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Kopa-Stojak PN, Pawliczak R. Comparison of the effects of active and passive smoking of tobacco cigarettes, electronic nicotine delivery systems and tobacco heating products on the expression and secretion of oxidative stress and inflammatory response markers. A systematic review. Inhal Toxicol 2024; 36:75-89. [PMID: 38394073 DOI: 10.1080/08958378.2024.2319315] [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: 10/16/2023] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES This work attempts to summarize current knowledge on the effects of active and passive smoking of cigarettes, electronic nicotine delivery systems and tobacco heating products on the expression and secretion of oxidative stress and inflammatory response mediators, and on their possible impact on chronic obstructive pulmonary disease development. MATERIALS AND METHODS The literature was searched by the terms: 'smoking', 'active smoking', 'passive smoking', 'main-stream smoke', 'side-stream smoke', 'secondhand smoke', 'cigarette' 'THP', 'tobacco heating product', 'ENDS', 'electronic nicotine delivery system', 'e-cigarette', 'electronic cigarette', oxidative stress', inflammatory response' and 'gene expression'. RESULTS Cigarette smoking (active and passive) induces oxidative stress and inflammatory response in the airways. We present the effect of active smoking of e-cigarettes (EC) and heat-not-burn (HnB) products on the increased expression and secretion of oxidative stress and inflammatory response markers. However, there is only a limited number of studies on the effect of their second-hand smoking, and those available mainly describe aerosol composition. DISCUSSION The literature provides data which confirm that active and passive cigarette smoking induces oxidative stress and inflammatory response in the airways and is a key risk factor of COPD development. Currently, there is a limited number of data about ENDS and THP active and passive smoking effects on the health of smokers and never-smokers. It is particularly important to assess the effect of such products during long-term use by never-smokers who choose them as the first type of cigarettes, and for never-smokers who are passively exposed to their aerosol.
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Affiliation(s)
- Paulina Natalia Kopa-Stojak
- Department of Immunopathology, Division of Biomedical Science, Faculty of Medicine, Medical University of Lodz, Lodz, Poland
| | - Rafal Pawliczak
- Department of Immunopathology, Division of Biomedical Science, Faculty of Medicine, Medical University of Lodz, Lodz, Poland
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Pangeni R, Meng T, Poudel S, Sharma D, Hutsell H, Ma J, Rubin BK, Longest W, Hindle M, Xu Q. Airway mucus in pulmonary diseases: Muco-adhesive and muco-penetrating particles to overcome the airway mucus barriers. Int J Pharm 2023; 634:122661. [PMID: 36736964 PMCID: PMC9975059 DOI: 10.1016/j.ijpharm.2023.122661] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023]
Abstract
Airway mucus is a complex viscoelastic gel that provides a defensive physical barrier and shields the airway epithelium by trapping inhaled foreign pathogens and facilitating their removal via mucociliary clearance (MCC). In patients with respiratory diseases, such as chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF), non-CF bronchiectasis, and asthma, an increase in crosslinking and physical entanglement of mucin polymers as well as mucus dehydration often alters and typically reduces mucus mesh network pore size, which reduces neutrophil migration, decreases pathogen capture, sustains bacterial infection, and accelerates lung function decline. Conventional aerosol particles containing hydrophobic drugs are rapidly captured and removed by MCC. Therefore, it is critical to design aerosol delivery systems with the appropriate size and surface chemistry that can improve drug retention and absorption with the goal of increased efficacy. Biodegradable muco-adhesive particles (MAPs) and muco-penetrating particles (MPPs) have been engineered to achieve effective pulmonary delivery and extend drug residence time in the lungs. MAPs can be used to target mucus as they get trapped in airway mucus by steric obstruction and/or adhesion. MPPs avoid muco-adhesion and are designed to have a particle size smaller than the mucus network, enhancing lung retention of particles as well as transport to the respiratory epithelial layer and drug absorption. In this review, we aim to provide insight into the composition of airway mucus, rheological characteristics of airway mucus in healthy and diseased subjects, the most recent techniques to study the flow dynamics and particle diffusion in airway mucus (in particular, multiple particle tracking, MPT), and the advancements in engineering MPPs that have contributed to improved airway mucus penetration, lung distribution, and retention.
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Affiliation(s)
- Rudra Pangeni
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA, USA
| | - Tuo Meng
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA, USA
| | - Sagun Poudel
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA, USA
| | - Divya Sharma
- Department of Physiology and Biophysics, Virginia Commonwealth University, Richmond, VA, USA
| | - Hallie Hutsell
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA, USA
| | - Jonathan Ma
- Department of Pediatrics, Children's Hospital of Richmond, Richmond, VA, USA
| | - Bruce K Rubin
- Department of Physiology and Biophysics, Virginia Commonwealth University, Richmond, VA, USA; Department of Pediatrics, Children's Hospital of Richmond, Richmond, VA, USA
| | - Worth Longest
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA, USA; Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Michael Hindle
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA, USA
| | - Qingguo Xu
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA, USA; Department of Ophthalmology, Massey Cancer Center, Center for Pharmaceutical Engineering, and Institute for Structural Biology, Drug Discovery & Development (ISB3D), Virginia Commonwealth University, Richmond, VA, USA.
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Chami HA, Houjeij N, Makki M, Itani L, Tamim H, Al Mulla A, Celli B, Zeineldine S. Increased airway resistance among exclusive waterpipe smokers detected using impulse oscillometry. Ann Thorac Med 2023; 18:23-30. [PMID: 36968332 PMCID: PMC10034824 DOI: 10.4103/atm.atm_165_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/05/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Waterpipe smoking is increasing in popularity, yet the evidence implicating waterpipe smoking in lung disease is limited. We hypothesized that impulse oscillometry (IOS) would detect airway abnormalities in waterpipe smokers (WPS). METHODS We studied 210 participants, 40 years or older, from the community, of whom 92 were exclusive WPS and 118 were never-smokers. Waterpipe smoking history was assessed using a validated questionnaire. All participants underwent spirometry, and IOS and absolute and percentage predicted results (for age, sex, height, and weight) were compared between WPS and nonsmokers. The association of IOS parameters with waterpipe smoking duration and extent (waterpipe smoked/day * smoking duration) was evaluated using linear regression. RESULTS WPS smoked on average 1.8 ± 1.2 waterpipes/day, over an average duration of 23.3 ± 39.8 years. WPS and nonsmokers were largely asymptomatic and had similar age, body mass index, sex distribution, and spirometric values. Nevertheless, WPS had higher IOS measured resistance at 5Hz compared to nonsmokers, (0.53 ± 0.2 vs. 0.48 ± 0.2 kPa/L/s, P = 0.03) and higher percentage-predicted resistance (124.5 ± 36.3 vs. 115.7% ± 35.6%, P = 0.04). Waterpipe smoking duration was also associated with resistance (β = 0.04 kPa/L/s/year, P = 0.01) and with percentage-predicted resistance (β = 0.05/year, P = 0.02). Waterpipe smoking extent was associated with resistance (β = 0.009 kPa/L/s/waterpipe-year, P = 0.04), while the association with percentage-predicted resistance was near significance (β = 0.009/waterpipe-year, P = 0.07). CONCLUSIONS Waterpipe smoking is associated with increased airway resistance assessed by IOS but not by spirometry in largely asymptomatic individuals from the community.
