Expert: Ronald Levy, M.D. - 5/27/2007

Question
Dr. Levy,

Hi, I know this is not your specialty, but this website, great as it is, does not have pulmonology and I figured anesthesiologists need to know a lot about lungs. I have an observation, and am curious to find an explanation: If a nonsmoker smokes, they start coughing. Yet a smoker can pull smoke deep into their lungs without coughing, something that would send a nonsmoker into a coughing fit. Logic suggests that smoke irritates and damages lung tissue, so it would make sense that someone who smokes would be the one to cough, and someone who doesn't smoke with pristine lungs would not cough. If you can't answer this question I will understand since it is not your field of specialty, but I have been very curious as to an explanation. Thanks in advance.

Answer
You are correct (in part). Imagine the first time you try something REALLY sour. That first bite is horrible but by the tenth bite it is tolerable and perhaps pleasurable. It's adaptation. Smoker's lungs have gotten used to the smoke and developed some resistance while virgin lungs have not yet done that. But don't kid yourself. Smokers do cough a lot. Partuclarly after surgery, when they are waking up, they have what we call "smoker's cough". It is persistant, violent and productive. We don't see it in non smokers and it is because smokers have more secretions and their lung tissue is more irritable.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston