You can see how over expanded Mr. Bredwell's chest is in order to contain his overinflated lungs. You can see how labored his breathing is even at rest. He breathes rapidly and utilizes his rib muscles and neck muscles to pull in enough air. A person with severe emphysema is frequently panicked, just trying to get enough oxygen to survive. Before they died, both men wanted to leave a message for kids. "My message to younger children is to not start smoking because it's not cool at all and then you won't have to worry about stopping" (Tadge Bredwell). "I would advise young people to be smarter than I was, and stronger and braver than I was because if I had been smart enough I wouldn't have started, and that's the way you need to think" (Richard Heath).

VIDEO SEGMENT 15
"Surgeon Generals warning: smoking causes chronic bronchitis"
"I was choking on my own air". This is Mr. Harold Mulhauser (slide 22). After years of smoking he developed a persistent smokers cough which produced increasing amounts of thick mucous. These are the symptoms of chronic bronchitis which is defined clinically as a chronic cough which produces mucous for at least 3 months per year for at least two years. This is very common and occurs in 75% of regular smokers.

How does smoking cause these symptoms?

1) Harmful chemicals in tobacco smoke cause chronic inflammation in the large airways which are called the bronchial tubes. 2) This leads to a marked increase in the size and number of mucous glands in the bronchial wall. 3) The large number of mucous glands secrete a large amount of mucous into the airway which must be coughed up to prevent drowning in your own secretions.

Because of trouble clearing these secretions, Mr. Mulhauser required a tracheostomy, a surgically placed hole in his neck through which the excessive mucous could be suctioned out (slide 23). Mr. Mulhauser's bronchus looks like the one in the bottom panel which contains about ten