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Affiliation(s)
- Hassan A. Chami
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America, Beirut, Lebanon
- Department of Medicine and Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Nourhan Houjeij
- Department of Nephrology, Saint Louis University, St Louis, Missouri, United States of America
| | - Maha Makki
- Department of Medicine and Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Lina Itani
- Department of Medicine and Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Department of Medicine and Clinical Research Institute, American University of Beirut, Beirut, Lebanon
- College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Ahmad Al Mulla
- Tobacco Control Center, WHO Collaborative Center, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Bartolome Celli
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Salah Zeineldine
- Department of Medicine and Clinical Research Institute, American University of Beirut, Beirut, Lebanon
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Ye BZ, Wang XY, Wang YF, Liu NN, Xie M, Gao X, Liang Y. Impact of Tobacco Smoking on Health Care Utilization and Medical Costs in Chronic Obstructive Pulmonary Disease, Coronary Heart Disease and Diabetes. Curr Med Sci 2022; 42:304-316. [PMID: 35391619 DOI: 10.1007/s11596-022-2581-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/23/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the impact of smoking on disease-specific health care utilization and medical costs in patients with chronic non-communicable diseases (NCDs). METHODS Participants were middle-aged and elderly adults with chronic NCDs from a prospective cohort in China. Logistic regressions and linear models were used to assess the relationship between tobacco smoking, health care utilization and medical costs. RESULTS Totally, 1020 patients with chronic obstructive pulmonary disease (COPD), 3144 patients with coronary heart disease (CHD), and 1405 patients with diabetes were included in the analysis. Among patients with COPD, current smokers (β: 0.030, 95% CI: -0.032-0.092) and former smokers (β: 0.072, 95% CI: 0.014-0.131) had 3.0% and 7.2% higher total medical costs than never smokers. Medical costs of patients who had smoked for 21-40 years (β: 0.028, 95% CI:-0.038-0.094) and ≥41 years (β: 0.053, 95% CI: -0.004β0.110) were higher than those of never smokers. Patients who smoked ≥21 cigarettes (β: 0.145, 95% CI: 0.051-0.239) per day had more inpatient visits than never smokers. The association between smoking and health care utilization and medical costs in people with CHD group was similar to that in people with COPD; however, there were no significant associations in people with diabetes. CONCLUSION This study reveals that the impact of smoking on health care utilization and medical costs varies among patients with COPD, CHD, and diabetes. Tobacco control might be more effective at reducing the burden of disease for patients with COPD and CHD than for patients with diabetes.
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Affiliation(s)
- Bei-Zhu Ye
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiao-Yu Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yu-Fan Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Nan-Nan Liu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Min Xie
- Department of Respiratory Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiao Gao
- Department of Endocrinology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yuan Liang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Dong JJ, Shen JJ, Lee YJ. Dose-Dependent Effect of Cotinine-Verified Tobacco Smoking on Serum Immunoglobulin E Levels in Korean Adult Males. Nicotine Tob Res 2020; 21:813-817. [PMID: 29126169 DOI: 10.1093/ntr/ntx247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/02/2017] [Indexed: 11/14/2022]
Abstract
BACKGROUND Smoking is one of the risk factors to exacerbate allergic diseases, and it may affect serum immunoglobulin E (IgE) levels. However, few studies have relied on an objective biomarker to examine the effect of tobacco smoking on serum IgE levels. METHOD A nationwide cross-sectional study was conducted to examine the relationship between urinary cotinine (Ucot) concentrations and IgE levels in 973 males using data from the 2010 Korean National Health and Nutrition Examination Survey (KNHANES). Ucot was classified into four groups based on concentration (ng/mL) as follows: nonsmoker group (Ucot <50 ng/mL) and three tertile groups in smokers (T1 [Ucot: 50.00-921.28 ng/mL]; T2 [Ucot: 921.29-1869.36 ng/mL]; and T3 [Ucot ≥1869.37 ng/mL]). The dose-response relationships between Ucot concentrations and total serum IgE level were estimated using analysis of covariance (ANCOVA) and multiple linear regression analysis after adjusting for confounding variables. RESULTS We found a significant and positive dose-related effect of cigarette smoking as measured by Ucot concentrations on the total serum IgE level. The multivariate adjusted means of total serum IgE levels (SE) were 321.0 (36.3), 404.4 (102.7), 499.2 (79.2), and 534.7 (82.7) IU/mL, after adjusting for age, body mass index, alcohol ingestion, physical exercise, job, and household income. The regression coefficient β for total serum IgE was β = 68.6 with increasing level of Ucot group after adjusting for the same covariables (p = .009). CONCLUSION These findings suggest that the amount of smoking may have a dose-dependent effect on total serum IgE levels. IMPLICATION Smoking is one of the risk factors to exacerbate allergic diseases, and it may affect serum immunoglobulin E (IgE) levels, which is closely related to type 1 mediated allergic diseases. However, few studies have relied on an objective biomarker to examine the effect of tobacco smoking on serum IgE levels. We found that tobacco exposure, as measured by Ucot concentrations, increased the serum IgE levels in a dose-response manner in a representative sample of Korean adult males.
