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United States National Institutes of Health

This isnt the 50s, when you would see TV commercials with lab-coat-wearing doctors spitting chewing tobacco right on the examination-room floor, said activist Helen Pertwee of The Great American Tobacco Backwash, a citizens group dedicated to fighting the rising tide of secondhand tobacco spit in public places

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Once there, smoke-expanded pools of alveolar macrophages are paradoxically less effective: phagocytosis, autophagy, antigen presentation, and production of key cytokines such as tumor necrosis factor- (TNF-), interleukin-12 (IL-12), and interferon- (IFN-) are all attenuated, while a shift toward anti-inflammatory M2 phenotypes and smoke-induced metabolic exhaustion enable intracellular survival of the pathogen (Leemans et al., 2005