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Original Research: COPD |

Chinese Water-Pipe Smoking and the Risk of COPDNew Risk of COPD

Jun She, MD, PhD; Ping Yang, MD, PhD; Yuqi Wang, MD, PhD; Xinyu Qin, MD, PhD; Jia Fan, MD, PhD; Yi Wang, PhD; Guangsuo Gao, MD; Guangxiong Luo, MD; Kaixiang Ma, MD; Baoyan Li, MD; Caihua Li, MD; Xiangdong Wang, MD, PhD; Yuanlin Song, MD; Chunxue Bai, MD, PhD, FCCP
Author and Funding Information

From the Department of Pulmonary Medicine (Drs She, Yuqi Wang, Qin, Fan, X. Wang, Song, and Bai), Zhongshan Hospital, Fudan University, Shanghai, China; the Department of Health Sciences Research (Drs Yang and Yi Wang), Mayo Clinic, Rochester, MN; Fuyuan County Hospital (Drs Gao, Luo, Ma, B. Li, and C. Li), Yunnan, China; And the Division of Preventive Medicine (Dr Yi Wang), Wenzhou Medical University, Zhejiang, China.

CORRESPONDENCE TO: Chunxue Bai, MD, PhD, FCCP, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, China, 200032; e-mail: bai.chunxue@zs-hospital.sh.cn


FOR EDITORIAL COMMENT SEE PAGE 875

This study was presented as an oral presentation at CHEST 2012, October 20-25, 2012, Atlanta, GA.

FUNDING/SUPPORT: This work was supported primarily by the National Key Scientific and Technology Support Program: Collaborative Innovation of Clinical Research for Chronic Obstructive Pulmonary Disease and Lung Cancer [2013BAI09B09]. Dr She was supported by the National Natural Science Foundation for Young Scholars of China [ 81200051]; the Research Fund for the Doctoral Program of Higher Education of China [20110071120060]; the Science Foundation for Young Scholars in Zhongshan Hospital [2012ZSQN04]; and the Scientific Project for Fudan University [20520133474].

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


Chest. 2014;146(4):924-931. doi:10.1378/chest.13-1499
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BACKGROUND:  Studies show that the incidence of COPD has remained high in southwest China despite the 1976 National Stove Improvement Program for indoor air quality. Chinese water-pipe tobacco smoking (commonly referred to as water-pipe smoking), which is thought to be less harmful under the assumption that no charcoal is used and water filters tobacco smoke, is popular in China. We investigated whether Chinese water-pipe use and exposure are associated with the risk of COPD.

METHODS:  This multicenter, cross-sectional study enrolled 1,238 individuals from 10 towns in the Fuyuan area, Yunnan Province, China. A matched design was used to estimate the impact of active and passive exposure to Chinese water-pipe smoking on COPD risk; multivariate analyses adjusted for other risk factors. We also collected the water from Chinese water pipes to assess the mutagenicity of its major components and simulated Chinese water-pipe smoke exposure fine particulate 2.5 (PM2.5) by using the High Volume Air Sampler and individuals’ sera to search for the potential protein biomarkers of COPD.

RESULTS:  The increased risk of COPD was profound for Chinese water-pipe smokers (adjusted OR, 10.61; 95% CI, 6.89-16.34), Chinese water-pipe passive smokers (adjusted OR, 5.50; 95% CI, 3.61-8.38), cigarette smokers (adjusted OR, 3.18; 95% CI, 2.06-4.91), and cigarette passive smokers (adjusted OR, 2.52; 95% CI, 1.62-3.91) compared with never-smoking control subjects. Chinese water-pipe use aggravates lungs with more PM2.5 compared with cigarettes. ChemR23 and tissue inhibitor of metalloproteinase-1 may be potential protein biomarkers of COPD.

CONCLUSIONS:  Chinese water-pipe smoking significantly increases the risk of COPD, including the risk to women who are exposed to the water-pipe smoke.

TRIAL REGISTRY:  Chinese Clinical Trial Registry; No.: ChiCTR-CCH-12002235; URL: www.chictr.org/cn/

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