By Denise Mann
MONDAY, Feb. 15, 2010 (Health.com) — Cigar aficionados and pipe smokers often claim that their habit is safer than cigarette smoking because they don't inhale. Even if they think they're just harmlessly puffing away, they're still damaging their lungs, a new study shows.
People who smoke cigars and pipes, but have never smoked cigarettes, are more than twice as likely as people who never smoked to have decreased lung function, according to the study. Cigar and pipe smokers who smoke cigarettes (or used to) are at even greater risk; those smokers were nearly 3.5 times more likely than nonsmokers to have decreased lung function.
The cigar and pipe smokers also had elevated levels of a nicotine by-product called cotinine in their urine, the researchers found.
"Some pipe and cigar smokers say they do not inhale, or inhale less, than cigarette smokers," says the lead author of the study, Josanna Rodriguez, MD, a fellow in pulmonary medicine at Columbia University Medical Center, in New York City. "The elevated cotinine levels found in this study, however, prove that nicotine is being absorbed when you smoke pipes or cigars."
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Thanks to public-health campaigns, cigarette smoking has been on the decline, but as the study points out, pipe and cigar smoking has increased in recent years. Studies have shown that many cigarette smokers turn to pipes and cigars in the mistaken belief that they are safer than cigarettes. (Ex-cigarette smokers also cite cost as a factor in making the switch.)
Although cigar and pipe tobacco don't contain many of the harmful, cancer-causing additives found in cigarettes, the study's findings show that they still increase the risk of developing chronic obstructive pulmonary disease (COPD), a diagnosis that includes both emphysema and chronic bronchitis.
About 12 million people in the U.S. have been diagnosed with COPD and another 12 million have the disease without knowing it; COPD is the country's fourth leading cause of death. People with COPD have an irreversible decline in lung function to the point that they may need oxygen just to perform daily activities.
Pipes and cigars also put smokers at increased risk for oral cancers, such as lip and mouth cancer.
Next page: No such thing as a safe tobacco product
“Tobacco people have let the rumor fly that cigars and pipes are somehow safer than cigarettes,” says Neil Schachter, MD, the director of the COPD program at Mount Sinai Medical Center, in New York City. “There is no safe cigarette or tobacco product. They all have complications associated with them, and you are not finding a safe harbor if you switch from cigarettes to cigars and pipes."
In the study, published this week in the Annals of Internal Medicine and funded by the National Heart, Lung, and Blood Institute, some 3,500 people ages 48 to 90 answered questionnaires about their current and past smoking habits. Of the participants, 11% reported smoking cigars, 9% reported smoking a pipe, and 52% said they smoked cigarettes now or in the past. The vast majority of pipe and cigar smokers—nearly 9 out of 10—also smoked cigarettes currently or formerly.
The researchers tested the participants' breathing function and measured the amount of cotinine in their urine. The people who smoked cigarettes had lower lung function than the people who smoked cigars or pipes alone, according to the study. Cotinine levels were also lower among cigar and pipe smokers than among cigarette smokers.
A number of studies have explored the link between cigarette smoking and COPD, says Dr. Rodriguez. This study is one of the few to look at the lung damage caused by pipes and cigars, and the first to do so in the United States.
The study does have some limitations. Although it included more than 3,500 people overall, just 56 of the participants smoked cigars or pipes but had never smoked cigarettes.
And as Dr. Schachter points out, because most people don't smoke 20 cigars or pipes a day (the way a pack-a-day smoker does with cigarettes), the time elapsed between the study participants' urine test and their last cigarette, cigar, or pipe is likely to vary considerably.
Still, the findings underscore that smoking in any form is bad for your lungs. "I would counsel someone who smokes a pipe or cigars to stop smoking," says Dr. Rodriguez.