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Original Research: COPD |

The Acute Effects of Water-Pipe Smoking on the Cardiorespiratory System

Fahed Hakim, MD; Elias Hellou, BSc; Aviv Goldbart, MD; Rina Katz, MSc; Yedidia Bentur, MD; Lea Bentur, MD
Author and Funding Information

From the Pediatric Pulmonology Unit, Meyer Children’s Hospital (Drs Hakim and L. Bentur); The Israel Poison Information Center (Dr Y. Bentur); and the Department of Immunology (Ms Katz), Rambam Health Care Campus (Drs Hakim, L. Bentur, and Y. Bentur; Mr Hellou; and Ms Katz), Haifa, Israel; The Faculty of Medicine (Drs Hakim, L. Bentur, and Y. Bentur; Mr Hellou; and Ms Katz), Technion-Israel Institute of Technology, Haifa, Israel; and The Department of Pediatrics (Dr Goldbart), Soroka University Medical Center, Beer-Sheva, Israel.

Correspondence to: Lea Bentur, MD, Meyer Children’s Hospital, Rambam Health Care Campus, PO Box 9602, Haifa 31092, Israel; e-mail: l_bentur@rambam.health.gov.il


For editorial comment see page 737

Funding: This work was supported by the Israel Cancer Association, the Israel Lung Association, and the Israel Science Foundation Legacy [Grant 1817/2007].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(4):775-781. doi:10.1378/chest.10-1833
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Objective:  There are limited data on the acute effects of water-pipe tobacco smoking, commonly known as water-pipe smoking (WPS), on cardiopulmonary parameters. This study evaluated the acute effects of a single 30-min session of WPS on carboxyhemoglobin (COHb) levels, pulmonary function test results, vital signs, fractional exhaled nitric oxide (Feno) levels, and exhaled breath condensate (EBC) cytokine levels in volunteers in a domestic, open-air, group smoking setting.

Methods:  This prospective study evaluated the above-noted outcome parameters before and after 30 min of WPS. The primary outcome parameter was the change in COHb levels.

Results:  Forty-five volunteers (30 men, 15 women), aged 32.35 ± 15.33 years, were recruited. After one session of WPS, the COHb levels rose significantly, from 1.47% ± 0.57% (median 1.4) to 9.47% ± 5.52% (median 7.4), P < .001. Systolic and diastolic BP levels significantly increased after smoking (systolic, 119.52 ± 12.07 mm Hg vs 131.98 ± 17.8 mm Hg; diastolic, 74.84 ± 7.89 mm Hg vs 82.98 ± 12.52 mm Hg, respectively; P < .001). Heart rates increased from 80.39 ± 9.92 beats/min to 95.59 ± 17.41 beats/min, P < .001; and respiratory rates increased from 14.36 ± 1.63 breaths/min to 16.68 ± 2.24 breaths/min, P < .001. There were decreases in forced expiratory flow between 25% and 75% of FVC, peak expiratory flow rate, Feno levels, percentage of eosinophils in peripheral blood, and 8-isoprostane levels in EBC.

Conclusions:  This study shows that one session of WPS causes acute biologic changes that might result in marked health problems. It adds to the limited evidence that WPS is harmful and supports interventions to control the continuing global spread of WPS, especially among youth.

Trial registry:  ClinicalTrials.gov; No.: NCT01157832; URL: www.clinicaltrials.gov

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