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Brinkman MC, Kim H, Buehler SS, Adetona AM, Gordon SM, Clark PI. Evidence of compensation among waterpipe smokers using harm reduction components. Tob Control 2020; 29:15-23. [PMID: 30377243 PMCID: PMC7350613 DOI: 10.1136/tobaccocontrol-2018-054502] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/26/2018] [Accepted: 10/01/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVES We examined two waterpipe tobacco smoking components advertised to reduce harm to determine if they result in lower levels of biomarkers of acute exposure. METHODS We conducted a crossover study of 34 experienced waterpipe smokers smoking a research-grade waterpipe in three configurations ad libitum in a controlled chamber: control (quick-light charcoal), electric (electric heating) and bubble diffuser (quick-light charcoal and bubble diffuser). We collected data on smoking topography, environmental carbon monoxide (CO), subjective effects, heart rate, plasma nicotine and exhaled CO and benzene. RESULTS Smokers' mean plasma nicotine, heart rate, and exhaled benzene and CO boost were all significantly lower for electric compared with control. However, smokers puffed more intensely and took significantly more and larger volume puffs for a larger total puffing volume (2.0 times larger, p<0.0001) when smoking electric; machine yields indicate this was likely due to lower mainstream nicotine. Smokers rated electric smoking experience less satisfying and less pleasant. For charcoal heating, the mean mass of CO emitted into the chamber was ~1 g when participants smoked for a mean of 32 minutes at a typical residential ventilation rate (2.3 hr-1). CONCLUSION Waterpipe smokers engaged in compensation (i.e., increased and more intense puffing) to make up for decreased mainstream nicotine delivery from the same tobacco heated two ways. Waterpipe components can affect human puffing behaviours, exposures and subjective effects. Evidence reported here supports regulation of waterpipe components, smoking bans in multifamily housing and the use of human studies to evaluate modified or reduced risk claims.
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Affiliation(s)
- Marielle C Brinkman
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
- School of Public Health, Tobacco Center of Regulatory Science, University of Maryland, College Park, Maryland, USA
| | - Hyoshin Kim
- Battelle Public Health Center for Tobacco Research, Battelle, Seattle, Washington, USA
| | - Stephanie S Buehler
- Battelle Public Health Center for Tobacco Research, Battelle, Columbus, Ohio, USA
| | - Anna M Adetona
- Battelle Public Health Center for Tobacco Research, Battelle, Columbus, Ohio, USA
| | - Sydney M Gordon
- Battelle Public Health Center for Tobacco Research, Battelle, Columbus, Ohio, USA
| | - Pamela I Clark
- School of Public Health, Tobacco Center of Regulatory Science, University of Maryland, College Park, Maryland, USA
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Dorey A, Scheerlinck P, Nguyen H, Albertson T. Acute and Chronic Carbon Monoxide Toxicity from Tobacco Smoking. Mil Med 2019; 185:e61-e67. [DOI: 10.1093/milmed/usz280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/18/2019] [Indexed: 12/12/2022] Open
Abstract
ABSTRACT
Introduction: Carbon monoxide (CO) is produced from incomplete combustion of hydrocarbons and is a by-product of tobacco smoking. Chronic cigarette smokers often have carboxyhemoglobin (COHb) concentrations as high as 10%. We report a case of severely elevated COHb and polycythemia because of tobacco smoking and provide a review of the literature regarding elevated COHb in smokers. Materials and Methods: A comprehensive search of PubMed and Google Scholar was performed looking for articles on tobacco smoking and CO, COHb, CO poisoning, cigarettes, pipes, cigars and water pipes/hookah smokers. Result: COHb levels in frequent cigarette smokers generally range from 4.2% presmoking to 8.6% postsmoking. A heavy cigarette smoker presented twice with symptoms of CO toxicity and was found to have levels 21.8 to 24.2%. Cigar smokers have been found to have COHb ranging as high as 13.0 to 38.6% in case reports. Waterpipe or “hookah” smokers generally have COHb levels 10.1% +/−2.5% and case reports, and series of even higher levels associated with CO toxicity symptoms are common. Waterpipe smokers have been found to have COHb levels as high as 39.2% after smoking. Conclusions: Many active duty military and military veterans are tobacco smokers and these patients and their health care providers should be aware of the adverse effects of CO toxicity from tobacco smoking. Patients may have symptoms such as headaches, syncope, and ataxia in the setting of acute CO toxicity; however, the chronic effects of CO may not be completely understood. Future work could explore chronic CO toxicity and its effects on strength and exercise tolerance in military personnel and provide education to service members, veterans, and health care providers.
