Respiratory irritation from environmental tobacco smoke

TFOS Lifestyle: Impact of lifestyle challenges on the ocular surface

Many factors in the domains of mental, physical, and social health have been associated with various ocular surface diseases, with most of the focus centered on aspects of dry eye disease (DED). Regarding mental health factors, several cross-sectional studies have noted associations between depression and anxiety, and medications used to treat these disorders, and DED symptoms. Sleep disorders (both involving quality and quantity of sleep) have also been associated with DED symptoms. Under the domain of physical health, several factors have been linked to meibomian gland abnormalities, including obesity and face mask wear. Cross-sectional studies have also linked chronic pain conditions, specifically migraine, chronic pain syndrome and fibromyalgia, to DED, principally focusing on DED symptoms. A systematic review and meta-analysis reviewed available data and concluded that various chronic pain conditions increased the risk of DED (variably defined), with odds ratios ranging from 1.60 to 2.16. However, heterogeneity was noted, highlighting the need for additional studies examining the impact of chronic pain on DED signs and subtype (evaporative versus aqueous deficient). With respect to societal factors, tobacco use has been most closely linked to tear instability, cocaine to decreased corneal sensitivity, and alcohol to tear film disturbances and DED symptoms.

Estimating the Economic Impact of Secondhand Smoke on the Health of a Community

Purpose.

This study provides a model to estimate the health-related costs of secondhand smoke exposure at a community level.

Model Development.

Costs of secondhand smoke–related mortality and morbidity were estimated using national attributable risk values for diseases that are causally related to secondhand smoke exposure for adults and children. Estimated costs included ambulatory care costs, hospital inpatient costs, and loss of life costs based on vital statistics, hospital discharge data, and census data.

Application of the Model.

The model was used to estimate health-related costs estimates of secondhand smoke exposure for Marion County, Indiana. Attributable risk values were applied to the number of deaths and hospital discharges to determine the number of individuals impacted by secondhand smoke exposure.

Results.

The overall cost of health care and premature loss of life attributed to secondhand smoke for the study county was estimated to be $53.9 million in 2000—$10.5 million in health care costs and $20.3 million in loss of life for children compared with $6.2 million in health care costs and $16.9 million in loss of life for adults. This amounted to $62.68 per capita.

Conclusions.

This method may be replicated in other counties to provide data needed to educate the public and community leaders about the health effects and costs of secondhand smoke exposure.

(Ex-)smoking asthma patients in general and specialized Belgian practice

INTRODUCTION

Smokers are often excluded from asthma studies. In the present study, data are presented on the prevalence, characteristics and management approach of this patient population in the Belgian practice both at the level of general practitioners (GPs) and specialists.

MATERIALS AND METHODS

One hundred and nineteen smoking, non-smoking and ex-smoking patients (25-65 yrs) with asthma, COPD or both, were recruited by 33 GPs and 33 specialists. Data were obtained retrospectively from medical records. However, only a small number of files were complete.

RESULTS

The majority of COPD patients were (ex-)smokers: 94% in the specialist group, 78% in the GP group. Cardiovascular comorbidity appeared in both groups in the same frequency order: COPD>(ex-)smoking patients with asthma (AS)>non-smoking patients with asthma (ANS), with a significant difference between AS and ANS in the specialist population. Chronic cough during more than 3 months in two consecutive years was reported in 97% of COPD patients, in 71% of the AS patients and in only 25% of the ANS patients. The type of cough differed between AS and ANS in the GP group, with a higher prevalence of productive cough in the former. Treatment patterns observed were as expected according to diagnosis except for a disproportionate use of Tiotropium in AS in the GP group.

CONCLUSION

AS were somewhere in between COPD patients and ANS for a large number of the characteristics studied, suggesting that they are an intermediate phenotype between COPD and asthma.