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Affiliation(s)
- Jae-June Dong
- Department of Family Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Medicine, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Jay J Shen
- Department of Healthcare Administration and Policy, School of Community Health Sciences, University of Nevada, Las Vegas, NV
| | - Yong-Jae Lee
- Department of Family Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Healthcare Administration and Policy, School of Community Health Sciences, University of Nevada, Las Vegas, NV
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Li X, Wu Z, Xue M, Du W. Smoking status affects clinical characteristics and disease course of acute exacerbation of chronic obstructive pulmonary disease: A prospectively observational study. Chron Respir Dis 2020; 17:1479973120916184. [PMID: 32216568 PMCID: PMC7119232 DOI: 10.1177/1479973120916184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 02/28/2020] [Indexed: 12/21/2022] Open
Abstract
Existing studies primarily explored chronic obstructive pulmonary disease (COPD) in smokers, whereas the clinical characteristics and the disease course of passive or nonsmokers have been rarely described. In the present study, patients hospitalized and diagnosed as acute exacerbation of COPD (AECOPD) were recruited and followed up until being discharged. Clinical and laboratory indicators were ascertained and delved into. A total of 100 patients were covered, namely, 52 active smokers, 34 passive smokers, and 14 nonsmokers. As revealed from the results here, passive or nonsmokers developed less severe dyspnea (patients with modified Medical Research Council scale (mMRC) <2, 0.0% vs. 8.8% vs. 14.3%, p < 0.05, active, passive, and nonsmokers, respectively), higher oxygenation index (206.4 ± 45.5 vs. 241.2 ± 51.1 vs. 242.4 ± 41.8 mmHg, p < 0.01), as well as lower arterial partial pressure of carbon dioxide (70.8 ± 12.7 vs. 58.85 ± 9.9 vs. 56.6 ± 6.5 mmHg, p < 0.001). Despite lower treatment intensity over these patients, amelioration of dyspnea, mitigation of cough, and elevation of oxygenation index were comparable to those of active smokers. However, in terms of patients exhibiting mMRC ≥2 and type 2 respiratory failure, amelioration of dyspnea was more common in nonsmokers as compared with passive smokers (46.4% vs. 83.3%, p < 0.05, passive and nonsmokers, respectively). In terms of patients exhibiting Global Initiative for COPD severity <3, mMRC ≥2, and type 2 respiratory failure, active smokers achieved the least mitigation of cough symptom (8.7% vs. 35.0% vs. 44.4%, p < 0.05). Similar results could be achieved after the effects of confounders were excluded, with the most prominent amelioration of dyspnea (odds ratio (OR) 3.8, 95% confidence interval (CI) 1.1-13.6, p < 0.05, as compared with active smokers) and cough (OR 3.3, 95% CI 1.0-10.7, p < 0.05) in nonsmokers, and relatively better amelioration of hypoxemia in passive smokers (oxygenation index change, 39.0 ± 34.6 vs. 51.5 ± 32.4 vs. 45.3 ± 25.4 mmHg, p < 0.05). In brief, passive or nonsmokers with AECOPD were subjected to less severe disease, and nonsmokers, especially patients with more severe disease, might achieve the optimal enhancement of clinical presentation after treatment.
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Affiliation(s)
- Xiaolong Li
- Affiliated Haian Hospital of Nantong University, Haian, China
| | - Zhen Wu
- Affiliated Haian Hospital of Nantong University, Haian, China
| | - Mingyue Xue
- Affiliated Haian Hospital of Nantong University, Haian, China
| | - Wei Du
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, School of Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Daniels KJ, Irusen E, Pharaoh H, Hanekom S. Post-tuberculosis health-related quality of life, lung function and exercise capacity in a cured pulmonary tuberculosis population in the Breede Valley District, South Africa. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2019; 75:1319. [PMID: 31392293 PMCID: PMC6676936 DOI: 10.4102/sajp.v75i1.1319] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/23/2019] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Pulmonary tuberculosis (PTB) remains a major concern worldwide. Albeit curable, PTB continues to negatively affect patients' health-related quality of life (HRQoL) and functioning even after cure. OBJECTIVES To describe the demographics, respiratory symptoms, pulmonary airflow patterns, HRQoL and exercise capacity of cured PTB patients, in the Breede Valley district of South Africa. METHODS A cross-sectional study conducted at five primary health care facilities included adult patients diagnosed with PTB, who had completed anti-tuberculosis treatment. Post-treatment bronchodilator lung function, HRQoL and 6-min walk distance (6MWD) were measured. RESULTS Three hundred and twenty-four patients were screened. Specific challenges resulted in 45 patients being included (male n = 25 [56%]; mean population age 39.9 [± 10.2]). HRQoL was assessed using the short-form 12v2, part of the burden of lung disease core questionnaire. In general, self-reported physical scores (physical health component summary score = 45) were higher than mental scores (mental health component summary score = 39). The mean 6MWD was 294.5 m (± 122.7) m (range 110 m - 600 m), which is well below normal reference values. Forty-eight percent (48%) of the sample presented with abnormal lung function, including obstructive (n = 9; 21%), restrictive (n = 11; 25%) and mixed (n = 1; 2%). CONCLUSIONS This pilot study suggests that most cured PTB patients have decreased HRQoL, exercise capacity and abnormal lung function. This study is the first to describe the combination of these three outcomes in a South African population. CLINICAL IMPLICATIONS Clinicians must recognise that holistic management of PTB patients is required after cure.