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Affiliation(s)
- Alyrene Dorey
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA 95817
- Department of Medicine, VA Northern California Hospitals and Clinics, Mather, CA 95655
| | - Pieter Scheerlinck
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA 95817
- Department of Medicine, VA Northern California Hospitals and Clinics, Mather, CA 95655
| | - Hoanvu Nguyen
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA 95817
| | - Timothy Albertson
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA 95817
- Department of Medicine, VA Northern California Hospitals and Clinics, Mather, CA 95655
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA 95817
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Miri-Moghaddam M, Shahrakipour M, Nasseri S, Miri-Moghaddam E. Higher prevalence of water pipe compared to cigarette smoking among medical students in Southeast Iran. Cent Eur J Public Health 2019; 27:188-194. [PMID: 31580552 DOI: 10.21101/cejph.a5615] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/14/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Smoking of water pipe (WP) and cigarettes has recently turned into a major global health burden. The present study aimed at assessing WP and cigarette smoking among Zahedan University of Medical Sciences (ZUMS) students in Iran. METHODS A cross-sectional survey was conducted on 500 students in ZUMS (182 males, 318 females). The subjects were selected through randomized cluster sampling. Morgan's chart was applied to calculate the sample size; 96.6% of the attendees completed a questionnaire designed to address the aims of the study. RESULTS The mean age of the subjects was 21.2 ± 2.4 years. WP and cigarette smoker rates were at 31.2% and 15.2%, respectively. The age of smoking initiation ranged between 15 and 20 years. Friends played crucial roles in triggering the smoking in both groups of WP and cigarette smokers (78% and 54%, respectively). The main reasons for WP and cigarette smoking were entertainment followed by curiosity. Furthermore, males used more cigarette (26.5 vs. 8.7%) and WP (50.6 vs. 20.4%) than females. Among father and mother smokers, respectively, 54.2% and 60% of children were also WP smokers (p = 0.001). Also, 21.9% and 60% of children smoking cigarettes had father and mother smokers, respectively (p = 0.05). CONCLUSION Tobacco use, especially for WP seems to be at alarming rates among medical students in Iran. It is highly recommended to control the progressive prevalence of WP smoking by governmental/academic preventive measures as educational and smoking cessation activities.
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Affiliation(s)
- Masoud Miri-Moghaddam
- Student Research Centre, Faculty of Dentistry, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mahnaz Shahrakipour
- Department of Biostatistics and Epidemiology, Oral and Dental Disease Research Centre, Health Faculty, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Saeed Nasseri
- Cellular and Molecular Research Centre, Birjand University of Medical Sciences, Birjand, Iran
| | - Ebrahim Miri-Moghaddam
- Department. of Molecular Medicine, Cardiovascular Research Centre, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
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Eichhorn L, Michaelis D, Kemmerer M, Jüttner B, Tetzlaff K. Carbon monoxide poisoning from waterpipe smoking: a retrospective cohort study. Clin Toxicol (Phila) 2017; 56:264-272. [PMID: 28906147 DOI: 10.1080/15563650.2017.1375115] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Waterpipe smoking may increasingly account for unintentional carbon monoxide poisoning, a serious health hazard with high morbidity and mortality. We aimed at identifying waterpipe smoking as a cause for carbon monoxide poisoning in a large critical care database of a specialty care referral center. METHODS This retrospective cohort study included patients with a history of exposure to waterpipe smoking and carbon monoxide blood gas levels >10% or presence of clinical symptoms compatible with CO poisoning admitted between January 2013 and December 2016. Patients' initial symptoms and carbon monoxide blood levels were retrieved from records and neurologic status was assessed before and after hyperbaric oxygen treatment. RESULTS Sixty-one subjects with carbon monoxide poisoning were included [41 males, 20 females; mean age 23 (SD ± 6) years; range 13-45] with an initial mean carboxyhemoglobin of 26.93% (SD ± 9.72). Most common symptoms included syncope, dizziness, headache, and nausea; 75% had temporary syncope. Symptoms were not closely associated with blood COHb levels. CONCLUSION CO poisoning after waterpipe smoking may present in young adults with a wide variability of symptoms from none to unconsciousness. Therefore diagnosis should be suspected even in the absence of symptoms.
