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Pipe and cigar smoking, both of which are on the rise, are linked to health impacts similar to those seen with cigarette smoking, researchers found.

Compared with people who had no smoking history, those who smoked pipes or cigars had increased odds of airflow obstruction, whether they also smoked cigarettes (OR 3.43, 95% CI 1.75 to 6.71; P<0.0001) or not (OR 2.31, CI 1.04 to 5.11; P=0.039), according to the report published in the Feb. 15 issue of Annals of Internal Medicine.

And the longer a person smoked pipes or cigars the more likely they were to have reduced performance on lung function tests, R. Graham Barr, MD, DrPH, of Columbia University Medical Center, and colleagues wrote.

"These findings, together with increased cotinine levels in current pipe and cigar smokers, suggest that long-term pipe and cigar smoking may damage the lungs and contribute to the development of COPD," they concluded. "Physicians should consider pipe and cigar smoking a risk factor for COPD and counsel cessation of pipe and cigar smoking regardless of cigarette smoking history."

Although cigarette smoking has decreased substantially since the 1960s, pipe and cigar smoking have increased rapidly in recent years with cigar smoking up by 46.4% from 1993 to 1997 and pipe and cigar tobacco smoking up by 28% and 8%, respectively, from 2002 to 2006, according to the report.

And recent questionnaire-based studies found that smoking pipes and cigars raises risk of hospitalization and death, the researchers wrote.

To investigate the risk of COPD, Barr and colleagues set out to determine if pipe and cigar smoking resulted in biological absorption of tobacco smoke, as assessed by urine cotinine levels, and whether these forms of smoking were linked to decreased lung function and airway obstruction.

They analyzed data from the 3,528 men and women -- ages of 48 to 90 -- who participated in the Multi-Ethnic Study of Atherosclerosis. The participants' exposure to pipe and cigar smoking was determined using self-report questionnaires. Their lung function was assessed using spirometry according to American Thoracic Society guidelines and their urine cotinine levels measured through immunoassay.

Among the participants, 9% reported pipe smoking (for a median of 15 pipe-years), 11% reported cigar smoking (median of six cigar-years) and 52% reported smoking cigarettes (median, 18 pack-years).

"Some pipe and cigar smokers say they do not inhale, or inhale less than cigarette smokers," the authors wrote. "The elevated cotinine levels in the current study, however, belie this notion and provide a biological measure of nicotine exposure."

The authors cautioned that the study was limited by its cross-sectional design, which could have yielded different results than a long-term study and been subject to selection bias.

They also noted that cigarette smoking could have been a confounding factor, but assured that they had attempted to control for this possibility.

In an accompanying editorial, Michael B. Steinberg, MD, MPH, and Cristine D. Delnevo, PhD, MPH, both of the University of Medicine and Dentistry of New Jersey, wrote that the new study adds further evidence that tobacco smoking is unhealthy, no matter the form.

"The results are especially important because the tobacco industry is challenged by decreasing cigarette sales," Steinberg and Delnevo wrote, "and is actively promoting product substitution and concurrent use as an alternative to complete tobacco cessation."