MARKOV PRESS, Box 561, Clifton, NJ 07012
On the web at http://www.spiritcrow.com/quitsmoking/
The entire text (You are viewing only the first chapter.) is available FREE in several formats at
If you find the information within this text helpful to you,
please tell your friends about this book,
especially those who may benefit and improve their lives by quitting smoking.
Copyright © 1990, 2001 by Mark Pilipski, Box 588, Westbrookville, NY 12785
All rights reserved. No part of this book may be reproduced in any form or by electronic or mechanical means including information storage and retrieval systems without permission in writing from the author except for those pages designated in the text for duplication as part of the course materials for the lectures and activities presented herein and brief quotes of passages by reviewers and students.
A note for readers of this text:
You are looking at only the introductory chapter of this book. The entire text is available FREE at this website. This outline and the classroom sessions repeat several important points. If you are reading the text and not attending the regular sessions, please reread sections of the text whenever advised to do so. This course is designed to take about six weeks to complete. Many readers will finish and become nonsmokers in less time. Some will require more time than the six weeks. Most people will find that these six weeks are just enough time to learn to quit smoking. If you finish early, good for you. If you require more time, just keep at it by following the instructions presented here and you will succeed.
The outline headings are capitalized on the pages to allow you to find a subject easily for review.
Please note that we have made this book available to everyone on the web for FREE at http://www.spiritcrow.com/quitsmoking/. It is FREE but if you can help us, we'll do our best to help you and many others. Our only goal here is to help people quit smoking and allow them to live full and happy lives. If you find the information within this text helpful to you, please tell your friends about this book, especially those who may benefit and improve their lives by quitting smoking. We do ask that if you feel this information is helpful and if you would like to support this work, you may send $1 (or whatever you think is appropriate) to help cover our administrative costs to:
|LIST OF FIGURES||PAGE|
|FIGURE #1 - broncho-pulmonary tree||9|
|FIGURE #2 - normal and obstructed airways||10|
|FIGURE #3 - cross-section and side view of airways||11|
|FIGURE #4 - enlargement of three epithelial cells||12|
|FIGURE #5 - respiratory bronchioles and alveoli||13|
|FIGURE #6 - inhaled dust||15|
|FIGURE #7 - inhaled dust - large amounts||16|
|FIGURE #8 - effect of toxic particles in cells||17|
|FIGURE #9 - hemoglobin||19|
|FIGURE #10- normal cell and parts||35|
|FIGURE #11- DNA beads||35|
|FIGURE #12- radiation types - alpha, beta, gamma||36|
|FIGURE #13- asbestos/smoking risk of dying chart||39|
|FIGURE #14- spirogram||45|
|FIGURE #15- flow-volume loop||46|
|FIGURE #16- heart - four chambers||54|
|FIGURE #17- lungs - heart - body||55|
|FIGURE #18- artery - capillaries - vein||56|
|FIGURE #19- electrocardiograph||57|
|FIGURE #20- open, blocked and squeezed tube||70|
|FIGURE #21- inhalation - exhalation||71|
|FIGURE #22- normal vs. asthmatic||72|
|FIGURE #23- normal vs. restricted volumes||73|
|FIGURE #24- emphysematory lung tissue||75|
|FIGURE #25- normal vs. emphysema||76|
The average man has a Total Lung Capacity of about seven liters (two gallons) of air. This means that if you took in a deep breath, somewhere in your chest you would have about two gallons of air. The average woman's lungs are a bit smaller. The size of your lungs is proportional to your height. If you are tall your lungs are big. If you are short your lungs are small.
You breathe about 15 to 20 times each minute. Each breath you take moves about a half liter (one pint) of air in and out of your lungs. This means that you move about ten liters (10 l.) or 2.5 gallons
20 x 0.5 liter = 10 liters
or 20 x 1 pint = 2.5 gallons of air each minute of your life.
Let's think about this for a minute. We breathe
10 liters of air every minute
600 liters of air every hour
14,400 liters of air every day
5,259,800 liters of air every year of our lives.
This means that a forty year old person has moved over 200 million liters of air in and out of his lungs, and has taken almost half a billion breaths. We could round all these numbers and say that in a lifetime (about 80 years) you take more than one billion breaths.
If we were able to follow a breath of air into the lungs we would pass through the mouth or nose to the trachea. Your trachea or windpipe is a small tube about one centimeter in diameter and four or five centimeters in length. It is about the size of a standard piece of blackboard chalk.