Cigarette smoke suppresses Th1 cytokine production and increases RSV expression in a neonatal model

Respiratory syncytial virus (RSV) infects approximately 90% of young children by the age of 2 yr, with peak rates occurring during 2-6 mo of age. Exposure to side-stream cigarette smoke (SS) may increase the incidence or manifestation of an RSV infection. We hypothesized that exposure to SS would alter the subsequent immune response to RSV infection in neonatal mice. BALB/c mice were exposed to air or 1.5 mg/m3 of SS from day (d) 1 up to 35 d of age. A subset was intranasally infected with 4x10(4) PFU of RSV/g body wt on d 7 and rechallenged at 28 d of age. Immune responses were assessed on d 4 and 7 after RSV rechallenge. Both air- and SS-exposed mice responded to RSV rechallenge with neutrophilia and decreased Clara cell secretory protein levels within the lung. However, an increase in bronchoalveolar lavage fluid eosinophils, in addition to reduced levels of Th1 cytokines (IFN-gamma and IL-12), decreased lung tissue inflammation, and decreased mucus production was observed in SS-exposed mice compared with air-exposed mice after RSV rechallenge. Ultimately changes in cytokine and inflammatory responses due to SS exposure likely contributed to increased viral gene expression. These results suggest that SS exposure plays a significant role in shaping the neonatal response to RSV infection.

Support for smoking restrictions in bars and gaming areas: review of Australian studies

OBJECTIVE

To document levels of public support in Australia for smoking restrictions in licensed premises, including trends over time, and to examine the potential effects of a ban on patronage.

METHOD

Systematic review of published and unpublished studies of community and staff attitudes towards smoking in bars, gaming areas and related venues were identified using Medline, Current Contents, PsycINFO and AUSTHealth prior to September 2002. State and Territory health departments, cancer organisations and branches of the National Heart Foundation were approached. Cross-sectional surveys reporting data on attitudes towards smoking restrictions and/or perceptions of effects on patronage were sought. Two reviewers assessed studies for inclusion. One extracted data using pre-coded categories with checking by the second.

RESULTS

Thirty-four community and seven staff surveys were synthesised qualitatively, with greater emphasis given to surveys using random selection. All surveys conducted since 1993, which included the separate smoking area response option, have demonstrated majority support for some form of smoking restriction on licensed premises. From 2000, surveys with the ban option alone report majority support for prohibiting smoking completely in bars (52-68%) and gaming areas (64-76%). Support increased significantly after the Sharp damages award. Customer preference data indicate banning smoking is most likely to have a neutral or positive effect on patronage.

CONCLUSIONS AND IMPLICATIONS

Support for a ban on smoking in licensed premises has increased by almost 20% in the past decade. State and Territory governments should introduce legislation banning smoking in all indoor drinking and gaming areas immediately.

Cigarette smoke-induced airway hyperresponsiveness is not dependent on elevated immunoglobulin and eosinophilic inflammation in a mouse model of allergic airway disease

Epidemiologic studies suggest that children raised in homes of cigarette smokers have a higher incidence of asthma than children who are raised in homes of nonsmokers. We sought to develop an experimental model to understand the mechanisms involved. Female BALB/c mice were paired with male DO11.10 ovalbumin (OVA)-T cell receptor hemizygous (+/-) mice such that the offspring were either transgene positive (+/-) or negative (-/-). Mice were exposed to either air or mainstream cigarette smoke (100 mg/m(3) total particulate matter, 6 hours/day, 7 days/week) during pregnancy. Immediately after birth, newborn mice were exposed for 4 weeks to either air or sidestream cigarette smoke (SS; 5 mg/m(3) total particulate matter, 6 hours/day, 5 days/week) and then exposed for the following 6 weeks to either air, SS, OVA (5 mg/m(3), 6 hours/day, 5 days/week) or a combination of OVA-SS. DO11.10 +/- offspring exposed to OVA had increased airway hyperresponsiveness (AHR) to methacholine challenge, total IgE, OVA-specific IgE and IgG(1), lymphocytes, and neutrophils in bronchoalveolar lavage and perivascular and peribronchiolar inflammation. Exposure to SS alone caused a significant increase in AHR in both +/- and -/- mice. Transgene -/- mice did not exhibit AHR after OVA exposure unless it was delivered in combination with SS. When compared with OVA-only exposure, OVA-SS exposure decreased total IgE, OVA-specific IgE, and IgG(1) amounts in +/- mice. These results indicate that exposure to SS after birth enhanced AHR in offspring that are both predisposed (+/-) and nonpredisposed (-/-) to develop an allergic response to OVA, but this AHR was not associated with elevated lung eosinophilia or OVA-specific Ig amounts.

