It is very meaningful that Arcavi and Benowitz1 remind us of the impact of smoking on susceptibility to infections, especially respiratory tract infections. Although they reviewed the mechanism of increased susceptibility to infections in smokers, ranging from structural changes in the respiratory tract to alternation of cellular and humoral immune system functions, we greatly regret that they did not mention swallowing and cough reflexes, possibly the most important defense mechanism of airway infection.
Ebihara S, Ebihara T, Okazaki T, Sasaki H. Cigarette Smoking, Cough Reflex, and Respiratory Tract Infection. Arch Intern Med. 2005;165(7):814. doi:10.1001/archinte.165.7.814-a