Use your finger to touch your neck just under the point of your chin. Now, slowly slide your finger down your neck. In the middle of your neck you will feel a bump. This is your voicebox or larynx. Say a few words and feel the vibrations at your finger tip. The larynx sits atop the trachea. All the air you breathe every minute of your life passes through this single tube called the trachea. It's easy to understand how someone can choke on a piece of food and have all his air blocked. Children, because their airways are smaller than adult airways ,are especially subject to choking on food, peanuts for example, or small objects such as buttons.
The single tube called the trachea points toward the center of the chest and then branches into two smaller tubes. These smaller tubes are called bronchi. The left and right mainstem bronchi in turn branch into smaller tubes. They in turn branch into still smaller tubes. We use the word "branch" for a good reason. If we were to view the whole system of airways upside down, the trachea would look like the trunk of a tree. As we looked higher into the tree we would see each generation of branches form the next smaller generation. In fact, the total airways system is often referred to as the "broncho-pulmonary tree".
If we call all the airways of about the same size a generation. That is the trachea is one generation. The left and right main stem bronchi form another generation and so on. Each generation of tubes branches into about twice as many tubes to form the next smaller generation of tubes. Thus, each generation of airways has about twice as many tubes as the previous generation. There are about twenty-four generations of airways.
Therefore we have
2x2x2x2x2x2x2x2x2x2x2x2x2x2x2x2x2x2x2x2x2x2x2x2 = 224
Two to the twenty-fourth power or roughly about ten million (10,000,000) tiny tubes connected to the business end of the lungs.
The structure of the airways is important to our breathing. The larger airways have rings of cartilage to provide support and hold the airways open. Cartilage is a stiff substance. your nose is made of cartilage. The cartilage rings are held in place by a net of fibers and muscles. The muscles wrap around the airways almost like the stripes on a barber's pole or candy cane. Whenever, these muscles contract, the airways are reduced in diameter. Whenever the airways are made narrower than normal air does not pass through as easily as whenever the airways are in their normal state.
If these muscles go into a spasm, we call this an asthma attack. Many different types of inhaled irritants can trigger an asthma attack. The inhalation of smoke always irritates the small airways and causes some degree of obstruction to normal airflow.
Let us examine the lining of these airways more closely. The lining is exposed to the air we breathe as it passes through the airways to the business end of the lungs.
If we were to magnify the lining of the airways, we would see several distinct tissues and structures.
Above the basement membrane we find a very delicate lining, a layer of cells. the scientific name for these cells is columnar (columns) epithelial (on the surface) cells. They are packed very tightly together. At the top of every cell are tiny hair-like structures called cilia.
The cilia beat in a wave motion like the oars of an old wooden warship. This motion of the cilia slowly moves a mucous blanket up and out of the airways. To help you imagine how this works, think of a field full of people standing shoulder to shoulder with their arms stretched up over their heads. Their arms represent cilia. Imagine a very large blanket, so large that it covers everyone in the field. If these people were to use their hands and arms to move the blanket over their heads to one side of the field; they would be working in a manner similar to the cilia in our airways. Cilia are so small that thousands bundled together would not equal the width of a human hair. Cilia are delicate structures, yet their function is very important to maintain clear airways.
Mucous is familiar to most people. Although, it is not usually a topic of polite conversation. It is an important substance in our airways. Mucous is composed of water, sugars, proteins and several other substances. It is thick, moist, viscous, and sticky. This last property is used by the body to remove inhaled particles. Whenever a tiny speck of dust or a particle of smoke passes through the nose or mouth into the airways, it sticks to the mucous blanket along the walls of the airways. This trapped particle is then moved along with the mucous blanket up and out of the airways. Once the mucous is moved to the top of the airways sensitive nerves at the junction of these tubes cause us to cough and thus expel the dust or particle and mucous from our lungs. Normally, all day long we are swallowing a mixture of saliva from our mouths and mucous from our airways. Mucous is produced by special cells, called goblet cells. These cells are shaped like tiny goblets and are scattered among the epithelial cells.
Let's examine the far end of the airway system. The business end of the lungs is located at the farthest end of the airways from the mouth. The trachea and other airway tubes continue to branch and each generation is smaller than the one before. after about twenty generations or branchings, the tiny tubes begin to have some out-pockets. These pouches are the beginnings of our air sacs or alveoli. Within these tiny balloons gas exchange with our blood takes place. These airways are called respiratory bronchioles.
The alveoli or air sacs are tiny balloons. There are millions of them. They are clustered around the respiratory bronchioles . You may imagine them as grape-like bunches of balloons. Remember, the air we inhale is on the inside of these sacs and our body is the outside. We are interested in the nature of the thin "skins" around each one of these tiny balloons. Thus, the skins of these air sacs face the "outside" of our body. Just as our regular skin touches the air, the alveolar linings touch the air we inhale. The total area of these linings is surface area for your body. Let's go back to the idea of a bunch of grapes, for a moment. If we were to carefully peel a grape and then flatten the peel (to spread it, not to stretch it) on a table, we would see how big an area the skin represented.
