Cigarette Smoking and Ozone-Associated Emergency Department Use for Asthma by Adults in New York City

Abstract

The association between ambient ozone (O3) and hospital use for asthma in children and adults is well documented. The question remains of whether there are susceptible subpopulations of asthmatic individuals who are particularly vulnerable to high O3 levels. Because tobacco use was prevalent in our cohort of inner-city adult asthmatic individuals (n = 1,216) in New York City (NYC), we investigated whether cigarette smoking was an effect modifier for asthma morbidity. We examined the relationship between personal tobacco use and O3-associated emergency department (ED) use for asthma in public hospitals in NYC. Three subpopulations were defined: never smokers (0 pack-yr), heavy smokers (>/= 13 pack-yr) and light smokers (< 13 pack-yr). Time-series regression analysis of ED use for asthma and daily O3 levels was done while controlling for temperature, seasonal/long-term trends, and day-of-week effects. Heavy smokers displayed an increased relative risk (RR) of ED visits for asthma in response to increases in 2-d lagged O3 levels (RR per 50 ppb O3 = 1.72; 95% confidence interval: 1.13 to 2.62). Logistic regression analysis confirmed that heavy cigarette use was a predictor of ED use for asthma following days with high O3 levels. Although adverse health effects of ambient O3 have also been documented in asthma populations not using cigarettes (e.g., children), our results suggest that in adult asthmatic individuals, heavy personal tobacco use may be an effect modifier for O3-associated morbidity.

Air pollution, aeroallergens and cardiorespiratory emergency department visits in Saint John, Canada

“…Further examination of effect modification by coincident exposure to tobacco smoke is also recommended. In a recent study examining ozone and asthma ED visits in New York City, a strong association was found for heavy smokers (defined as !13 pack years ), whereas none was found for light or never smokers (Cassino et al, 1999 ) . A somewhat higher risk of airpollution-related mortality was also observed in a longitudinal study in relation to tobacco smoke exposure (Dockery et al, 1993 ) .…”

What is the clinical effectiveness and cost-effectiveness of cytisine compared with varenicline for smoking cessation? A systematic review and economic evaluation

“…Relative risks for the incidence of each disease in the model for smokers were taken from the literature and used to calculate the expected number of cases in the cohort of smokers. 78,79 These data are reproduced in Table 19. …”

“…Relative risks for smokers, short-run and recent quitters were generated from the literature 78,79 and used to generate absolute probabilities of incidence. As can be seen, the incidence of smoking-related diseases is at least as high in smokers compared with recent quitters and in recent quitters compared with long-run quitters.…”

“…Relative risks of mortality for smokers, recent quitters and long-run quitters were generated from the literature. 78,79 The probability of smoking-related mortality is equivalent or lower for recent quitters compared with smokers, and for long-run quitters relative to recent quitters. …”

Clinical Characteristics of Smoking Asthmatics

“…Asthmatic smokers are also more likely to require hospital care than asthmatic non-smokers [7][8][9][10] . Furthermore, asthma-related morbidity and mortality is higher among smokers Original Article than non-smokers 3,11 .…”