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Although clinicians are generally well-versed in the risks and consequences of cigarette smoking, most are not as well-informed about health toxicity of cigar smoking.
The risk of laryngeal and oral cancers is increased to a similar extent in both groups. On the other hand, lung cancer and COPD risk is lower in cigar smokers, and cigar smoking has not been definitively shown to be a coronary heart disease risk factor.
The difference in production methods between cigars and cigarettes render different nicotine absorption patterns. Cigar tobacco is more alkaline, enhancing trans-buccal absorption; the more acidic cigarette smoke requires inhalation for efficient absorption.
Individual smoking habits determine toxin intake for cigar smokers; whereas cigarette smokers average 10 puffs per cigarette over six minutes, smoke more than one pack per day, and have carbon monoxide levels well-correlated with the number of cigarettes smoked, cigar smokers are highly variable in degree of inhalation. For instance, previous cigarette smokers who take up cigar smoking are more likely to inhale than those who have not previously smoked cigarettes. Since cigarette smokers are accustomed to rapid increases in nicotine levels, they may inhale more deeply on cigars in an attempt to provide more substantial immediate nicotine responses. On the other hand, carbon monoxide levels and nicotine levels may be discordant in cigar smokers who inhale minimally. Individual cigar smokers may surpass cigarette smokers in nicotine and other toxin intake, depending upon the type of cigar smoked and the person’s smoking style.
Henningfield J. JAMA 1996;276: 1857-1858.