Pipe and Cigar Smoking Linked to Faster Lung Decline

[JohnS]

This is very recent article from the European Medical Journal. Feel free to discuss...

Pipe and Cigar Smoking Linked to Faster Lung Decline

8 Mar 2026 - Ada Enesco

PIPE and cigar smoking is often perceived as a safer alternative to cigarettes, but new evidence suggests this assumption may be misplaced. A large pooled analysis of long-running USA cohort studies has found that pipe and cigar smoking is associated with accelerated lung function decline and increased risks of death and serious respiratory outcomes, even among people who have never smoked cigarettes.

Smoking tobacco remains a leading cause of heart and lung disease worldwide. While cigarette smoking has been extensively studied, the long-term health effects of pipe and cigar smoking have received far less attention, despite their continued use among adults. This new analysis helps fill that gap by examining lung health and clinical outcomes over several decades.

Pipe and Cigar Smoking and Lung Function Loss

Researchers analysed data from more than 22,000 adults enrolled between 1971 and 2011 and followed through 2018. Lung function was assessed using standard spirometry measures, including forced expiratory volume in one second (FEV₁) and forced vital capacity, which are routinely used in clinical practice to monitor respiratory health.

Compared with people who had never used any tobacco, exclusive pipe and cigar smokers experienced a faster annual decline in lung function. The reduction affected both airflow and lung volume, alongside a gradual worsening of the ratio used to identify obstructive lung disease. These changes are clinically meaningful, as even small yearly losses can accumulate over time and increase vulnerability to chronic lung conditions.

Higher Risks of Mortality and Chronic Lung Disease

Beyond lung function decline, pipe and cigar smoking was linked to poorer clinical outcomes. Exclusive users had a higher risk of death from any cause and were more than twice as likely to experience hospitalisation or death related to chronic obstructive pulmonary disease. They were also more likely to develop a spirometry pattern associated with impaired lung health despite preserved airflow ratios.

Importantly, these associations were observed in people with no history of cigarette smoking, suggesting the risks were not driven solely by prior cigarette exposure.

Implications for Prevention and Clinical Practice

The findings reinforce that pipe and cigar smoking is not a benign habit. From a clinical perspective, they highlight the importance of asking patients about all forms of tobacco use, not just cigarettes, when assessing respiratory risk. At a population level, the results support stronger prevention and cessation efforts targeting non-cigarette tobacco products.

While the study cannot prove cause and effect, the consistency of lung function changes and adverse outcomes over long follow-up periods emphasises the potential harm of pipe and cigar smoking, challenging lingering perceptions of relative safety.

Reference

Gardner WM et al. Pipe and cigar use, lung function decline and clinical outcomes: an analysis of the NHLBI Pooled Cohorts Study. Thorax. 2026; DOI:10.1136/thorax-2025-224461.

Featured image: DanielViero on Adobe Stock

Source: https://www.emjreviews.com/respiratory/news/pipe-and-cigar-smoking-linked-to-faster-lung-decline/

[ha_banos]

What a conclusion. And is there any difference in those smoking through 5 a day compared to 1 a week? Doesn't say. Absolutely no details. Grrrrr. The data is available if anyone cares to request it.

While the study cannot prove cause and effect, the consistency of lung function changes and adverse outcomes over long follow-up periods emphasises the potential harm of pipe and cigar smoking, challenging lingering perceptions of relative safety.

The BMJ also holds a summary. The conclusion is below https://thorax.bmj.com/content/early/2026/03/03/thorax-2025-224461

Conclusion...These findings underscore the need for prevention and cessation efforts targeting non-cigarette tobacco.

[Tunkat92]

56 minutes ago, ha_banos said:

What a conclusion. And is there any difference in those smoking through 5 a day compared to 1 a week? Doesn't say. Absolutely no details. Grrrrr. The data is available if anyone cares to request it. 

Agree, I also hate how they neglected to mention to say how they define a cigar or pipe smoker. Come on, we should all know that exposure to smoke has these affects on us. I'm more interested in the quantity.

[Li Bai]

I'd come across a study a few years back about the life expectancy of cigar smokers compared to non-smokers.

Scientists were surprised (annoyed 🤔?) to conclude that they couldn't see any difference, if I recall correctly, the cigar smokers were 1 to 2 cigars a day smokers, I'll try to find a link but the unexpected results were very interesting, that's what happens when serious people decide to use a wider lens...

[ha_banos]

8 hours ago, Li Bai said:

I'd come across a study a few years back about the life expectancy of cigar smokers compared to non-smokers.

Scientists were surprised (annoyed 🤔?) to conclude that they couldn't see any difference, if I recall correctly, the cigar smokers were 1 to 2 cigars a day smokers, I'll try to find a link but the unexpected results were very interesting, that's what happens when serious people decide to use a wider lens...

https://pubmed.ncbi.nlm.nih.gov/25907101/ ?

Low Frequency (1–2 Cigars/Day): The review found that for primary cigar smokers who do not inhale, the risks for heart disease and lung cancer were not significantly different from non-smokers. However, the risk for oral, esophageal, and laryngeal cancers remained significantly elevated even at this lower level of consumption.  

[Li Bai]

4 minutes ago, ha_banos said:

https://pubmed.ncbi.nlm.nih.gov/25907101/ ?

Low Frequency (1–2 Cigars/Day): The review found that for primary cigar smokers who do not inhale, the risks for heart disease and lung cancer were not significantly different from non-smokers. However, the risk for oral, esophageal, and laryngeal cancers remained significantly elevated even at this lower level of consumption.  

