Cigarette smoking stimulates cysteinyl leukotriene production in man

Chronic cigarette smoking is an important risk factor for pulmonary and cardiovascular diseases. An increased production of cysteinyl leukotrienes has been shown in asthma and in cardiac ischaemia. The effect of cigarette smoking on cysteinyl leukotriene biosynthesis is, however, not known. Urinary leukotriene E₄ (LTE₄)was measured in 30 habitual smokers and in 30 non-smokers. In a further 12 non-smokers urinary LTE₄ excretion was assessed before and after smoking six cigarettes. In addition, the effect of transdermal nicotine on urinary LTE₄ excretion was studied in seven non-smokers. There was a close correlation (r = 0.92, P < 0.0001) between urinary excretion of LTE₄ and the number of cigarettes smoked daily by habitual smokers. Smoking six cigarettes within 12 h resulted in a significant (P = 0.0047), twofold increase in the mean individual LTE₄ excretion in non-smokers. Transdermal nicotine had no effect on LTE₄ excretion in non-smokers. In conclusion, cigarette smoke causes a dose-related increase in cysteinyl leukotriene production in habitual smokers. Some of the adverse effects of smoking may be related to an enhanced leukotriene synthesis.     

Serum thiocyanate, smoking habits and smoking cessation trial in patients with peripheral atherosclerosis

The smoking habits in patients with atherosclerosis in the lower limbs and the effect of advising them to stop smoking was studied by means of self-declaration of the number of cigarettes smoked per day and determination of serum thiocyanate. Ninety-six per cent of males and 70 per cent of the females were smokers or ex-smokers. The number of years of smoking was about 40 for the smokers of both sexes and the male ex-smokers and 23 for the female ex-smokers. The number of cigarettes smoked per day reported by the patients was less than that reported by the smokers in a reference population. The serum thiocyanate levels confirmed the smoking status of the non-smokers and showed that about one-sixth of the ex-smokers had smoked in the last month prior to the study, and that the smokers on the average were heavy smokers smoking much more than the self-reported number of cigarettes. The effect of advising the patients to quit smoking was very disappointing. A maximum of 15 per cent of the smokers stopped smoking while some of the ex-smokers resumed smoking.     

Cigarette smoking stimulates cysteinyl leukotriene production in man

Chronic cigarette smoking is an important risk factor for pulmonary and cardiovascular diseases. An increased production of cysteinyl leukotrienes has been shown in asthma and in cardiac ischaemia. The effect of cigarette smoking on cysteinyl leukotriene biosynthesis is, however, not known. Urinary leukotriene E₄ (LTE₄)was measured in 30 habitual smokers and in 30 non-smokers. In a further 12 non-smokers urinary LTE4 excretion was assessed before and after smoking six cigarettes. In addition, the effect of transdermal nicotine on urinary LTE₄ excretion was studied in seven non-smokers. There was a close correlation ( r  = 0.92, P  < 0.0001) between urinary excretion of LTE₄ and the number of cigarettes smoked daily by habitual smokers. Smoking six cigarettes within 12 h resulted in a significant ( P  = 0.0047), twofold increase in the mean individual LTE₄ excretion in non-smokers. Transdermal nicotine had no effect on LTE₄ excretion in non-smokers. In conclusion, cigarette smoke causes a dose-related increase in cysteinyl leukotriene production in habitual smokers. Some of the adverse effects of smoking may be related to an enhanced leukotriene synthesis.     

Depressive symptomatology and smoking among persons with diabetes

The purpose of this study was to determine whether (a) symptoms of depression are more prevalent and severe among diabetic smokers than diabetic nonsmokers, (b) smoking is related to depressive symptomatology among diabetic patients, and (c) there is a positive relationship between number of cigarettes smoked and severity of depressive symptoms. Diabetic non-smokers (n = 103) and diabetic smokers (n = 83) were surveyed regarding symptoms of depression as measured by the Beck Depression Inventory (BDI). Depressive symptomatology was more prevalent and severe among smokers than nonsmokers. Smoking was significantly associated with depressive symptomatology. Among smokers, the number of cigarettes smoked per day was independently associated with cognitive symptoms of depression.     

