CHEST
Volume 146, Issue 4, October 2014, Pages 924-931
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Original Research
Chinese Water-Pipe Smoking and the Risk of COPD

https://doi.org/10.1378/chest.13-1499Get rights and content

BACKGROUND

Studies show that the incidence of COPD has remained high in southwest China despite the 1976 National Stove Improvement Program for indoor air quality. Chinese water-pipe tobacco smoking (commonly referred to as water-pipe smoking), which is thought to be less harmful under the assumption that no charcoal is used and water filters tobacco smoke, is popular in China. We investigated whether Chinese water-pipe use and exposure are associated with the risk of COPD.

METHODS

This multicenter, cross-sectional study enrolled 1,238 individuals from 10 towns in the Fuyuan area, Yunnan Province, China. A matched design was used to estimate the impact of active and passive exposure to Chinese water-pipe smoking on COPD risk; multivariate analyses adjusted for other risk factors. We also collected the water from Chinese water pipes to assess the mutagenicity of its major components and simulated Chinese water-pipe smoke exposure fine particulate 2.5 (PM2.5) by using the High Volume Air Sampler and individuals' sera to search for the potential protein biomarkers of COPD.

RESULTS

The increased risk of COPD was profound for Chinese water-pipe smokers (adjusted OR, 10.61; 95% CI, 6.89-16.34), Chinese water-pipe passive smokers (adjusted OR, 5.50; 95% CI, 3.61-8.38), cigarette smokers (adjusted OR, 3.18; 95% CI, 2.06-4.91), and cigarette passive smokers (adjusted OR, 2.52; 95% CI, 1.62-3.91) compared with never-smoking control subjects. Chinese water-pipe use aggravates lungs with more PM2.5 compared with cigarettes. ChemR23 and tissue inhibitor of metalloproteinase-1 may be potential protein biomarkers of COPD.

CONCLUSIONS

Chinese water-pipe smoking significantly increases the risk of COPD, including the risk to women who are exposed to the water-pipe smoke.

TRIAL REGISTRY

Chinese Clinical Trial Registry; No.: ChiCTR-CCH-12002235; URL: www.chictr.org/cn/

Section snippets

Individuals and Study Design

This multicenter, population-based, cross-sectional study (October 15, 2011 to January 12, 2013) enrolled 1,238 individuals from 10 towns (Dahe, Dongshan, Housuo, Fuchun, Zhongan, Yingshang, Zhuyuan, Laochang, Shibalianshan, and Huangnihe) covering a wide geographic area in Fuyuan County, Yunnan Province, China, and representing a total population of > 780,000.

We targeted all residents ≥ 40 years of age14 and used a random-digit phone sampling at 12 local hospitals and clinics (see e-Appendix 1

Individual Characteristics

A total of 1,238 individuals were included in the analysis (Fig 2); baseline characteristics are presented in Table 1. Smokers and passive smokers were similar in individual demographics including age, height, weight, and hypertension, whereas the NS group tended to consume less alcohol compared with the CWS and CS groups.

Pulmonary Impairment

The mean smoking duration (years) was similar in the CWS and CS groups (28 ± 11.2 vs 28.5 ± 13.5) (Table 1). The CWS group subconsciously increased the daily frequency of

Discussion

We provide robust results that large-volume Chinese water-pipe use and exposure are associated with the elevated prevalence of COPD, which has been identified by epidemiologic, physiologic, radiologic, and toxicologic findings for the first time. One thousand two hundred and thirty-eight individuals, 40 years of age or older, were enrolled from 10 towns. In our study, potential risk factors for COPD included the following: CWS (OR, 10.61; 95% Cl, 6.89-16.34), CWPS (OR, 5.50; 95% Cl, 3.61-8.38),

Conclusions

In conclusion, the Chinese water pipe has mistakenly been deemed as less harmful. Our study has provided evidence confirming this misconception. Exposure to active and passive Chinese water-pipe smoke may be a significant risk factor for developing COPD. The damage from Chinese water-pipe use and exposure is worse than that from cigarettes. Our results highlight that smoking cessation in Chinese water-pipe users is as important as the smoking cessation of other tobacco products in the

Acknowledgments

Author contributions: C. B. takes responsibility for the content of the manuscript, including data and analysis. J. S. contributed to the conduct of the study; J. S., P. Y., Yuqi Wang, X. Q., J. F., Yi Wang, G. G., G. L., K. M., B. L., C. L., X. Wang, Y. S., and C. B. contributed to the completion of the work and development of the manuscript; J. S. contributed to the drafting of the manuscript; P. Y. contributed to the design of the work and revision of the manuscript; Yuqi Wang, X. Q., J. F.,

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    This study was presented as an oral presentation at CHEST 2012, October 20-25, 2012, Atlanta, GA.

    FUNDING/SUPPORT: This work was supported primarily by the National Key Scientific and Technology Support Program: Collaborative Innovation of Clinical Research for Chronic Obstructive Pulmonary Disease and Lung Cancer [2013BAI09B09]. Dr She was supported by the National Natural Science Foundation for Young Scholars of China [81200051]; the Research Fund for the Doctoral Program of Higher Education of China [20110071120060]; the Science Foundation for Young Scholars in Zhongshan Hospital [2012ZSQN04]; and the Scientific Project for Fudan University [20520133474].

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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