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Chronic exposure to this smoke causes metaplastic alterations to the respiratory mucosa with an increase in the number and size of goblet cells and consequent increase in upper airway secretion.17,18 Cohen et al.13 and Kreindler et al.19 also showed in vitro that exposure to cigarette smoke inhibits chloride transport in epithelial cells, causing physiological alterations similar to those found in patients with cystic fibrosis

Research from NZ found changing the stick design could greatly reduce the appeal of smoking to young people and, importantly, among older people who smoke, 11, 12 a population group where declines in smoking prevalence have occurred more slowly than among other age groups

For use in joints, however, they are not suitable

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