Carboxyhemoglobin Levels in Primary and Secondary Cigar and Pipe Smokers*

doi:10.1378/chest.72.1.33

Chest

Volume 72, Issue 1, July 1977, Pages 33-35

https://doi.org/10.1378/chest.72.1.33 Get rights and content

This study of 130 subjects was performed to obtain more data about the smoking habits and levels of carboxyhemoglobin in various types of pipe and cigar smokers. These smokers may be divided by history into primary or secondary smokers and also into current inhalers and noninhalers. Prior studies of carboxyhemoglobin levels have yielded conflicting results, presumably due to differences in current habits of inhalation, which were often not taken into account. Cigarette, primary pipe, and secondary pipe inhalers had similar carboxyhemoglobin levels that were significantly higher than nonsmokers (5.6, 5.0, 5.4, and 1.0 percent, respectively). Cigar inhalers had markedly elevated concentrations of carboxyhemoglobin (13.8 and 11.8 percent in primary and secondary inhalers, respectively). Most secondary cigar and pipe smokers inhaled, whereas most primary smokers did not Intentional inhalation, rather than past smoking history, is the most important factor in determining the carboxyhemoglobin level for each type of smoker.

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Materials and Methods

A total of 130 subjects were studied and grouped by smoking habits, as determined by a questionnaire administered by pulmonary technicians. All subjects were studied in the Tampa (Fla) Veterans Administration Hospital's Pulmonary Function Laboratory.

Subjects had been referred for an analysis of arterial blood gas levels, which was performed on a blood gas analyzer (Radiometer PHM-72). Arterial oxygen saturation (SaO₂) was calculated from the arterial oxygen pressure (PaO₂) and pH. A portion of

Results

Table 1 gives the mean carboxyhemoglobin level and mean measured SaO₂ of the groups studied. There was no apparent difference in the amount of tobacco smoked, the frequency of smoking, or the time since last exposure in the different groups of particular types of smokers. From Table 1, it can be seen that noninhaling (whether primary or secondary) cigar or pipe smokers had similar carboxyhemoglobin levels that were only slightly higher than nonsmokers. The mean values for SaO₂ in the

Discussion

The present study has examined different categories of cigar and pipe smokers in regard to their past and present smoking habits and present carboxyhemoglobin levels. Previous studies have yielded conflicting results on carboxyhemoglobin levels in cigar and pipe smokers, probably due to differences in the groups under study, as well as insufficient data on past smoking history and inhalation.

Goldsmith and Landaw⁴ in 1968 reported that pipe and cigar smokers had estimated carboxyhemoglobin

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Pipe and cigar smokers traditionally have been subdivided into primary (never regular cigarette) and secondary (ex-cigarette) smokers. This distinction is considered important because it is believed that former cigarette smokers who switch to pipes or cigars inhale their pipe or cigar smoke, whereas primary pipe and cigar smokers do not. In this study, it was found that self-reported inhalation more accurately predicted expired-air carbon monoxide levels than cigarette smoking history and, combined with self-reported per day consumption, could account for most instances of carbon monoxide levels above the nonsmoker cut-off level of 8 parts per million. Thus, it is concluded that a primary/secondary distinction is less useful than a noninhaling/inhaling distinction in attempting to assess health risks associated with pipe and cigar smoking, and health-care providers and researchers should focus their attention on the more direct questions of inhalation and daily intake.
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Read in part at the annual meeting of the American Thoracic Society, New Orleans, May 17, 1976.

Manuscript received August 30; revision accepted October 12.

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