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Affiliation(s)
- Kurt J Daniels
- Division of Physiotherapy, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Elvis Irusen
- Department of Internal Medicine, Faculty of Health Science, Stellenbosch University, Cape Town, South Africa
| | - Hamilton Pharaoh
- Division of Physiotherapy, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Susan Hanekom
- Division of Physiotherapy, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
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Soule EK, Ramôa C, Eissenberg T, Cobb CO. Differences in puff topography, toxicant exposure, and subjective response between waterpipe tobacco smoking men and women. Exp Clin Psychopharmacol 2018; 26:440-447. [PMID: 30102062 PMCID: PMC6162145 DOI: 10.1037/pha0000207] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Waterpipe tobacco smoking (WTS) exposes users to toxicants in much greater amounts than a cigarette. Little is known about how gender affects WTS toxicant exposure and subjective response. Data from three WTS clinical laboratory studies were combined for analysis. Participants (N = 99; 38 women) completed a 45-min WTS session where they smoked a waterpipe ad libitum. Puff topography was measured throughout, and plasma nicotine concentration, expired air carbon monoxide (CO), and subjective responses were measured pre- and post-WTS. There was a gender effect for total puff volume with men inhaling a greater smoke volume, on average (M = 59.9 L, SD = 40.7), compared with women (M = 38.8 L, SD = 27.8; p < .01). Men had greater post-WTS mean plasma nicotine concentrations (M = 10.0 ng/ml, SD = 7.1) compared with women (M = 6.9 ng/ml, SD = 5.2; p < .05). Post-WTS expired air CO was not associated with gender (men M = 27.6 ppm, SD = 18.9; women M = 22.7 ppm, SD = 17.0, ns). Relative to men, women had higher post-WTS scores for subjective measures of "nauseous," "dizzy," "nervous," "headache," and "heart pounding." Men and women are exposed to toxicants during WTS, and men may achieve higher nicotine exposure than women, likely resulting from differences in smoke inhaled. However, similar post-WTS expired air CO between men and women and higher ratings of negative subjective responses among women may indicate that factors beyond puff topography may impact toxicant exposure and subjective response to WTS. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Ghanname I, Chaker A, Cherkani Hassani A, Herrak L, Arnaul Ebongue S, Laine M, Rahhali K, Zoglat A, Benitez Rexach AM, Ahid S, Cherrah Y. Factors associated with asthma control: MOSAR study (Multicenter Observational Study of Asthma in Rabat-Morocco). BMC Pulm Med 2018; 18:61. [PMID: 29699541 PMCID: PMC5921326 DOI: 10.1186/s12890-018-0624-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 04/11/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The purpose of the study is to describe the profile of patients with asthma and to identify the signifiant risks and the protective factors associated with asthma control. METHODS A prospective epidemiological study was conducted in three hospitals of Rabat-Morocco and included 396 patients with asthma. Differences in characteristics across the levels of asthma control were compared by the one-way analysis of variance for continuous variables, and chi-square test was used for categorical variables. The risk and protective factors associated with the asthma control levels were determined by Proportional Odds Model (POM) for bivariate and multivariate ordinal logistic regression, also expressed as Odds Ratios (OR) and 95% Confidence Intervals (95% CI). RESULTS From 7440 patients screened by 28 physicians, 396 were included in study. 53% of the particiants sufferd controlled, 18% had partly controlled and 29% had uncontrolled asthma symptoms. A multivariate ordinal logistic regression analysis showed that having respiratory infections (AOR = 5.71), suffering from concomitant diseases (AOR = 3.36) and being allergic to animals (AOR = 2.76) were positively associated with poor control of asthma. However, adherence to treatement (AOR = 0.07), possession of health insurance (AOR = 0.41) and having more than 2 children (AOR = 0.47) were associated with good asthma control. CONCLUSION The study established a clinical-epidemiological profile of asthmatic patients in Rabat region in Morocco. By ordinal logistic regression we found that 6 factors - respiratory infections, concomitant diseases, animals allergy, adherence to treatment, health insurance and having more than two children - were associated with asthma control.
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Affiliation(s)
- Imane Ghanname
- Research team of Pharmacoepidemiology & Pharmacoeconomics, Laboratory of Pharmacology and Toxicology, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco. .,Faculty of Health Sciences, International University of Casablanca, Bouskoura, Morocco.
| | - Ahmed Chaker
- Laboratory of Applied Mathematics, Faculty of Sciences, Mohammed V University, Rabat, Morocco
| | - Abha Cherkani Hassani
- Unit of training and research in Nutrition and Food Sciences, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Laila Herrak
- Department of Pneumology, Ibn Sina Hospital, Rabat, Morocco
| | | | - Mustapha Laine
- Department of Pneumology, Moulay Youssef Hospital, Rabat, Morocco
| | - Khalid Rahhali
- Laboratory of Applied Mathematics, Faculty of Sciences, Mohammed V University, Rabat, Morocco
| | - Abdelhak Zoglat
- Laboratory of Applied Mathematics, Faculty of Sciences, Mohammed V University, Rabat, Morocco
| | - Aida Maria Benitez Rexach
- Department of Languages, International University of Casablanca, Bouskoura, Morocco.,Doctoral Student in Psychology, Walden University, Minneapolis, USA
| | - Samir Ahid
- Research team of Pharmacoepidemiology & Pharmacoeconomics, Laboratory of Pharmacology and Toxicology, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Yahia Cherrah
- Research team of Pharmacoepidemiology & Pharmacoeconomics, Laboratory of Pharmacology and Toxicology, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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Waziry R, Jawad M, Ballout RA, Al Akel M, Akl EA. The effects of waterpipe tobacco smoking on health outcomes: an updated systematic review and meta-analysis. Int J Epidemiol 2018; 46:32-43. [PMID: 27075769 DOI: 10.1093/ije/dyw021] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2016] [Indexed: 12/25/2022] Open
Abstract
Background and aims A systematic review conducted in 2008 found significant associations between waterpipe tobacco smoking and lung cancer, respiratory disease, periodontal disease and low birthweight. Since then, a number of relevant studies have been published. The objective of this study was to update the systematic review on the effects of waterpipe tobacco smoking on health outcomes. Methods In May 2015 we electronically searched the following databases with no date restrictions: MEDLINE, EMBASE and the ISI Web of Science using a detailed search strategy with no language restrictions. We also screened the references' lists of the included studies. We included cohort, case-control and cross-sectional studies, and excluded case reports, conference abstracts, editorials and reviews. We excluded studies not conducted in humans, assessing physiological outcomes, not distinguishing waterpipe tobacco smoking from other forms of smoking or not reporting association measures. We assessed risk of bias for each included study and conducted meta-analyses for each of the outcomes of interest. Results We identified 50 eligible studies. We found that waterpipe tobacco smoking was significantly associated with: respiratory diseases [COPD; odds ratio (OR) = 3.18, 95% confidence interval CI = 1.25, 8.08; bronchitis OR = 2.37, 95% CI = 1.49, 3.77; passive waterpipe smoking and wheeze OR) = 1.97, 95% CI = 1.28, 3.04]; oral cancer OR = 4.17, 95% CI = 2.53, 6.89; lung cancer OR = 2.12, 95% CI = 1.32, 3.42; low birthweight (OR = 2.39, 95% CI = 1.32, 4.32); metabolic syndrome (OR 1.63-1.95, 95% CI = 1.25, 2.45); cardiovascular disease (OR = 1.67, 95% CI = 1.25, 2.24); and mental health (OR 1.30-2.4, 95% CI = 1.20, 2.80). Waterpipe tobacco smoking was not significantly associated with: oesophageal cancer (OR = 4.14, 95% CI = 0.93, 18.46); worse quality of life scores [standardized mean difference (SMD) = -0.16, 95% CI = -0.66, 0.34]; gastric carcinoma (OR = 2.16, 95% CI = 0.72, 6.47); bladder cancer (OR = 1.25, 95% CI = 0.99, 1.57); prostate cancer (OR = 7.00, 95% CI = 0.90, 56.90); hepatitis C infection (OR = 0.98, 95%0.80, 1.21); periodontal disease (OR = 3.00, 5.00); gastro-oesophageal reflux disease (OR = 1.25, 95% CI = 1.01, 1.56); nasopharyngeal carcinoma (OR = 0.49, 95% CI = 0.20, 1.23); bladder cancer (OR = 1.25, 95% CI = 0.99, 1.57); infertility (OR = 2.50, 95% CI = 1.00, 6.30); and mortality (OR = 1.15, 95% CI = 0.93, 1.43). Conclusions There is accumulating evidence about the association of waterpipe tobacco smoking with a growing number of health outcomes.