I came across that one too but the one I was talking about only took life expectancy into account, nothing else. I'll see if I can find a link.

[tbelle7]

Yawn. DO what makes you happy fellas.

[Duder]

Air pollution is far more harmful. That goes in to your lungs like it or not. To live is to die - enjoy your life. You decide the risk/reward. Even cigarette smoking pales in comparison to poor nutrition which is by far the most impactful on your health. Cheers!

[Li Bai]

If only officials put as much effort in fighting sugar. I guess selling insulin is too good money.

[Puros Y Vino]

I'm starting to suspect that tobacco/smoking is the scapegoat for the ever increasing toxicity we are exposed to from industry, car exhaust and lax environmental laws, etc.

Years ago a friend of mine was buying keyman insurance from Lloyds of London. Needless to say he got put through the wringer from his financials and his health. Diet, pre-existing conditions, family history, vices (alcohol, smoking, etc). He smokes cigars. So he marked that down and he expected to be hit with a nasty premium but he wanted to be truthful and not expose himself/estate by fibbing about details. Apparently, Lloyds has actuarial data from as far back as the 1700's in regards to tobacco use and its corollary effects. In order, the highest premiums for tobacco consumption, from high to low were the following

1. Pipe smoking
2. Cigarette smoking
3. Cigar smoking.

I don't recall the #'s but when he was presented with the breakdown of what the cigar smoking premium was, he was very surprised. He asked what the premiums for other two were and they were significantly higher.  

Anecdotally. When I've had the odd health scare and had to answer the "do you smoke" question, I can see the visible change in the doctor's face when I mention cigar smoking vs the expected cigarette smoking admission. Same with my dentist. It seems the medical community does have an understanding of the actual impacts of the habits but the medical establishment and more importantly, governments, don't care and want go with the most negative data to bolster their stance. I walk a lot and if I walk for an hour in downtown Toronto during rush hour, my chest feels like it smoked a box of cigars at all once.

[CaptainQuintero]

5 hours ago, Puros Y Vino said:

I'm starting to suspect that tobacco/smoking is the scapegoat for the ever increasing toxicity we are exposed to from industry, car exhaust and lax environmental laws, etc.

Years ago a friend of mine was buying keyman insurance from Lloyds of London. Needless to say he got put through the wringer from his financials and his health. Diet, pre-existing conditions, family history, vices (alcohol, smoking, etc). He smokes cigars. So he marked that down and he expected to be hit with a nasty premium but he wanted to be truthful and not expose himself/estate by fibbing about details. Apparently, Lloyds has actuarial data from as far back as the 1700's in regards to tobacco use and its corollary effects. In order, the highest premiums for tobacco consumption, from high to low were the following

1. Pipe smoking
2. Cigarette smoking
3. Cigar smoking.

I don't recall the #'s but when he was presented with the breakdown of what the cigar smoking premium was, he was very surprised. He asked what the premiums for other two were and they were significantly higher.  

Anecdotally. When I've had the odd health scare and had to answer the "do you smoke" question, I can see the visible change in the doctor's face when I mention cigar smoking vs the expected cigarette smoking admission. Same with my dentist. It seems the medical community does have an understanding of the actual impacts of the habits but the medical establishment and more importantly, governments, don't care and want go with the most negative data to bolster their stance. I walk a lot and if I walk for an hour in downtown Toronto during rush hour, my chest feels like it smoked a box of cigars at all once.

It sounds like you need to kick that nasty walking habit you've got!

[JohnS]

5 hours ago, Li Bai said:

If only officials put as much effort in fighting sugar. I guess selling insulin is too good money.

Right on. Well said! 👍

[Nevrknow]

Always nagged me. Grandparents smoked cigs and hit late 80's. No cancer. Paternal grandmother lived to 91 and I have TWO photos of her without a cigarette out of 50.

Adopted daughter in Nashville just beat breast cancer. Found out minutes ago they just found brain cancer. Health nut and never smoked a day in her life. No hazardous job, no exposure.

Gave up on all of the "we know", yeah, you know s**t.

I follow the $$ now.

 

[loose_axle]

My doctor said smoke cigars, stress will kill you well before they do. She stressed that she wouldn't give the same advice if I'd said cigarettes. 

My nan also never drank water, never ate vegetables except for the ones she liked and lived off cake the last 10 years of her life. Outlived all my grandparents by a good decade into her mid 90s and her husband, who never drank, clocked it at 70. 

[Ford2112]

My Dr. tried to get me to cut out my cigar habit and was met with vehement hostility! She acquiesced and that was that lol. I'm a house painter. The chemicals got me already I bet. 

[Cestis4]

I quit for almost 30 years and got hit with the big C diagnosis anyway despite strict exercising, living and eating very well (think I beat it so far). Said screw it, and started smoking cigars again and life is good. I just wish I didn't have that huge time gap in my collection. Something’s going to kill us and it’s just a matter of when. So, enjoy yourselves. 

[JDoughty]

Something crucial that doesn't seem to come up in these studies is that pipes and cigars are not physically addictive. If I'm too busy to relax with a cigar on a given day, or even for a given week, it's not a big issue. While I may want a nice cigar and miss being able to enjoy one if I don't get one for awhile, it never gets to the level of a huge physical craving. This is typical for most cigar smokers in my experience. It's very nice to have one, but literally no one is going to be huddled out in the rain desperately smoking a Cohiba because they're jonesing for a fix.