Carboxyhemoglobin, cotinine, and thiocyanate assay compared for distinguishing smokers from non-smokers

We compared cotinine, carboxyhemoglobin, and thiocyanate concentrations in blood sampled from 187 cigarette smokers and 181 non-smokers. All three differed significantly between smokers and non-smokers. Cotinine performed best as a test for assessing smoking status, with a sensitivity of 98% as compared with 94% for carboxyhemoglobin and 80% for thiocyanate, all at a specificity of 95%. These differences were statistically significant. Results by none of these three methods correlated well with number of cigarettes smoked per day.     

Effects of tobacco and non-tobacco cigarette smoking on endothelium and platelets

Endothelial damage and platelet activation may mediate increased cardiovascular morbidity and mortality in tobacco cigarette smokers. Our study was designed to determine whether acute effects of tobacco smoking on endothelium and platelets could be avoided by the substitution of non-tobacco cigarettes. Twenty healthy nonsmokers smoked two tobacco cigarettes in 20 minutes and on another occasion (separated by 1 week) smoked two cigarettes made from wheat, cocoa, and citrus plants. Mean endothelial cell counts from venous blood before and after smoking tobacco cigarettes were 2.3 and 4.8 and before and after smoking non-tobacco cigarettes counts were 2.5 and 3.0. Mean platelet aggregate ratios before and after smoking tobacco cigarettes were 0.80 and 0.65 and before and after smoking non-tobacco cigarettes they were 0.81 and 0.78. Much greater effects of tobacco smoking on endothelial cell counts and platelet aggregate ratios suggest the possibility that non-tobacco cigarette smoking may be less harmful to the cardiovascular system than is tobacco cigarette smoking.     

Serum angiotensin converting enzyme activity in ex-smokers

A low activity of angiotensin converting enzyme (ACE) has been reported in people who smoke. To determine whether this low ACE activity would be reversible on cessation of smoking, we measured serum ACE activity in 107 healthy male volunteers. They included 27 active cigarette smokers, 28 non-smokers, 24 ex-smokers who had stopped smoking for less than 10 yr, and 28 ex-smokers who had stopped smoking for more than 10 yr. The mean value (±SD) of serum ACE in those who had stopped smoking for more than 10 yr was comparable to that of non-smokers: 23.2 ± 5.1 and 23.5 ± 4.5, respectively. ACE activity in smokers and the ex-smokers who had stopped smoking for less than 10 yr was significantly lower (17.8 ± 4.5 and 17.8 ± 3.9, respectively) than values obtained in non-smokers and the group who had not smoked for more than 10 yr (p < 0.001). These findings suggest that the effect of chronic smoking on the serum ACE activity may be reversible.     

Recoveries of phosphatidylcholine and alveolar macrophages in lung lavage from healthy light smokers

Summary. Twenty-one healthy volunteers, 11 light smokers and 10 non-smokers, were studied by broncho-alveolar lavage. The levels of the phosphatidylcholine (PC) in broncho-alveolar lavage were measured and used as an index of surfactant. The PC levels in broncho-alveolar lavage obtained from the smokers were significantly lower than in lavage fluid from the non-smokers. There was an inverse correlation between PC levels and cumulated tobacco smoke exposure, as estimated by the number of pack-years, and to current smoking habits as estimated by the number of cigarettes smoked per day. The number of alveolar macrophages was significantly higher in broncho-alveolar lavage obtained from smokers, and there was a significant inverse correlation between PC levels and numbers of alveolar macrophages in the lavage fluids. The potential role of alveolar macrophages in the elimination of surfactant lipids is discussed.     

Smoking is associated with a high prevalence of microalbuminuria in hypertensive high-risk patients: data from I-SEARCH

Background

Microalbuminuria (MAU) is a marker of endothelial dysfunction and a predictor of cardiovascular events. The effects of cigarette smoking on the prevalence of MAU in a high-risk population with arterial hypertension are unclear.

