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Original Research: Tobacco Cessation and Prevention |

Laboratory and Clinical Acute Effects of Active and Passive Indoor Group Water-Pipe (Narghile) SmokingAcute Effects of Water-Pipe Smoking

Lea Bentur, MD; Elias Hellou, BSc; Aviv Goldbart, MD; Giora Pillar, MD; Einat Monovich, BSc; Maram Salameh, PharmD; Inna Scherb, MSc; Yedidia Bentur, MD
Author and Funding Information

From the Pediatric Pulmonology Unit (Drs L. Bentur and Salameh), Meyer Children’s Hospital, Rambam Health Care Campus, Haifa; Rappaport Faculty of Medicine (Drs L. Bentur, Pillar, and Y. Bentur; Mr Hellou; and Ms Monovich), Technion–Israel Institute of Technology, Haifa; Department of Pediatrics (Dr Goldbart), Faculty of Health Sciences, Ben Gurion University, Soroka University Medical Center, Beer-Sheva; Department of Pediatrics (Dr Pillar), Carmel Medical Center, Haifa; School of Pharmacy (Dr Salameh), Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem; and Clinical Toxicology and Pharmacology Laboratory (Ms Scherb) and Israel Poison Information Center (Ms Scherb and Dr Y. Bentur), Rambam Health Care Campus, Haifa, Israel.

Correspondence to: Lea Bentur, MD, Pediatric Pulmonology Unit, Meyer Children’s Hospital, Rambam Health Care Campus, PO Box 9602, Haifa 31096, Israel; e-mail: l_bentur@rambam.health.gov.il


Funding/Support: The study was supported by the Israel Cancer Association, Israel Lung Association, and Israel Science Foundation [Grant 753/2011].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(4):803-809. doi:10.1378/chest.13-0960
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Background:  Indoor group water-pipe tobacco smoking, commonly referred to as water-pipe smoking (WPS), especially in coffee shops, has gained worldwide popularity. We performed a comprehensive laboratory and clinical evaluation of the acute effects of active and passive indoor group WPS.

Methods:  This comparative study evaluated pre- and post-30-min active and passive indoor group WPS. The outcome parameters were carboxyhemoglobin (COHb), nicotine, and cotinine levels; CBC count; and cardiorespiratory parameters. Exhaled breath condensate (EBC) cytokines and endothelial function (using the EndoPat device [Itamar Medical Ltd]) were measured only in active smokers. Statistical methods used were Student t test, Wilcoxon signed rank test, Fisher exact test, analysis of variance, and Newman-Keuls post hoc test where relevant.

Results:  Sixty-two volunteers aged 24.9 ± 6.2 years were included; 47 were active smokers, and 15 were passive smokers. COHb level increased postactive WPS (active smokers, 2.0% ± 2.9% vs 17.6% ± 8.8%; P < .00001); six subjects (12.7%) had a > 25% increase, and two subjects (4.2%) had a > 40% increase. Plasma nicotine level increased postactive WPS (active smokers, 1.2 ± 4.3 ng/mL vs 18.8 ± 13.9 ng/mL; P < .0001); plasma cotinine and urinary nicotine and cotinine levels also increased significantly. EBC IL-4, IL-5, IL-10, IL-17, and γ-interferon decreased significantly with postactive smoking; endothelial function did not change. WPS was associated with adverse cardiorespiratory changes. In passive smokers, COHb level increased (0.8% ± 0.25% vs 1.2% ± 0.8%, respectively, P = .003) as did respiratory rate.

Conclusions:  One session of active indoor group WPS resulted in significant increases in COHb and serum nicotine levels (eightfold and 18-fold, respectively) and was associated with adverse cardiorespiratory health effects. The minor effects found in passive smokers suggest that they too may be affected adversely by exposure to WPS. The results call for action to limit the continuing global spread of WPS in coffee shops.

Trial registry:  ClinicalTrials.gov; No.: NCT1237548; URL: www.clinicaltrials.gov


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