REF-1460 · Juhasz et al., 2017 · Chest · Paper · PubMed

Is hookah CO gone by the next morning?

In 32 students exhaled CO ran about 7.5-fold a cigarette session's level indoors and was still raised 10 h after, size not given. A marker, not performance. From the abstract.

Main caveat: Abstract only; no absolute exhaled CO values, no size for the 10-h rise, no comparator named for it.
limited evidenceMeasured on non-athletes and recreational people

Juhasz and colleagues (National Koranyi Institute, Budapest) compared smoke exposure and exhaled CO kinetics between water-pipe and cigarette smokers.

In a crossover, exhaled CO and urinary cotinine were measured in 32 healthy university students after water-pipe sessions indoors and outdoors, with an indoor cigarette session using equal amounts of tobacco as the reference; active and passive smokers took part in all sessions.

Among active participants indoors, exhaled CO was approximately 7.5-fold higher with water-pipe than with cigarettes, and remained significantly raised 10 h after the water-pipe ended. Passive water-pipe smokers had levels in the same range as active cigarette smokers. Outdoors, levels in active users were lower than indoors but still higher than in cigarette smokers indoors.

Urinary cotinine was comparable between active water-pipe and cigarette smokers. Our reading: the only time-course number the base has for a hookah evening, and it runs to 10 h. It is a marker in students with no exercise measured; the abstract does not say how high the 10-h value was, so it does not say how much of a next-morning session it would touch.

Protocol

Participants: n = 32 healthy university students, active and passive smokers in all sessions.
Sessions: water-pipe indoors; water-pipe outdoors; indoor cigarette session with equal amounts of tobacco, as a reference. Order, session length and spacing are not in the abstract.
Outcomes: exhaled CO kinetics; urinary cotinine.
Funding and interests: PubMed lists non-US government support; one author's affiliation is a company (Wessling Hungary Kft); no funder or conflict statement in the record.

Key Results

OutcomeResult (as printed; no absolute values in the abstract)
Exhaled CO, indoors, active: water-pipe vs cigaretteapproximately 7.5-fold higher
Exhaled CO 10 h after water-pipestill significantly elevated
Exhaled CO, passive indoor water-pipesame range as active cigarette smokers
Exhaled CO, active water-pipe, outdoorslower than indoors; still higher than active cigarette smokers indoors
Urinary cotininecomparable between active water-pipe and cigarette smokers

Mechanisms

Measured: exhaled CO over time after each kind of session; urinary cotinine.
Authors' interpretation: water-pipe smoking is associated with significantly higher toxicant exposure than cigarette smoking even outdoors, and passive indoor exposure may carry significant health hazards compared with active cigarette smoking.
Inference: similar cotinine with much higher CO suggests the gap between the products here is more about combustion gases than about nicotine. That is our reading; the abstract does not measure blood CO.

Practical Application

Is hookah CO gone by the next morning? In 32 students exhaled CO ran about 7.5-fold a cigarette session's level indoors and was still raised 10 h after, size not given. A marker, not performance. From the abstract.
A session the morning after: not from this paper; the base's own practice: treat the next morning as possibly affected and read heart rate in that light (PHYS-12). Any rule such as "easy next morning" is practice and does not carry this entry's level.
Outdoors and passive: outdoors lowers the marker and does not remove it; sitting in the room gave levels like active cigarette smoking here.
What it does not show: that performance is lower at 10 h (not tested); the size of the 10-h rise; any COHb value; anything in trained athletes.

Limitations

Abstract only; no absolute exhaled CO values, no size for the 10-h rise, no comparator named for it.
Exposure marker, not performance: exhaled CO is indirect and no exercise was measured.
Who was measured: healthy students, not athletes.
Dose undefined in the abstract: equal amounts of tobacco, session length and ventilation unknown, so the 7.5-fold figure cannot be read per cigarette.
Order and blinding are not stated.
Funding and interests: non-US government support per PubMed; one author at a private company; no statement in the record.
How this entry was checked and changed
Why this level

(from the abstract) — a crossover of 32 would reach the rubric's B+, held one step down because the outcome is an exposure marker (exhaled CO, urinary cotinine), not performance, and the abstract gives no absolute values