If we could do the same thing for all the tiny air sacs within our lungs and place them next to each other we would cover an area about the size of a tennis court! This is amazing.
Folded up in the shape of millions of tiny little balloons is a surface the size of a tennis court within our chest.
The analogy of a tennis court is also helpful for explaining the slow progression of most lung damage. Most of you are somewhat familiar with the game of tennis. Players bounce a small ball from side to side over a net across the center of the court. Tennis may be played on any one of several court surfaces. We will consider the clay court. Clay courts require special care. Normally, the clay is moistened and rolled flat in preparation for a game.
Imagine, if you will, a smooth clay court in the early morning, wet with dew. The clay is soft from the water. If we continue to imagine, the sun will rise and its heat will dry the clay to a hard smooth surface. This hard surface will be just right for playing tennis. At this time, just before the clay hardens, let's envision a small child out walking his dog, crossing a corner of the court, leaving his footprints in the soft clay.
Do these footprints (tiny ridges in the corner of the court) make it impossible to play tennis on this court? Of course not! Although, some world class tennis players may object, the few footprints would not have any effect upon the game as played by most people. (Most people are lucky if they can hit the ball. That they may be able to aim and direct the ball to a tiny footprint to cause an erratic bounce is unlikely.)
Oddly enough, the surface of our lungs functions in a similar manner. Small areas of damage go completely unnoticed. Except by a few well trained world class athletes, most of us simply don't use our lungs well enough to notice any small "footprints" on the surface.
After they've gone and the clay hardens, will anyone be able to play tennis on that court? Probably not. Because, even a bad player would not be able to move the ball without it hitting a footprint.
Lung disease is that range between the complete inability of the lungs to support life and the first insensibly small areas of damage. This is a very big range. That is the heart of the tragedy.
With this information we can follow the path of a tiny dust particle that has been inhaled. Normally, any small particle that passes the nose will float upon the inhaled air until it gets stuck to the mucous blanket lining the airways. The mucous blanket is slowly moved up and out to the upper airways by the action of the cilia.
As mucous accumulates in the large airways, nerves sensitive to fluid movement cause us to cough. The cough pushes the mucous up to our throat and we are able to swallow the mucous. All day long saliva from our mouth is mixed with mucous from our lungs and is swallowed. This is how the lungs, normally, clear inhaled dust.
It is a simple cleansing mechanism. Dust gets stuck and is carried away. As long as the cilia keep working, the airways under ordinary conditions remain clean of dust particles.
But, what happens if we inundate our airways with too much dust? What happens in the airways of a coal miner, a sand blaster, a welder, a baker, or anyone working in a very dusty environment?
Inhaled dust particles get stuck to the mucous at such a high rate and in such a large quantity that some of the dust particles "rain out" or "fall through" the mucous blanket.
These particles are now among the cilia. They cannot be removed from the airways. They are beyond the reach of the cleansing mechanism of the airways.
These particles are sitting right on top of the epithelial cells lining the airways. The cells will incorporate these particles. If the particles are edible (they, usually are not) the cell will digest them. If the particles are not edible (this is usually the case) the cells will still ingest them but will have to leave them encysted within the cell structure. The cells can't digest these particles. As the particles accumulate, slowly, the cells take on the physical characteristics of the particle material. The cells become more particle like than cell-like. Not only do the cells take in more particles, soon there is more dust than cells.
Imagine using a small dime-store sponge (the kind you would use to wash dishes) to help mix concrete. After a few times of being pushed around in the mixture of concrete, sand, and water the tiny little spaces in the sponge would be filled with concrete. Once dry, the sponge would be more like a brick than a sponge.
Use another sponge to mix bread dough. Soon the sponge is more like a piece of dough than a sponge.
The same process occurs within the lungs and the cells of the body. If we expose the cells to high or constant concentrations of particulate matter, the cells will take up the particles and take on the physical characteristics of the particle substance. If the substance is stiff, the lungs become stiff. If the substance is viscous, the lungs become viscous.
Almost every type of particle has a disease associated with the inhalation and deposition of the material in the lungs. Silicosis is caused by inhaling silica. Bagassosis is caused from inhaling too much bagasse (sugar cane). Pneumoconiosis from too much coal dust (black lung), Asbestosis from inhaled asbestos, etc. These physical changes in the soft pliable nature of the normal lungs are called restrictive disorders. Anything that restricts the volume of air breathed is a restrictive defect.
