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Respiratory Effects of Environmental Tobacco Exposure Are Enhanced by Bronchial Hyperreactivity

Division of Pulmonary Medicine, University Hospitals of Geneva, Geneva; Institute of Social and Preventive Medicine, University of Basel, Basel; Service of Pulmonology, University Hospital Lausanne, Lausanne; Zürcher Höhenklinik, Wald; Klinik Barmelweid, Aarau; and Hôpital Intercantonal de la Broye, Payerne, Switzerland; Division of Environmental Health, Keck School of Medicine, University of Southern California, Los Angeles, California; and Departments of Environmental Health and Epidemiology, Harvard School of Public Health, Boston, Massachusetts

Correspondence and requests for reprints should be addressed to Margaret W. Gerbase, M.D., Ph.D., Division of Pulmonary Medicine, University Hospitals of Geneva, 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland. E-mail: margaret.gerbase{at}hcuge.ch

Rationale: Exposure to environmental tobacco smoke (ETS) is associated with increased reports of respiratory symptoms and reduced lung function, but the long-term effects of ETS are unclear, notably in healthy individuals with bronchial hyperresponsiveness (BHR).

Objective: To assess the longitudinal effects of ETS exposure on the development of respiratory symptoms and spirometry in subjects with BHR.

Methods: The study population included 1,661 never-smokers from the SAPALDIA (Swiss Study on Air Pollution and Lung Diseases in Adults) cohort, assessed in 1991 (baseline) and 11 yr later, who were symptom-free at baseline. Incident reports of respiratory symptoms and results of spirometry were assessed at the follow-up survey.

Main Results: Exposure to ETS reported in the two surveys was strongly associated with the development of cough (odds ratio, 2.1; 95% confidence interval, 1.2–3.7; p = 0.01). In subjects with BHR exposed to ETS at both surveys, a trend for strong associations were observed for wheeze, cough, dyspnea, and chronic bronchitis; however, the association reached statistical significance only for the symptom of dyspnea (p < 0.01). Lower FEV₁/FVC (mean ± SD, 72.9 ± 7.7 vs. 76.8 ± 6.1%; p < 0.01) and FEF_25–75 (forced expiratory flow, midexpiratory phase)/FVC (mean ± SD, 56.1 ± 22.5 vs. 68.1 ± 21.6%; p < 0.01) were observed in subjects with BHR exposed to ETS compared with nonexposed subjects without BHR. Lower values were found in subjects continuing exposure by the follow-up survey.

Conclusion: Exposure to ETS was strongly associated with the development of respiratory symptoms in previously asymptomatic subjects with BHR within 11 yr. Furthermore, subjects with underlying BHR had reduced lung function at follow-up, thus suggesting a higher risk for the development of chronic respiratory disease in this subset of the population.

Key Words: bronchial hyperreactivity • cohort studies • environmental tobacco smoke • lung function • respiratory symptoms

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Exposure to environmental tobacco smoke (ETS) is associated with increased reports of respiratory symptoms and reduced lung function, but the long-term effects of ETS are unclear, notably in healthy individuals with bronchial hyperresponsiveness. What This Study Adds to the Field Exposure to ETS was significantly associated with the development of respiratory symptoms within eleven years. Subjects with underlying bronchial hyperresponsiveness had reduced lung function, suggesting a higher risk for the development of chronic respiratory disease.

 

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