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Affiliation(s)
- Lars Eichhorn
- a Department of Anesthesiology and Intensive Care Medicine , University Hospital of Bonn , Bonn , North Rhine-Westphalia , Germany
| | - Dirk Michaelis
- b Asklepios Paulinen Klinik Wiesbaden , Wiesbaden , Hessen , Germany.,c Druckkammerzentrum RMT GmbH , Wiesbaden , Hessen , Germany
| | | | - Björn Jüttner
- d Department of Anesthesiology , Hanover Medical School , Hannover , Niedersachsen , Germany
| | - Kay Tetzlaff
- e Department of Sports Medicine , University of Tübingen , Tübingen , Baden-Württemberg , Germany
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Erdöl C, Ergüder T, Morton J, Palipudi K, Gupta P, Asma S. Waterpipe Tobacco Smoking in Turkey: Policy Implications and Trends from the Global Adult Tobacco Survey (GATS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:15559-66. [PMID: 26670238 PMCID: PMC4690940 DOI: 10.3390/ijerph121215004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 11/21/2015] [Accepted: 11/30/2015] [Indexed: 11/24/2022]
Abstract
Waterpipe tobacco smoking (WTS) is an emerging tobacco product globally, especially among adolescents and young adults who may perceive WTS as a safe alternative to smoking cigarettes. Monitoring the use of WTS in Turkey in relation to the tobacco control policy context is important to ensure that WTS does not become a major public health issue in Turkey. The Global Adult Tobacco Survey (GATS) was conducted in Turkey in 2008 and was repeated in 2012. GATS provided prevalence estimates on current WTS and change over time. Other indicators of WTS were also obtained, such as age of initiation and location of use. Among persons aged 15 and older in Turkey, the current prevalence of WTS decreased from 2.3% in 2008 to 0.8% in 2012, representing a 65% relative decline. Among males, WTS decreased from 4.0% to 1.1% (72% relative decline). While the overall smoking prevalence decreased among females, there was no change in the rate of WTS (0.7% in 2008 vs. 0.5% in 2012), though the WTS prevalence rate was already low in 2008. Comprehensive tobacco control efforts have been successful in reducing the overall smoking prevalence in Turkey, which includes the reduction of cigarette smoking and WTS. However, it is important to continue monitoring the use of waterpipes in Turkey and targeting tobacco control efforts to certain groups that may be vulnerable to future WTS marketing (e.g., youth, women).
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Affiliation(s)
- Cevdet Erdöl
- Rector of Health Science University, Istanbul 34688, Turkey.
- Former Head of the Commission on Health, Family, Labour and Social Affairs of the Grand National Assembly of Turkey, Ankara 06543, Turkey.
| | - Toker Ergüder
- World Health Organization Country Office, Ankara 06610, Turkey.
| | - Jeremy Morton
- Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
| | - Krishna Palipudi
- Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
| | - Prakash Gupta
- Healis Sekhsaria Institute for Public Health, Navi Mumbai 400701, India.
| | - Samira Asma
- Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Soule EK, Lipato T, Eissenberg T. Waterpipe tobacco smoking: A new smoking epidemic among the young? CURRENT PULMONOLOGY REPORTS 2015; 4:163-172. [PMID: 26756025 PMCID: PMC4706079 DOI: 10.1007/s13665-015-0124-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Waterpipe (hookah, narghile) tobacco smoking (WTS) is becoming prevalent worldwide and is one of the most popular forms of tobacco use among youth. WTS prevalence has increased dramatically among youth in the United States within the past decade. Misperceived as less harmful than cigarette smoking, WTS is associated with many of the same chronic health effects such as lung cancer, chronic obstructive pulmonary disease, cardiovascular disease, bronchitis, and asthma. Much of this risk is due to the fact that a single WTS session exposes users to large volumes of smoke that contain toxic chemicals such as carbon monoxide, cancer-causing polycyclic aromatic hydrocarbons, and volatile aldehydes. Unlike cigarette smoking, WTS poses unique risks of acute negative health outcomes including carbon monoxide poisoning and the spread of communicable diseases such as herpes and tuberculosis. Because waterpipe tobacco smoke contains the addictive chemical nicotine, youth who smoke tobacco from a waterpipe may be at risk for dependence. As a result, many youth may initiate WTS and continue to use despite negative health effects. Considering many of the potential negative health effects associated with WTS affect the pulmonary system, pulmonologists and primary care providers may treat patients who are waterpipe tobacco smokers and should be aware of the risk associated with WTS. The purpose of this review is to describe a waterpipe, the prevalence and correlates of WTS, the toxicants found in waterpipe tobacco smoke, the health effects of WTS, and implications for pulmonologists and other clinicians.