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Affiliation(s)
- Reem Waziry
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.,Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mohammed Jawad
- Department of Primary Care and Public Health, Imperial College London, London, UK.,Academic Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Rami A Ballout
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Mohammad Al Akel
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.,Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
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11
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Lee PN, Forey BA, Coombs KJ, Hamling JS, Thornton AJ. Epidemiological evidence relating environmental smoke to COPD in lifelong non-smokers: a systematic review. F1000Res 2018. [PMID: 32089819 DOI: 10.12688/f1000research.13887.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background: Some evidence suggests environmental tobacco smoke (ETS) might cause chronic obstructive pulmonary disease (COPD). We reviewed available epidemiological data in never smokers. Methods: We identified epidemiological studies providing estimates of relative risk (RR) with 95% confidence interval (CI) for various ETS exposure indices. Confounder-adjusted RRs for COPD were extracted, or derived using standard methods. Meta-analyses were conducted for each exposure index, with tests for heterogeneity and publication bias. For the main index (spouse ever smoked or nearest equivalent), analyses investigated variation in RR by location, publication period, study type, sex, diagnosis, study size, confounder adjustment, never smoker definition, and exposure index definition. Results: Twenty-eight relevant studies were identified; nine European or Middle Eastern, nine Asian, eight American and two from multiple countries. Five were prospective, seven case-control and 16 cross-sectional. The COPD definition involved death or hospitalisation in seven studies, GOLD stage 1+ criteria in twelve, and other definitions in nine. For the main index, random-effects meta-analysis of 33 heterogeneous (p<0.001) estimates gave a RR of 1.20 (95%CI 1.08-1.34). Higher estimates for females (1.59,1.16-2.19, n=11) than males (1.29,0.94-1.76, n=7) or sexes combined (1.10,0.99-1.22, n=15 where sex-specific not available), and lower estimates for studies of 150+ cases (1.08,0.97-1.20, n=13) partly explained the heterogeneity. Estimates were higher for Asian studies (1.34,1.08-1.67, n=10), case-control studies (1.55,1.04-2.32, n=8), and COPD mortality or hospitalisation (1.40,1.12-1.74, n=11). Some increase was seen for severer COPD (1.29,1.10-1.52, n=7). Dose-response evidence was heterogeneous. Evidence for childhood (0.88,0.72-1.07, n=2) and workplace (1.12,0.77-1.64, n=4) exposure was limited, but an increase was seen for overall adulthood exposure (1.20,1.03-1.39, n=17). We discuss study weaknesses that may bias estimation of the association of COPD with ETS. Conclusions: Although the evidence suggests ETS increases COPD, study weaknesses and absence of well-designed large studies precludes reliable inference of causality. More definitive evidence is required.
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Affiliation(s)
- Peter N Lee
- P.N. Lee Statistics and Computing Ltd, Sutton, Surrey, SM2 5DA, UK
| | - Barbara A Forey
- P.N. Lee Statistics and Computing Ltd, Sutton, Surrey, SM2 5DA, UK
| | | | - Jan S Hamling
- P.N. Lee Statistics and Computing Ltd, Sutton, Surrey, SM2 5DA, UK
| | - Alison J Thornton
- Independent Consultant in Statistics, Okehampton, Devon, EX20 1SG, UK
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12
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Lee PN, Forey BA, Coombs KJ, Hamling JS, Thornton AJ. Epidemiological evidence relating environmental smoke to COPD in lifelong non-smokers: a systematic review. F1000Res 2018; 7:146. [PMID: 32089819 PMCID: PMC6953425 DOI: 10.12688/f1000research.13887.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2018] [Indexed: 01/01/2023] Open
Abstract
Background: Some evidence suggests environmental tobacco smoke (ETS) might cause chronic obstructive pulmonary disease (COPD). We reviewed available epidemiological data in never smokers. Methods: We identified epidemiological studies providing estimates of relative risk (RR) with 95% confidence interval (CI) for various ETS exposure indices. Confounder-adjusted RRs for COPD were extracted, or derived using standard methods. Meta-analyses were conducted for each exposure index, with tests for heterogeneity and publication bias. For the main index (spouse ever smoked or nearest equivalent), analyses investigated variation in RR by location, publication period, study type, sex, diagnosis, study size, confounder adjustment, never smoker definition, and exposure index definition. Results: Twenty-eight relevant studies were identified; nine European or Middle Eastern, nine Asian, eight American and two from multiple countries. Five were prospective, seven case-control and 16 cross-sectional. The COPD definition involved death or hospitalisation in seven studies, GOLD stage 1+ criteria in twelve, and other definitions in nine. For the main index, random-effects meta-analysis of 33 heterogeneous (p<0.001) estimates gave a RR of 1.20 (95%CI 1.08-1.34). Higher estimates for females (1.59,1.16-2.19, n=11) than males (1.29,0.94-1.76, n=7) or sexes combined (1.10,0.99-1.22, n=15 where sex-specific not available), and lower estimates for studies of 150+ cases (1.08,0.97-1.20, n=13) partly explained the heterogeneity. Estimates were higher for Asian studies (1.34,1.08-1.67, n=10), case-control studies (1.55,1.04-2.32, n=8), and COPD mortality or hospitalisation (1.40,1.12-1.74, n=11). Some increase was seen for severer COPD (1.29,1.10-1.52, n=7). Dose-response evidence was heterogeneous. Evidence for childhood (0.88,0.72-1.07, n=2) and workplace (1.12,0.77-1.64, n=4) exposure was limited, but an increase was seen for overall adulthood exposure (1.20,1.03-1.39, n=17). We discuss study weaknesses that may bias estimation of the association of COPD with ETS. Conclusions: Although the evidence suggests ETS increases COPD, study weaknesses and absence of well-designed large studies precludes reliable inference of causality. More definitive evidence is required.
