Carboxyhemoglobin levels in primary and secondary cigar and pipe smokers

Survey of Premium Versus Large Manufactured Cigars Use in U.S. Consumers

INTRODUCTION

An Internet questionnaire was used to determine smoking behavior, purchasing behavior, and risk perceptions among exclusive or nearly exclusive current users of either large manufactured (LMC) or premium cigars (PC).

AIMS AND METHODS

Respondents (n = 250) were recruited from a nationally representative market research panel. An a priori designation of PC users was adapted from criteria in published literature and the recent National Academy of Science report.

RESULTS

Examination of responses revealed a (n = 19) disagreement between cigar users' self-classifications and the a priori classification. After eliminating ineligible respondents 188 participants were classified as PC (n = 92; 55 male) or LMC (n = 96; 49 male) users. There were no significant differences in age or gender between groups. Respondents were all over 21 years old. The largest age groups were 30-39 years and 60-69 years. PC users were significantly more likely to have higher annual incomes and to buy cigars online or through tobacco specialty shops, whereas LMC users purchased from convenience stores. Most participants had used other combustible tobacco products (88%) but few had used ENDS (24%) or oral tobacco (7.5%). There was no significant difference in the frequency of smoke inhalation or perceptions of risk for health. There was marked uncertainty in self-characterization of cigar type; our sample had higher female representation than expected (n = 84, 45%), and inhalation was frequently endorsed in both groups (52%, overall).

CONCLUSIONS

The results support the need for standardized classifications and suggest current trends may indicate shifts in gender and use behavior but provide no evidence supporting less restrictive regulation of PC.

IMPLICATIONS

An Internet questionnaire was used to determine smoking behavior, purchasing behavior, and risk perceptions among current users of LMC or PC. There was uncertainty about cigar classification even in this sample of regular users. Our results demonstrated more than expected inhalation of cigar smoke, considerable use by females, and under appreciation of health risks. No results supported less restrictive regulations for premium cigars.

Carbon Monoxide Signaling: Examining Its Engagement with Various Molecular Targets in the Context of Binding Affinity, Concentration, and Biologic Response

Carbon monoxide (CO) has been firmly established as an endogenous signaling molecule with a variety of pathophysiological and pharmacological functions, including immunomodulation, organ protection, and circadian clock regulation, among many others. In terms of its molecular mechanism(s) of action, CO is known to bind to a large number of hemoproteins with at least 25 identified targets, including hemoglobin, myoglobin, neuroglobin, cytochrome c oxidase, cytochrome P450, soluble guanylyl cyclase, myeloperoxidase, and some ion channels with dissociation constant values spanning the range of sub-nM to high μM. Although CO's binding affinity with a large number of targets has been extensively studied and firmly established, there is a pressing need to incorporate such binding information into the analysis of CO's biologic response in the context of affinity and dosage. Especially important is to understand the reservoir role of hemoglobin in CO storage, transport, distribution, and transfer. We critically review the literature and inject a sense of quantitative assessment into our analyses of the various relationships among binding affinity, CO concentration, target occupancy level, and anticipated pharmacological actions. We hope that this review presents a picture of the overall landscape of CO's engagement with various targets, stimulates additional research, and helps to move the CO field in the direction of examining individual targets in the context of all of the targets and the concentration of available CO. We believe that such work will help the further understanding of the relationship of CO concentration and its pathophysiological functions and the eventual development of CO-based therapeutics. SIGNIFICANCE STATEMENT: The further development of carbon monoxide (CO) as a therapeutic agent will significantly rely on the understanding of CO's engagement with therapeutically relevant targets of varying affinity. This review critically examines the literature by quantitatively analyzing the intricate relationships among targets, target affinity for CO, CO level, and the affinity state of carboxyhemoglobin and provide a holistic approach to examining the molecular mechanism(s) of action for CO.

Immediate effects of cigar smoking on respiratory mechanics and exhaled biomarkers; differences between young smokers with mild asthma and otherwise healthy young smokers

Background

We aimed to investigate the immediate respiratory effects of cigar smoking(CS), among young smokers with and without mild asthma.

Materials and methods

Forty-seven young smokers (18–31years old, 29 males, average pack-years = 3.6 ± 2.8) were enrolled. Twenty-two were mild asthmatics(MA-subgroup) and the remaining 25 were otherwise healthy smokers(HS-subgroup). Exhaled carbon monoxide(eCO), multi-frequency respiratory system impedance(Z), resistance(R), reactance(X), frequency-dependence of resistance(fdr = R5Hz - R20Hz), resonant frequency(f_res), reactance area(AX) and exhaled nitric oxide(FENO) were measured at the aforementioned sequence, before and immediately after 30 min of CS, or equal session in the smoking area while using a sham cigar(control group). Chi-square, student’s t-tests, mixed linear models and Pearson correlation tests were used for the statistical analysis; level of significance was defined as p < 0.05.