The miseries of passive smoking

Passive smoking is defined as an involuntary exposure to a combined but diluted cigarette sidestream smoke (SS, gas and particle phases that are evolved from the smoldering end of a cigarette while the smoker is not puffing) and the exhaled smoke from smokers. SS contains numerous cytotoxic substances such as polycyclic aromatic hydrocarbons (PAHs), aromatic amines, nitrosamines, heavy metals, poisonous gases, pesticide residues, and radioactive elements in quantities much higher than those found from the cigarette mainstream smoke (MS) which is puffed by smokers. Passive smoking is found to be the cause of death from cancers and cardiac disease. Furthermore, it damagingly involves reproductive organs, the nervous system, genetic materials, and is particularly hazardous to mother and child during pregnancy and to those with a history of asthma, chronic infections, induced or earned immune deficiency, or predisposed susceptibility.

Environmental risk factors for respiratory infections

In this study, the authors investigated the possible relationship between environmental-including dietary-factors and respiratory and ear infections in children. A sample of 304 children, aged 4-5 y, in Geneva, Switzerland, was studied. Mothers filled out a questionnaire that the authors provided. The questionnaire included items on food frequency, infections, and background factors (e.g., education, housing conditions, parents' smoking habits). Allergy was a risk factor for all infections, and mother's age was a protective factor. Humid conditions at home was a significant risk factor for cold, sore throat, and otitis (odds ratios = 2.71, 3.03, and 2.77, respectively); mold in the home was a significant risk factor for otitis (odds ratio = 2.80); and attending day-care centers was a significant risk factor for cold and bronchitis (odds ratios = 1.36 and 1.89, respectively). Dietary factors were not related to disease risk nor were environmental tobacco smoke or housing conditions generally related to an increased risk.

The nose versus the environment: 1982 and today

A brief overview of recent publications dealing with the effects of environmental pollutants on upper respiratory tract mucosa is presented. It mainly focuses on airborne irritants, substances inducing epithelial hyperplasia, metaplasia, and epithelial damage, and on inflammatory changes of nasal mucosa associated with environmental pollutants. Data from epidemiologic surveys, human exposure studies, animal experiments, and in vitro studies have improved present concepts of the significance of environmental pollutants for upper respiratory diseases. Although various national and international initiatives have resulted in a considerable reduction of indoor and outdoor pollutants within recent years, environmental pollutants continue to affect upper respiratory tract health of the population in urban areas and industrialized regions. Continuing efforts to reduce emissions of air pollutants are indispensable.

Odor sensitivity and respiratory complaint profiles in a community-based sample with asthma, hay fever, and chemical odor intolerance

This is a community-based study of odor sensitivity and respiratory complaints for persons reporting asthma (n = 14/141), hay fever (n = 72/140), and chemical odor intolerance (CI) (n = 41/181). CI, a symptom of multiple chemical sensitivity (MCS), was determined from self-ratings of feeling 'moderately' to 'severely' ill using the Chemical Odor Intolerance Index (CII). Index odors included perfume, pesticide, drying paint, new carpet odor, and car exhaust. Six additional odors [natural gas, disinfectants, chlorinated water, room deodorizers, and environmental tobacco smoke (ETS)] were also assessed in the health and environment survey. Asthmatics reported feeling 'frequently' to 'almost always' ill from the CII index odors of drying paint, new carpet odor, perfume, and cleaning agents compared to nonasthmatics. People with hay fever documented feeling 'frequently' to 'almost always' ill from pesticides, drying paint, and car exhaust compared to individuals without hay fever. The CI cited illness from air freshener, natural gas and chlorinated water, in addition to the index odors of perfume, paint, pesticides, new carpeting and auto exhaust. All three groups were significantly more likely to report feeling ill from ETS. People with asthma were significantly more likely to report lower lung complaints, such as wheeze and dyspnea. People with hay fever cited more chest tightness. The CI were significantly more likely to report upper and lower respiratory symptoms. Given this overlap in respiratory complaints, it could be that CI may serve to amplify these traditional immune-related disorders and/or suggest that having asthma or hay fever could make one more vulnerable to CI.