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Affiliation(s)
- Peter N. Lee
- P.N. Lee Statistics and Computing Ltd, Sutton, Surrey, SM2 5DA, UK
| | - Barbara A. Forey
- P.N. Lee Statistics and Computing Ltd, Sutton, Surrey, SM2 5DA, UK
| | | | - Jan S. Hamling
- P.N. Lee Statistics and Computing Ltd, Sutton, Surrey, SM2 5DA, UK
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13
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Arora S, Rasania SK, Bachani D, Gandhi A, Chhabra SK. Air pollution and environmental risk factors for altered lung function among adult women of an urban slum area of Delhi: A prevalence study. Lung India 2018; 35:193-198. [PMID: 29697074 PMCID: PMC5946550 DOI: 10.4103/lungindia.lungindia_263_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Household and ambient air pollution are jointly responsible for about 7 million premature deaths annually. Women living in slums, with unhealthy environment, both indoors and outdoors, particularly those living close to industrial and/or vehicular pollution zones due to multiple sources of air pollution, are at the higher risk of having impaired lung function tests. Objective: The aim of this study was to estimate the prevalence of abnormal lung functions and to identify the environmental risk factors associated with them among adult women of 18–59 years. Materials and Methods: A total of 550 women aged 18–59 years were approached in a representative urban slum. Five hundred consented to participate and 299 had prebronchodilator spirometry satisfying ATS standards. House visits to assess environmental conditions were conducted to determine their association with forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). Chi-square test was used to test the association of risk factors with lung functions. ANOVA was used to test the association of mean values of FEV1 and FVC with age. Results: Out of 299 participants with acceptable spirometric curves, 5% had reduced FEV1/FVC ratio than the normal and 26.8% and 17.4% had lower values than predicted for FVC and FEV1, respectively. Altered lung function was related to age, tobacco smoking, and history of respiratory disease. Conclusions: Both ambient and household air pollution have a deleterious pulmonary effect on long-term women residents of a representative urban slum in Delhi.
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Affiliation(s)
- Shweta Arora
- Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
| | - S K Rasania
- Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
| | - D Bachani
- Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
| | - Asha Gandhi
- Department of Physiology, Lady Hardinge Medical College, New Delhi, India
| | - S K Chhabra
- Department of Pulmonary Medicine, Primus Super Specialty Hospital, New Delhi, India
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14
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Mahboub BH, Vats MG, Al Zaabi A, Iqbal MN, Safwat T, Al-Hurish F, Miravitlles M, Singh D, Asad K, Zeineldine S, Al-Hajjaj MS. Joint statement for the diagnosis, management, and prevention of chronic obstructive pulmonary disease for Gulf Cooperation Council countries and Middle East-North Africa region, 2017. Int J Chron Obstruct Pulmon Dis 2017; 12:2869-2890. [PMID: 29070946 PMCID: PMC5640411 DOI: 10.2147/copd.s136245] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Smoking and subsequent development of COPD is an ever-increasing epidemic in Arabian Gulf and Middle East countries, with no signs of decline. The important fact to be highlighted is that this COPD epidemic of increasing incidence and prevalence is mostly unrecognized by patients, due to the common attribution of symptoms to "smoker's cough", and the underdiagnosis and undertreatment by physicians because the common signs and symptoms masquerade as asthma. Consequently, there are long-term adverse effects of missing the diagnosis. The purpose of this review article is to focus upon the status of COPD in Arabian Gulf and Middle East countries, stressing the increasing burden of smoking and COPD, to emphasize the specific factors leading to rise in prevalence of COPD, to bring to light the underdiagnosis and undermanagement of COPD, and to treat COPD in conformity with standard guidelines with local and regional modifications. This review ends with suggestions and recommendations to the health department to formulate policies and to generate awareness among the general public about the side effects of smoking and consequences of COPD.
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Affiliation(s)
- Bassam H Mahboub
- College of Medicine, University of Sharjah, Sharjah
- Department of Pulmonary Medicine, Rashid Hospital, Dubai Health Authority, Dubai
| | - Mayank Gian Vats
- Department of Pulmonary Medicine, Rashid Hospital, Dubai Health Authority, Dubai
| | - Ashraf Al Zaabi
- Department of Pulmonary Medicine, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | - Mohammed Nizam Iqbal
- Department of Pulmonary Medicine, Rashid Hospital, Dubai Health Authority, Dubai
| | - Tarek Safwat
- Chest Department, Ain Shams University, Cairo, Egypt
| | - Fatma Al-Hurish
- Department of Pulmonology and Allergy, Al-Sabah Hospital, Kuwait City, Kuwait
| | - Marc Miravitlles
- Department of Pneumology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Dave Singh
- Centre for Respiratory Medicine and Allergy, University of Manchester, University Hospital of South Manchester, Manchester, UK
| | - Khaled Asad
- Pulmonary and Critical Care, Istishari Hospital, Amman, Jordan
| | - Salah Zeineldine
- Faculty of Medicine
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
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15
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Environmental risk factors and the associated morbidity in a periurban area, Alexandria, Egypt. J Egypt Public Health Assoc 2017; 91:44-51. [PMID: 27110860 DOI: 10.1097/01.epx.0000480930.70965.83] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND According to the WHO, nearly 24% of the global disease burden is attributable to environmental risk factors (RFs). People living in periurban areas are particularly at risk due to lack of basic sanitation requirements. OBJECTIVE To investigate the possible association between environmental RFs and disease prevalence for a community living in a periurban area in Alexandria, Egypt. MATERIALS AND METHODS A cross-sectional study was conducted in 2012. The study sample consisted of 355 families. An interviewing questionnaire and an observation checklist were used for data collection. In addition, 10 drinking water samples were randomly collected for physical, chemical, and bacteriological analyses. The questionnaire included questions on indoor environmental RFs as well as morbidity in the study sample, and the observation checklist covered outdoor environmental RFs. The environmental risk was determined using a risk score whose calculation was based upon the presence/absence of 10 indoor and 12 outdoor environmental RFs. The association between risk scores and 14 morbidities was investigated using unconditional logistic regression analysis, expressed as odds ratio (OR) and 95% confidence interval (CI). RESULTS A significant association was found between the total environmental risk score and respiratory diseases (OR=2.298, 95% CI: 1.231-4.291), diarrhea (OR=2.083, 95% CI: 1.102-3.939), liver diseases (OR=2.491, 95% CI: 1.067-5.819), skin diseases (OR=1.821, 95% CI: 1.012-3.310), and bronchial asthma (OR=2.228, 95% CI: 1.066-4.565). Noncommunicable diseases such as cardiovascular diseases and musculoskeletal diseases did not show any significant association with environmental RFs. CONCLUSION AND RECOMMENDATIONS Environmental RFs have an adverse impact on health within communities living in periurban areas. It is recommended that sanitation be improved and various outdoor environmental RFs be addressed in these underprivileged areas, as well as health education campaigns be organized aiming at raising the awareness of residents on indoor environmental RFs and ways to prevent them.
