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Jihad Irani, MD, MPH; Dany Raad, MD; Elie A. Akl, MD, PhD, MPH
Author and Funding Information

From the Faculty of Health Sciences (Dr Irani), University of Balamand, and Department of Medicine (Drs Raad and Akl), State University of New York at Buffalo.

Correspondence to: Elie A. Akl, MD, PhD, MPH, State University of New York at Buffalo, ECMC CC-142, 462 Grider St, Buffalo, NY 14215; e-mail: elieakl@buffalo.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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(5):1251-1252. doi:10.1378/chest.11-0023
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To the Editor:

We thank Dr Chaouachi for his letter regarding our article1; it raises a valid point about the variability of the exposure in water-pipe tobacco smoking (commonly referred to as water-pipe smoking) research and the bias that it can introduce. We do acknowledge this variability in the discussion of the limitations of our systematic review. Along the same line, we highlighted the problem of not having a standardized tool to measure exposure.

On the other hand, the letter appears to be suggesting that moassel smoking is less harmful than smoking other types of tobacco but fails to provide convincing data. We believe that the burden of proof falls on Dr Chaouachi and others who have been advocating the safety of certain forms of smoking. Until such proof is available, it would be prudent to accept the findings that water-pipe smoking may negatively affect lung function parameters, keeping in mind the relatively low quality of the supporting evidence behind them.

We believe that our systematic review methodology is standard and rigorous. Taking into account the points raised in our discussion, our conclusion remains the same: There is potential harm in smoking a water pipe, the quality of evidence is low, and further research is needed.

Raad D, Gaddam S, Schunemann HJ, et al. Effects of water-pipe smoking on lung function: a systematic review and meta-analysis. Chest. 2011;1394:764-774. [CrossRef] [PubMed]
 

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Raad D, Gaddam S, Schunemann HJ, et al. Effects of water-pipe smoking on lung function: a systematic review and meta-analysis. Chest. 2011;1394:764-774. [CrossRef] [PubMed]
 
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