Annals of Thoracic Medicine Official publication of the Saudi Thoracic Society, affiliated to King Saud University
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Year : 2023  |  Volume : 18  |  Issue : 1  |  Page : 23-30

Increased airway resistance among exclusive waterpipe smokers detected using impulse oscillometry

1 School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America; Department of Medicine and Clinical Research Institute, American University of Beirut, Beirut, Lebanon
2 Department of Nephrology, Saint Louis University, St Louis, Missouri, United States of America
3 Department of Medicine and Clinical Research Institute, American University of Beirut, Beirut, Lebanon
4 Department of Medicine and Clinical Research Institute, American University of Beirut, Beirut, Lebanon; 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

Correspondence Address:
Dr. Salah Zeineldine
Department of Internal Medicine, American University of Beirut, Riad El Solh 11-0236, Beirut
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/atm.atm_165_22

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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.

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