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Effects Of Waterpipe Smoking On The Human Lung

Abstract : Waterpipe, an instrument for smoking fruit-flavored tobacco, is used by millions of people worldwide. There is limited data on the health effects of waterpipe smoking, and no regulations to its use. We hypothesized that even young, light-use waterpipe smokers have abnormalities relevant to lung health. Based on the knowledge that the first abnormalities associated with cigarette smoking are in lung cells long before there are clinical abnormalities, we compared young, light-use waterpipe smokers to nonsmokers, using a variety of lung-related parameters, including: blood carboxyhemoglobin (CO) levels; cough and sputum scores; lung function; metabolites present in lower respiratory tract epithelial lining fluid (ELF); cell differentials and transcriptome of small airway epithelium (SAE); cellular composition of ELF; transcriptome of alveolar macrophages (AM); and levels of total and apoptotic endothelial microparticles (EMPs). Light-use waterpipe smokers displayed abnormalities in all parameters assessed. Compared to nonsmokers, waterpipe smokers had more cough and sputum, higher CO levels, reduced diffusing capacity for carbon monoxide (DLCO), abnormal ELF metabolome profile, increased proportions of SAE secretory and intermediate cells, reduced proportions of SAE ciliated and basal cells, markedly abnormal SAE and AM transcriptomes, and elevated levels of total and apoptotic EMPs.DLCO, a lung function parameter linked to emphysema and small airway disease, was affected by light-use waterpipe smoking. The relevance of this comes from our studies that demonstrated, in a separate cohort of cigarette smokers with normal spirometry, that reduced DLCO predicted a high risk for developing chronic obstructive pulmonary disease (COPD), a leading cause of death worldwide. We assessed the risk for developing COPD, a clinical disorder characterized by a mixture of small airway disease and parenchymal destruction (emphysema), with a serial lung function in cigarette smokers with normal spirometry and no emphysema as assessed by HRCT, by comparing smokers with reduced DLCO vs normal DLCO. Despite having normal spirometry, cigarette smokers with reduced DLCO were at significantly higher risk for developing COPD within <4 years compared to those with normal DLCO i.e., the DLCO can be used to identify smokers at high risk for developing COPD, and could be a unique parameter in future studies to assess waterpipe smokers over time.Plasma levels of total and apoptotic EMPs, indicative of pulmonary capillary endothelial apoptosis, were elevated in light-use waterpipe smokers. The possible importance of this observation was highlighted by a parallel study, where we assessed the stability and reversibility of EMP levels in nonsmokers, healthy cigarette smokers and COPD cigarette smokers at 4 time points over a period of 1 year. The levels of total and apoptotic EMPs remained high with continuous smoking in healthy and COPD cigarette smokers. A subset of the healthy cigarette smokers and COPD cigarette smokers agreed to quit smoking. Following smoking cessation for 1 year, total and apoptotic EMP levels returned to normal nonsmoker levels in healthy cigarette smokers but remained abnormally high in COPD cigarette smokers. High levels of circulating and apoptotic EMPs are indicative of persistent and irreversible destruction of pulmonary capillaries and may be another unique parameter to assess waterpipe smokers over time.In summary, young, light-use waterpipe smokers have a number of lung clinical and biologic abnormalities compared to nonsmokers, including reduced DLCO, found to predict high risk for developing COPD in cigarette smokers, and elevated plasma levels of total and apoptotic EMPs, a marker of alveolar destruction, shown to be persistent and irreversible in COPD cigarette smokers despite smoking cessation. Together, these studies suggest that even light-use waterpipe smokers may be at risk for developing lung disease.
Keywords : Waterpipe Smoking Lung
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Submitted on : Tuesday, January 2, 2018 - 2:02:25 AM
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Yael Strulovici Barel. Effects Of Waterpipe Smoking On The Human Lung. Pulmonology and respiratory tract. Université Paris-Saclay, 2016. English. ⟨NNT : 2016SACLS160⟩. ⟨tel-01674194v2⟩

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