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Khaldi S, Derbel K, Ghannouchi I, Guezguez F, Sayhi A, Benzarti W, Barkous B, Bouafia S, Dabbebi FZ, Charfedi E, Ben Saad H. Short-term effects of announcing spirometric lung-age on smokers' attitudes: results from a Tunisian real-life pilot study. Expert Rev Respir Med 2024; 18:655-668. [PMID: 39118455 DOI: 10.1080/17476348.2024.2390992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 08/04/2024] [Accepted: 08/07/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND To determine the effects of informing smokers of their spirometric lung-age (SLA) on smoking cessation (SC) rates and tobacco consumption. RESEARCH DESIGN AND METHODS An interventional study was conducted in real-life through a humanitarian event led by the Red Crescent on 9 January 2022, in Hammam-Sousse (Sousse, Tunisia). The study comprised four steps: i) Medical questionnaire (general questionnaire, Fagerström test for cigarette dependence, SC motivation questionnaire); ii) Measurement of spirometric data; iii) SLA estimation and its announcement to participants; and iv) Self-reported evaluation of smoking behavior three months later through telephonic recall. Smokers were divided into groups (nondependent vs. dependent groups and insufficient/moderate motivation vs. high/very high motivation groups) and categories (ceased smoking, reduced consumption, maintained stable or increased consumption). RESULTS Fifty-two smokers were included (94% were males). Three months after the event, i) 9 (17%) smokers ceased smoking, ii) 39 (75%) smokers reduced their daily smoking consumption by 12 ± 8 cigarettes/day, and iii) 4 (8%) smokers maintained stable (n = 3) or increased (n = 1) consumption. CONCLUSIONS Informing smokers of their SLA led 92% of them to cease smoking or reduce their consumption. Announcing SLA could be an effective motivational tool and an easy-to-understand concept to help smokers cease their habit.
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Affiliation(s)
- Soumaya Khaldi
- Department of Physiology and Functional Explorations, Abderrahmene MAMI Hospital, Aryanah, Tunisia
| | - Khansa Derbel
- Laboratory of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia
- Heart Failure (LR12SP09) Research Laboratory, Farhat HACHED Hospital, Sousse, Tunisia
| | - Ines Ghannouchi
- Laboratory of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia
- Heart Failure (LR12SP09) Research Laboratory, Farhat HACHED Hospital, Sousse, Tunisia
| | - Fatma Guezguez
- Laboratory of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia
- Heart Failure (LR12SP09) Research Laboratory, Farhat HACHED Hospital, Sousse, Tunisia
| | - Amani Sayhi
- Laboratory of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia
- Heart Failure (LR12SP09) Research Laboratory, Farhat HACHED Hospital, Sousse, Tunisia
| | - Wafa Benzarti
- Pneumology Department, Farhat HACHED Hospital, Sousse, Tunisia
| | - Balsam Barkous
- Laboratory of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia
- Heart Failure (LR12SP09) Research Laboratory, Farhat HACHED Hospital, Sousse, Tunisia
| | | | | | - Emna Charfedi
- Laboratory of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia
| | - Helmi Ben Saad
- Laboratory of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia
- Heart Failure (LR12SP09) Research Laboratory, Farhat HACHED Hospital, Sousse, Tunisia
- Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
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Liang X, Xie Y, Gao Y, Zhou Y, Jian W, Jiang M, Wang H, Zheng J. Estimation of lung age via a spline method and its application in chronic respiratory diseases. NPJ Prim Care Respir Med 2022; 32:36. [PMID: 36175436 PMCID: PMC9522795 DOI: 10.1038/s41533-022-00293-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 08/16/2022] [Indexed: 11/12/2022] Open
Abstract
Lung age is a simplified concept that makes spirometry data easier to understand, but it is not widely used due to limitations in estimation methods. The aim of this study was to develop new equations to estimate lung age and to explore the application value of lung age in chronic respiratory diseases. Retrospective spirometric data of 18- to 80-year-old healthy subjects were used to develop the lung age estimation equations. Models were respectively built by multiple linear regression, piecewise linear regression, and the natural cubic spline method. Patients with chronic obstructive pulmonary disease (COPD) and asthma were subdivided into stages I–IV according to the severity of airflow limitation under the recommendation of the Global Initiative for Chronic Obstructive Lung Disease. Propensity score matching was performed to balance age, height and sex between healthy subjects and patients. The difference between lung age and chronological age (∆ lung age) of patients with COPD and asthma was analyzed. A total of 3409 healthy subjects, 280 patients with COPD and 285 patients with asthma data were included in the analysis. The lung age estimation equation with the best goodness of fit was built by the spline method and composed of FEV1, FEF50%, FEF75% and height as explanatory variables. ∆ lung age progressively increased with the degree of airflow limitation in patients with COPD or asthma. Lung age estimation equations were developed by a spline modeling method. Lung age may be used in the assessment of chronic respiratory patients.
