The association of pipe and cigar use with cotinine levels, lung function, and airflow obstruction: a cross-sectional study.
BACKGROUND
Cigarette smoking is the major cause of chronic obstructive pulmonary disease, but studies on the contribution of other smoking techniques are sparse.


OBJECTIVE
To determine whether pipe and cigar smoking was associated with elevated cotinine levels, decrements in lung function, and increased odds of airflow obstruction.


METHODS
Cross-sectional study.


METHODS
Population-based sample from 6 U.S. communities.


METHODS
Men and women aged 48 to 90 years without clinical cardiovascular disease at enrollment who were part of MESA (Multi-Ethnic Study of Atherosclerosis).


METHODS
The MESA Lung Study measured spirometry according to American Thoracic Society guidelines and urine cotinine levels by immunoassay on a subsample of MESA. Pipe-years and cigar-years were calculated as years from self-reported age of starting to age of quitting (or to current age in current users) multiplied by pipe-bowls or cigars per day.


RESULTS
Of 3528 participants, 9% reported pipe smoking (median, 15 pipe-years), 11% reported cigar smoking (median, 6 cigar-years), and 52% reported cigarette smoking (median, 18 pack-years). Self-reported current pipe and cigar smokers had elevated urine cotinine levels compared with never-smokers. Pipe-years were associated with decrements in FEV(1), and cigar-years were associated with decrements in the FEV(1)-FVC ratio. Participants who smoked pipes or cigars had increased odds of airflow obstruction whether they had also smoked cigarettes (odds ratio, 3.43 [95% CI, 1.75 to 6.71]; P < 0.001) or not (odds ratio, 2.31 [CI, 1.04 to 5.11]; P = 0.039) compared with participants with no smoking history.


CONCLUSIONS
Cross-sectional design.


CONCLUSIONS
Pipe and cigar smoking increased urine cotinine levels and was associated with decreased lung function and increased odds of airflow obstruction, even in participants who had never smoked cigarettes.


BACKGROUND
National Heart, Lung, and Blood Institute, National Institutes of Health.
Columbia University Medical Center, PH 9 East, Room 105, 630 West 168th Street, New York, NY 10032, USA.
Josanna
J
Rodriguez
Rui
R
Jiang
W Craig
WC
Johnson
Barbara A
BA
MacKenzie
Lewis J
LJ
Smith
R Graham
RG
Barr
D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000209:etiology*; D015986:Confounding Factors, Epidemiologic; D003367:Cotinine / Q000652:urine*; D003430:Cross-Sectional Studies; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000209:etiology*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000503:physiopathology* / Q000652:urine*; D013147:Spirometry; D014797:Vital Capacity
D003367:Cotinine