Methods

The International Survey Evaluating Microalbuminuria Routinely by Cardiologists in patients with Hypertension (I-SEARCH) documented the clinical profile of 20,364 patients with arterial hypertension and cardiovascular risk factors. In this population, 13,690 patients had no history of smoking, 4,057 patients were former smokers and 2,617 patients were current smokers.

Results

The prevalence of MAU was associated with the smoking status. Consumption of 1–20 cigarettes per day leads to an increase of 6.8% in the prevalence of MAU compared to non-smokers (P < 0.001). Smoking of >20 cigarettes per day was associated with a 12.5% higher prevalence of MAU compared to non-smokers, while former smokers had a 4.7% higher prevalence of MAU. Multivariable analysis revealed that smoking was independently associated with MAU [odds ratio (OR) smoking vs. non-smoking 1.16; 95% confidence interval (CI) 1.01–1.33; P < 0.05]. Particularly, a consumption of >20 cigarettes per day was associated with high odds for MAU (OR 1.33; CI 1.01–1.75; P < 0.05). Interestingly, independently of blood pressure, the use of an angiotensin receptor blocker and an ACE was associated with significantly reduced odds ratio for MAU in the smoking group, while there was no significant association in the non-smoking group.

Conclusion

The prevalence of MAU in hypertensive patients is higher in smokers than in non-smokers with a strong dose dependency.     

Smoking and mortality among women with type 2 diabetes: The Nurses' Health Study cohort.

OBJECTIVE: To assess the relationship between cigarette smoking and mortality among women with type 2 diabetes in the Nurses' Health Study cohort. RESEARCH DESIGN AND METHODS: The Nurses' Health Study, a prospective cohort of U.S. female registered nurses, included 7,401 women with type 2 diabetes diagnosed at baseline or during follow-up from 1976 to 1996. Total and cause-specific mortality of these diabetic women were the outcomes of interest. RESULTS: We documented 724 deaths during 20 years of follow-up (67,420 person-years) among women with type 2 diabetes. In multivariate analyses, adjusting for age, history of high blood pressure and high cholesterol, and other cardiovascular risk factors, compared with never smokers, the RRs of mortality were 1.31 (95% CI 1.11-1.55) for past smokers, 1.43 (0.96-2.14) for current smokers of 1-14 cigarettes/day, 1.64 (1.24-2.17) for current smokers of 15-34 cigarettes/day, and 2.19 (1.32-3.65) for current smokers of > or =35 cigarettes/day (P for trend = 0.0002). Women with type 2 diabetes who had stopped smoking for > or =10 years had a mortality RR of 1.11 (0.92-1.35) compared with diabetic women who were never smokers. CONCLUSIONS: Cigarette smoking is associated in a dose-response manner with an increased mortality among women with type 2 diabetes. Furthermore, quitting smoking appears to decrease this excess risk substantially. Diabetes patients should be strongly advised against smoking.     

Influence of smoking habits on Down’s syndrome risk evaluation at mid-trimester through biochemical screening

Expectant mothers who smoke have higher levels of maternal serum alpha-fetoprotein and lower levels of unconjugated estriol and total human chorionic gonadotrophin than non-smoking mothers. This significantly affects performance of screening for Down’s syndrome. This study includes 22,169 pregnant women: 18,876 non-smokers, 2,660 smoking ≤10 cigarettes/day, and 633 smoking >10 cigarettes/day. Mean maternal age (32.6 years), maternal weight (60.5 kg), and gestational age (114.7 days) were similar or only slightly different between the three groups. To verify the effects of smoking on screening, we studied retrospectively 130 sequential Down’s syndrome cases (47 from the screening program, 83 from the prenatal diagnosis program). The proportion of smokers in the Down’s syndrome and unaffected pregnancies was similar, whilst the false-positive rate and detection rate, based on fetal outcome, differed: false-positive rates were 5.63% in smokers and 9.42% in non-smokers, and detection rate 55.6% in smokers and 83.0% in non-smokers. Since the prevalence of Down’s syndrome pregnancies was the same at mid-trimester in smokers and non-smokers and the proportion of smokers was not related to maternal age, we propose an adjustment of the Down’s syndrome risk evaluation algorithm according to smoking habits.     