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Affiliation(s)
- Xiaolin Liang
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yanqing Xie
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yi Gao
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yumin Zhou
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wenhua Jian
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Mei Jiang
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Hongyu Wang
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.,Firestone Institute for Respiratory Health, the Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jinping Zheng
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
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Derbel K, Maatoug C, Mchita A, Mabrouk KH, Saad HB. Self-Reported Smoking Status 10-Months After a Single Session Intervention Including an Education Conference About Smoking Harms and Announcement of Spirometric Lung-Age. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2021; 15:11795484211047041. [PMID: 34690503 PMCID: PMC8532218 DOI: 10.1177/11795484211047041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022]
Abstract
Background Studies investigating the effects of announcing spirometric lung-age (SLA) on the smokers' self-reported smoking status reported conflicting results. Main objective To evaluate the effects of a single session intervention including an education conference about smoking harms and announcement of SLA on the participants' self-reported smoking status. Methodology An interventional study was conducted in a cable factory. The intervention included four steps: PowerPoint presentation about raising smoking hazards awareness; general questionnaire; measurement of the anthropometric and spirometric data, and announcement of SLA; and evaluation of the smokers' self-reported smoking status 10 months later (quitted smoking, decreased consumption; stable consumption, increased consumption). Results Thirty-six smokers completed the four steps. Ten months after the intervention, 11.1% of smokers quitted smoking, 52.7% decreased their consumption by 7 ± 4 cigarettes/day, 30.5% kept a stable consumption, and 5.5% increased their consumption by 9 ± 6 cigarettes/day. Conclusion Providing an education conference combined with announcing SLA motivated 64% of smokers to quit smoking or to reduce their cigarette consumption.
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Affiliation(s)
- Khansa Derbel
- Laboratory of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia
| | | | - Amira Mchita
- Occupational Medicine Group of Sousse, Sousse, Tunisia
| | | | - Helmi Ben Saad
- Laboratory of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia.,Occupational Medicine Group of Sousse, Sousse, Tunisia.,Heart Failure (LR12SP09) Research Laboratory, Farhat HACHED Hospital, Sousse, Tunisia.,Université de Sousse. Faculté de Médecine de Sousse. Laboratoire de Physiologie. Sousse, Tunisie
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Triki L, Ben Saad H. The impacts of parity on spirometric parameters: a systematic review. Expert Rev Respir Med 2021; 15:1169-1185. [PMID: 34033730 DOI: 10.1080/17476348.2021.1935246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction: The relationship between parity and health outcomes has been debated in the scientific literature in terms of 'selection-pressure'. However, no previous review has raised the impacts of parity on spirometric parameters. This Systematic Review aimed to review the impacts of parity on spirometric parameters.Areas covered: PubMed and Scopus were searched on October 1st, 2020, using the combination of the following two medical subject headings: 'Parity' and 'Respiratory Function Tests'. Only original articles published in English/French were retained. Ten studies investigated the impacts of parity on spirometric parameters: six included healthy females, three involved unhealthy females [chronic obstructive pulmonary disease, defect in protease inhibitor, and some other conditions] and one included a mixed population of healthy/unhealthy females. The studies reported conflicting results: no impact, positive impact (multiparity is associated with larger forced-expiratory-volume in one second, forced- and slow- vital-capacity, and inspiratory-capacity), or negative impact (multiparous females has lower bronchial flows, higher static volumes, an accelerated lung-aging, a tendency to an obstructive-ventilatory-defect and/or to lung-hyperinflation, and increased protease inhibitor levels).Expert opinion: The ten studies presented some limitations that made data interpretation relatively difficult. Future research to identify the 'real' impact of parity on spirometric parameters are therefore encouraged.
