Continual smoking of mentholated cigarettes may mask the early warning symptoms of respiratory disease

Prev Med. 2003 Oct;37(4):291-6. doi: 10.1016/s0091-7435(03)00116-6.


Background: Continual use of cold preparations including those containing menthol for relief from congestion, cough, or difficulty in breathing can mask the early warning symptoms of respiratory dysfunction. These products usually carry a warning label on the packaging that indicates that they are not for continuous use and may mask the early warning symptoms of a more serious condition. Menthol can be delivered in many dosage forms including the smoke of a mentholated cigarette.

Methods: Literature searches were done for the NLM databases (e.g., MEDLINE from 1966, TOXLINE, OLDMEDLINE (1958-1965), CANCERLIT), plus tobacco industry documents and hardcopy indices. The evidence was evaluated with application to mentholated cigarette smoking.

Results: A logical progression is presented to attempt to demonstrate that the continuous smoking of mentholated cigarettes may also mask the early warning symptoms of respiratory distress. The early warning symptoms caused by chronic irritation of the respiratory tract may be reduced in severity when the menthol found in a mentholated cigarette is continually delivered to the tract.

Conclusion: This masking of the symptoms of an underlying respiratory disease can lead to delays in seeking medical attention resulting in a poor prognosis, additional suffering, and eventual death.

Publication types

  • Review

MeSH terms

  • Black or African American
  • Humans
  • Menthol / adverse effects*
  • Respiratory System / drug effects
  • Respiratory Tract Diseases / diagnosis*
  • Respiratory Tract Diseases / etiology
  • Smoking / adverse effects*
  • Smoking / ethnology


  • Menthol