Objectives-Vibration white finger (VWF), also known as "occupational Raynau
d's phenomenon", is marked by arterial hyperresponsiveness and vasoconstric
tion during cold stimulation. The impact of tobacco use, and by extension s
topping smoking, on the long term course of the disease has been inconclusi
vely characterised. The objectives of this study included assessment of the
impact of tobacco use on symptoms and on objective tests in shipyard worke
rs exposed to vibration, and in gauging the natural history of the disorder
after stopping exposure and changing smoking patterns.
Methods-In a cross sectional investigation, 601 current and former users of
pneumatic tools were evaluated subjectively for cold related vascular symp
toms, and tested by cold challenge plethysmography. There was follow up and
subsequent testing of 199 members of the severely effected subgroup of smo
kers and non-smokers, many of whom had stopped smoking in the interval betw
een tests. Effects of smoking and stopping smoking on symptoms and plethsym
ographic results were assessed.
Results-Symptoms and measured abnormal vascular responses related to cold w
ere more severe in smokers than in non smokers. Follow up of 199 severely e
ffected members of the cohort, all removed from exposure for 2 years, indic
ated that smokers were almost twice as likely to have more severe vasospasm
(test finger/ control finger systolic blood pressure% (FSBP%) <30) than we
re non-smokers (-32.2% v 17.4%). 53 Subjects who stopped smoking during the
interval between tests improved, and were indistinguishable from non-smoke
rs similarly exposed to vibration. Additional physiological benefits of sto
pping smoking were still apparent at further follow up examination, 1 year
later. Improvements evident on plethysmography were not accompanied by impr
ovements in symptoms, which were unaffected by smoking.
Conclusions-Smoking seems to delay physiological improvement in response to
cold challenge in workers with VWF, after the end of exposure to vibration
. Symptoms were less likely to improve over time than digital blood pressur
e, and were less affected by smoking.