Intravenous nicotine replacement suppresses nicotine intake from cigarette smoking

Insofar as smokers regulate body levels of nicotine, nicotine replacement is expected to suppress the desire to smoke a cigarette. Our study was designed to test the hypothesis that i.v. replacement of nicotine will suppress daily intake of nicotine from ad libitum cigarette smoking and to compare the physiological effects of prolonged exposure to nicotine infused i.v. to the effect of smoking cigarettes throughout the day. Eight subjects received a 14-hr infusion of deuterium-labeled nicotine dosed to achieve levels of nicotine similar to those while smoking cigarettes for each individual (average, 33.1 mg; range, 17.7-49.9 mg) or saline (placebo). Cigarette smoking was permitted as desired. Nicotine infusion did not significantly affect the number of cigarettes smoked or the amount of tobacco burned, but nicotine intake from cigarette smoking was suppressed in all but one subject by an average of 24.6% (range, 4.0-51.2%). Down-regulation of levels of nicotine while smoking in response to infusion of nicotine was imprecise, which may be a result of psychosocial factors influencing smoking behavior along with the development of tolerance to toxic effects of nicotine as a consequence of prolonged exposure to nicotine. Intravenous nicotine and cigarette smoking increased average heart rate and blood pressure throughout the day and 24-hr urinary epinephrine excretion to a similar extent. Despite higher levels of nicotine when subjects smoked during infusion of nicotine, there were no additional nicotine-related effects. No adverse effects were noted; most subjects could not distinguish nicotine from saline.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prevalence of tobacco smoking among urban population of Samara and causative factors

AIM: To examine prevalence and intensity of smoking among general population of Samara, physicians and students of Samara Medical University; to study dependence of this prevalence on different social factors. MATERIAL AND METHODS: A representative sample of adult population was selected by the lists of outpatients of Samara outpatient clinic. The study enrolled 2931 outpatients (1272 males, 1659 females aged 15 years and older)--3.95% of all Samara outpatients. The questionnaire survey covered 360 physicians aged 28-57 years (the response 96.5%), 652 senior medical students aged 21-24 years (the response 93.14%). The results were processed with the statistical computer program BIOSTAT. RESULTS: The percentage of smoking men among 15-19-year-olds was 42.94%, 20-29-year-olds--59.29% (p < 0.01), 30-39-year-olds--62.18%, 60-year-olds and older--35.64%. This proportion for smoking women was 15.04%, 27.11% (p < 0.01), 22.92%, 9.06% (p < 0.001), 5.04%, respectively. Among male physicians smokers were 47.37% (14.29% smoked less than 10 cigarettes, 50.79%--10-20 cigarettes, 34.92%--more than 20 cigarettes a day); 16.54% male physicians smoked earlier, 36.09% never smoked. Relevant percentage for female physicians was 25.99 (38.98, 47.46, 13.56, 13.66 and 60.35, respectively). Among male medical students smokers were 58.6% (29.2% less than 10 cigarettes a day, 55.8%--0-20, 14.9%--more than 20 cigarettes a day); 9.1% smoked earlier, 32.3% never smoked. Among female medical students smokers were 20.3% (70.9, 21.5, 7.6, 9.3 and 70.4%, respectively). CONCLUSION: Tobacco smoking depends on education and marital status. Both in men and women the least number of smokers are among persons with higher education and married ones.     

