Abstract
Introduction: Waterpipe smoking gained popularity during recent years. Although waterpipe smoking exposes people to the same noxious substances found in cigarettes, popular belief considers it harmless. Our objective was to evaluate the association between waterpipe smoking and dependence, and COPD. Methods: We conducted a case-control study in two tertiary care hospitals. Cases were included if diagnosed as COPD by a pulmonologist and confirmed by post-bronchodilator FEV1/FVC<0.7; controls were included if free of any respiratory disease or symptom. After oral consent, a standardized questionnaire was administered and spirometry results were collected. Results: 211 COPD cases and 527 controls were studied. In previous smokers, any smoking type was associated with COPD. The ORs were 29.0[14.3-58.8] (p<0.001) for previous cigarette smoking, 11.7[4.4-31.2] (p<0.001) for previous waterpipe smoking, and 44.1[16.3-4.4] (p<0.001) for previous mixed smoking. In current smokers, the ORs were 20.5[10.2-41.2] (p<0.001) for cigarette smoking, 1.8[0.5-5.9] (p=0.299) for waterpipe smoking, and 9.4[3.81-23.0] (p<0.001) for mixed smoking. Nevertheless, we found in waterpipe current smokers, an OR=8.9[3.9-20.7] (p<0.001) for the association between dependence evaluated by LWDS-11 scale, and COPD. These results were confirmed by stratified and multivariate analysis, after adjustment for cigarette smoking and confounding variables. A cumulative smoking of one waterpipe per week for 20years (or its equivalent) was predictive of higher risk of COPD. Discussion: Whereas evidence showing harmful effects of waterpipe smoking is sparse, this study showed a high OR between the risk of developing COPD and being an ex-smoker of waterpipe, or a current waterpipe dependent individual. Additional studies are necessary to confirm our results.
Highlights
Waterpipe smoking gained popularity during recent years
211 patients (38.4%) fulfilled the definition of chronic obstructive pulmonary disease (COPD), while the rest, i.e. 338 (61.6%) persons with respiratory symptoms, did not fulfill this definition, and could not be classified; they were subsequently removed from the analysis
There was a significant positive and strong association between current waterpipe dependence and COPD (ORa=5.88[1.1131.05];p=0.037). This is the first study that thoroughly looks at the relationship between waterpipe smoking and COPD
Summary
Waterpipe smoking gained popularity during recent years. waterpipe smoking exposes people to the same noxious substances found in cigarettes, popular belief considers it harmless. WP smokers are potentially exposed to the cigarettes substances that are harmful, and studies concerning WP smoking effects are not extensive, they suggest that it leads to cancer, genetic damage, lung diseases and other conditions in active and passive smokers [7,8,9,10,11,12] It is considered a global public health threat by the World Health Organization [3], and given the large number of WP smokers, it is essential to study the health effects of waterpipe smoking with renewed emphasis [13]. We had found prevalence ratios of 2.5 for
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