A cigar is a tightly rolled bundle of fermented tobacco, typically wrapped in a tobacco leaf. Unlike the quick consumption of a cigarette, smoking a cigar is often a leisurely pursuit. Many smokers believe that avoiding inhalation makes the practice significantly safer. However, the scientific reality of nicotine absorption and the smoke’s chemical nature complicate this assumption.
How Cigar Smoke Differs from Cigarette Smoke
The fundamental difference between cigar and cigarette smoke lies in the tobacco processing and chemical composition. Cigars contain significantly more tobacco, often holding as much as an entire pack of cigarettes. The tobacco used in most cigars is air-cured and fermented, which leads to a higher concentration of toxins, such as cancer-causing nitrosamines, compared to cigarette tobacco.
The smoke produced by a cigar is characteristically more alkaline, or basic, compared to the smoke from a typical cigarette. Cigarette smoke is usually acidic, with a pH of around 5.3, which requires deep inhalation into the lungs for efficient nicotine absorption. In contrast, the smoke from most cigars is alkaline, with a pH that can be around 8.5, which is a critical distinction for the non-inhaling smoker.
The higher alkalinity means the nicotine in cigar smoke is present in a free, non-ionized form. This form is readily absorbed directly through the mucous membranes of the mouth, pharynx, and nasal passages, even without reaching the lungs. Consequently, cigar smokers do not need to inhale to receive a dose of nicotine, which is why most primary smokers practice the technique of holding the smoke in their mouth.
Localized Health Risks from Non-Inhaling
Even without inhalation, cigar smoking exposes the upper respiratory tract to a high concentration of toxins and carcinogens. The smoke is held in the mouth, bathing the lips, tongue, oral cavity, and pharynx in harmful chemicals for an extended period. This direct, prolonged exposure is the mechanism behind the increased risk of certain cancers.
Regular cigar smoking elevates the risk of developing cancers of the mouth, tongue, pharynx, larynx, and esophagus. Non-inhaling cigar smokers face a risk of oral and esophageal cancers that can be comparable to that of cigarette smokers. The toxic components in the smoke mix with saliva, and when swallowed, they expose the esophagus to carcinogens.
The continuous contact with the mucous membranes can also lead to non-cancerous but concerning oral health issues. These include gum disease, tooth loss, and smoker’s melanosis, which is a dark pigmentation of the oral tissues caused by nicotine and other compounds. The absence of a filter on most cigars means the lips and mouth are in direct contact with the tobacco, further concentrating exposure to the harmful substances.
Systemic Nicotine Absorption and Cardiovascular Effects
Despite not inhaling, the alkaline cigar smoke allows nicotine to be absorbed through the buccal mucosa, leading to systemic effects. The absorbed nicotine enters the bloodstream, where it acts as a psychostimulant and a highly addictive drug. This mechanism is sufficient to cause nicotine dependence and addiction in cigar smokers, similar to the dependence seen in cigarette users.
Once in the bloodstream, nicotine triggers the release of chemicals that increase heart rate and raise blood pressure. This cardiovascular impact is a significant systemic risk, as it puts stress on the heart and blood vessels. Nicotine and other toxins absorbed through the mouth contribute to arterial damage, increasing the risk of serious conditions like heart disease, stroke, and aortic aneurysm.
For cigar smokers who previously smoked cigarettes, the tendency to inhale the smoke often persists, which dramatically increases the health risks. When cigar smoke is inhaled into the lungs, the smoker faces risks of lung cancer and chronic obstructive pulmonary disease (COPD) similar to those of a cigarette smoker. While non-inhalation reduces the likelihood of these specific lung diseases, substantial risks associated with cigar smoking remain regardless of the technique used.