Effects of cigarette smoking on short-term variability of blood pressure in smoking and non smoking healthy volunteers

The present trial was planned to study the effects of smoking on short-term variability of blood pressure and on haemodynamic parameters after an overnight cessation and after one day of repeated smoking in healthy cigarette smoking volunteers, compared to a control group of non-smokers who were not asked to smoke. 40 healthy male volunteers, 20 smokers and 20 non-smokers, participated in an open study with two period of measurements over a single day (morning and afternoon). Blood pressure and heart rate were measured using standard and finger recordings over 6 min before and 10 min after smoking one cigarette (in smokers only). During the two periods, smokers were asked to smoke 4 cm of a cigarette containing 1 mg of nicotine in 2 min, and a blood sample was taken for a plasma nicotine assay. In the smoking group, smoking the first cigarette of the day caused a significant increase of systolic blood pressure (+7%), diastolic blood pressure (+10%) and heart rate (+25%). The blood pressure variability in the frequency range of the Mayer waves (66-129 mHz) was increased after an overnight cessation of smoking in the smoking group in comparison to the non-smokers, and decreased significantly after the first cigarette of the day (7.1 +/- 4.0 to 3.2 +/- 1.8 mmHg2; P < 0.01). The changes observed in the afternoon after continuous smoking were significantly less important (3.8 +/- 1.9 to 3.2 +/- 1.9 mmHg2; NS). In the non-smoking group, the different parameters remained stable between the different measurements. These results suggest that an overnight cessation of smoking in smoking subjects is associated with a increase in sympathetic activity to the vascular system in the morning, which is released by smoking the first cigarette. This effect of smoking is reduced in the afternoon after a continuous nicotinic impregnation.     

Lower quit rates among African American and Latino menthol cigarette smokers at a tobacco treatment clinic

Background: Lower rates of smoking cessation and higher rates of lung cancer in African American (AA) smokers may be linked to their preference for mentholated cigarettes. Aim: This study assessed the relationship between menthol smoking, race/ethnicity and smoking cessation among a diverse cohort of 1688 patients attending a specialist smoking cessation service. Results: 46% of the patients smoked mentholated cigarettes, but significantly more AA (81%) and Latino (66%) patients than Whites (32%) smoked menthols. AA and Latino menthol smokers smoked significantly fewer cigarettes per day (CPD) than non‐menthol smokers (15.7 vs. 20.3, for AA, and 17.0 vs. 22.1, for Latinos), with no differences among White menthol and non‐menthol smokers. At 4‐week follow up, AA, Latino and White non‐menthol smokers had similar quit rates (54%, 50% and 50% respectively). In contrast, among menthol smokers, AAs and Latinos had lower quit rates (30% and 23% respectively) compared with Whites (43%, p < 0.001). AA and Latino menthol smokers had significantly lower odds of quitting [odds ratio (OR) = 0.34; 95% CI = 0.17, 0.69 for AA, and OR = 0.32; 95% CI = 0.16, 0.62 for Latinos] than their non‐menthol counterparts. At 6‐month follow up, a similar trend was observed for the race/ethnicity subgroups, with AA menthol smokers having half the odds of being abstinent compared with AA non‐menthol smokers (OR = 0.48; 95% CI = 0.25, 0.9). Conclusions: Despite smoking fewer CPD, AA and Latino menthol smokers experience reduced success in quitting as compared with non‐menthol smokers within the same ethnic/racial groups.     

Maintained hyperexcretion of thromboxane A2 metabolite in healthy young cigarette smokers: results from a prospective study in randomly sampled males with stable smoking habits

Summary. Although several studies have identified cigarette smoking as a factor increasing platelet formation of thromboxane A₂ (TxA₂), no prospective data on this issue have been presented in a defined population with stable smoking habits. Therefore, we analysed the relation between smoking habits and urinary excretion of the 2, 3-dinor metabolites of thromboxane A₂ (Tx-M) and prostacyclin (PGI-M) in 87 males, randomly sampled from a population of 18–19-year-old men, at two different occasions separated by 31–49 months. The daily cigarette consumption among the smokers was unchanged between the study occasions (11 vs. 11 cigarettes day^-1), but 9 of 43 initial smokers had quit. None of the initial non-smokers had begun smoking. Tx-M was higher in the smokers than in the non-smokers and correlated with the daily cigarette consumption both at the initial (176 vs. 123 pg mg^-1 creatinine; P = 0.01) and the second (214 vs. 164 pg mg^-1; P = 0.002) study occasion. Those who had quit smoking since the initial study did not differ in Tx-M from the non-smokers at the second study occasion. Urinary PGI-M did not differ between cigarette smokers, non-smokers and quitters at either of the study occasions. We conclude that cigarette smoking elicits an increased formation of thromboxane A₂, indicating platelet activation, that is stable during an observation period of up to 4 years. The increased platelet activity is reversible upon quitting.     

