Biochemically and pathologically, there is strong evidence for both atopic and nonatopic airway sensitization, hyperresponsiveness, and inflammation as a consequence of exposure to tobacco mainstream or sidestream smoke particulate. There is growing evidence for the relation between exposure to mainstream and sidestream smoke and diseases resulting from reactive oxidant challenge and inflammation directly as a consequence of the combined activity of neutrophils, macrophages, dendritic cells, eosinophils, basophils, as a humoral immunological consequence of sensitization, and that the metal components of the particulate play a role in adjuvant effects. As an end consequence, carcinogenicity is a known outcome of chronic inflammation. Smokeless tobacco has been evaluated by the IARC as a group 1 carcinogen. Of the many harmful constituents in smokeless tobacco, oral tissue metallothionein gradients suggest that metals contribute to the toxicity from smokeless tobacco use and possibly sensitization. This work reviews and examines work on probable contributions of toxic metals from tobacco and smoke to pathology observed as a consequence of smoking and the use of smokeless tobacco.

Metals are one of five major categories of carcinogenic or toxic constituents in tobacco and tobacco smoke. Cadmium is highly volatile and a higher percentage of the total tobacco cadmium content is efficiently transferred to mainstream tobacco smoke than many other toxic metals in tobacco. Inhaled cadmium bioaccumulates in the lungs and is distributed beyond the lungs to other tissues, with a total body biological half-life of one to two decades. Chronic cadmium exposure through tobacco use elevates blood and urine cadmium concentrations. Cadmium is a carcinogen, and an inducer of proinflammatory immune responses. Elevated exposure to cadmium is associated with reduced pulmonary function, obstructive lung disease, bronchogenic carcinoma, cardiovascular diseases including myocardial infarction, peripheral arterial disease, prostate cancer, cervical cancer, pancreatic cancer, and various oral pathologies. Cadmium and zinc have a toxicologically inverse relationship. Zinc is an essential element and is reportedly antagonistic to some manifestations of cadmium toxicity. This review summarizes associations between blood, urine, and tissue cadmium concentrations with emphasis on cadmium exposure due to tobacco use and several disease states. Available data about zinc and cadmium/zinc ratios and tobacco-related diseases is summarized from studies reporting smoking status. Collectively, data suggest that blood, urine, and tissue cadmium and cadmium/zinc ratios are often significantly different between smokers and nonsmokers and they are also different in smokers for several diseases and cancers. Additional biomonitoring data such as blood or serum and urine zinc and cadmium levels and cadmium/zinc ratios in smokers may provide further insight into the development and progression of diseases of the lung, cardiovascular system, and possibly other organs.

Public health officials and leaders of 168 nations have signaled their concern regarding the health and economic impacts of smoking by becoming signatory parties to the World Health Organization Framework Convention on Tobacco Control (FCTC). One of FCTC's purposes is to help achieve meaningful regulation for tobacco products in order to decrease the exposure to harmful and potentially harmful constituents (HPHCs) delivered to users and those who are exposed to secondhand smoke. Determining baseline delivery ranges for HPHCs in modern commercial tobacco products is crucial information regulators could use to make informed decisions. Establishing mainstream smoke delivery concentration ranges for toxic metals was conducted through analyses of total particulate matter (TPM) collected with smoking machines using standard smoking regimens. We developed a rapid analytical method with microwave digestion of TPM samples obtained with smoking machines using electrostatic precipitation under the ISO and Intense smoking regimens. Digested samples are analyzed for chromium, manganese, cobalt, nickel, arsenic, cadmium and lead using inductively coupled plasma-mass spectrometry. This method provides data obtained using the ISO smoking regimen for comparability with previous studies as well as an Intense smoking regimen that represents deliveries that fall within the range of human exposure levels to toxic metals.

Smoking remains the leading cause of preventable death in the United States. There are numerous harmful substances in tobacco and tobacco smoke. Among the more than 4,000 identified compounds in smoke, many metals contribute to the health risks associated with tobacco use. Specific metals found in tobacco and tobacco smoke have been classified as carcinogens by the International Agency for Research on Cancer. Exposure to toxic metals can cause outcomes including inflammation, sensitization and carcinogenesis. Metals in tobacco are transported in tobacco smoke proportionally with their concentrations in tobacco filler for a given cigarette design. To quantitatively examine the metal content in numerous tobacco products, high throughput methods are desired. This study developed a simple, rapid tobacco digestion method coupled with a sensitive analytical method using inductively coupled plasma-mass spectrometry. Because of known memory effects and volatility of mercury, quantitative determinations of mercury were made with a direct combustion analyzer. The methods were utilized to examine arsenic, beryllium, cadmium, chromium, cobalt, lead, manganese, mercury and nickel contents in cigarette tobacco and to establish a reference range for the metals in 50 varieties of cigarettes available in the US. These results are comparable to the limited data sets reported by others and with available standard reference material values.