Increased airway resistance among exclusive waterpipe smokers detected using impulse oscillometry

Hassan A Chami; Nourhan Houjeij; Maha Makki; Lina Itani; Hani Tamim; Ahmad Al Mulla; Bartolome Celli; Salah Zeineldine

doi:10.4103/atm.atm_165_22

Increased airway resistance among exclusive waterpipe smokers detected using impulse oscillometry

Ann Thorac Med. 2023 Jan-Mar;18(1):23-30. doi: 10.4103/atm.atm_165_22. Epub 2023 Jan 25.

Authors

Hassan A Chami^{1

2}, Nourhan Houjeij³, Maha Makki², Lina Itani², Hani Tamim^{2

4}, Ahmad Al Mulla⁵, Bartolome Celli⁶, Salah Zeineldine²

Affiliations

¹ School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America, Beirut, Lebanon.
² Department of Medicine and Clinical Research Institute, American University of Beirut, Beirut, Lebanon.
³ Department of Nephrology, Saint Louis University, St Louis, Missouri, United States of America.
⁴ College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia.
⁵ Tobacco Control Center, WHO Collaborative Center, Department of Medicine, Hamad Medical Corporation, Doha, Qatar.
⁶ Harvard Medical School, Boston, Massachusetts, United States of America.

Abstract

Introduction: Waterpipe smoking is increasing in popularity, yet the evidence implicating waterpipe smoking in lung disease is limited. We hypothesized that impulse oscillometry (IOS) would detect airway abnormalities in waterpipe smokers (WPS).

Methods: We studied 210 participants, 40 years or older, from the community, of whom 92 were exclusive WPS and 118 were never-smokers. Waterpipe smoking history was assessed using a validated questionnaire. All participants underwent spirometry, and IOS and absolute and percentage predicted results (for age, sex, height, and weight) were compared between WPS and nonsmokers. The association of IOS parameters with waterpipe smoking duration and extent (waterpipe smoked/day * smoking duration) was evaluated using linear regression.

Results: WPS smoked on average 1.8 ± 1.2 waterpipes/day, over an average duration of 23.3 ± 39.8 years. WPS and nonsmokers were largely asymptomatic and had similar age, body mass index, sex distribution, and spirometric values. Nevertheless, WPS had higher IOS measured resistance at 5Hz compared to nonsmokers, (0.53 ± 0.2 vs. 0.48 ± 0.2 kPa/L/s, P = 0.03) and higher percentage-predicted resistance (124.5 ± 36.3 vs. 115.7% ± 35.6%, P = 0.04). Waterpipe smoking duration was also associated with resistance (β = 0.04 kPa/L/s/year, P = 0.01) and with percentage-predicted resistance (β = 0.05/year, P = 0.02). Waterpipe smoking extent was associated with resistance (β = 0.009 kPa/L/s/waterpipe-year, P = 0.04), while the association with percentage-predicted resistance was near significance (β = 0.009/waterpipe-year, P = 0.07).

Conclusions: Waterpipe smoking is associated with increased airway resistance assessed by IOS but not by spirometry in largely asymptomatic individuals from the community.

Keywords: Lung disease; nicotine; noncigarette tobacco product; smoking caused disease; waterpipe.