Nicotine dependency and lung functions of cigarette and non-cigarette forms of tobacco smokers in Faisalabad, Pakistan

OBJECTIVES: To compare nicotine dependency and lung functions among cigarette and non-cigarette (e-cigarette & hookah) form of tobacco smokers. METHODS: This cross-sectional study was conducted from December 2023 and January 2024, at Aziz Fatimah Medical and Dental College, Faisalabad, Pakistan. The study included 100 male tobacco users aged 18 to 60 years, comprising 25 conventional cigarette smokers, 48 e-cigarette users, 25 hookah users, and 2 dual product users. Subjects with known lung diseases (asthma, COPD, tuberculosis), chest deformities affecting lung function, and smokers using nicotine patches or gum for smoking cessation were excluded. Nicotine dependence was assessed using the Fagerstr & ouml;m test for nicotine dependence (FTND) and its adapted versions (eFTND) for hookah and e-cigarettes. Lung function parameters, were measured using a digital spirometer. RESULTS: Mean +/- SD FTND and eFTND scores for cigarette, e-cigarette, hookah, and dual users were 5.44 +/- 1.91, 6.25 +/- 2.20, 4.84 +/- 1.106 and 5.50 +/- 0.707 respectively (p=0.027). FEV1 of cigarettes, e-cigarettes, hookah, and dual product users were 4.44 +/- 2.69, 4.04 +/- 1.56, 3.28 +/- 2.21 and 4.72 +/- 0.763 respectively (p-value=0.84).FVC for the same groups were 5.86 +/- 3.33, 4.35 +/- 1.79, 3.7 +/- 2.58, and 5.05 +/- 0.53 (p=0.012) respectively. FEV1/FVC as followed: cigarettes, 79.44 +/- 14.88; e-cigarettes, 94.20 +/- 6.5; hookah, 87.39 +/- 13.8; dual products, 93.29 +/- 5.16 (p-value=0.000). PEF of cigarettes, ecigarettes, hookah, and dual product users were 7.35 +/- 3.71, 8.18 +/- 2.52, 5.4 +/- 3.4, 8.45 +/- 0.19 respectively (p-value=0.001). CONCLUSION: This study reveals significant differences in nicotine dependency and lung function among tobacco-users. E-cigarette users have the highest nicotine dependence but less short-term lung impairment than hookah users. Targeted public health interventions, stricter advertising regulations, and multi-center studies on larger populations are recommended