The acute effects of waterpipe smoking on lung function and exercise capacity in a pilot study of healthy participants.

CONTEXT: Waterpipe tobacco smoking (WTS) has gained popularity, but its physiologic effects have not been extensively studied: rather, studies have focused on WTS's chronic effects or have evaluated limited respiratory/cardiac parameters. OBJECTIVE: We sought to characterize in a more detailed manner the acute effects of WTS on lung function and exercise capacity. METHOD: We recruited 24 healthy WTS males. We used a pilot single-group pre-test (abstained from WTS for ≥48 h) post-test (within 0.5 h of a 45-min WTS session) design. We performed spirometry, diffusing lung capacity and time-limited CPE testing (CPET; cycloergometer; 2-min 20-Watt warm-up and 25-Watt increase every 2-min for 10 min). RESULTS: Mean age was 20.4 years; Post-WTS, the following significant changes were observed: CO level increased from 3.7 ppm to 24.4; oxygen consumption decreased (from 1.86 L/min to 1.7); baseline respiratory rate increased (from 17.7 breath/min to 19.7); forced expiratory flow over the middle half of the forced vital capacity decreased (from 5.51 L to 5.29); and perceived exertion (measured by Borg scale) at mid and peak exercise increased. Baseline resting systolic blood pressure, pulse pressure, and pulse pressure product increased post-WTS (from 118.9 mmHg to 129.2; from 45.3 mmHg to 55.6; and from 9.9 mmHg/min to 11.1 post-WTS, respectively). During exercise, a decrease in oxygen pulse was observed post-WTS (from 10.89 ml/beat to 9.97), while the heart rate-oxygen consumption relationship increased post-WTS (from 3.52 beats/ml/kg to 3.91). CONCLUSION: Acute WTS appears to induce impairment in lung function and exercise capacity. Larger studies are warranted to further characterize the nature and extent of such impairment.

Smoking cessation treatment and outcomes in medium to heavy cigarette smokers being treated for cancer in Jordan.

BACKGROUND: Studies evaluating smoking cessation treatment outcomes in cancer patients are scarce, despite smoking cessation importance in cancer care. We sought to add to the literature by evaluating smoking cessation in a challenging group of cancer patients (medium-to-heavy smokers) visiting an out-patient smoking cessation clinic (SCC) in a cancer center in Amman, Jordan. MATERIALS AND METHODS: Patients smoking >9 cigarettes per day (CPD) and referred to the SCC between June 2009 and May 2012 were studied. Clinic records were reviewed to measure demographic and baseline clinical characteristics, and longitudinal (3-, 6- and 12- month) follow- up by phone/clinic visit was conducted. At each follow-up, patients were asked if they experienced medication side-effects, if they had returned to smoking, and reasons for failing to abstain. Descriptive and multivariable logistic regression analyses were performed. RESULTS: A total of 201 smokers were included in the analysis. The 3-month abstinence was 23.4% and significantly associated with older age, being married, and presenting with lower (≤ 10 ppm) baseline carbon monoxide (CO) levels. On a multivariable level, lower CO levels, a higher income (relative to the lowest income group), being older, and reporting severe dependence (relative to dependence reported as 'somewhat' or 'not') were significant predictors of higher odds of abstinence at three months. Reasons for failing to quit included not being able to handle withdrawal and seeing no value in quitting. Long- term ARs did not reach 7%. CONCLUSIONS: In a sample of Jordanian smokers (>9CPD) with cancer and receiving smoking cessation treatment, ARs were low and further declined with time. Results underscore the need for more aggressive patient management and rigorous follow-up during and after smoking cessation treatment, particularly when this takes place in challenging settings. Observed reasons for failure to abstain should be used to tailor counseling practices.

Smoking abstinence rates and reasons for failure to quit smoking in cancer patients in Jordan.

BACKGROUND: Failure to quit smoking in cancer patients is associated with the development of a second primary tumor and a suboptimal response to chemotherapy. However, data characterizing cancer patients' ability to quit is scarce, particularly in developing countries. Such information is valuable in highlighting the potential of cessation interventions in countries where smoking rates are high and antismoking policies are not yet fully implemented. OBJECTIVES: To measure the abstinence rates and identify reasons for the failure to quit smoking in patients visiting a smoking cessation clinic in a comprehensive cancer center in Jordan. METHODS: Through retrospective medical chart review and prospective follow-up by phone, we studied long-term abstinence rates and reasons for the failure to quit smoking in 156 cancer patients referred to the smoking cessation clinic to receive counseling and pharmacological treatment. Patient demographics, clinical and smoking characteristics and long-term abstinence at 12 months were recorded, as were reasons for the failure to quit smoking. RESULTS: The 12-month abstinence rate was 21.2%. The main reasons for failing to quit smoking included personal or professional stressful situations, not being able to handle withdrawal and the belief that quitting had no value. CONCLUSION: Abstinence rates in Jordanian cancer patients fall at the lower end of the range that has been reported in the literature for cancer patients. Efforts to improve these rates should focus on assisting patients in handling stress, and in adjusting medications to improve withdrawal symptoms.