Cigarette Filters Really Reduce Damages of Smoking?

Does The Use Of Filtered Mouth-Pieces Reduce the Nicotin Exposure in Smoking People?


Smoking the tobacco leaves in cigarette, pipe or cigar results in the absorption and metabolization of nicotine. The mean metabolite of nicotine is cotinine. It is widely know that there is a relationship between smoking and CHD, cancer, stroke. On the other hand it is documented that the usage of different type of combinations of filtered mouth- pieces decreases the negative effects of tobacco. In our study we investigated the effect of application of the filtered mouth-pieces to the smokers on the nicotine exposure. such as such as

14 volunteer smokers were included to the study. Urine specimens of participants were gathered before using filtered mouth-pieces. Then volunteers used the filtered mouth-pieces for a week time, in each cigarette and after one week the urine specimens were gathered again and cotinine levels were measured.

According to the results of our study filtered mouth-pieces significantly decrease the urine cotinine levels (Before use: 6158,05±6580,57 ng/mL; after use: 4290,74±4706,86ng/mL; p = 0,019).

The decrease in nicotine levels with the use of filtered mouth-pieces could decrease the mortality and morbidity due to smoking. Recent studies state that the own filters of cigarettes are functionally insufficient and do not protect adequately. So, using an external filter like the one in our study could provide an extra protection, but this protection will be within certain limits, undoubtedly.

Key Words: Filtered mouth- pieces, Cotinine, Smoking


The dry leaves of tobacco plant Nicotania tabaccum are the main source of nicotine in humans. When the leaves are smoked, smoking in a pipe or cigar, nasally taken or chewed, nicotine is rapidly absorbed and dispersed over a large area in the body

  • Nicotine is metabolized by oxidation through several metabolites including cotinine
  • Cotinine is the main metabolite in which 70-80% of nicotine is metabolized
  • It has been show that smoking from cigarette nicotine-containing products is related to cancer such as
  • or coronary artery disease and stroke
  • Tobacco use during pregnancy leads to an increase in spontaneous abortion and perinatal mortality; It is also associated with a decrease in maternal weight increase and a decrease in pregnant and infant weight
  • Kaiserman and Rickert, in their study with different branded tobacco, suggested that the main factor that determines the effect of toxic components is the combination of filter nozzle and cigarette filter
  • In another study, it was claimed that a special type of filter nozzle resulted in a significant decrease in the content of urinary nicotine and this decrease was due to the reduction of nicotine passing from cigarette to the organism by the filter nozzle
  • In the light of research that claims that the use of cigarette is a serious health problem as well as the use of filter and filter nozzle to reduce the exposure to nicotine from the toxic products of the cigarette, this study tested whether nicotine exposure could be reduced only by the use of external mouthpiece without applying any change in smoking habits. such as


The study included a group of 14 volunteer cigarette smokers with no systemic or respiratory pathology, consisting of the students of the Faculty of Medicine and hospital staff of the Faculty of Medicine. After determination of age and smoking characteristics of the subjects included in the study, initial urine samples (urine samples before using filter mouthpiece) were taken. such as

The samples were centrifuged before being stored against turbidity and the supernatant was stored in the cooler for 1 week. Participants were given a cigarette filter with a cigarette for 1 week. During this time, the participants did not change their smoking habits and the brand they smoked. such as

The urine samples of the participants were taken again after the use of a weekly filter nozzle. Before and after filter nozzle samples were measured by a nicotine metabolite kit from DPC in a gamma counter. For the qualitative and quantitative measurement of urinary cotinine, the main urinary metabolite of nicotine, 125 I radioimmunoassay kit based on the double antibody principle of DPC was used.

The working principle of the double-antibody nicotine metabolite kit of DPC is based on a liquid phase radioimmunoassay method for antibody binding sites, where cotinine in the patient urine samples and 125I-labeled cotinine are competed. The CV of the measurement is less than 10%. such as


A total of 14 people were included in our study: 5 women (35.7%) and 9 men (64.3%). The mean age of the subjects was 28.5 ± 7.82 (min: 20 – max: 48). such as

The mean urine cotinine levels before using the filter mouthpiece were 6158.05 ± 6580.57 ng / ml (min: 1203.6 – max: 24480 ng / ml). After one week of use of the filter nozzle, these values decreased to 4290,74 ± 4706,86 ng / ml (min: 791,84 47 max: 18960 ng / ml) (Figure 1). It was observe that urine cotinine levels decreased with the use of filtered mouthpiece (Wilcoxon Ranks Sum test, z = 2.35; p = 0.019).

