NEW YORK - If you thought it was only cigarettes that were dangerous to smoke, think again, with a US study showing cigars and pipes also raise the risk of lung disease, defying their image of sophistication and celebration.
Researchers from the University of Medicine and Dentistry of New Jersey in New Brunswick found that even if the smoke is not inhaled, people who smoke cigars or pipes have a greater risk of airway damage that could lead to emphysema and other diseases.
Cigarette smoking is a well-known risk factor for chronic obstructive pulmonary disease (COPD), a group of lung diseases that includes emphysema and chronic bronchitis, but few studies have looked at whether other types of smoking add to COPD.
This research found that among more than 3,500 U.S. adults, those who had ever smoked cigars or pipes were more likely than non-smokers to show obstructed airflow - a hallmark of COPD -- during tests of lung function.
Researchers Michael Steinberg and Cristine Delnevo said the findings were particularly important as cigars and pipes are still often seen as emblems of "sophistication, affluence, education and celebration" and people had the mistaken belief that not inhaling the smoke meant it was not harmful.
"These images largely fostered by the tobacco industry, perpetuate the idea that these products play a suitable role in our society," they said in a study published in the Annals of Internal Medicine.
The study found that among 56 participants who said they had smoked at least 20 cigars or pipe-bowls in their lives, 18 percent showed airway obstruction. That compared with less than 8 percent of men and women who had never smoked.
Study participants who had only smoked cigars or pipes -- that is, cigarette-free -- generally had poorer scores on their lung-function tests and were twice as likely to show airflow obstruction as people who had never smoked.
The effects were compounded among people who had smoked cigarettes. Their risk of airflow obstruction was increased more than three-fold. Among 428 study participants who had smoked both cigarettes and cigars or pipes, 21 percent had obstructed airways.
When the researchers weighed other factors -- like age and history of cigarette smoking -- cigar and pipe smoking were linked to a doubling in the odds of airflow obstruction.
The findings "suggest that pipe and cigar smoking produce a measurable increase in the risk for COPD," the researchers said.
The findings add to evidence of the health risks of cigars and pipes, which many people tend to view as "safe" ways to smoke.
Cigar and pipe smoking have also been linked to increased risks of mouth and throat cancers, heart disease and lung cancer. One study estimated that those risks were on par with those associated with light cigarette smoking which was defined in the study as up to 19 cigarettes per day.
Steinberg and Delnevo said people wrongly believed that pipes and cigars were safer smoking alternatives as the smoke was not inhaled into the lungs.
But they said this study showed "further evidence that smokers of these products are exposed to sufficient levels of toxins to affect" their lung health.