cigarette smoking among asthmatic adults. What impressed me most was their finding that, although 50% of current smokers admitted smoking worsens their asthma symptoms, only 4% stated that smoking was responsible for their current exacerbation.1
A similar scenario exists in patients with pulmonary emphysema.
In my practice, I saw many patients with chronic cor pulmonale due to pulmonary emphysema who are invariably cigarette smokers. They continue to smoke, despite the obvious fact smoking made their cough worse. The invariable answer to my question why they continued to smoke if smoking made their cough worse was that cigarette-induced cough loosened their sputum. This seems to be a universal response of cigarette smokers, in both the United States and China where cigarette smoking is rampant.2–3
In Chinese, xiao tan is the equivalent expression for loosening the phlegm. What I usually did for these patients in China was to ask them to perform a simple FVC test to measure the FEV1 before and after they smoked a cigarette. I then showed how the FEV1 fell instead of rising after they smoked a cigarette. Such a visual demonstration that cigarette smoking worsened instead of improving the airway obstruction usually did more good than my constant preaching of the harm of smoking. As they say in China, one picture is better than a thousand words.
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