Prolonged surgical mask wearing amplifies harms of smoking, study claims

Greece: Smoking traditional or non-combustible cigarettes while wearing a surgical mask results in a two-fold rise in exhaled carbon monoxide and impaired blood vessel function compared to non-mask periods. That's the finding of research published today in the European Journal of Preventive Cardiology, a journal of the ESC.

The study focused on traditional (combustible) cigarettes and non-combustible cigarettes, also called "heat not burn" or "heated" tobacco products. The researchers investigated the levels of exhaled carbon monoxide in smokers while wearing a mask during working hours and compared it to carbon monoxide levels during days off without a mask. In a second step, the researchers examined whether the change in carbon monoxide exposure was accompanied by impaired blood vessel function.

The study included 40 smokers of conventional cigarettes, 40 exclusive heat not burn cigarette users, and 40 non-smokers with similar age and sex who were medical personnel in a university hospital. Individuals with known cardiovascular disease, hypertension, diabetes, dyslipidaemia, chronic kidney disease or atrial fibrillation were excluded as these conditions may affect vascular function.

A similar number of combustible or non-combustible cigarettes were smoked during mask and non-mask periods. In conventional cigarette smokers, exhaled carbon monoxide increased from 8.00 parts per million (ppm) at baseline to 12.15 ppm with no mask and 17.45 ppm with a mask. In non-combustible cigarette smokers, exhaled carbon monoxide increased from 1.15 ppm at baseline to 1.43 ppm with no mask and 2.20 ppm with a mask. Among non-smokers, exhaled carbon monoxide did not differ between the baseline, non-mask and mask periods.

In both combustible and non-combustible cigarette smokers, all vascular markers were higher while wearing a mask compared to no mask. In non-smokers, there were no differences in vascular markers between the three periods concluded the researchers.

Reference: Ignatios Ikonomidis, Konstantinos Katogiannis, Kallirhoe Kourea, Kostelli Gavriella, Damianos Tsilivarakis, Vaia Lambadiari, Dimitrios Kouretas, Giuseppe Biondi-Zoccai, The effect of smoking on exhaled carbon monoxide and arterial elasticity during prolonged surgical mask use in the COVID-19 era, European Journal of Preventive Cardiology, 2022;, zwac101, https://doi.org/10.1093/eurjpc/zwac101.