Results

Immediately after CS, Z5Hz, R5Hz, R10Hz, R20Hz and eCO increased significantly in both subgroups(MA and HS). A greater increase was found for R20 in HS-subgroup. Fdr, f_res and AX increased in MA, while decreased in HS. On the contrary, X10 decreased in MA and increased in HS, while X20 showed a greater decrease in MA. Changes in fdr, f_res and AX were significantly correlated in both subgroups. No significant FENO alterations were detected in both subgroups.

Conclusion

CS has immediate effects on pulmonary function. Mild asthma predisposes to higher increase of peripheral resistance(increased fdr). In otherwise healthy smokers, central resistance(R20Hz) is more affected. FENO levels are not significantly affected by CS.

Use & Misuse of Water-filtered Tobacco Smoking Pipes in the World. Consequences for Public Health, Research & Research Ethics

BACKGROUND

The traditional definition of an "epidemic" has been revisited by antismoking researchers. After 400 years, Doctors would have realized that one aspect of an ancient cultural daily practice of Asian and African societies was in fact a "global "epidemic"". This needed further investigation particularly if one keeps in his mind the health aspects surrounding barbecues.

METHOD

Here, up-to-date biomedical results are dialectically confronted with anthropological findings, hence in real life, in order to highlight the extent of the global confusion: from the new definition of an "epidemic" and "prevalence" to the myth of "nicotine "addiction"" and other themes in relation to water filtered tobacco smoking pipes (WFTSPs).

RESULTS

We found that over the last decade, many publications, -particularly reviews, "meta-analyses" and "systematic reviews"- on (WFTSPs), have actually contributed to fuelling the greatest mix-up ever witnessed in biomedical research. One main reason for such a situation has been the absolute lack of critical analysis of the available literature and the uncritical use of citations (one seriously flawed review has been cited up to 200 times). Another main reason has been to take as granted a biased smoking robot designed at the US American of Beirut whose measured yields of toxic chemicals may differ dozens of times from others' based on the same "protocol". We also found that, for more than one decade, two other main methodological problems are: 1) the long-lived unwillingness to distinguish between use and misuse; 2) the consistent unethical rejection of biomedical negative results which, interestingly, are quantitatively and qualitatively much more instructive than the positive ones.

CONCLUSION

the great majority of WFTSP toxicity studies have actually measured, voluntarily or not, their misuse aspects, not the use in itself. This is in contradiction with both the harm reduction and public health doctrines. The publication of negative results should be encouraged instead of being stifled.

Non-cigarette tobacco products: what have we learnt and where are we headed?

A wide variety of non-cigarette forms of tobacco and nicotine exist, and their use varies regionally and globally. Smoked forms of tobacco such as cigars, bidis, kreteks and waterpipes have high popularity and are often perceived erroneously as less hazardous than cigarettes, when in fact their health burden is similar. Smokeless tobacco products vary widely around the world in form and the health hazards they present, with some clearly toxic forms (eg, in South Asia) and some forms with far fewer hazards (eg, in Sweden). Nicotine delivery systems not directly reliant on tobacco are also emerging (eg, electronic nicotine delivery systems). The presence of such products presents challenges and opportunities for public health. Future regulatory actions such as expansion of smoke-free environments, product health warnings and taxation may serve to increase or decrease the use of non-cigarette forms of tobacco. These regulations may also bring about changes in non-cigarette tobacco products themselves that could impact public health by affecting attractiveness and/or toxicity.

Effects of type of smoking (pipe, cigars or cigarettes) on biological indices of tobacco exposure and toxicity

Although all forms of smoking are harmful, smoking pipes or cigars is associated with lower exposure to the lethal products of tobacco products and lower levels of morbidity and mortality than smoking cigarettes. Cytochrome P-450-1A (CYP1A) is a major pathway activating carcinogens from tobacco smoke. Our primary aim was to compare CYP1A2 activity in individuals smoking pipes or cigars only, cigarettes only and in non-smokers. We studied 30 smokers of pipes or cigars only, 28 smokers of cigarettes only, and 30 non-smokers male subjects matched for age. CYP1A2 activity was assessed as the caffeine metabolic ratio in plasma. One-day urine collection was used for determining exposure to products of tobacco metabolism. Nitrosamine and benzo[a]pyrene DNA adducts were measured in lymphocytes. CYP1A2 activity was greater (p<0.0001) in cigarette smokers (median: 0.61; interquartile range: 0.52-0.76) than in pipe or cigar smokers (0.27; 0.21-0.37) and non-smokers (0.34; 0.25-0.42) who did not differ significantly. Urinary cotinine and 1-hydroxypyrene levels were higher in cigarette smokers than in pipe or cigar smokers and higher in the later than in non-smokers. DNA adducts levels were significantly lower in pipe or cigar smokers than in cigarette smokers. In multivariate analysis, cigarette smoking was the only independent predictor of CYP1A2 activity (p<0.0001) and of 1-hydroxypyrene excretion in urine (p=0.0012). In this study, pipe or cigar smoking was associated with lower exposure to products of tobacco metabolism than cigarette smoking and to an absence of CYP1A2 induction. Cigarette smoking was the only independent predictor of CYP1A2 activity in smokers. However, inhalation behaviour, rather than the type of tobacco smoked, may be the key factor linked to the extent of tobacco exposure and CYP1A2 induction. Our results provide a reasonable explanation for the results of epidemiological studies showing pipe or cigar smoking to present fewer health hazards than cigarette smoking.

