Water-pipe Smoking among young healthy smokers: Immediate effects on breathing pattern, respiratory drive and mechanics of tidal breathing
More details
Hide details
George D. Behrakis RESEARCH LAB, Hellenic Cancer Society, Athens, Greece
Institute of Public Health- The American College of Greece, Athens, Greece
Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens
Biomedical Research Foundation, Academy of Athens, Athens, Greece
Anna S. Tzortzi   

Institute of Public Health - The American College of Greece, 17b Ipitou street, Plaka Athens, Greece
Pneumon 2018;31(3):151–158
The present study assessed the immediate respiratory effects of water-pipe smoking (WPS) specifically focusing on tidal breathing examining Impulse Oscillometry (IOS), Control of Breathing (CoB) and exhaled CO (eCO) among young healthy adults.

A cross-over study design with sample size of 50 young healthy smokers was used. All measurements were taken immediately pre and post a Control and Experimental session. Repeated analysis of variance (ANOVA) and log-transformations were used for comparisons between pre-post and sessions. Significance was set to p<0.05.

During the Experimental session, TI/TE, TI/Ttot (p<0.001), P0.1 (p=0.005) and P0.1/(VT/TI) (p=0.021) increased significantly while TE/Ttot decreased (p=0.003) post WPS. IOS parameters Ζ5, R5, R10, R20 and fdr all increased significantly immediately post WPS (p<0.001) as did eCO and COHb (p<0.001).

A 30-minute session of WPS altered respiratory mechanics expressed by the increased large and peripheral airways resistance, control of breathing expressed by increased P0.1 and modified the tidal breathing pattern.

