When compared to non-mask times, smoking regular or non-combustible cigarettes while wearing a surgical mask leads to a twofold increase in exhaled carbon monoxide and reduced blood vessel function.

That is the conclusion of a study that was published today in the ESC journal, European Journal of Preventive Cardiology.

According to study author Professor Ignatios Ikonomidis of the National and Kapodistrian University of Athens, Greece, “the study suggests that smoking any tobacco product has become even more hazardous during the COVID-19 pandemic because of the need to wear a mask for long hours.”

Prior studies have demonstrated a connection between heart trouble and early death and poor vascular function.

Traditional (combustible) cigarettes and non-combustible cigarettes, often known as “heat not burn” or “heated” tobacco products, were the subjects of the study.

Smoking non-combustible cigarettes produce an inhalable aerosol of nicotine by electronically heating the tobacco to a lower temperature than a combusted cigarette.

The study excluded e-cigarettes (commonly known as vaping), which electrically heat a nicotine-containing liquid to produce an aerosol that is inhaled.

The researchers compared the levels of inhaled carbon monoxide in smokers who wore masks during working hours to levels of carbon monoxide in smokers who did not wear masks on days off.

In a second phase, the researchers assessed whether the shift in exposure to carbon monoxide was accompanied by altered blood vessel function.

The study included 40 conventional cigarette smokers, 40 exclusive heat-not-burn cigarette users, and 40 nonsmoking medical workers from a university hospital of similar age and gender.

As these disorders may influence vascular function, people with known cardiovascular disease, hypertension, diabetes, dyslipidemia, chronic renal disease, or atrial fibrillation were not included in the study.

The researchers examined exhaled carbon monoxide following a deep breath as well as vascular function markers (pulse wave velocity, augmentation index and central systolic blood pressure).

To get values after a prolonged period without smoking, baseline evaluations were completed early in the morning after sleeping without a mask.

Participants were assigned to a second assessment after either an eight-hour shift with a mask or an eight-hour break without a mask.

Then, after either eight hours off with no mask or eight hours of work with a mask, they moved on to a third test.

The participants’ average age was 45, and 72% of them were female. During mask and non-mask periods, the same number of cigarettes, whether they were combustible or not, were smoked.

Compared to nonsmokers, conventional cigarette smokers had an increase in exhaled carbon monoxide from 8.00 to 12.15 ppm without a mask and from 8.00 to 17.45 ppm while using a mask.

Exhaled carbon monoxide among non-combustible cigarette smokers was 1.15 ppm at baseline, rising to 1.43 ppm without a mask and 2.20 ppm with a mask.

Exhaled carbon monoxide in non-smokers was the same during the baseline, non-mask, and mask periods.

All vascular markers in smokers of combustible and non-combustible cigarettes were greater when wearing a mask than when not wearing one. There were no variations in vascular indicators among non-smokers throughout the three-time periods.

According to Professor Ikonomidis, Compared to combustible cigarette smokers, non-combustible cigarette users exhibited lower carbon monoxide levels at baseline and smaller increases in vascular damage when wearing a mask. 

However, the results suggest that smoking any tobacco product while wearing a mask may worsen blood vessel function compared to non-mask times, at least in part because of increased re-inhalation of carbon monoxide and/or nicotine-rich vapour.

The results give smokers even more reason to give up the habit.

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