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Affiliation(s)
- Eric K. Soule
- Virginia Commonwealth University, Department of Psychology, Center for the Study of Tobacco Products, PO Box 980205, Richmond, VA 23298, USA, Phone: 804-827-3562
| | - Thokozeni Lipato
- Virginia Commonwealth University, School of Medicine, PO Box 980102, Richmond, VA 23298, USA, Phone: 804-628-3626
| | - Thomas Eissenberg
- Virginia Commonwealth University, Department of Psychology, Center for the Study of Tobacco Products, PO Box 980205, Richmond, VA 23298, Phone: 804-827-4617, Fax: 804-828-7862
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Soule EK, Barnett TE, Curbow BA, Moorhouse MD, Weiler RM. Hookah and Alcohol Use among Young Adult Hookah Smokers: A Mixed Methods Study. Am J Health Behav 2015; 39:665-73. [PMID: 26248176 DOI: 10.5993/ajhb.39.5.8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Hookah tobacco smoking has grown steadily in popularity among young adults in the United States. Little attention has been given to the relationship between hookah smoking and another behavior that is common among young adults - alcohol use. The purpose of this study was to examine hookah and alcohol use among young adults. METHODS Forty young adult hookah smokers (55% female) participated in focus group sessions on hookah use beliefs and a brief survey examining hookah and alcohol use including drinking alcohol before, during, or after smoking hookah. RESULTS Quotes from the focus groups indicated that alcohol use may promote hookah use among individuals who have little or no hookah smoking experience. Alcohol use, binge drinking, and alcohol use before, during, and after hookah use were common among the participants regardless of legal drinking age status. Nearly half of the participants preferred to drink alcohol while smoking hookah due to the improved physical and social effects they associated with combining the 2 behaviors. CONCLUSIONS For some young adult hookah smokers, alcohol appears to enhance the hookah smoking experience and may play a role in hookah smoking initiation. Future research and interventions should address the association between hookah and alcohol use.
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Affiliation(s)
- Eric K Soule
- Virginia Commonwealth University, Department of Psychology, Center for the Study of Tobacco Products, Richmond, VA, USA.
| | - Tracey E Barnett
- University of Florida, Department of Behavioral Science and Community Health, Gainesville, FL, USA
| | - Barbara A Curbow
- University of Maryland, School of Public Health, College Park, MD, USA
| | - Michael D Moorhouse
- University of Florida, Department of Behavioral Science and Community Health, Gainesville, FL, USA
| | - Robert M Weiler
- George Mason University, Department of Global and Community Health, Fairfax, VA, USA
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El-Zaatari ZM, Chami HA, Zaatari GS. Health effects associated with waterpipe smoking. Tob Control 2015; 24 Suppl 1:i31-i43. [PMID: 25661414 PMCID: PMC4345795 DOI: 10.1136/tobaccocontrol-2014-051908] [Citation(s) in RCA: 239] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/23/2014] [Accepted: 01/15/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE It is widely held that waterpipe smoking (WPS) is not associated with health hazards. However, several studies have documented the uptake of several toxicants and carcinogens during WPS that is strongly associated with harmful health effects. This paper reviews the literature on the health effects of WPS. DATA SOURCES Three databases-PubMed, MEDLINE and EMBASE-were searched until August 2014 for the acute and long-term health effects of WPS using the terms 'waterpipe' and its synonyms (hookah, shisha, goza, narghileh, arghileh and hubble-bubble) in various spellings. STUDY SELECTION We included original clinical studies, case reports and systematic reviews and focused on clinical human studies. ∼10% of the identified studies met the selection criteria. DATA EXTRACTION Data were abstracted by all three authors and summarised into tables. Abstracted data included study type, results and methodological limitations and were analysed jointly by all three authors. DATA SYNTHESIS WPS acutely leads to increased heart rate, blood pressure, impaired pulmonary function and carbon monoxide intoxication. Chronic bronchitis, emphysema and coronary artery disease are serious complications of long-term use. Lung, gastric and oesophageal cancer are associated with WPS as well as periodontal disease, obstetrical complications, osteoporosis and mental health problems. CONCLUSIONS Contrary to the widely held misconception, WPS is associated with a variety of adverse short-term and long-term health effects that should reinforce the need for stronger regulation. In addition, this review highlights the limitations of the published work, which is mostly cross-sectional or retrospective. Prospective studies should be undertaken to assess the full spectrum of health effects of WPS, particularly in view of its growing popularity and attractiveness to youth.
