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The respiratory system is quickly impaired by smoking. Smokers can feel the impact of smoking in a relatively short period of time - they are more prone to breathlessness, chronic cough, and excess phlegm production than nonsmokers of their age. Smokers tend to miss work one third more often than nonsmokers do, primarily because of respiratory diseases. Cigarette smokers are up to 18 times more likely than nonsmokers to die of diseases of the lungs. Cigarette smokers have higher death rates from emphysema and chronic bronchitis and more frequently have impaired lung function and other symptoms of lung disease than do non-smokers.

Chronic bronchitis is the presence of a productive cough that persists or reoccurs frequently. It may develop in smokers because their inflamed lungs produce more mucus and constantly try to rid themselves of this mucus and foreign particles. The effort to do so results in the "smoker's hack," the persistent cough experienced by most smokers. Smokers are more prone than nonsmokers to respiratory ailments such as influenza, pneumonia, and colds.

Emphysema is a chronic disease in which the alveoli (the tiny air sacs in the lungs) are destroyed, impairing the lungs' ability to obtain oxygen and remove carbon dioxide. As a result, breathing becomes difficult. Whereas healthy people expend only about 5 percent of their energy in breathing, people with advanced emphysema expend nearly 80 percent of their energy in breathing. A simple movement such as rising from a seated position may be painful and difficult for the emphysema patient. Since the heart has to work harder to do even the simplest tasks, it may become enlarged and the person may die from heart damage. There is no known cure for emphysema. Approximately 80 percent of all cases of emphysema are related to cigarette smoking.