The common perception that cigar smoke is simply “puffed” and never inhaled complicates the question of whether it reaches the lungs. A cigar is a roll of fermented, air-cured tobacco wrapped in a tobacco leaf or a substance containing tobacco, unlike a cigarette, which is wrapped in paper. While the traditional method of consumption involves keeping the smoke in the mouth, scientific analysis confirms that exposure to the lungs is a reality for many cigar smokers. The difference in smoking technique compared to cigarettes is determined by the distinct chemical makeup of the smoke itself, which influences how nicotine is absorbed.
The Chemical Properties of Cigar Smoke
The fundamental difference between cigar and cigarette smoke lies in its alkalinity, or higher pH level. Most large, premium cigars are made with air-cured tobacco, which produces smoke with a pH of 6.5 or higher, making it alkaline. This chemical environment causes the nicotine to exist predominantly in its un-ionized, or “free base,” form.
Free base nicotine is a potent form that easily permeates biological membranes, including the mucous membranes lining the mouth and nasal passages. This means that deep inhalation into the lungs is not necessary for the smoker to absorb a significant amount of nicotine. Furthermore, the alkaline smoke is inherently harsher and more irritating to the respiratory tract, which naturally discourages deep lung inhalation. The more acidic smoke of most cigarettes, by contrast, requires deep lung inhalation for efficient nicotine absorption.
How Smoking Technique Affects Exposure
The conventional method for consuming a cigar is “puffing,” where the smoke is drawn into the mouth to savor the flavor and then immediately expelled without passing into the lungs. This technique ensures that the nicotine is absorbed through the buccal mucosa, or the lining of the mouth, as intended. This practice, however, does not guarantee zero lung exposure.
Even with conscious puffing, some smoke is drawn into the lungs through incidental or involuntary inhalation, particularly when a large volume of smoke is involved. For former cigarette smokers who transition to cigars, the habit of inhaling can be retained, leading to conscious, deep inhalation of the cigar smoke. Inhaling cigar smoke significantly increases the amount of toxicants and nicotine delivered to the lower respiratory tract, similar to cigarette smoking.
The size of the cigar also influences the degree of inhalation, with smaller cigars and cigarillos often being inhaled more deeply, much like cigarettes. Evidence from studies measuring carboxyhemoglobin and plasma nicotine levels confirms that ex-cigarette smokers who smoke large cigars inhale and absorb significant amounts of nicotine and carbon monoxide. Therefore, while the technique is designed to avoid inhalation, smoke does get into the lungs for many smokers, either passively or intentionally.
Health Implications of Systemic Absorption
The two distinct pathways of absorption—oral and pulmonary—lead to serious health risks. Nicotine absorption through the buccal mucosa, even without inhalation, still results in systemic effects, including an increased heart rate and higher blood pressure. The constant exposure of the mouth, throat, and esophagus to the carcinogenic cigar smoke puts the smoker at a higher risk for cancers in the upper aerodigestive tract.
The full range of health dangers associated with cigar smoking approaches that of cigarette smoking when the smoke is inhaled. When cigar smoke reaches the lungs, whether incidentally or by design, the smoker faces an increased risk of lung cancer and chronic obstructive pulmonary disease (COPD). Cigar smoke contains higher concentrations of toxic and carcinogenic compounds than cigarette smoke, and deep inhalation introduces these substances directly to the delicate tissues of the lung.
Regardless of the inhalation technique, the cardiovascular system is affected by the absorbed nicotine, which is a potent vasoconstrictor and can impair endothelial function over time. The practice of simply puffing a cigar does not eliminate the risk of nicotine dependence or the high risk of cancers in the oral cavity and upper airways. Any exposure to cigar smoke, whether through the mouth or the lungs, carries substantial health consequences.