Tobacco Smoke by Any Other Name Is Still as Deadly: Association of Pipe and Cigar Use With Cotinine Levels, Lung Function, and Airflow Obstruction

In a study of 3528 participants, 9% reported pipe smoking, 11% reported cigar smoking, and 52% reported cigarette smoking.

Self-reported current pipe and cigar smokers had elevated urine cotinine levels compared with never-smokers.

Participants who smoked pipes or cigars had increased odds of airflow obstruction.

Pipe and cigar smoking increased urine cotinine levels and was associated with decreased lung function and increased odds of airflow obstruction, even in participants who had never smoked cigarettes.

References:
http://www.annals.org/content/152/4/201.short
http://www.annals.org/content/152/4/259.short
Image source: Wikipedia, public domain.

Emphysema and Airflow Obstruction Associated with Impaired Left Ventricular Filling

Very severe chronic obstructive pulmonary disease (COPD) causes cor pulmonale - elevated pulmonary vascular resistance and secondary reductions in left ventricular filling, stroke volume, and cardiac output.

The authors of this NEJM study hypothesized that emphysema, as detected on computed tomography (CT), and airflow obstruction are inversely related to left ventricular end-diastolic volume, stroke volume, and cardiac output among persons without very severe lung disease.

Of the study participants, 13% were current smokers, 38% were former smokers, and 49% had never smoked.

A 10% increase in emphysema on CT was related to decrease in left ventricular end-diastolic volume, stroke volume, and cardiac output.

Percent emphysema and airflow obstruction were not associated with the left ventricular ejection fraction (LVEF).

Mind map of Chronic Obstructive Pulmonary Disease (COPD) (click to enlarge the image).

References:
Percent Emphysema, Airflow Obstruction, and Impaired Left Ventricular Filling. R. Graham Barr et al. NEJM Volume 362:217-227 January 21, 2010 Number 3.

Image source: Enlarged view of lung tissue showing the difference between healthy lung and COPD, Wikipedia, public domain.