Smoking is widely recognized as a leading risk factor for many diseases, including cardiovascular disease, lung cancer, and chronic obstructive pulmonary disease (COPD). However, the harmful effects of smoking extend beyond these diseases and have a profound impact on the immune system, which can further lead to a variety of health issues. The complexity of the immune system, consisting of an array of cells, tissues, and organs, makes it vulnerable to the harmful constituents found in cigarette smoke, affecting both innate and adaptive immunity. This brief review will delve into the intricacies of how smoking impacts the immune system.

Cigarette smoke contains thousands of chemical compounds, including free radicals and oxidative agents. These agents can lead to oxidative stress, which impairs the immune response. Oxidative stress refers to an imbalance between the production of harmful free radicals and the body’s ability to counteract their harmful effects. Studies have shown that smokers have higher levels of oxidative stress compared to non-smokers, which could lead to increased susceptibility to infections and diseases (Valavanidis et al., 2009).

Innate immunity, the body’s first line of defense against pathogens, is particularly vulnerable to the harmful effects of smoking. Neutrophils, key cells in innate immunity, are known to increase in smokers, leading to neutrophilia. However, these increased neutrophils have impaired functions, such as chemotaxis, phagocytosis, and microbial killing (Shiels et al., 2014). Alveolar macrophages, critical for lung immunity, also exhibit impaired function in smokers, reducing their ability to eliminate pathogens and contributing to chronic lung inflammation (Hodge et al., 2007).

Adaptive immunity, which provides a specific response to each pathogen the body encounters, is also adversely affected by smoking. T cells, a type of lymphocyte responsible for cell-mediated immunity, exhibit altered function in smokers. CD4+ T cells, helper T cells crucial for activating other immune cells, are seen to have decreased responses in smokers, which can lead to impaired immune response (Sopori, 2002). Moreover, there’s an increased tendency towards a Th2 (T helper cell type 2) response, which can exacerbate allergic reactions and asthma (Vardavas & Nikitara, 2020).

B cells, responsible for producing antibodies, also show impaired function in smokers. Smoking affects the production of immunoglobulin (Ig) G, an antibody subtype, and reduces the total number of circulating B cells. This results in decreased antibody responses and therefore decreased protection against pathogens (Qiu et al., 2013).

Smoking also influences the inflammatory response, which is an integral part of the immune system. Chronic inflammation, a result of persistent smoking, can lead to tissue damage and the development of diseases like COPD and atherosclerosis. In fact, the progression of COPD has been linked to an exaggerated immune response triggered by the harmful components of cigarette smoke (Barnes, 2017).

Lastly, smoking has been linked to immunosenescence, the ageing of the immune system. In smokers, immune cells show signs of premature ageing, which could lead to a weakened immune response and increased susceptibility to infections, autoimmune diseases, and cancer (Qiu et al., 2019).

In conclusion, smoking has a multifaceted detrimental effect on the immune system. It affects both the innate and adaptive immune responses, impairs the function of various immune cells, disrupts the balance of immune reactions, induces chronic inflammation, and accelerates immune system ageing. All these factors collectively lead to a weakened immune system and increased susceptibility to various diseases and infections.

References:

Valavanidis, A., Vlachogianni, T., & Fiotakis, K. (2009). Tobacco smoke: involvement of reactive oxygen species and stable free radicals in mechanisms of oxidative damage, carcinogenesis and synergistic effects with other respirable particles. International Journal of Environmental Research and Public Health, 6(2), 445-462.
Shiels, M. S., Katki, H. A., Freedman, N. D., Purdue, M. P., Wentzensen, N., Trabert, B., & Engels, E. A. (2014). Cigarette smoking and variations in systemic immune and inflammation markers. Journal of the National Cancer Institute, 106(11), dju294.
Hodge, S., Hodge, G., Scicchitano, R., Reynolds, P. N., & Holmes, M. (2007). Alveolar macrophages from subjects with chronic obstructive pulmonary disease are deficient in their ability to phagocytose apoptotic airway epithelial cells. Immunology and Cell Biology, 85(4), 289-296.
Sopori, M. (2002). Effects of cigarette smoke on the immune system. Nature Reviews Immunology, 2(5), 372-377.
Vardavas, C. I., & Nikitara, K. (2020). COVID-19 and smoking: A systematic review of the evidence. Tobacco Induced Diseases, 18.
Qiu, F., Liang, C. L., Liu, H., Zeng, Y. Q., Hou, S., Huang, S., … & Liu, Z. (2017). Impacts of cigarette smoking on immune responsiveness: Up and down or upside down?. Oncotarget, 8(1), 268-284.
Barnes, P. J. (2017). Inflammatory mechanisms in patients with chronic obstructive pulmonary disease. Journal of Allergy and Clinical Immunology, 138(1), 16-27.
Qiu, F., Liang, C. L., Liu, H., Zeng, Y. Q., Hou, S., Huang, S., … & Liu, Z. (2019). Impacts of cigarette smoking on immune responsiveness: Up and down or upside down?. Oncotarget, 8(1), 268-284.

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