Re: Is inhaled cigar smoke as deadly as inhaled cigarette smoke?

In response:

The inhalation of cigar smoke is probably as "deadly" as cigarette smoke,
however, the "deadliness" probably relates to differences in inhalation 
techniques. A study in France between 1976 and 1980 demonstrated that 
the relative risk of lung cancer (compared to non-smokers) from smoking 
cigars was 5.6 compared with 13.3 for cigarette smokers (1). That is, cigar 
smokers are 5.6 times more likely to develop lung cancer, etc. However, 
when their inhalation techniques were compared, 29.8% of cigarette 
smokers never inhaled the smoke, compared with 89.5% of cigar smokers.

This was reflected in another study which attempted to measure smoke 
exposure in cigar and pipe smokers by measuring serum thiocyanate (2). 
For people who previously smoked cigarettes, and who now smoked 
cigars, serum thiocyanate levels were significantly higher than those who 
only ever have smoked cigars. Ex-cigarette smokers, are also 1.63 times 
more likely to have chronic cough and phlegm when smoking cigars than 
those who have only smoked cigars (4). This demonstrated that 
ex-cigarette smokers were more likely to inhale the smoke than those who 
have only smoked cigars.

In terms of morbidity (relating to disease) and mortality (loss of life), cigar 
smokers are less likely to have chronic obstructive airways disease (eg. 
emphysema) and lung cancer than cigarette smokers (6). However, after 
adjusting for inhalation habit, this difference was again markedly reduced. 
The prevalence of oral leukoplakia (a malignant lesion) in cigar smokers is 
less than cigarette and pipe smokers (3). The incidence of strokes is also 
higher for cigarette smokers with a relative risk of 4.1 compared with 2.2 for 
cigar and/or pipe smokers (7).

For smoke content, large cigars appear to have the lowest mean deliveries 
of smoke, tar, nicotine and carbon monoxide, followed by hand-rolled and 
manufactured cigarettes, and small cigars (5). Smoking four or more cigars 
per day, is equivalent to the smoke exposure of smoking ten cigarettes per 
day (2).

In conclusion, although it appears that cigar smokers have a lower 
incidence of morbidity and mortality when compared with cigarette 
smokers, this difference is likely to be related to inhalation habits and the 
amount to cigars/cigarettes smoked.

David Ng, BPharm MClinPharm
PhD Candidate
School of Pharmacy and Medical Sciences
University of South Australia
North Terrace
ADELAIDE SA 5000
Australia
http://www.merlin.net.au/~psycho (Last updated 30th March 1997)
e-mail: psycho@merlin.net.au

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RV, Gillum RF, Blackburn H. Smoke exposure in pipe and cigar smokers. 
Serum thiocyanate measures. JAMA 1985; 254(23): 3330-2.
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