Two studies published in the April issue of Chest journal report serious health effects including reduced lung function and cardiorespiratory conditions due to water pipe smoking (WPS). Hookah or WPS, is a form of tobacco use that has been practiced for hundreds of years but has recently seen a dramatic increase in popularity, leading to its description as "an emerging deadly trend." WPS was common mainly in the Middle East, Turkey , India , and Pakistan but with globalization and immigration from these countries, it has spread to Western countries, notably among youth. According to reports more than 100 million people worldwide smoke WPS daily. "Many adolescents and adults believe that hookah use is less dangerous than cigarette smoking," says Bengt Arnetz, Professor of Social Medicine at Uppsala University and Professor of Occupational and Environmental Medicine at the Wayne State University School of Medicine. "Some fail to understand that hookah use involves tobacco. In fact, smoking a hookah entails much greater exposure to carbon monoxide and other dangerous and carcinogenic substances in tobacco smoke than does smoking cigarettes." Raad et al from the State University of New York at Buffalo conducted two separate meta-analyses on six eligible cross-sectional studies comparing lung function between water-pipe smokers and non-smokers and water-pipe smokers and cigarette smokers, respectively. Three spirometric measurements (FEV 1 , FVC, and FEV 1 /FVC) were examined, and the standardized mean difference was used to pool results. A significant decrease in the FEV 1 , equivalent to a 4.04% lower FEV 1 % was found in the WPS group compared with the nonsmokers, as was a trend (nonsignificant) toward a lower FVC and FEV 1 /FVC. No difference was found in FEV 1 , FVC, or FEV 1 /FVC between the WPS and cigarette smoking groups. The significant decrease in FEV 11 among WPS showed clinical relevance. According to the authors, the results of this study along with reports of elevated levels of parameters for oxidant injury and decreased total antioxidant activity associated with WPS, suggest that it may play a possible role in development of COPD. They also recommend that further prospective studies should be conducted to establish the causal relationship between WPS and clinical outcomes. In another study, Hakim et al from Israel evaluated the acute effects of WPS on cardiorespiratory system. They analysed 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. Forty-five volunteers (30 men and 15 women) smoked 10 g of double apple flavored "moasel" (hookah tobacco) of the same brand at their own pace and pattern using a standard charcoal disk for ignition. Carboxyhemoglobin levels were significantly raised post-WPS, especially in women (P <0 .001). Three of 45 subjects demonstrated carboxyhemoglobin concentrations varying between 20% and 26%, high enough levels for consideration of inpatient treatment, oxygen therapy, and hyperbaric oxygen therapy , in susceptible individuals. The researchers suggest that the gender difference found in the results may be because of differences in alveolar ventilation and smoking patterns. Blood pressure, heart rate and respiratory rate were all significantly increased post-WPS with no sex differences apparent. Acute decreases in FEF 25%–75% levels and PEFRs were observed after 30 min of WPS. However, the marginal statistically significant changes in PEFRs, percentage of eosinophils, and levels of FEF 25%–75%, FENO, and 8-isoprostane became insignificant after applying Bonferroni correction. Thus the results obtained from both the studies conclude that WPS has important short and long-term adverse effects on health similar or possibly even more harmful than cigarette smoking. The researchers unanimously call for interventions to control the continuing global spread of WPS, especially among youth.
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