TY - JOUR T1 - Cadmium lung adsorption, citrullination and an enhanced risk of COPD JF - European Respiratory Review JO - EUROPEAN RESPIRATORY REVIEW DO - 10.1183/16000617.0054-2018 VL - 27 IS - 149 SP - 180054 AU - David Hutchinson Y1 - 2018/09/30 UR - http://err.ersjournals.com/content/27/149/180054.abstract N2 - The paper “Cadmium in tobacco smokers: a neglected link to lung disease?” by Ganguly et al. [1] was read with great interest. The authors excellently review the evidence that cadmium (Cd) present in cigarette smoke is associated with chronic obstructive pulmonary disease (COPD) development. They emphasise the importance of lung Cd tissue levels by highlighting a study that demonstrated significantly increased lung tissue levels of Cd in severe COPD lung tissue compared to smokers without COPD, although the consumption of tobacco was higher in those patients with severe COPD [2]. Furthermore, Ganguly et al. [1] cite further evidence linking Cd exposure to COPD development, such as development of emphysema in animal models exposed to nebulised Cd and in individuals exposed to occupational Cd fumes. Additionally they emphasise the accumulation of Cd in smokers' organs, such as the kidney, compared to nonsmokers, and that Cd statistically increases markers of innate immunity activation.Cadmium in cigarettes has been overlooked as a risk factor for COPD development as studies have failed to take into account lung tissue levels. The levels of cadmium in blood and urine may not reflect lung cadmium tissue levels in smokers. http://ow.ly/u6Of30lCyw8 ER -