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Affiliation(s)
- Leila Triki
- Department of Physiology and Functional Exploration, Habib BOURGUIBA Hospital, Sfax, Tunisia
| | - Helmi Ben Saad
- Department of Physiology and Functional Exploration, Farhat HACHED University Hospital of Sousse, Sousse, Tunisia.,Heart Failure Research Laboratory (LR12SP09), Farhat HACHED Hospital, Sousse, Tunisia.,Faculté De Médecine De Sousse, Laboratoire De Physiologie, Université De Sousse. Sousse, Tunisie
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Ketfi A, Triki L, Gharnaout M, Ben Saad H. The impacts of parity on lung function data (LFD) of healthy females aged 40 years and more issued from an upper middle income country (Algeria): A comparative study. PLoS One 2019; 14:e0225067. [PMID: 31703108 PMCID: PMC6839841 DOI: 10.1371/journal.pone.0225067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/28/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Studies evaluating the impacts of parity on LFD of healthy females presented controversial conclusions. AIM To compare the LFD of healthy females broken down according to their parities. METHODS A medical questionnaire was administered and anthropometric data were determined. Two groups [G1 (n = 34): ≤ 6; G2 (n = 32): > 6] and three classes [C1 (n = 15): 1-4; C2 (n = 28): 5-8; C3 (n = 23): 9-14] of parities were identified. LFD (plethysmography, specific airway resistance (sRaw)] were determined. Student's t-test and ANOVA test with post-Hoc test were used to compare the two groups' and the three classes' data. RESULTS G1 and G2 were age and height matched; however, compared to G1, G2 had a lower body mass index (BMI). C1, C2 and C3 were height, weight and BMI matched; however, compared to C2, C3 was older. G1 and G2 had similar values of FEV1, forced- and slow- vital capacities (FVC, SVC), maximal mid-expiratory flow (MMEF), forced expiratory flow at x% of FVC (FEFx%), peak expiratory flow (PEF), expiratory and inspiratory reserve volumes (ERV, IRV, respectively), inspiratory capacity (IC), sRaw, FEV1/FVC, FEV1/SVC, and residual volume/total lung capacity (RV/TLC). The three classes had similar values of MMEF, FEFx%, PEF, thoracic gas volume (TGV), ERV, IRV, FEV1/FVC, FEV1/SVC and RV/TLC. Compared to G1, G2 had higher TGV (2.68±0.43 vs. 3.00±0.47 L), RV (1.80±0.29 vs. 2.04±0.33 L) and TLC (4.77±0.62 vs. 5.11±0.67 L). Compared to C1, C2 had higher FEV1 (2.14±0.56 vs. 2.47±0.33 L), FVC (2.72±0.65 vs. 3.19±0.41 L), SVC (2.74±0.61 vs. 3.24±0.41 L), TLC (4.47±0.59 vs. 5.10±0.58 L), IC (1.92±0.41 vs. 2.34±0.39 L) and sRaw (4.70±1.32 vs. 5.75±1.18 kPa*s). Compared to C1, C3 had higher TLC (4.47±0.59 vs. 5.05±0.68 L) and RV (1.75±0.29 vs. 2.04±0.30 L). CONCLUSION Increasing parity induced a tendency towards lung-hyperinflation.
