Background The clinical significance of pipe and cigar use among persons with no history of cigarette smoking (?exclusive pipe/cigar use?) is incompletely understood.
 
Aim Test associations of exclusive pipe/cigar use with clinical cardiopulmonary outcomes and lung function in a multi-ethnic US general population-based sample of adults.
 
Methods Data were harmonized and pooled from 5 US cohorts. In never-cigarette smokers, pipe or cigar use and respiratory symptoms were self-reported on repeated standardized questionnaires. Clinical outcomes were defined by adjudication/administrative criteria. Incident airflow limitation (AL) and preserved ratio impaired spirometry (PRISm) were defined via longitudinal spirometry in participants with normal baseline lung function. Competing risk models were adjusted for demographics, anthropometry and comorbidities.
 
Results Among 8534 never-cigarette smoking adults (mean age 52yrs, 63% women, 62% white, 27% Black, median 28yrs follow-up), 169 (2%) were current pipe/cigar users and 423 (5%) were ever pipe/cigar users. Compared to never pipe/cigar users, the ever-users had higher risk of all-cause mortality, cardiopulmonary hospitalization/death, and incident PRISm, but not incident AL(Table). Similar results were seen in current users for PRISm. There were no associations with respiratory symptoms.
 
Conclusion Exclusive pipe/cigar use was associated with adverse cardiopulmonary outcomes.