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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

The percentage was highest among young adults aged 18 to 25 (4.1 percent or 1.4 million people), followed by adults aged 26 or older (3.4 percent or 7.5 million people), then by adolescents aged 12 to 17 (1.6 percent or 396,000 people)

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