title: Laboratory and clinical acute effects of active and passive indoor group water-pipe (narghile) smoking.
abstract: 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.
  
  
  BACKGROUND
  ClinicalTrials.gov; No.: NCT1237548; URL: www.clinicaltrials.gov.
authors.affiliation: Pediatric Pulmonology Unit, Meyer Children's Hospital, Rambam Health Care Campus, Haifa; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa. Electronic address: l_bentur@rambam.health.gov.il.
authors.forename: Lea
authors.initials: L
authors.lastname: Bentur
authors.affiliation: Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa.
authors.forename: Elias
authors.initials: E
authors.lastname: Hellou
authors.affiliation: Department of Pediatrics, Faculty of Health Sciences, Ben Gurion University, Soroka University Medical Center, Beer-Sheva.
authors.forename: Aviv
authors.initials: A
authors.lastname: Goldbart
authors.affiliation: Department of Pediatrics, Carmel Medical Center, Haifa.
authors.forename: Giora
authors.initials: G
authors.lastname: Pillar
authors.affiliation: Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa.
authors.forename: Einat
authors.initials: E
authors.lastname: Monovich
authors.affiliation: Pediatric Pulmonology Unit, Meyer Children's Hospital, Rambam Health Care Campus, Haifa; School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem.
authors.forename: Maram
authors.initials: M
authors.lastname: Salameh
authors.affiliation: Clinical Toxicology and Pharmacology Laboratory and Israel Poison Information Center, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Inna
authors.initials: I
authors.lastname: Scherb
authors.affiliation: Pediatric Pulmonology Unit, Meyer Children's Hospital, Rambam Health Care Campus, Haifa; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa; Clinical Toxicology and Pharmacology Laboratory and Israel Poison Information Center, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Yedidia
authors.initials: Y
authors.lastname: Bentur
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D012907:Smoking / Q000009:adverse effects* / Q000097:blood / Q000652:urine; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D014028:Tobacco Smoke Pollution