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16
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Haddad L, Kelly DL, Weglicki LS, Barnett TE, Ferrell AV, Ghadban R. A Systematic Review of Effects of Waterpipe Smoking on Cardiovascular and Respiratory Health Outcomes. Tob Use Insights 2016; 9:13-28. [PMID: 27398028 PMCID: PMC4934173 DOI: 10.4137/tui.s39873] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/01/2016] [Accepted: 06/03/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Waterpipe smoking (WPS) is a social custom common in many Middle Eastern, North African, and Asian countries and has become increasingly popular in the US, especially among youth; however, WPS smoking may be increasing in the US adult population as well. There is a common belief among waterpipe (WP) smokers that WPS is less harmful than smoking cigarettes. Thus, this review aims to systematically explore the literature on the effects of WP tobacco smoking with a particular focus on cardiovascular and respiratory health outcomes as well as on oxidative stress, immunity, and cell cycle interference health outcomes. METHODOLOGY We conducted a systematic review, guided by the criteria of The Preferred Reporting Items for Systematic Reviews and Meta-Analyses, using the following online databases MEDLINE, CINAHL, ScienceDirect, PMC, and Cochrane Library. Results were summarized qualitatively. RESULTS Forty studies met the inclusion criteria established for this review. Based on the existing evidence, several cardiovascular and respiratory physiologic health indicators and conditions have been shown to be negatively affected by WPS. In addition to the effects of nicotine and chemical toxicant exposures, WPS was significantly associated with an increase in heart rate, blood pressure, and lower pulmonary function test results, as well as a number of health conditions such as lung cancer, alterations in oxidative stress, immunity, and cell cycle interference. CONCLUSION The current literature provides evidence that WPS is associated with a number of negative health indicators and outcomes. There is need for more research related to WPS and its effects on health so that appropriate campaigns and prevention interventions can be implemented to control the epidemic increase of WPS in the US.
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Affiliation(s)
- Linda Haddad
- Associate Dean for Academic Affairs, College of Nursing, University of Florida, Gainesville, FL, USA.,CORRESPONDENCE:
| | - Debra Lynch Kelly
- Assistant Professor, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Linda S. Weglicki
- Professor and Schmidt Family Foundation Distinguished Professor, Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Tracey E. Barnett
- Associate Professor, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | | | - Roula Ghadban
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
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17
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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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18
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Shi J, Fu QL, Zhang H, Cheng L, Wang YJ, Zhu DD, Lv W, Liu SX, Li PZ, Ou CQ, Xu G. Epidemiology of chronic rhinosinusitis: results from a cross-sectional survey in seven Chinese cities. Allergy 2015; 70:533-9. [PMID: 25631304 PMCID: PMC4409092 DOI: 10.1111/all.12577] [Citation(s) in RCA: 276] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Chronic sinusitis (CRS) is a common otorhinolaryngologic disease that is frequently encountered in everyday practice, but there is a lack of precise data regarding the prevalence of CRS in developing countries. We performed a national investigation in China to determine the prevalence and associated factors of CRS. METHODS We conducted a cross-sectional investigation in 2012. A stratified four-stage sampling method was used to select participants randomly from seven cities in mainland China. All participants were interviewed face-to-face via a standardized questionnaire. Unconditional logistic regression analyses were conducted to examine the association between smoking and sinusitis after adjusting for socio-demographic factors. RESULTS This study included a total of 10 636 respondents from seven cities. The overall prevalence of CRS was 8.0% and ranged from 4.8% to 9.7% in seven centres. Chronic sinusitis affected approximately 107 million people in mainland China. Chronic sinusitis was particularly prevalent among people with specific medical conditions, including allergic rhinitis, asthma, chronic obstructive pulmonary disease and gout. The prevalence was slightly higher among males (8.79%) than females (7.28%) (P = 0.004), and the prevalence varied by age group, ethnicity and marital status and education (P < 0.05), but not by household per capita income or living space (P > 0.05). Both second-hand tobacco smoke and active smoking were independent risk factors for CRS (P = 0.001). CONCLUSIONS Chronic sinusitis is an important public health problem in China. Our study provides important information for the assessment of the economic burden of CRS and the development and promotion of public health policies associated with CRS particularly in developing countries.
