Environmental Tobacco Smoke Exposure and Pulmonary Function among Adults in NHANES III: Impact on the General Population and Adults with Current Asthma. (Articles)
Eisner, Mark D., Environmental Health Perspectives
The impact of environmental tobacco smoke (ETS) exposure on adult pulmonary function has not been dearly 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 (FE[V.sub.1]), forced vital capacity (FVC), and FE[V.sub.1]/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 FE[V.sub.1] [-100 mL; 95% confidence interval (CI), -143 to -56 mL], FVC (-119 mL; 95% CI, -168 to -69 mL), and FE[V.sub.1]/FVC ratio (-1.77%; 95% CI, -2.18% to -1.36%). Among women with asthma, the highest cotinine tertile was also associated with decreased FE[V.sub.1] (-261 mL; 95% CI, 492 to -30 mL), FVC (-291 mL; 95% CI, -601 to 20 mL), and FE[V.sub.1]/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. Key words: asthma, environmental tobacco smoke, respiratory function tests, tobacco smoke pollution. Environ Health Perspect 110:765-770 (2002). [Online 14 June 2002]
Environmental tobacco smoke (ETS) exposure is widespread, affecting the majority of U.S. adults (1-3). A complex mixture of over 4,000 chemical compounds, ETS contains potent respiratory irritants such as sulfur dioxide, ammonia; formaldehyde, and acrolein (1,4). As a consequence, ETS exposure could negatively affect adult pulmonary function. Although ETS exposure during early life appears to attenuate the development of peak lung function (1), the impact of ongoing exposure on pulmonary function during adulthood has not been dearly determined.
Because adults with established asthma have chronic respiratory disease, they may be particularly susceptible to adverse health effects of ETS exposure. Reflecting this view, national asthma guidelines recommend that persons with asthma avoid ETS exposure (5). Clearly, understanding the impact of ETS exposure on health status among adult asthmatics has important clinical and public policy implications. Despite the importance of this question, existing data on the effect of ETS exposure on adults with asthma are surprisingly limited. The few previous epidemiologic studies in adults have suggested a relationship between ETS exposure and greater respiratory symptoms, medication use, and health care utilization for asthma (6-9). The effects of ETS exposure on pulmonary function among adults with asthma have not been well characterized.
Previous reports using data from the population-based Third National Health and Nutrition Examination Survey (NHANES III) have reported the prevalence of ETS exposure (2,10) and effects of ETS on childhood respiratory symptoms and pulmonary function (11). The present study examines the cross-sectional relationship between serum cotinine, a biomarker of ETS exposure, and pulmonary function in the general population of nonsmoking U. …