# From Airways to Alveoli: A Review of Smoking-Related Respiratory Disorders

## TL;DR

This review explores how smoking affects respiratory health, highlighting ongoing challenges and the need for better tobacco control strategies.

## Contribution

The paper provides a comprehensive synthesis of smoking's impact on respiratory diseases and identifies gaps in current tobacco control strategies.

## Key findings

- Smoking remains a leading cause of respiratory illness despite declining rates in some regions.
- Low- and middle-income countries face rising smoking-related disease burdens due to population growth and aging.
- The review identifies gaps in long-term data and evidence on newer nicotine products.

## Abstract

Despite significant declines in smoking rates over recent decades, tobacco use remains a leading preventable cause of respiratory illness and death worldwide. While global smoking rates have declined, progress has slowed in many regions, and the smoking-attributable disease burden continues to rise in low- and middle-income countries due to population growth and ageing. Smoking is a major risk factor for a wide range of respiratory diseases, including chronic obstructive pulmonary disease, lung cancer, and emerging post-infectious conditions, and it contributes significantly to disability-adjusted life years globally. This narrative review synthesizes the available literature to critically evaluate the impact of smoking on respiratory health, integrating evidence on conventional cigarette smoking and electronic cigarette use. It examines current trends, highlights unmet clinical and public health needs, and identifies key knowledge gaps to inform future research and tobacco control strategies. The review examines the respiratory effects of tobacco and e-cigarette constituents, including their inflammatory, oxidative, and immunomodulatory mechanisms, and assesses the physiological and clinical benefits of smoking cessation. Current pharmacological and behavioral cessation strategies are reviewed, alongside emerging approaches and public health interventions. Particular attention is given to disparities in respiratory health priorities, healthcare infrastructure, and access to evidence-based therapies across different socioeconomic settings. Finally, key knowledge gaps are identified, including limitations in long-term outcome data, underrepresentation of vulnerable populations, and insufficient evidence on newer nicotine products, and future research directions are proposed to strengthen tobacco control policies and improve respiratory disease prevention globally.