Intervention study for smoking cessation in diabetic patients: a randomized controlled trial in both clinical and primary care settings

OBJECTIVE: To evaluate the effectiveness of a nurse-managed smoking cessation intervention in diabetic patients. RESEARCH DESIGN AND METHODS: This randomized controlled clinical trial involved 280 diabetic smokers (age range 17-84 years) who were randomized either into control (n = 133) or intervention (n = 147) groups at 12 primary care centers and 2 hospitals located in Navarre, Spain. The intervention consisted of a 40-min nurse visit that included counseling, education, and contracting information (a negotiated cessation date). The follow-up consisted of telephone calls, letters, and visits. The control group received the usual care for diabetic smokers. Baseline and 6-month follow-up measurements included smoking status (self-reported cessation was verified by urine cotinine concentrations), mean number of cigarettes smoked per day, and stage of change. RESULTS: At the 6-month follow-up, the smoking cessation incidence was 17.0% in the intervention group compared with 2.3% in the usual care group, which was a 14.7% difference (95% CI 8.2-21.3%). Among participants who continued smoking, a significant reduction was evident in the average cigarette consumption at the 6-month follow-up. The mean number of cigarettes per day decreased from 20.0 at baseline to 15.5 at 6 months for the experimental group versus from 19.7 to 18.1 for the control group (P < 0.01). CONCLUSIONS: A structured intervention managed by a single nurse was shown to be effective in changing the smoking behavior of diabetic patients.     

Smoke-derived nitric oxide and vascular prostacyclin are unable to counteract the platelet effect of increased thromboxane formation in healthy female smokers

Summary. The incidence of cigarette smoking tends to be higher in women, justifying directed studies on smoke-related mechanisms of cardiovascular disorder in females. Platelet activity plays an important etiological role in several settings of cardiovascular disease. Cigarette smoking facilitates platelet formation of proaggregatory thromboxane A₂. However, cigarette smoke contains nitric oxide (NO), which has antiplatelet activity. Furthermore, the formation of anti-aggregatory prostacyclin (PGl₂) may be higher in smokers than in non-smokers. Hence, the concerted action of NO and PGI₂ on platelet activity in smoking females is important to elucidate. The metabolites of TxA₂, NO, and PGI₂, as well as cyclic guanosine 3′:5′-monophosphate (cGMP; second messenger for NO in the platelets) and cyclic adenosine 3′:5′-monophosphate (cAMP; second messenger for PGI₂ in the platelets), were analysed in 23 healthy female smokers (daily consumption 11–20 cigarettes per day) and in 26 matched non-smokers. The urinary excretion of 2,3-dinor TxB₂ (metabolite of TxA₂) was considerably higher in smokers than in non-smokers (177 vs. 72 pg/mg creatinine, respectively; P < 0.001). Plasma and urinary levels of nitrate (metabolite of inhaled NO) did not differ between the groups. Plasma and urinary cGMP were slightly increased (252 vs. 193 nmol/L; P < 0.05 and 0.63 vs. 0.51 μmol/24 h; P < 0.05, respectively) in smokers compared to non-smokers, while platelet cGMP was lower in smokers than in non-smokers (81 vs. 10.3 pmol/10⁶ platelets, respectively; P < 0.05).The urinary excretion of 2,3-dinor-6-keto-PGF_1a (metabolite of PGI₂) did not differ between the groups. Platelet or urinary cAMP did not differ between the groups either, while plasma cAMP was lower in smokers than in non-smokers (19.2 vs. 26.2 nmol/1, respectively; P < 0.001). In healthy female smokers NO is not absorbed from the inhaled smoke, and endothelial PGI₂ formation is not enhanced to counterbalance the increased platelet formation of proaggregatory TxA₂.     

