Comparative assessment of respiratory, hematological and inflammatory profiles of long-term users of cigarettes, shisha, and e-cigarettes in Saudi Arabia

Abstract

Introduction Globally, over 1 billion people smoke, resulting in approximately 8 million deaths each year. Although the health risks associated with traditional cigarettes are extensively documented, there is an increasing need to evaluate the long-term effects of alternative tobacco products, particularly shisha, and e-cigarettes. This study seeks to compare the respiratory, hematological, and inflammatory profiles of long-term users of cigarettes, shisha, and e-cigarettes in Saudi Arabia. Methods A cross-sectional, observational study was conducted at the Respiratory Therapy laboratories of Batterjee Medical College (BMC), Jeddah, Saudi Arabia, between February 2022 and August 2023. It involved four groups: cigarette smokers, shisha smokers, e-cigarette users, and non-smokers. Pulmonary function tests (PFTs) measured FEV 1 , FVC, and other lung function parameters. Hematological profiles, including WBC, neutrophils, lymphocytes, monocytes, and C-reactive protein (CRP) levels, were assessed. Results Cigarette and shisha users demonstrated significantly reduced FEV 1 (cigarettes: 3.11 ± 0.54 L/s, shisha: 3.26 ± 0.71 L/s; p≤0.0001), FEV 1 (% predicted: 81.63 ± 12.11 for cigarettes, 88.09 ± 12.92 for shisha; p≤0.0001), and FVC (3.87 ± 0.68 L for cigarettes, 3.95 ± 0.880 L for shisha; p=0.004), compared to non-smokers and e-cigarette users. Cigarette smokers exhibited significantly elevated WBC (7.92 ± 2.84 ×10 9 /L; p≤0.001), neutrophil (4.03 ± 2.29 ×10 9 /L), lymphocyte (2.95 ± 0.95 ×10 9 /L), and monocyte counts (0.67 ± 0.21 ×10 9 /L) compared to non-smokers, shisha, and e-cigarette users (p≤0.0001). Cigarette smokers and shisha smokers presented different lung function results but similar inflammatory profiles. However, e-cigarette users demonstrated comparatively higher lung function and lower inflammatory markers compared to both cigarette and shisha users. Cigarette smokers and Shisha smokers presented different lung function results but similar inflammatory profile. However, E-cigarette users demonstrated comparatively higher lung function and lower inflammatory markers compared to both cigarette and shisha users. Conclusions Compared to non-smokers, long-term cigarette and shisha smoking is associated with airway obstructive changes and increased inflammatory responses. Although e-cigarette users demonstrated lower inflammatory markers and less deviation from normal PFT, some exhibited borderline values with airway obstruction. Further research is needed to clarify the long-term health consequences of e-cigarette use.

Keywords

• cigarettes
• shisha
• e-cigarettes
• hematology
• pft