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Affiliation(s)
- J.B. Shi
- Otorhinolaryngology Hospital The First Affiliated Hospital Sun Yat‐sen University Guangzhou China
| | - Q. L. Fu
- Otorhinolaryngology Hospital The First Affiliated Hospital Sun Yat‐sen University Guangzhou China
| | - H. Zhang
- Department of Otorhinolaryngology, The First Affiliated Hospital Xinjiang Medical University Urumqi China
| | - L. Cheng
- Department of Otorhinolaryngology The First Affiliated Hospital Nanjing Medical University Nanjing China
| | - Y. J. Wang
- Department of Otorhinolaryngology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - D. D. Zhu
- Department of Otolaryngology Head and Neck China‐Japan Union Hospital Jilin University Changchun China
| | - W. Lv
- Department of Otolaryngology Peking Union Medical College Hospital Beijing China
| | - S. X. Liu
- Department of Otorhinolaryngology West China Hospital of Medicine Sichuan University Chengdu China
| | - P. Z. Li
- Department of Otorhinolaryngology Affiliated Huai'an First People's Hospital Nanjing Medical University Huaian China
| | - C. Q. Ou
- State Key Laboratory of Organ Failure Research Department of Biostatistics School of Public Health and Tropical Medicine Southern Medical University Guangzhou China
| | - G. Xu
- Otorhinolaryngology Hospital The First Affiliated Hospital Sun Yat‐sen University Guangzhou China
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O'Brien E, Spiess PC, Habibovic A, Hristova M, Bauer RA, Randall MJ, Poynter ME, van der Vliet A. Inhalation of the reactive aldehyde acrolein promotes antigen sensitization to ovalbumin and enhances neutrophilic inflammation. J Immunotoxicol 2015; 13:191-7. [PMID: 25875327 DOI: 10.3109/1547691x.2015.1033571] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Acrolein (ACR), an α,β-unsaturated aldehyde and a major component of tobacco smoke, is a highly reactive electrophilic respiratory irritant implicated in asthma pathogenesis and severity. However, few studies have directly investigated the influence of ACR exposure on allergen sensitization and pulmonary inflammation. The present study was designed to examine the impact of ACR inhalation on allergic sensitization to the inhaled antigen ovalbumin (OVA), as well as pulmonary inflammation during subsequent OVA challenge. Adult male C57BL/6 mice were exposed to inhaled OVA (1%, 30 min/day, 4 days/week) and/or ACR (5 ppm, 4 h/day, 4 days/week) over 2 weeks and subsequently challenged with aerosolized OVA (1%, 30 min/day) over three consecutive days. Serum anti-OVA IgG1 levels were increased significantly in animals exposed to both OVA and ACR, compared to animals exposed to either OVA or ACR alone. In addition, differential cell counts and histological analysis revealed an increase in BAL neutrophils in animals exposed to both OVA and ACR. However, exposure to both OVA and ACR did not influence mRNA expression of the cytokines il5, il10, il13 or tnfa, but significantly increased mRNA expression of ccl20. Moreover, ACR exposure enhanced lung mRNA levels of il17f and tgfb1, suggesting development of enhanced inhalation tolerance to OVA. Overall, the findings indicate that ACR inhalation can promote airway-mediated sensitization to otherwise innocuous inhaled antigens, such as OVA, but also enhances immune tolerance, thereby favoring neutrophilic airway inflammation.
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Affiliation(s)
| | | | | | | | | | | | - Matthew E Poynter
- b Department of Medicine , College of Medicine, University of Vermont , Burlington , VT , USA
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20
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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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Chaouachi K. Use & Misuse of Water-filtered Tobacco Smoking Pipes in the World. Consequences for Public Health, Research & Research Ethics. THE OPEN MEDICINAL CHEMISTRY JOURNAL 2015; 9:1-12. [PMID: 25861403 PMCID: PMC4384226 DOI: 10.2174/1874104501509010001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 12/27/2014] [Accepted: 01/22/2015] [Indexed: 01/07/2023]
Abstract
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.
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Affiliation(s)
- Kamal Chaouachi
- Address correspondence to this author at the DIU Tabacologie, Université
Paris XI, 63 avenue Gabriel Peri, 94276 Le Kremlin-Bicêtre, France;
Tel: 33 1 4959 6617; Fax: 33 1 5839 3695; E-mail:
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Koubaa A, Triki M, Trabelsi H, Masmoudi L, Zeghal KN, Sahnoun Z, Hakim A. Lung function profiles and aerobic capacity of adult cigarette and hookah smokers after 12 weeks intermittent training. Libyan J Med 2015; 10:26680. [PMID: 25694204 PMCID: PMC4332739 DOI: 10.3402/ljm.v10.26680] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 01/17/2015] [Accepted: 01/19/2015] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Pulmonary function is compromised in most smokers. Yet it is unknown whether exercise training improves pulmonary function and aerobic capacity in cigarette and hookah smokers and whether these smokers respond in a similar way as do non-smokers. AIM To evaluate the effects of an interval exercise training program on pulmonary function and aerobic capacity in cigarette and hookah smokers. METHODS Twelve cigarette smokers, 10 hookah smokers, and 11 non-smokers participated in our exercise program. All subjects performed 30 min of interval exercise (2 min of work followed by 1 min of rest) three times a week for 12 weeks at an intensity estimated at 70% of the subject's maximum aerobic capacity (VO2max). Pulmonary function was measured using spirometry, and maximum aerobic capacity was assessed by maximal exercise testing on a treadmill before the beginning and at the end of the exercise training program. RESULTS As expected, prior to the exercise intervention, the cigarette and hookah smokers had significantly lower pulmonary function than the non-smokers. The 12-week exercise training program did not significantly affect lung function as assessed by spirometry in the non-smoker group. However, it significantly increased both forced expiratory volume in 1 second and peak expiratory flow (PEF) in the cigarette smoker group, and PEF in the hookah smoker group. Our training program had its most notable impact on the cardiopulmonary system of smokers. In the non-smoker and cigarette smoker groups, the training program significantly improved VO2max (4.4 and 4.7%, respectively), v VO2max (6.7 and 5.6%, respectively), and the recovery index (7.9 and 10.5%, respectively). CONCLUSIONS After 12 weeks of interval training program, the increase of VO2max and the decrease of recovery index and resting heart rate in the smoking subjects indicated better exercise tolerance. Although the intermittent training program altered pulmonary function only partially, both aerobic capacity and life quality were improved. Intermittent training should be advised in the clinical setting for subjects with adverse health behaviors.
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Affiliation(s)
- Abdessalem Koubaa
- Laboratory of Pharmacology, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Research Unit (EM2S), Higher Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Moez Triki
- Laboratory of Cardio-Circulatory, Respiratory, and Hormonal Adaptations to Muscular Exercise, Faculty of Medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia;
| | - Hajer Trabelsi
- Research Unit (EM2S), Higher Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Liwa Masmoudi
- Research Unit (EM2S), Higher Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Khaled N Zeghal
- Laboratory of Pharmacology, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Zouhair Sahnoun
- Laboratory of Pharmacology, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Ahmed Hakim
- Laboratory of Pharmacology, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
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