Effect of cigar smoking on the risk of cardiovascular disease, chronic obstructive pulmonary disease, and cancer in men

BACKGROUND

The sale of cigars in the United States has been increasing for the past six years. Cigar smoking is a known risk factor for certain cancers and for chronic obstructive pulmonary disease (COPD). However, unlike the relation between cigarette smoking and cardiovascular disease, the association between cigar smoking and cardiovascular disease has not been clearly established.

METHODS

We performed a cohort study among 17,774 men 30 to 85 years of age at base line (from 1964 through 1973) who were enrolled in the Kaiser Permanente health plan and who reported that they had never smoked cigarettes and did not currently smoke a pipe. Those who smoked cigars (1546 men) and those who did not (16,228) were followed from 1971 through the end of 1995 for a first hospitalization for or death from a major cardiovascular disease or COPD, and through the end of 1996 for a diagnosis of cancer.

RESULTS

In multivariate analysis, cigar smokers, as compared with nonsmokers, were at higher risk for coronary heart disease (relative risk, 1.27; 95 percent confidence interval, 1.12 to 1.45), COPD (relative risk, 1.45; 95 percent confidence interval, 1.10 to 1.91), and cancers of the upper aerodigestive tract (relative risk, 2.02; 95 percent confidence interval, 1.01 to 4.06) and lung (relative risk, 2.14; 95 percent confidence interval, 1.12 to 4.11), with evidence of dose-response effects. There appeared to be a synergistic relation between cigar smoking and alcohol consumption with respect to the risk of oropharyngeal cancers and cancers of the upper aerodigestive tract.

CONCLUSIONS

Independently of other risk factors, regular cigar smoking can increase the risk of coronary heart disease, COPD, and cancers of the upper aerodigestive tract and lung.

The importance of direct questions about inhalation and daily intake in the evaluation of pipe and cigar smokers

Pipe and cigar smokers traditionally have been subdivided into primary (never regular cigarette) and secondary (ex-cigarette) smokers. This distinction is considered important because it is believed that former cigarette smokers who switch to pipes or cigars inhale their pipe or cigar smoke, whereas primary pipe and cigar smokers do not. In this study, it was found that self-reported inhalation more accurately predicted expired-air carbon monoxide levels than cigarette smoking history and, combined with self-reported per day consumption, could account for most instances of carbon monoxide levels above the non-smoker cut-off level of 8 parts per million. Thus, it is concluded that a primary/secondary distinction is less useful than a noninhaling/inhaling distinction in attempting to assess health risks associated with pipe and cigar smoking, and health-care providers and researchers should focus their attention on the more direct questions of inhalation and daily intake.

Does switching from cigarettes to pipes or cigars reduce tobacco smoke exposure?

Cigarette smoking histories, reported depth of inhalation, number of pipe and cigars (PC) smoked, serum thiocyanate (SCN) and expired air carbon monoxide (CO) levels were examined in PC male smokers enrolled in the Multiple Risk Factor Intervention Trial (MRFIT). Serum SCN levels for all PC smokers were higher than for non-smokers and lower than for current cigarette smokers. Levels were related to the amount of product smoke. Prior cigarette smokers had higher SCN levels when compared to PC users who had never smoked cigarettes, smoked a larger number of tobacco products per day, and reported inhaling into the chest more often. Prospective data on baseline cigarette smokers demonstrated that smokers who stopped all tobacco products had a greater drop in SCN and CO than those who switched to PC. The findings strongly suggest that cessation of all tobacco products is the best strategy for decreasing exposure to tobacco smoke.

The inhaling habits of pipe smokers

Carboxyhaemoglobin and plasma nicotine levels were compared in five primary and five secondary pipe (i.e. previous cigarette smoking) smokers over the course of one hour's pipe smoking. The primary pipe smokers had low pre-smoking nicotine and carboxyhaemoglobin levels with a small increase after smoking (carboxyhaemoglobin 1.1% rising to 1.26% and nicotine 7.7 nmol/litre rising to 33.9 nmol/litre). Secondary pipe smokers had a higher pre-smoking carboxyhaemoglobin and nicotine level with a significant rise during smoking (carboxyhaemoglobin 3.0% rising to 4.3%, plasma nicotine 74.3 nmol/litre rising to 215.8 nmol/litre), indicating significant inhalation and absorption of carbon monoxide and nicotine. These results indicate that primary pipe smokers, who have never smoked cigarettes, do not inhale and absorb very little nicotine. Secondary pipe smokers do not lose their habit of inhaling and absorb large amounts of nicotine and carbon monoxide. They may not share the lower health hazard of the primary pipe smoker.