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 Smokers who reported using menthol cigarettes had more trips to the
emergency room and more hospitalizations or treatment for severe
worsening of their lung disease compared to people smoking regular
tobacco, the study found.
These worsenings, or “exacerbations,” might include difficulty
breathing or a major increase in phlegm that lasts for days.
“We were surprised that menthol smokers, compared to non-menthol
cigarette smokers, reported more severe exacerbations and had a
greater odds of experiencing severe exacerbations,” said Dr. Marilyn
Foreman of the Morehouse School of Medicine in Atlanta, Georgia, one
of the study authors, in an email to Reuters Health.
She and her colleagues compared 3,758 menthol smokers and 1,941
regular smokers, ages 45 to 80, who smoked at least 10 packs of
cigarettes per year. The menthol smokers were slightly younger and
more likely to be female and black, they found.
At first glance, it seemed that the menthol smokers had less chronic
obstructive pulmonary disease (COPD), and they were less likely to
have chronic cough or chronic sputum production and less likely to
use medications to help them breathe.
Overall, the two groups had similar frequencies of COPD
exacerbations during the average 18-month period of the study,
according to the report of the study in the journal Respirology.
But the menthol smokers had more frequent severe exacerbations: 0.22
per year, versus 0.18 per year among smokers of regular tobacco
cigarettes.
The menthol smokers also did worse on a test of how far they could
walk in six minutes, and they were more short of breath than people
who smoked regular cigarettes.
When the researchers took other patient factors into account, such
as age and other diseases, there were no longer any differences
between the menthol and regular tobacco smokers in lung function,
exercise capacity, or breathing problems.
There was still, however, a 29 percent higher risk of severe lung
disease exacerbations with use of menthol cigarettes.
The researchers think menthol might have an anesthetic effect on the
airways, and as a result, it might take longer to recognize that
smokers’ lung disease is worsening, said Foreman.
She and her colleagues admit, though, that their study can’t prove
menthol is responsible for making smokers’ lung problems worse.
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“In general in the article, the people who smoked menthol cigarettes
were different, younger, more likely to be African-American and
female,” Dr. Sean Forsythe said in a phone interview with Reuters
Health. “So maybe the differences weren’t due to menthol but were
due to the fact that the patients were different.”
Forsythe, who is division director of Pulmonary and Critical Care
Medicine at Loyola University Medical Center in Maywood, Illinois,
said that while exacerbations appeared to be worse for the menthol
smokers, only a longer study could say for sure.
“That’s the type of thing where only following these patients for a
year and a half is going to become a bit misleading,” said Forsythe,
who wasn’t involved with Foreman’s study. “If you’re looking for
some of these bigger outcomes in the COPD world, maybe you need to
follow them longer,” he added.
Foreman pointed out frequent exacerbations might end up having a
long-term effect.
“Frequent exacerbations do affect quality of life and may result in
greater loss of lung function over time,” said Foreman.
Both agreed the results send an important message to smokers.
“If one thinks that smoking menthol cigarettes is safer, that’s
completely inaccurate,” said Forsythe.
It would be as if there were a group of people slowly poisoning
themselves with arsenic and then you would compare if cherry
flavored arsenic was safer.
“It’s still arsenic,” said Forsythe.
SOURCE: http://bit.ly/1tfw7M4
Respirology, October 19, 2014.
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