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Affiliation(s)
- Ziad M El-Zaatari
- Department of Pathology and Laboratory Medicine, American University of Beirut, Beirut, Lebanon
| | - Hassan A Chami
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ghazi S Zaatari
- Department of Pathology and Laboratory Medicine, American University of Beirut, Beirut, Lebanon
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Wollina U. Water pipe smoking and dermatologic consequences. J Eur Acad Dermatol Venereol 2015; 29:1481-4. [PMID: 25677592 DOI: 10.1111/jdv.12984] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 12/24/2014] [Indexed: 11/30/2022]
Abstract
Water pipe smoking is a recently growing addiction worldwide. It has become popular in Africa and the Western World and enfaces a renaissance in Middle East and Asia. The smoking technique leads to a different exposure to potential hazardous compounds compared to cigarette or classical pipe smoking. The common assumption that water pipe smoking is less dangerous to health is not substantiated by scientific data. Non-tobacco-based preparations reduce the exposure to nicotine but may contain equal or even higher concentrations of other toxic compounds. The medical literature on adverse effect of water pipe smoking on skin and oral mucosa is reviewed but future research is a demand.
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Affiliation(s)
- U Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
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von Rappard J, Schönenberger M, Bärlocher L. Carbon monoxide poisoning following use of a water pipe/hookah. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:674-9. [PMID: 25346357 PMCID: PMC4215085 DOI: 10.3238/arztebl.2014.0674] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/04/2014] [Accepted: 08/04/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Water pipe (hookah) smoking has become a common activity in Germany, particularly among adolescents and young adults; in 2011, its lifetime prevalence was as high as 68.8%. Similar trends can be seen in other European countries. Water-pipe smokers are exposed to the same health-endangering substances as cigarette smokers, and the inhaled amount of carbon monoxide (CO) can be as much as ten times as high. In CO intoxication, carboxyhemoglobin is formed and causes direct injury at the cellular level, leading to hypoxia and nonspecific neuro logical manifestations. There have only been ten reported cases around the world of CO intoxication due to the use of a water pipe, and none of these were fatal. It should be recalled, however, that accidental CO intoxication is common and is associated with high morbidity and mortality. CASE PRESENTATION AND COURSE We present a series of four young adults, aged 16 to 21, three of whom were hospitalized because of transient unconsciousness. The carboxyhemoglobin (CO-Hb) content of the blood in the symptomatic patients ranged from 20.1% to 29.6%, while the asymptomatic patient had a CO-Hb content of 16.7%. Water-pipe smoking was the cause of CO intoxication in all four cases. The CO-Hb values were successfully brought down by the administration of highly concentrated oxygen and all patients were discharged in asymptomatic condition. CONCLUSION This case series reveals that CO intoxication due to water-pipe smoking is probably more common than is generally realized. Emergency room staff should be aware of this problem and inquire specifically about water-pipe smoking in patients with nonspecific neurological manifestations.
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Bonadies N, Tichelli A, Rovó A. When water does not clear the smut from the smoke. BMJ Case Rep 2013; 2013:bcr-2013-200665. [PMID: 24142566 DOI: 10.1136/bcr-2013-200665] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Water-pipe (shisha) smoking is increasingly popular among young people in Europe and North America. The proponents claim that smoking water-pipe is much 'cleaner' than cigarettes. Although, a recent analysis of toxicant yields during 1-2 h water-pipe smoking resulted comparable to 100-200 cigarettes. We report a case of a 25-year-old patient with elevated haemoglobin, impaired concentration and reduced physical performance. Molecular investigations for JAK2 mutations and BCR-ABL fusion transcripts were negative and the arterial blood gas analysis revealed an elevated carboxyhaemoglobin of 6.1%. In a follow-up visit, the patient disclosed excessive shisha smoking. Secondary polycythaemia was diagnosed caused by chronic carbon monoxide poisoning. After cessation of shisha smoking all blood values returned to normal ranges within 6 weeks. Owing to the increasing popularity of water-pipe smoking and the anticipated health risks, our report should help to enhance awareness and advocate more information in tobacco prevention programmes on its potential toxicities.
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Affiliation(s)
- Nicolas Bonadies
- Department of Internal Medicine and Haematology, University Hospital Basel, Basel, Switzerland
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