PURPOSE: Smoking Hookah seems to be getting popular among youth, who may not consider it a health hazard or habit forming. We looked into patterns of Hookah smoking among patients with chronic obstructive pulmonary disease (COPD).
METHODS: Consenting patients with a diagnosis of COPD were interviewed at a pulmonary clinic at the Sheri-Kashmir Institute of Medical Sciences in Srinagar, India. The patients responded to a pre-approved questionnaire.
RESULTS: The mean age of the study group (n=36) was 68 ± 8.7 years and 77% were men. Fifty eight percent were living in the rural areas. Average duration of COPD diagnosis was 6.5± 3.6 (range 2-15) years. All the patients smoked Hookah and about half (53%) also smoked cigarettes. A majority (67%) started smoking by the age of 20 years; 36% started smoking at the age of 15 years or less. Mean duration of smoking was 33.1 ± 15 years. Seventy seven percent smoked tobacco mixed with molasses; 80% used charcoal (soft coal) while as the rest used wood or paper to burn the tobacco. Daily consumption of tobacco was 50-200 grams in 55% of patients, more than 200 grams in 18% and 50 grams in 27%. On average, patients would buy 300 grams of tobacco at a time. Fifty five percent stated that they were allowed to smoke at work. Almost half (47%) had urge to smoke within 5 minutes after waking up in the morning compared to 30% who would smoke an hour after waking up. Fifty eight percent used to smoke more often in the morning hours compared to rest of the day. All but 11% patients had stopped smoking at the time of interview, although more than half (53%) continued to smoke for some time while they were sick. Forty four percent of patients found it most difficult to give up the morning sessions of smoking. Most of the patients (80%) considered smoking Hookah bad for health.
CONCLUSIONS: All patients smoked Hookah and about half also smoked cigarettes. The majority started smoking by the age of 20 years. Craving for the smoking was greatest in morning and almost half of the patients found it difficult to give up smoking in the early part of the day.
CLINICAL IMPLICATIONS: There is need to increase awareness among local youth about possible hazards of Hookah smoking as the majority of smokers start smoking as young adults. Large epidemiological studies may be helpful in understanding patterns of smoking that can be used in smoking cessation.
DISCLOSURE: The following authors have nothing to disclose: Omair Kawoosa, Umar Hafiz Khan, Hikmat Jamil, Parvaiz Koul
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