CO: Carbon monoxide, COHb: Carboxyhaemoglobin, CoB: Control of Breathing, TI/Ttot:Duty cycle, eCO: Exhaled carbon monoxide, VT/TI: Mean inspiratory flow, ANOVA: Repeated measurements analysis of variance, f: Respiratory frequency, V·E: Minute Ventilation, WPS: Water-pipe smoking
Chaouachi K, Kamal. Hookah (Shisha, Narghile) Smoking and Environmental Tobacco Smoke (ETS). A Critical Review of the Relevant Literature and the Public Health Consequences. Int J Environ Res Public Health 2009;6:798-843. doi:10.3390/ ijerph6020798.
Haddad L, Kelly DL, Weglicki LS, Barnett TE, Ferrell AV, Ghadban R. A Systematic Review of Effects of Waterpipe Smoking on Cardiovascular and Respiratory Health Outcomes. Tob Use Insights 2016;9:TUI.S39873. doi:10.4137/TUI.S39873.
Juhasz A, Pap D, Barta I, Drozdovszky O, Egresi A, Antus B. Kinetics of Exhaled Carbon Monoxide following Water-pipe Smoking Indoors and Outdoors. Chest 2018;151:1051-7. doi:10.1016/j.chest.2017.02.006.
Bentur L, Hellou E, Goldbart A, et al. Laboratory and clinical acute effects of active and passive indoor group water-pipe (narghile) smoking. Chest 2014;145:803-9. doi:10.1378/chest.13-0960.
El-Zaatari ZM, Chami HA, Zaatari GS. Health effects associated with waterpipe smoking. Br Med J 2015;24:i31-i43. doi:10.1136/ tobaccocontrol-2014-051908.
Hawari FI, Obeidat N a, Ayub H, et al. The acute effects of waterpipe smoking on lung function and exercise capacity in a pilot study of healthy participants. Inhal Toxicol 2013;25:492-7. doi:10.3109/08958378.2013.806613.
Yalcin F, Er M, Hasanoglu HC, et al. Deteriorations of pulmonary function, elevated carbon monoxide levels and increased oxidative stress amongst water-pipe smokers. Int J Occup Med Environ Health 2017;30:731-42. doi:10.13075/ijomeh.1896.00912.
Hakim F, Hellou E, Goldbart A, Katz R, Bentur Y, Bentur L. The acute effects of water-pipe smoking on the cardiorespiratory system. Chest 2011;139:775-81. doi:10.1378/chest.10-1833.
Ben Saad H, Khemis M, Bougmiza I, et al. Spirometric profile of narghile smokers. Rev Mal Respir 2011;28:e39-e51. doi:10.1016/j. rmr.2008.10.001.
Ben Saad H, Babba M, Boukamcha R, et al. Investigation of exclusive narghile smokers: Deficiency and incapacity measured by spirometry and 6-minute walk test. Respir Care 2014;59:1696-709. doi:10.4187/respcare.03058.
Shaikh RB, Vijayaraghavan N, Sulaiman AS, Kazi S, Shafi MSM. The acute effects of waterpipe smoking on the cardiovascular and respiratory systems. J Prev Med Hyg 2008;49:101-7. http:// www.ncbi.nlm.nih.gov/pubmed/19.... Accessed January 12, 2018.
Milic-Emili J. Recent advances in clinical assessment of control of breathing. Lung 1982;160:1-17. doi:10.1007/BF02719267.
Anderson WJ, Lipworth BJ. Relationships between impulse oscillometry, spirometry and dyspnoea in COPD. J R Coll Physicians Edinb 2012;42:111-5. doi:10.4997/JRCPE.2012.204.
American Thoracic Society-European Respiratory Society. ATS/ ERS Recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005. Am J Respir Crit Care Med 2005;171:912-30. doi:10.1164/rccm.200406-710ST.
Lappas AS, Konstantinidi EM, Tzortzi AS, Tzavara CK, Behrakis PK. Immediate effects of cigar smoking on respiratory mechanics and exhaled biomarkers; differences between young smokers with mild asthma and otherwise healthy young smokers. Tob Induc Dis 2016;14:29. doi:10.1186/s12971-016-0095-6.
Lappas AS, Tzortzi AS, Konstantinidi EM, et al. Short-term respiratory effects of e-cigarettes in healthy individuals and smokers with asthma. Respirology 2018;23:291–7. doi:10.1111/ resp.13180.
Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J 2005;26:319-38. doi:10.1183/090319 36.05.00034805.
Oostveen E, MacLeod D, Lorino H, et al. The forced oscillation technique in clinical practice: methodology, recommendations and future developments. Eur Respir J 2003;22:1026-41. doi:1 0.1183/09031936.03.00089403.
Bickel S, Popler J, Lesnick B, Eid N. Impulse oscillometry: Interpretation and practical applications. Chest 2014;146:841-7. doi:10.1378/chest.13-1875.
Kera T, Rpt P, Aihara A, Rpt M, Inomata T. Reliability of Airway Occlusion Pressure as an Index of Respiratory Motor Output. Respir Care 2013;58:845-9. doi:10.4187/respcare.01717.
Andersson MF, Møller AM. Assessment of carbon monoxide values in smokers: A comparison of carbon monoxide in expired air and carboxyhaemoglobin in arterial blood. Eur J Anaesthesiol 2010;27:812-8. doi:10.1097/EJA.0b013e32833a55ea.
Deveci SE, Deveci F, Açik Y, Ozan AT. The measurement of exhaled carbon monoxide in healthy smokers and non-smokers. Respir Med 2004;98:551-6. doi:10.1016/j.rmed.2003.11.018.
Maziak W, Ward KD, Afifi Soweid RA, Eissenberg TE. Tobacco smoking using a waterpipe: A re-emerging strain in a global epidemic. Tob Control 2004;13:327-33. doi:10.1136/tc.2004.008169.
Kougias M, Vardavas CI, Anagnostopoulos N, et al. The acute effect of cigarette smoking on the respiratory function and FENO production among young smokers. Exp Lung Res 2013;39:359- 64. doi:10.3109/01902148.2013.830654.
Vardavas CI, Anagnostopoulos N, Kougias M, Evangelopoulou V, Connolly GN, Behrakis PK. Short-term pulmonary effects of using an electronic cigarette. Chest 2012;141:1400-6. doi:10.1378/ chest.11-2443.
Vardavas CI, Anagnostopoulos N, Kougias M, Evangelopoulou V, Connolly GN, Behrakis PK. Acute pulmonary effects of sidestream secondhand smoke at simulated car concentrations. Xenobiotica 2013;43:509-13. doi:10.3109/00498254.2012.74 1272.
Flouris AD, Chorti MS, Poulianiti KP, et al. Acute impact of active and passive electronic cigarette smoking on serum cotinine and lung function. Inhal Toxicol 2013;25:91-101. doi:10.3109 /08958378.2012.758197.
Desiraju K, Agrawal A. Impulse oscillometry: The state-ofart for lung function testing. Lung India 2016;33:410-6. doi:10.4103/0970-2113.184875.
Skloot G, Goldman M, Fischler D, et al. Respiratory Symptoms and Physiologic Assessment of Ironworkers at the World Trade Center Disaster Site*. Chest 2004;125:1248-55. http:// americansleepandbreathingacade... content/uploads/2015/08/IOS-WTC.pdf. Accessed March 14, 2017.
Lappas AS, Tzortzi AS, Behrakis PK. Forced Oscillations in Applied Respiratory Physiology: Clinical Applications. Clin Res Pulmonol 2014;2:1016.
Brashier B, Salvi S. Measuring lung function using sound waves: Role of the forced oscillation technique and impulse oscillometry system. Breathe 2015;11:57-65. doi:10.1183/20734735.20514.
Grassi V, Sorbini CA, Dottorini M, De Biase L, Todisco T. Control of Ventilation in Bronchial Asthma. Prog Respir Res 1980;14:20- 5. doi:10.1159/000390434.
Stuhmiller J, Stuhmiller L. A mathematical model of ventilation response to inhaled carbon monoxide. J Appl Physiol 2005;98:2033-44. doi:10.1152/japplphysiol.00034.2005.
Maziak W, Rastam S, Ibrahim I, Ward KD, Shihadeh A, Eissenberg T. CO exposure, puff topography, and subjective effects in waterpipe tobacco smokers. Nicotine Tob Re. 2009;11:806-11. doi:10.1093/ntr/ntp066.
von Rappard J, Schönenberger M, Bärlocher L. Carbon monoxide poisoning following use of a water pipe/hookah. Dtsch Arztebl Int 2014;111:674-9. doi:10.3238/arztebl.2014.0674.
Llano AL, Raffin TA. Management of Carbon Monoxide Poisoning. Chest 1990;97:165-9. doi:10.1378/chest.97.1.165.
Schulte JH. Effects of Mild Carbon Monoxide Intoxication. Arch Environ Heal An Int J 1963;7:524-30. doi:10.1080/00039896.1 963.10663580.