Environmental tobacco smoke exposure and pulmonary function among adults in NHANES III: impact on the general population and adults with current asthma.

Abstract

The impact of environmental tobacco smoke (ETS) exposure on adult pulmonary function has not been clearly determined. Because adults with asthma have chronic airway inflammation, they may be a particularly susceptible group. Using data from the Third National Health and Nutrition Examination Survey (NHANES III), I examined the cross-sectional relationship between serum cotinine, a biomarker of ETS exposure, and pulmonary function among 10,581 adult nonsmokers and 440 nonsmoking adults with asthma whose cotinine and spirometry data were available. I generated residuals, which are observed minus predicted values (based on Crapo equations), for forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio to adjust for age, sex, and height. In addition, I used multivariate linear regression to control for sociodemographic characteristics and previous smoking history. Most adults with and without asthma had detectable serum cotinine levels, indicating recent ETS exposure (85.7% and 83.4%, respectively). Among nonsmoking male participants, I found no evidence that ETS exposure was related to decreased pulmonary function. In the nonsmoking female stratum, the highest cotinine tertile was associated with a lower FEV1 [-100 mL; 95% confidence interval (CI), -143 to -56 mL], FVC (-119 mL; 95% CI, -168 to -69 mL), and FEV1/FVC ratio (-1.77%; 95% CI, -2.18% to -1.36%). Among women with asthma, the highest cotinine tertile was also associated with decreased FEV1 (-261 mL; 95% CI, -492 to -30 mL), FVC (-291 mL; 95% CI, -601 to 20 mL), and FEV1/FVC ratio (-1.6%; 95% CI, -3.3% to 0.19%). In conclusion, ETS exposure is associated with decreased pulmonary function in adult females, especially those with asthma. This analysis should provide further impetus for public policies that promote smoke-free environments.

Phthalate exposure and pulmonary function.

“…Previous pulmonary function analyses of the NHANES III data identified responses in women, but not in men, associated with serum cotinine measures of environmental tobacco smoke exposure (Eisner 2002). The magnitudes of the associations observed with MBP and MEP among men are similar to those observed for environmental tobacco smoke among women.…”

Lifetime environmental tobacco smoke exposure and the risk of chronic obstructive pulmonary disease

“…Previous studies have found moderate correlations between self-reported ETS exposure and biomarker levels (e.g., cotinine) or direct personal exposure monitoring (e.g., nicotine) [33,[37][38][39][40][41][42]. We cannot, however, exclude some systematic misclassification of ETS exposure.…”

“…Based on our results, the 95% confidence intervals for the lower exposure quartiles are compatible with a substantially increased risk of COPD. Moreover, we have previously shown that very low levels of ETS exposure can exacerbate adult asthma [33]. We have also shown that moderate levels of ETS exposure are associated with impaired pulmonary function [34].…”

Indoor exposures and acute respiratory effects in two general population samples from a rural and an urban area in Italy

“…In adults, the relevant role of ETS as a risk factor for the presence of respiratory symptoms/diseases among exposed subjects was shown in epidemiological studies (Leuenberger et al, 1994;Coultas, 1998;Jaakkola, 2002), while findings on lung function impairment are less consistent (Xu and Li, 1995;Eisner, 2002). Increased indoor concentrations of PM are associated with an increased frequency of respiratory symptoms of the lower respiratory tract in children (BraunFahrlander et al, 1992;Neas et al, 1994;Qian et al, 2002) and with adverse respiratory health effects in nonsmoker adults (Xu and Wang, 1993;Venners et al, 2001).…”