It is well recognised that inhalational injury is a major predictor of mortality in burns patients. However, there have not been any studies looking at the effect smoking (and its effects on the lungs) in these patients. Therefore, this is an interesting subject of study. The authors carried out a retrospective analysis of 580 patients with inhalational injury, 20% were cigarette or marijuana smokers, while 80% were non-smokers. It was found that smokers had significantly lower mortality rate (9%) compared to non-smokers (26%, p<0.01). It is postulated that pathophysiological adaptations that is has protective function during acute inhalational injury occur in smokers. Possible mechanisms include suppressed cell-mediated immunity, mooted inflammatory response and presence of anti-inflammatory substance in cigarette smoke. The authors acknowledge the limitations of a retrospective study, including inability to control factors like severity of inhalational injury or chronicity / packs per year history of smokers. Although an interesting paper, the findings raise more questions for future studies into the pathophysiology of smoking and its effects on molecular / immune mechanisms in inhalational injury. 

The effect of smoking status on burn inhalation injury mortality.
Knowlin L, Stanford L, Cairns B, Charles A.
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Kuen Y Chin

ST6 Plastic Surgery, St John’s Hospital, Livingston, UK

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