It is important to note that so far we have discussed only physical changes occurring in the lungs due to the inhalation of inert particles. The situation is a bit different if the particles contain toxic substances. The particles work their way into the cells, just as we have discussed above. Usually, a large amount of inhaled particles is needed to pass the mucous layer in the airways. Certainly, any particulate suspension that can be seen in the air (smoke, dust cloud, etc.) will provide more than enough particles to overload the lung's defense mechanisms.
After the epithelial (surface) cells ingest some of these particles, toxic substances from the particles begin to leach into the cell. If the particles are very small or if the poisons are not very strong, the cell will "get sick" for awhile. This means that its cilia will not function. If and whenever the cell recovers the ciliary action will resume. If the cell is reproducing under the effects of the toxin it may not divide properly. In fact, this is one explanation of cancer development. Cells under the influence of chemicals (carcinogenic chemicals - cancer-causing chemicals - toxic substances) divide abnormally and deform their DNA, thus forming cancer cells.
We can see how for the cells just "getting sick" is enough to start a vicious cycle:
A. Particles accumulate on the mucous layer
B. Cilia move the mucous up and out
C. Particles "rain out" on to the cell surface
D. Cells "get sick" - cilia stop moving
E. Back to step A. but skip step B. more and more particles accumulate.
This cycle leads to gross accumulation of particulate matter and mucous, as well as, ultimately, the destruction of lung cells and tissue.
Oxygen passes from the air we inhale into our blood by simple diffusion. Diffusion is easy to understand. Open a perfume bottle in a closed room. Leave the opened bottle in the room. After awhile, go back into the room. You will smell the perfume, even across the room. The perfume molecules have slowly diffused (spread) from the bottle to the air in the room. The process of molecules going from an area of high concentration (bottle) to an area of lower concentration (room air) is called diffusion. Oxygen diffuses from the air we breathe into our blood. Carbon dioxide from our cells diffuses from the blood into the air through our lungs.
The airways are tiny tubes that direct the flow of air to the alveoli (air sacs). The alveoli are the business end of the lungs. It is here that gas exchange takes place. The total surface area of all alveoli is equivalent to the area of a tennis court. Oxygen from the inhaled air travels to our blood and carbon dioxide (a waste product of respiration) passes from the blood to the exhaled air. This process is called gas exchange. A hard working member of this process is the red blood cell. These tiny almost doughnut shaped cells carry oxygen from the lungs to every tissue in the body. The red pigment hemoglobin within the red blood cell makes all this oxygen transport possible. Hemoglobin is a large molecule. It is composed of a heme (iron) group surrounded by a globular (globin) protein.
The heme group has an affinity for oxygen. This means that it attracts oxygen. The globular protein around the heme prevents oxygen from getting too close to the heme. Slight chemical changes within the blood cause the protein to expand or contract a channel to the heme. Whenever the red blood cell is near the alveolar surface the channel is opened and the heme in the hemoglobin attracts some of the plentiful oxygen. The hemoglobin holds onto this oxygen as it is carried by the circulating blood to our body's' tissue. As the red blood cell approaches some tissue, for example a muscle, the chemistry of the blood becomes more acidic, due to the production and accumulation of wastes from the muscle's activity. The acidic environment causes the globular protein to close the channel to the heme. It actually "pinches off" the oxygen molecule, so that the oxygen can by used by the muscle to aid its metabolism. This picking up, carrying, and dropping off of oxygen goes on constantly as the blood circulates from the lungs to the body to the lungs and so on.
Before we close this chapter let's review the information presented.
The branching tubes that are passages for the air we breathe lead to billions of tiny delicate sacs that are the sites of gas exchange. Inhaled substances and particles slowly destroy these delicate structures, as well as the linings of the airways. This destruction leads to disease. Blood passing through the lungs picks up inhaled oxygen and gives up carbon dioxide to the exhaled air. Hemoglobin carries the life- sustaining oxygen to all the tissues of the body.
This is a sample of the first chapter of the SMOKING CESSATION CLINIC. Please note that we have made the whole book available to everyone on the web for FREE at http://www.spiritcrow.com/quitsmoking/. It is FREE but if you can help us, we'll do our best to help you and many others. Our only goal here is to help people quit smoking and allow them to live full and happy lives. If you find the information within this text helpful to you, please tell your friends about this book, especially those who may benefit and improve their lives by quitting smoking. We do ask that if you feel this information is helpful and if you would like to support this work, you may send $1 (or whatever you think is appropriate) to help cover our administrative costs to: