Comparison of Heat-not-Burn-Tobacco-Products and Cigarette Use Effect on Lung Health Deterioration in Adults – A Single Center Experience
Aida Mujakovic 1, Saied Al Salloum2 , Besim Prnjavorac3 , Emir Cokic4
1 ¹Clinic for Pulmonary diseases and Tuberculosis “Podhrastovi”, Clinical Center University of Sarajevo, Bosnia and Herzegovina
2 Sarajevo Medical School, Sarajevo School of Science and Technology, Bosnia and Herzegovina
3 Department of Internal medicine, General Hospital Tešanj, Bosnia and Herzegovina
4 Department of Internal medicine, General Hospital “Prim. Dr. Abdulah Nakaš”, Bosnia and Herzegovina
Corresponding Author: Aida Mujakovic, MD, PhD. Clinic for Pulmonary Diseases and Tuberculosis; Clinical Center University of Sarajevo, Bosnia and Herzegovina; E-mail: mujakovic.aida@gmail.com; Phone: +387 33 290 608. ORCID ID: 0000-0002-0022-1482
Cite this article: Mujakovic A, Al Salloum S, Prnjavorac B, Cokic E. Comparison of Heat-not-Burn-Tobacco-Products and Cigarette Use Effect on Lung Health Deterioration in Adults – A Single Center Experience. Sar Med J 2025; 2(2):98-109. 
10.70119/0037-25
Pages: 98 – 109 / Published online: 16 December 2025
Original submission: 21 July 2025; Revised submission: 16 September 2025; Accepted: 29 November 2025
Abstract
Introduction. The harmful effect of cigarette use has been proven through existing studies, but the recent advanced use of heat-not-burn-tobacco-products (HNB) and its effect remains under observation.
Methods. To compare the overall effect of HNB tobacco products and conventional cigarette use (CCU), presuming that HNB tobacco products could induce fewer effects on lung health deterioration in adults.
Methods. Prospective cohort clinical study was conducted at the General Hospital “Prim. Dr. Abdulah Nakas” in the January-June 2025 timeframe. It included 60 adult participants divided into two groups: 30 HNB tobacco product users and 30 conventional cigarette smokers, each with a history of at least one year of continuous tobacco product use. Participants with a history of cardiovascular disease, diabetes mellitus, recent COVID-19 infection, malignancy, or mMRC dyspnea scale 3 and 4 were excluded. All participants underwent spirometry testing at baseline and after six months, including laboratory values measurements and a questionnaire with information on smoking history and respiratory symptoms. Ethical principles were rigorously upheld throughout the study.
Results. After six months, HNB users exhibited better-preserved FEV1 and small airway involvement (FEV1: 98% vs. 93%, p=0.01; FEF75: 100% vs. 76%, p=0.04) and peripheral oxygenation values (sO2: 96.0% vs. 95.0%, p<0.01) compared to conventional smokers. Conventional smokers showed higher pCO2 (5.75 vs. 5.30 kPa, p<0.01) and HCO3 levels (25.0 vs. 24.0 mEq/L,p<0.01), indicating compromised alveolar ventilation. Hematological analysis revealed elevated D-dimer (456 vs. 382 μg/L, p = 0.01) and triglyceride levels (1.70 vs. 1.40 mmol/L, p < 0.01) in HNB users, suggesting distinct inflammatory and metabolic profiles.
Conclusion. Patients using HNB tobacco products achieved better 6MWT and spirometry testing results and showed lower cholesterol and hs-CRP levels after six months of follow-up.
Keywords: smoking, spirometry, heat-not-burn, lung function decline, respiratory health.
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