Cigarette smoking and the risk of gestational and pregestational diabetes in two consecutive pregnancies

OBJECTIVE: Cigarette smoking during pregnancy may increase the risk of gestational diabetes mellitus (GDM) or pregestational diabetes mellitus (PDM). Smoking has been associated positively with hyperinsulinemia and insulin resistance in experimental studies, although the association with diabetes remains unclear. To further explore this issue, we examined the association with smoking in the largest prospective cohort study of GDM and PDM to date. RESEARCH DESIGN AND METHODS: The study population comprised 212190 women in the population-based Swedish Birth Registry who had their first and second deliveries between January 1987 and December 1995. Maternal characteristics were recorded in a standardized manner at the first prenatal visit, followed by a clinical examination and a standardized in-person interview to assess lifestyle habits. Women were categorized as nonsmokers, light smokers (one to nine cigarettes per day), or moderate-to-heavy smokers (at least 10 cigarettes per day). RESULTS: Women with GDM in their first pregnancy experienced an eight- to ninefold increased risk of GDM or PDM in their second pregnancy. Cigarette smoking was not associated with increased risk of these conditions. Neither women who smoked during their first and second pregnancies nor those who commenced smoking between pregnancies had a higher risk of GDM or PDM than nonsmokers. CONCLUSIONS: Our findings do not support an association between cigarette smoking and risk of GDM or PDM in young women of childbearing age.     

A History of Cigarette Smoking Is Associated With the Development of Cranial Autonomic Symptoms With Migraine Headaches

(Headache 2011;51:85‐91) Objective.— To look at the smoking history of migraine patients and to determine if a history of cigarette smoking is associated with the development of cranial autonomic symptoms with migraine headaches. Background.— It has recently been noted that a significant number of migraine patients may develop autonomic symptoms during their attacks of headache. Why some headache patients activate the trigeminal autonomic reflex and develop cranial autonomic symptoms while others do not is unknown. Cluster headache occurs more often in patients with a history of cigarette smoking, suggesting a link between tobacco exposure and cluster headache pathogenesis. Could cigarette smoking in some manner lead to activation of the trigeminal‐autonomic reflex in headache patients? If cigarette smoking does lower the threshold for activation of the trigeminal autonomic reflex then do migraine patients who have a history of cigarette smoking more often develop cranial autonomic symptoms than migraineurs who have never smoked? Methods.— Consecutive patients diagnosed with migraine (episodic or chronic) who were seen over a 7‐month time period at a newly established headache center were asked about the presence of cranial autonomic symptoms during an attack of head pain. Patients were deemed to have positive autonomic symptoms along with headache if they experienced at least one of the following symptoms: eyelid ptosis or droop, eyelid or orbital swelling, conjunctival injection, lacrimation, or nasal congestion/rhinorrhea. A smoking history was determined for each patient including was the patient a current smoker, past smoker, or had never smoked. Patients were deemed to have a positive history of cigarette smoking if they had smoked continuously during their lifetime for at least at 1 year. Results.— A total of 117 migraine patients were included in the analysis (96 female, 21 male). Forty‐six patients had a positive smoking history, while 71 patients had no smoking history. Some 70% (32/46) of migraineurs with a positive history of cigarette smoking had cranial autonomic symptoms along with their headaches, while only 42% (30/71) of the nonsmoking patients experienced at least 1 autonomic symptom along with headaches and this was a statistically significant difference (P < .005). In total, 74% of current smokers had autonomic symptoms with their headaches compared with 61% of past smokers and this was not a statistically significant difference. There was a statistically significant difference between the number of current smokers who had autonomic symptoms with their headaches compared with the number of patients who never smoked and had autonomic symptoms (P < .05). Overall, 52% of the studied migraineurs had autonomic symptoms. There was a statistically significant difference between autonomic symptom occurrence in male and female smokers vs male and female nonsmokers. Each subtype of cranial autonomic symptoms was all more frequent in smokers. Conclusion.— A history of cigarette smoking appears to be associated with the development of cranial autonomic symptoms with migraine headaches.