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Affiliation(s)
- Abdelbassat Ketfi
- Department of Pneumology, Phtisiology and Allergology, Rouiba Hospital, Algiers, University of Algiers 1, Faculty of Medicine, Algiers, Algeria
| | - Leila Triki
- Department of Functional Explorations, Habib-Bourguiba Hospital, University of Sfax, Faculty of Medicine of Sfax, Sfax, Tunisia
| | - Merzak Gharnaout
- Department of Pneumology, Phtisiology and Allergology, Rouiba Hospital, Algiers, University of Algiers 1, Faculty of Medicine, Algiers, Algeria
| | - Helmi Ben Saad
- Department of Physiology and Functional Explorations, University of Sousse, Farhat Hached Hospital, Sousse, Tunisia
- Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
- Heart Failure Research Laboratory (LR12SP09), Farhat Hached Hospital, University of Sousse, Sousse, Tunisia
- * E-mail:
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Saad HB. Promoting the Development of Reference Equations for Spirometric Lung-Age. CURRENT RESPIRATORY MEDICINE REVIEWS 2019. [DOI: 10.2174/2210327909666190404142439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Helmi Ben Saad
- Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
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Ben Khelifa M, Ben Saad H. [Which reference equation should be applied to estimate the lung age?]. Rev Mal Respir 2018; 35:997-998. [PMID: 29784503 DOI: 10.1016/j.rmr.2017.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/13/2018] [Indexed: 11/19/2022]
Affiliation(s)
- M Ben Khelifa
- Service de pneumologie, EPS Farhat Hached, Sousse, Tunisie
| | - H Ben Saad
- Laboratoire de physiologie, faculté de médecine « Ibn Elijazzar » de Sousse, université de Sousse, avenue Mohamed Karoui, 4000 Sousse, Tunisie; Laboratoire de recherche « insuffisance cardiaque, LR12SP09 », EPS Farhat Hached, Sousse, Tunisie.
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Khelifa MB, Salem HB, Sfaxi R, Chatti S, Rouatbi S, Saad HB. “Spirometric” lung age reference equations: A narrative review. Respir Physiol Neurobiol 2018; 247:31-42. [DOI: 10.1016/j.resp.2017.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/29/2017] [Accepted: 08/31/2017] [Indexed: 11/30/2022]
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Parker DR, Eltinge S, Rafferty C, Eaton CB, Clarke JG, Goldman RE. Primary care providers' views on using lung age as an aid to smoking cessation counseling for patients with chronic obstructive pulmonary disease. Lung 2015; 193:321-7. [PMID: 25791068 DOI: 10.1007/s00408-015-9708-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 02/28/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Smoking cessation is the primary goal for managing patients with chronic obstructive pulmonary disease (COPD) who smoke. However, previous studies have demonstrated poor cessation rates. The "lung age" concept (an estimate of the age at which the FEV(1) would be considered normal) was developed to present spirometry data in an understandable format and to serve as a tool to encourage smokers to quit. Primary care physicians' (PCPs) views of using lung age to help COPD patients to quit smoking were assessed. METHODS Post-intervention interviews were conducted with PCPs in the U.S. who participated in the randomized clinical trial, "Translating the GOLD COPD Guidelines into Primary Care Practice." RESULTS 29 physicians completed the interview. Themes identified during interviews included: general usefulness of lung age for smoking cessation counseling, ease of understanding the concept, impact on patients' thoughts of quitting smoking, and comparison to FEV(1). Most providers found lung age easy to communicate. Moreover, some found the tool to be less judgmental for smoking cessation and others remarked on the merits of having a simple, tangible number to discuss with their patients. However, some expressed doubt over the long-term benefits of lung age and several others thought that there might be a potential backfire for healthy smokers if their lung age was ≤ to their chronological age. CONCLUSIONS This study suggests that lung age was well received by the majority of PCPs and appears feasible to use with COPD patients who smoke. However, further investigation in needed to explore COPD patients' perspectives of obtaining their lung age to help motivate them to quit in randomized clinical trials.
