Chest
Volume 139, Issue 4, April 2011, Pages 775-781
Journal home page for Chest

Original Research
COPD
The Acute Effects of Water-Pipe Smoking on the Cardiorespiratory System

https://doi.org/10.1378/chest.10-1833Get rights and content

Objective

There are limited data on the acute effects of water-pipe tobacco smoking, commonly known as water-pipe smoking (WPS), on cardiopulmonary parameters. This study evaluated the acute effects of a single 30-min session of WPS on carboxyhemoglobin (COHb) levels, pulmonary function test results, vital signs, fractional exhaled nitric oxide (Feno) levels, and exhaled breath condensate (EBC) cytokine levels in volunteers in a domestic, open-air, group smoking setting.

Methods

This prospective study evaluated the above-noted outcome parameters before and after 30 min of WPS. The primary outcome parameter was the change in COHb levels.

Results

Forty-five volunteers (30 men, 15 women), aged 32.35 ± 15.33 years, were recruited. After one session of WPS, the COHb levels rose significantly, from 1.47% ± 0.57% (median 1.4) to 9.47% ± 5.52% (median 7.4), P < .001. Systolic and diastolic BP levels significantly increased after smoking (systolic, 119.52 ± 12.07 mm Hg vs 131.98 ± 17.8 mm Hg; diastolic, 74.84 ± 7.89 mm Hg vs 82.98 ± 12.52 mm Hg, respectively; P < .001). Heart rates increased from 80.39 ± 9.92 beats/min to 95.59 ± 17.41 beats/min, P < .001; and respiratory rates increased from 14.36 ± 1.63 breaths/min to 16.68 ± 2.24 breaths/min, P < .001. There were decreases in forced expiratory flow between 25% and 75% of FVC, peak expiratory flow rate, Feno levels, percentage of eosinophils in peripheral blood, and 8-isoprostane levels in EBC.

Conclusions

This study shows that one session of WPS causes acute biologic changes that might result in marked health problems. It adds to the limited evidence that WPS is harmful and supports interventions to control the continuing global spread of WPS, especially among youth.

Trial registry

ClinicalTrials.gov; No.: NCT01157832; URL: www.clinicaltrials.gov

Section snippets

Subjects

The study was approved by the Institutional Review Board, Rambam Health Care Campus (number 0219-09) and registered at ClinicalTrials.gov (identifier NCT01157832). Each subject read and signed an informed consent form prior to enrollment. Eligible subjects were older than 18 years and had previously smoked from WPs. Exclusion criteria included any chronic lung disease, pregnancy or lactation in women, acute illness during the previous 2 weeks, corticosteroid treatment, WPS in the previous 24 h,

Results

Forty-five subjects (30 men, 15 women) were included; their characteristics are presented in Table 1. The vital signs before and after one session of WPS are shown in Table 2. Significant increases in systolic and diastolic BP (≤ 186 mm Hg and 106 mm Hg, respectively), heart rate (≤ 141 beat/min), and respiratory rate (≤ 25 breaths/min) were observed. The visual analog scores of general feeling showed a significant decrease, from a median of 10 (9.68 ± 0.64) to 7 (6.95 ± 1.98) (P < .0001), even

Discussion

This study evaluated the short-term effects of a 30-min single session of WPS on multiple cardiorespiratory parameters. This model is a relatively easy and sensitive method of investigating the specific effects of WP smoke on these parameters.16

The study showed that one session of WPS resulted in significant increases in COHb concentrations, systolic and diastolic BP levels, and heart and respiratory rates. Decreases were observed in PEFRs, the percentage of eosinophils in the peripheral blood,

Summary

Our study demonstrates that one session of WPS caused significant cardiorespiratory changes in healthy volunteers. These changes were similar or even greater than those reported in cigarette smoking. Larger studies, including the evaluation of the short-term and long-term effects of WPS, are required. The results of our study add to the limited evidence that WPS is harmful and support interventions to control the continuing global spread of WPS, especially among youth.

Acknowledgments

Author contributions: Drs Hakim and L. Bentur both had full access to the data and both will vouch for the integrity of the data analysis.

Dr Hakim: contributed to the recruitment of patients, performance of all tests, and writing of the study.

Mr Hellou: submitted the institutional review board application and contributed to the recruitment of patients, performance of all tests, data analysis, and literature survey.

Dr Goldbart: analyzed the nitrotyrosine data and contributed to the discussion of

References (35)

  • RB Shaikh et al.

    The acute effects of waterpipe smoking on the cardiovascular and respiratory systems

    J Prev Med Hyg

    (2008)
  • H van der Vaart et al.

    Acute effects of cigarette smoking on inflammation in healthy intermittent smokers

    Respir Res

    (2005)
  • MR Miller et al.

    Standardisation of spirometry

    Eur Respir J

    (2005)
  • American Thoracic Society et al.

    ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005

    Am J Respir Crit Care Med

    (2005)
  • PP Rosias et al.

    Biomarker reproducibility in exhaled breath condensate collected with different condensers

    Eur Respir J

    (2008)
  • I Horváth et al.

    Exhaled breath condensate: methodological recommendations and unresolved questions

    Eur Respir J

    (2005)
  • H van der Vaart et al.

    Acute effects of cigarette smoke on inflammation and oxidative stress: a review

    Thorax

    (2004)
  • Cited by (0)

    Funding: This work was supported by the Israel Cancer Association, the Israel Lung Association, and the Israel Science Foundation Legacy [Grant 1817/2007].

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

    View full text