The Billowing Impact of Cigarette Smoking

In the past year, the head of Cancer Care Ontario died, tragically of cigarette-induced lung cancer. I learned last week that a gifted and brilliant surgeon has been diagnosed with unresectable cigarette-induced lung cancer. He is a thoracic surgeon with an international reputation in the surgical management of lung cancer. When one knows the people involved, the lunacy of cigarette addiction becomes even more disturbing. A report this week that early cigarette smoking among teenage girls (the current growth market) doubles their risk of breast cancer reinforces my long-standing desire to grab cigarettes from children and destroy them (I have controlled these desires, and thus I am still free to walk the streets).

Older people also suffer from the pernicious effects of tobacco. They are part of a cohort that started smoking when society considered cigarettes an acceptable part of life, and their longer period of smoking means more complications. Many of the articles in this issue focus on the pulmonary effects of tobacco, but it must be remembered that the number of premature cardiac deaths attributed to tobacco is even greater than the number of pulmonary deaths.

Dr. D'Arcy Little, Medical Director of CME for Geriatrics & Aging, sets the stage for this issue with his article on tobacco use in the elderly. Drs. Michael Johnston and Yaron Shargall discuss current practices in the screening and treatment of lung cancer, while Dr. Robert Hyland reviews chronic obstructive lung disease and its management. Drs. John Granton and Moiz Zafar cover the issue of pulmonary hypertension, an entity for which new information and new treatments seem to hit the general medical journals every month. Smoking is, of course, an important factor in the pathogenesis of secondary pulmonary hypertension via its contribution to chronic lung disease. The article on the aging respiratory system by Drs. Don Sin and Benjamin Chiam helps us put the various diseases discussed in this month's issue into the proper context. We have even included a patient information section detailing The BreathWorks Program, courtesy of the Ontario Lung Association. We are grateful for their participation.

As well as our focus on lung diseases in the elderly, we have our usual collection of interesting topics. Dr. Gladstone continues his superb series on the neurological examination in aging, dementia and cerebrovascular disease with an article on cerebellar testing. This is particularly relevant as instability and falls are considered "geriatric giants". Dr. Fodor discusses hypertension in the elderly, and Dr. D'Arcy Little explores an unusual aspect of dementia, that of personhood and spirituality.

Enjoy this edition, and remember, don't smoke!

Dr. Barry J. Goldlist, MD, FRCPC, FACP, AGSF is chief of the Conjoint Geriatric Program at the Rehabilitation Institute of Toronto and the Toronto Hospital. He is also an Associate Professor at the Department of Medicine and Department of Behavioural Science at the University of Toronto. Among other achievements, Dr. Goldlist has received the "Most Outstanding Teacher Award" from the University of Toronto, Division of Geriatric Medicine for the past three years in a row.
Dr. Goldlist has published articles in a variety of scholarly journals. Most of these have focused on geriatric issues such as hypertension, falls, psychoactive drugs, constipation and cluster deaths in long-term care institutions. Dr. Goldlist is the author of three books, has written numerous letters, abstracts and poster presentations, and is a prolific lecturer on geriatric issues.