You are using an outdated browser. Please upgrade your browser to improve your experience.
Become a Fellow
ACP offers a number of resources to help members make sense of the MOC requirements and earn points.
Understanding MOC Requirements
Earn MOC points
The most comprehensive meeting in Internal Medicine.
April 11-13, 2019
Internal Medicine Meeting 2019
Prepare for the Certification and Maintenance of Certification (MOC)
Exam with an ACP review course.
Board Certification Review Courses
MOC Exam Prep Courses
Treating a patient? Researching a topic? Get answers now.
Visit AnnalsLearn More
Visit MKSAP 17 Learn More
Visit DynaMed Plus
Ensure payment and avoid policy violations. Plus, new resources to help you navigate the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Access helpful forms developed by a variety of sources for patient charts, logs, information sheets, office signs, and use by practice administration.
ACP advocates on behalf on internists and their patients on a number of timely issues. Learn about where ACP stands on the following areas:
© Copyright 2018 American College of Physicians. All Rights Reserved. 190 North Independence Mall West, Philadelphia, PA 19106-1572
Toll Free: (800) 523.1546 · Local: (215) 351.2400
Graham Barr, MD, DrPH, discusses how pipe and cigar smoking
negatively affect lung function
Philadelphia, February 16, 2010 - According to a new study being
published in Annals of Internal Medicine, the flagship journal of
the American College of Physicians, pipe and cigar smoke may be
more harmful than once thought. While some believe pipes and cigars
are healthier than cigarettes, a major known cause of chronic
obstructive pulmonary disease (COPD), the study directly links pipe
and cigar smoking to decreased lung function.
Researchers conducted a population-based study to determine
whether pipe and cigar smoking was associated with elevated
cotinine levels (the end product of tobacco, which can be detected
in the urine), decrements in lung function, and increased odds of
airflow obstruction. Among 3,528 participants, those who did not
smoke cigarettes but did smoke pipes or cigars were more likely to
have airflow obstruction than those who had never smoked.
While cotinine levels among current pipe and cigar smokers were
lower than among current cigarette smokers, the relative
differences in cotinine levels may reflect differences in nicotine
absorption but not necessarily exposure to harmful products of
"Our study shows that pipe and cigar smoking is associated with
decrements in lung function that are consistent with obstructive
lung disease," said R. Graham Barr, MD, Dr.PH, Assistant Professor
of Medicine and Assistant Professor of Epidemiology at Columbia
Presbyterian and lead author of the study. "These findings,
together with increased cotinine levels in current pipe and cigar
smokers, suggest that long-term pipe and cigar smoking may damage
the lungs and contribute to the development of COPD. Physicians
should consider pipe and cigar smoking a risk factor for COPD and
counsel their patients to quit."
In a related editorial, Michael B. Steinberg, MD, MPH, of the
University of Medicine and Dentistry of New Jersey, Robert Wood
Johnson Medical School, stresses the importance of educating the
public, and expresses concern for the rising rate of tobacco use in
the United States.
"We are now witnessing the concerning trend of increased use of
other tobacco products," Dr. Steinberg writes. "As changes in
public health policy have made cigarette smoking less socially
acceptable, a distinct set of characteristics are associated with
cigar and pipe use, such as sophistication, affluence, education,
and celebration. These images, largely fostered by the tobacco
industry, perpetuate the idea that these products play a suitable
role in our society."
The American College of Physicians is the largest
medical specialty organization and the second-largest physician
group in the United States. ACP members include 129,000 internal
medicine physicians (internists), related subspecialists, and
medical students. Internists specialize in the prevention,
detection, and treatment of illness in adults. Follow ACP on
Twitter and Facebook.
About Annals of Internal MedicineAnnals of Internal Medicine is one of the five most widely
cited peer-reviewed medical journals in the world, with a current
impact factor of 17.5. The journal has been published for 82 years.
It accepts only 7 percent of the original research studies
submitted for publication.