Carboxyhaemoglobin levels in water-pipe and cigarette smokers

Abstract

Water-pipes (hookah, narghile, shisha, goza, hubble bubble and in South Africa hubbly-bubbly) have been used to smoke tobacco for more than 400 years. Traditionally in the Middle East water-pipe smoking has been the habit of older men, but it is increasing in popularity worldwide, especially among students, other young people and children. 1 The popularity of water-pipe smoking appears to be based on its social nature and the assumption that its effects are less harmful than those of cigarette smoking.2 The increase in water-pipe smoking can partly be attributed to the popularity of the sweetened and variously flavoured tobaccos that are used in the water-pipe.A water-pipe is essentially a glass bottle with hoses and a mouthpiece through which to smoke. 3 The head contains the tobacco, and since the tobacco is too moist to burn on its own, charcoal is placed on top of the tobacco-filled head. The body is fixed to the neck of the bottle, and its central conduit is submerged in the bottle. The bottle is half-filled with water and placed on the ground. The hose is attached to an aperture in the side of the pipe (Fig. 1). When the charcoal is lit, the smoker inhales through the hose. This creates a vacuum above the water, drawing air through the body and over the tobacco and charcoal. The smoke bubbles through the water, where it is diluted and cooled, and then inhaled by the smoker.Carbon monoxide (CO) is produced by the incomplete combustion of carbon-containing material, notably tobacco, biomass fuel and fossil fuel. The carboxyhaemoglobin (COHb) level in the blood (half-life 2 -6 hours) after inhalation of CO will depend on concentrations of inspired CO, duration of exposure, pulmonary ventilation and the COHb level before the inhalation. 4 COHb is a sensitive specific physiological marker of atmospheric CO exposure from both indoor and outdoor sources.In water-pipe smokers expired CO was reported to increase by 300% after an hour of smoking, while in cigarette smokers it only increased by 60%. 5During a single water-pipe smoking session a smoker may produce a 24-hour urinary cotinine level that is equivalent to smoking 10 cigarettes a day (95% confidence interval (CI) 7 -13 cigarettes a day).6 Contrary to popular belief, noxious substances such as nicotine, tar and heavy metals (chromium, arsenic, lead) are found in the smoke of water-pipes.7 Although water-pipe smoking is so widespread, its adverse health effects are not well documented. Data on CO levels in the blood after a controlled smoking session comparing water-pipe smoking with cigarette smoking are limited.We aimed to measure COHb levels in the blood before and after water-pipe smoking and cigarette smoking under controlled conditions. Materials and methodsOnly self-confessed smokers of cigarettes and water-pipes aged 18 years and older were recruited from students and hospital workers. There were no regular pipe smokers among Water-pipe smoking is growing in popularity, especially among young people, because of the social nature of the smoking sessio...

Health effects associated with waterpipe smoking

“…WPS acutely leads to a marked CO inhalation and increased carboxyhaemoglobin (COHb) or exhaled CO when compared to cigarette smokers 17 35–37 and non-smokers. 36–38 An acute increase in CO levels (exhaled CO or COHb) is demonstrated in smokers following a timed WPS session 8 10 11 13–18 39–42 after exiting WP cafés 43 or compared to non-WP cafés, 44 and among passive smokers.…”

Water Pipe and Smokeless Tobacco Use Among Medical Students in South Africa

“…Considering that health professionals, including medical students, are generally perceived as role models in many societies, the finding of prevalent use of water pipe although not daily still poses a concern to public health efforts for tobacco control especially because water pipe smokers do not consider the practice harmful (Hammal et al, 2008). This belief persists despite the fact that recent studies both in South Africa and elsewhere have demonstrated significant adverse health effects associated with water pipe smoking (Maziak, Ward, Soweid, & Eissenberg, 2004;Theron, Schultz, Ker, & Falzone, 2010).…”

Anesthesia implications of waterpipe use

“…Among United States college students pastmonth use is now reported between 10% and 20%, and even 7% of 12 th grade students report past-month waterpipe use [1]. Tobacco waterpipes, also known as hookahs, shishas, or narghiles, vary in composition by culture, but involve passing smoke through water and usually placing charcoal on top of a tobacco-filled pipe head [3,4]. Since the smoke in a waterpipe passes through water before inhalation by the user, and because the most popular type of waterpipe tobacco, maassel, is often fruit-flavored, waterpipes are often perceived to be less dangerous than cigarettes [1,4].…”