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Affiliation(s)
- Donna R Parker
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI, 02912, USA,
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Ben Saad H, Selmi H, Hadj Mabrouk K, Gargouri I, Nouira A, Said Latiri H, Maatoug C, Bouslah H, Chatti S, Rouatbi S. Spirometric “Lung Age” estimation for North African population. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2014.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Ben Saad H, Khemiss M, Nhari S, Ben Essghaier M, Rouatbi S. Pulmonary functions of narghile smokers compared to cigarette smokers: a case-control study. Libyan J Med 2013; 8:22650. [PMID: 24382307 PMCID: PMC3877776 DOI: 10.3402/ljm.v8i0.22650] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 12/03/2013] [Accepted: 12/04/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Studies of the lung function profiles of exclusive narghile smokers (ENS) are few, have some methodological limits, and present contradictory conclusions. The present study aimed to compare the plethysmographic profiles of ENS with age- and height-matched exclusive cigarette smokers (ECS). METHODS Males aged 35-60 living in Sousse, Tunisia, who have been smoking narghile exclusively for more than 10 narghile-years (n = 36) or cigarettes exclusively for more than 10 pack-years (n = 106) were recruited to participate in this case-control study. The anthropometric and plethysmographic data were measured according to international recommendations using a body plethysmograph (ZAN 500 Body II, Meβgreräte GmbH, Germany). Large-airway-obstructive-ventilatory-defect (LAOVD) was defined as: first second forced expiratory volume/forced vital capacity (FEV1/FVC) below the lower-limit-of-normal (LLN). Restrictive-ventilatory-defect (RVD) was defined as total lung capacity < LLN. Lung hyperinflation was defined as residual volume > upper-limit-of-normal. Student t-test and χ(2) test were used to compare plethysmographic data and profiles of the two groups. RESULTS The subjects in the ENS and ECS groups are well matched in age (45±7 vs. 47±5 years) and height (1.73±0.06 vs. 1.72±0.06 m) and used similar quantities of tobacco (36±22 narghile-years vs. 35±19 pack-years). Compared to the ENS group, the ECS group had significantly lower FEV1 (84±12 vs. 60±21%), FVC (90±12 vs. 76±18%), and FEV1/FVC (99±7 vs. 83±17%). The two groups had similar percentages of RVD (31 vs. 36%), while the ECS group had a significantly higher percentage of LAOVD (8 vs. 58%) and lung hyperinflation (36 vs.57%). CONCLUSION Chronic exclusive narghile smoking has less adverse effects on pulmonary function tests than chronic exclusive cigarette smoking.
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Affiliation(s)
- Helmi Ben Saad
- Department of Physiology and Functional Explorations, Farhat Hached Hospital, Sousse, Tunisia; Laboratory of Physiology, Faculty of Medicine, University of Sousse, Sousse, Tunisia; Research Unit: Secondary Prevention After Myocardial Infarction, N: 04/UR/08-18, Faculty of Medicine of Sousse, Sousse, Tunisia;
| | - Mehdi Khemiss
- Department of Physiology and Functional Explorations, Farhat Hached Hospital, Sousse, Tunisia
| | - Saida Nhari
- Department of Physiology and Functional Explorations, Farhat Hached Hospital, Sousse, Tunisia
| | - Mejda Ben Essghaier
- Department of Physiology and Functional Explorations, Farhat Hached Hospital, Sousse, Tunisia
| | - Sonia Rouatbi
- Department of Physiology and Functional Explorations, Farhat Hached Hospital, Sousse, Tunisia; Laboratory of Physiology, Faculty of Medicine, University of Sousse, Sousse, Tunisia
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