Cigarette Use, Whether Alone or With Cigars, Associated With Increased COPD Risk

Exclusive cigarette use and dual cigar/cigarette use were associated with increased chronic obstructive pulmonary disease (COPD) risk, while exclusive cigar use was not, according to a study published in Respiratory Research.

The researchers explained that cigar use has remained relatively stable among US adults despite cigarette use steadily declining. They noted that cigar sales increased between 2009 and 2020, showing that cigars are a key public health concern. Although cigar smoking is believed to have similar health risks to cigarette smoking, the respiratory impact of cigar use is not well characterized; many studies overlook cigar use since most adults who use cigars also use cigarettes. Consequently, there is a lack of research on the association between cigar use and COPD. Because of this, the researchers examined the prospective association between exclusive cigarette or cigar use, along with dual cigar and cigarette use, and incident self-reported COPD among US adults.

The researchers used data from Waves 1 through 5 (2013-2019) of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative survey of US adults, to create their study population. They included adult respondents aged 40 to 59 years at Wave 1 (baseline) without a pre-existing COPD diagnosis who participated in at least 1 follow-up interview. The researchers noted that those who self-reported being diagnosed with COPD, chronic bronchitis, or emphysema during any follow-up interview were considered to have COPD at follow-up.

To conduct the study, they examined the participants’ prospective COPD risk and developed a 1-wave lagged exposure variable combining current cigar and cigarette use to examine the relative contribution of exclusive cigar, exclusive cigarette, or dual cigar/cigarette use to COPD risk in comparison to nonuse. To determine more accurate results, the researchers adjusted for participants' cigarette smoking histories.

Current cigar use was defined as established everyday or some-days use of traditional cigars, cigarillos, or filtered cigars in the past 30 days. Similarly, current cigarette use was defined as everyday or some-days use in the past 30 days. Using these criteria, the researchers placed participants into 1 of 4 categories: noncurrent use of either product, exclusive cigar use, exclusive cigarette use, or dual use of cigars and cigarettes.

Man smoking a cigar | Image Credit: LIGHTFIELD STUDIOS - stock.adobe.com

The study population consisted of 9559 respondents who had a mean (SD) age of 56 (10.4) years; the respondents were predominately female (52.8%) and non-Hispanic White (70.8%). The researchers explained that, at baseline, most respondents did not currently use cigars or cigarettes (85%), while 13.6% (n = 3173) reported exclusive cigarette use, 0.8% (n = 184) reported dual cigar/cigarette use, and 0.6% (n = 134) reported exclusive cigar use.

Also, of the study population, 906 reported a COPD diagnosis at follow-up. The researchers explained that the weighted conditional COPD diagnosis probability ranged between 1.4% and 2.4%, with an average incidence of 2% during the 5 years of follow-up. In the fully adjusted model, the researchers determined that exclusive cigarette use (adjusted HR [aHR], 1.48; 95% CI, 1.13-1.93) and dual cigar/cigarette use (aHR, 1.88; 95% CI, 1.24-2.85) were associated with increased COPD risk while exclusive cigar use (aHR, 1.57; 95% CI, 0.77-3.21) was not.

The researchers acknowledged their study’s limitations, one being that the results relied on self-reported newly diagnosed COPD rather than spirometry test results; this is a limitation of the PATH data. Additionally, the study population included a small number of participants who use cigars, making it harder to determine an association between exclusive cigar use and COPD. The small number of cigar users in the population also meant that it was not possible to differentiate the use of traditional cigars from cigarillos and filtered cigars.

“Given the important differences across cigar types, future research would benefit from looking at the respiratory health effects of filtered cigar use separately from cigarillos and traditional cigars,” the authors wrote. “Larger, more diverse cohorts that oversample adults who use cigars may be able to build on our analyses and further examine the complexities of cigar use behavior.”

Reference

Cook S, Buskiewicz J, Levy DT, Meza R, Fleischer NL. Association between cigar use, with and without cigarettes, and incident diagnosed COPD: a longitudinal cohort study. Respir Res. 2024;25(1):13. doi:10.1186/s12931-023-02649-2