July 11, 2022 – Smoking traditional or non-combustible cigarettes while wearing a surgical mask results in a two-fold increase in exhaled carbon monoxide and impaired blood vessel function compared to mask-free periods. This is the result of research published in the European Journal of Preventive Cardiology, a journal of the ESC.1
“The study suggests that smoking any tobacco product has become even more dangerous during the COVID-19 pandemic due to the need to wear a mask for long hours,” the study author said. , Professor Ignatios Ikonomidis of the National and Kapodistrian University of Athens, Greece. “Previous research has shown that impaired vascular function is linked to heart problems and premature death.”
The study focused on traditional (fuel) cigarettes and non-combustible cigarettes, also known as “heat not burn” or “heated” tobacco products. Non-combustible cigarettes contain tobacco that is electronically heated to a lower temperature than a burnt cigarette, delivering an inhalable aerosol containing nicotine. The study did not include e-cigarettes (also called vaping) which electronically heat a nicotine-containing liquid to create an aerosol that is inhaled.
Researchers studied exhaled carbon monoxide levels in smokers wearing a mask during work hours and compared them to carbon monoxide levels on days off without a mask. In a second step, the researchers examined whether the change in exposure to carbon monoxide was accompanied by an alteration in the function of blood vessels.
The study included 40 smokers of conventional cigarettes, 40 exclusive users of unburnt heat cigarettes, and 40 non-smokers of similar age and sex who were medical staff at a teaching hospital. People with known cardiovascular disease, hypertension, diabetes, dyslipidemia, chronic renal failure, or atrial fibrillation were excluded because these conditions can affect vascular function.
The researchers measured exhaled carbon monoxide after deep breathing and markers of vascular function (pulse wave velocity, augmentation index, and central systolic blood pressure). Baseline assessments were performed early in the morning after sleeping without a mask to obtain values after a long period without smoking. Participants were randomized for a second assessment after an eight-hour shift with a mask or eight hours without a mask. They then moved on to a third assessment after eight hours without a mask or eight hours of working with a mask.
The average age of the participants was 45 years old and 72% were women. A similar number of combustible and non-combustible cigarettes were smoked during the masked and unmasked periods. Among conventional cigarette smokers, exhaled carbon monoxide increased from 8.00 parts per million (ppm) at baseline to 12.15 ppm without a mask and 17.45 ppm with a mask. Among smokers of noncombustible cigarettes, exhaled carbon monoxide increased from 1.15 ppm at baseline to 1.43 ppm without a mask and 2.20 ppm with a mask. In non-smokers, exhaled carbon monoxide did not differ between baseline, mask-off and mask-off periods.
In combustible and non-combustible cigarette smokers, all vascular markers were higher when wearing a mask compared to no mask. In non-smokers, there were no differences in vascular markers between the three time periods.
Professor Ikonomidis said: ‘Compared to smokers of combustible cigarettes, users of non-combustible cigarettes had lower baseline carbon monoxide levels and smaller increases in vascular damage when wearing a mask. Nonetheless, the results show that smoking any tobacco product while wearing a mask may impair blood vessel function more than mask-free periods, at least in part due to greater carbon monoxide rebreathing and/or nicotine-rich vapours. The results give even more impetus to all smokers to quit the habit.
For more information: https://www.escardio.org/
1Ikonomidis I, Katogiannis K, Kourea K, et al. The effect of smoking on exhaled carbon monoxide and arterial elasticity during prolonged surgical mask use in the age of COVID-19. Eur J Prev Cardiol. 2022. doi:10.1093/eurjpc/zwac101.
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