Mean urine cotinine levels Before used filters

Cigarette Filters
Cigarette filters

                                                         After used filters


Figure 1. Mean urinary cotinine levels before and after use of mouthpiece such as

There was no significant correlation between urine cotinine levels and age before and after use of filter mouthpiece (p> 0.05). There was a. Moderate idrar positive correlation between the number of cigarettes consumed per day and the levels of urine cotinine before the use of filter mouthpiece (r = 0.56) (Figure 2). This correlation was statistically significant (p <0.05). The same level of positive correlation was found between the number of cigarettes and the use of filtered mouthpiece after urinary cotinine levels (r = 0.47) (Figure 3); however, it was not significant (p> 0.05).

Number of smoke / days

Figure 2. Number of cigarettes and the level of urine cotinine before using cigarette filters mouthpiece such as

Number of smoke / days

Figure 3. Cigarette count and urinary cotinine levels after using cigarette filters mouthpiece such as


  • Measurement of metabolites such as cotinine in determining smoking is more advantageous than methods such as carboxy Hb or thiocyanate determination. This is because cotinine and other nicotine metabolites are specific to tobacco use; such as such as such as such as
  • However, parameters such as carboxy Hb or thiocyanate can be observe as a result of exposure to other environmental factors. Moreover, while the half-life of cotinine and other nicotine metabolites in blood and urine is over 10 hours (3), nicotine itself and carboxy Hb have a much shorter half-life
  • Plasma nicotine and thus urinary cotinine levels vary depending on the amount of nicotine in the cigarette
  • Therefore, in such research, it is more accurate for individuals to use the same cigarette as the standard nicotine content. such as such as
  • However, this standardization was not make in order to prevent the adaptation of smokers to research and they were allow to use the brand they always used. Nevertheless, prior to the use of filtered mouthpieces, a correlation was observe between the amount of cigarette consumed daily and urine cotinine levels.
  • (Figure 2). In a study conducted by Maritta S. et al., No correlation was found between salivary cotinine levels and daily number of cigarette consumption in up to 20 cigarettes per day.
  • This unexpected result was attributed to more exposure by young subjects because they inhaled cigarettes more frequently and deeply
  • However, there are also several studies showing that serum cotinine levels increase in direct proportion to the amount of cigarettes smoked daily
  •  In our study, a positive correlation was observe between the number of cigarettes and urine cotinine levels (Figure 2). The mean urine cotinine levels were decrease in smokers using a filter mouthpiece for a week compare to before (Figure 1). These decreases are statistically significant. This finding is consistent with some research in the literature
  • (No correlation was found between pre- or post-treatment mouth-to-mouth cotinine levels. This is not significant even if there is a low negative correlation between age and the use of mouthpiece and post-urine cotinine levels. This finding does not support the research that Maritta and colleagues found higher levels of salivary cotinine with less cigarette consumption in younger subjects cigarette filters cigarette filters
  • In recent years, low tar and nicotine cigarettes have been market as safer than high tar and nicotine cigarettes. such as such as
  • However, select cohort studies in the United Kingdom and the United States Despite the widespread use of tar and nicotine-reduced cigarettes in older people smoking from 1950 to 80, the risk of lung cancer has continued to increase. such as such as
  • The change in the use of filter products among male smokers who started to smoke during World War II and after World War II smokers was not able to prevent the progressive increase in lung cancer
  • There is no significant evidence that changes in cigarette designs for individual smokers or the whole community result in a significant benefit such as
  • In an excerpt from the Framingham study, it was note that filter smokers were less likely to have cardiovascular symptoms than unfilter smokers; however, it was also report that the incidence of cardiovascular disease is not lower in non-filtered smokers than in unfilter smokers when the incidence of cardiovascular disease is present
  • In addition, people with a low content of cigarette smoke, sometimes the ventile filters, finger, lip or tape because of the exposure to more exposure. It has been show that clogging of the holes has a great effect on the toxic products they give out
  • On the other hand, it is know that cigarette filters containing cellulose acetate or activate charcoal may cause digestion and respiration of the cellulose acetate or carbon particles during breathing, which is a serious health problem. Therefore, today’s cigarette filters are defective such as
  • In our study, it was observe that the use of filter mouthpiece in cigarette smoking significantly decrease urine cotinine levels. This is an important result, given the trends
  • That a fall in nicotine from smoking may cause a reduction in smoking-relate mortality.
  • On the other hand, this type of exogenous filter nozzle application can provide additional protection against insufficient protection from defective cigarette filters. It is also an additional risk factor to increase the exposure to cigarette intake in deeper and longer breaths to overcome the blockade create by the filter or filter mouthpiece such as
  • This type of external filter nozzle applications may be useful in preventing nicotine exposure. However, information regarding the cancer and cardiovascular disorders that long-term smoking can cause is still insufficient to say that filtered mouthpieces play a preventive role. such as


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