Cigarette smoking and irreversible airways obstruction in the West Indies.

, 495-504. Two communities, one in Jamaica and one in Guyana, have been surveyed in order to investigate the relationships between cigarette smoking, respiratory symptoms, and lung function in the West Indies. Cigarette consumption was less than that reported in the United Kingdom, particularly among women. Smoking was associated with cough, phlegm, increases in total lung capacity and residual volume, and reductions in FEV%, transfer coefficient (Kco), and alveolar capillary blood volume (Vc). Vital capacity (VC) and the diffusion capacity of the alveolar membrane (Dm) were normal. After allowing for differences in age and tobacco consumption, less cough, phlegm, and airways obstruction occurred in the West Indies than has been reported in the United Kingdom. Forty-seven patients in Jamaica with chronic obstructive lung disease were followed for three years. All except six female asthmatics were either current smokers or ex-smokers. Smoking in patients was associated with a similar but more severe pattern of lung disease to that found in survey subjects with, in addition, reductions in VC and Dm. In the non-smoking asthmatics Kco, Dm, and Vc were normal. The lung function of these 47 patients was similar to that reported for UK patients even though both chronic bronchitis and hypercapnia were considerably less common in Jamaica. Emphysema was present in all six patients who died and came to necropsy. It is suggested that in the West Indies emphysema contributes more than bronchitis to airways obstruction in smokers. There was also evidence that subjects of African origin were less susceptible to the emphysema-producing effect of cigarettes than were other ethnic groups.