Relationships among respiratory infections, triggers of attacks, and asthma severity in children

The present study of asthmatic children examined relationships among the frequencies of prior respiratory infections (i.e., those prior to the development of asthma) and recent (past year) respiratory infections, asthma severity, and the impacts of 12 common asthma triggers: air pollution, allergy problems, anger, cigarette smoke, excitement, high humidity, high or low environmental temperature, laughter, nighttime hours, physical activity, respiratory infection, and stress or worry. Data on these variables were obtained through a survey in which 325 families completed questionnaires; 121 families had asthmatic children who were 2-20 years of age. Pearson correlational analyses revealed many significant positive correlations: The frequencies of prior and recent infections were correlated. The frequency of prior infections was correlated with the impacts of all asthma triggers except allergy problems, but the frequency of recent infections was correlated only with the impacts of air pollution, cigarette smoke, respiratory infection, and nighttime hours as triggers of asthma attacks. Asthma severity was correlated with the frequencies of prior and recent respiratory infections and with the impact of respiratory infection as an asthma trigger.

Association between creatinine-adjusted and unadjusted urine cotinine values in children and the mother's report of exposure to environmental tobacco smoke

OBJECTIVE

To examine the association between parents' report of their child's secondhand smoke exposure and various adjustments of cotinine concentrations in random urine samples.

METHODS

Urine cotinine and creatinine were measured in 109 six to 11-year-old children from predominantly upper middle-class families. Cotinine values were considered as: (a) unadjusted, (b) as a cotinine/creatinine ratio, (c) as adjusted based on a regression relationship between cotinine and creatinine, and (d) and (e) as a cotinine/creatinine ratio adjusted for age and sex.

RESULTS

Little overlap in cotinine values occurred between exposed and nonexposed children, and a dose-response relationship was noted between the parental report and the urine cotinine values (r = 0.67). A modest improvement occurred in the correlation when the cotinine/creatinine ratio was considered. Considering exposure to cigarette smoke outside the home as well as in the household only improved the correlation when the former exposure was heavy. A high degree of concordance exists between the parents' report of exposure and the child's urine cotinine.

CONCLUSIONS

The value of adjusting this biochemical parameter by various means may be a function of the particular sample being investigated, suggesting no one method is universally appropriate.

Effects of exposure to environmental tobacco smoke on a human tracheobronchial epithelial cell line

BEAS-2B cells, a human bronchial epithelial line immortalized by viral transformation, were exposed to sidestream tobacco smoke (STS) as a surrogate for environmental tobacco smoke (ETS) under biphasic culture conditions where the apical portion of the cells was in direct contact with the gas phase. Dose-dependent cytotoxicity was observed. In addition, induction of an as yet uncharacterized protein of molecular weight 45,000 was associated with exposure to STS. This protein might be part of a protective response of exposed cells, which do not show a classical heat shock response when exposed to STS. We conclude that STS and ETS can be directly cytotoxic to human airway epithelial cells in biphasic culture at concentrations not unreasonable for smoky indoor atmospheres. The model system described in this paper should be useful for studying the detailed mechanisms of cytotoxicity of, and protection from, ETS exposure in the human cells most directly exposed to ETS in vivo.

Exposure to passive smoking during pregnancy and childhood, and cancer risk: the epidemiological evidence

There are relatively few studies on the association between environmental tobacco smoke (ETS) during pregnancy and childhood, and cancer in childhood, adolescence or adulthood. The associations between maternal smoking during pregnancy and childhood cancer have been studied intensively, but there is no clear association overall, or for specific sites. The association between childhood cancer and smoking by the father in the preconceptional period, and by either parent during the child's lifetime, has been little studied. Again, no clear associations have been identified. However, evidence from studies of exposure to known carcinogens from ETS, and of genotoxic effects indicates that any effect, if present, is expected to be weak, and therefore could not have been detected by most of the studies which have been performed, due to the small number of cases included. There is some consistency of association between ETS exposure in childhood and the risk of lung cancers in adulthood. There is therefore a need for further epidemiological studies on ETS exposure during pregnancy and childhood and the occurrence of cancers.

Effects of sidestream smoke exposure and age on pulmonary function and airway reactivity in developing rats

Children exposed to environmental tobacco smoke (ETS) in their homes have increased cough, respiratory illness, airway obstruction, and hyperreactivity. Since an animal model is needed to understand the mechanism by which this occurs, our study was designed to determine if immature rats develop airway obstruction and increased airway reactivity when exposed to sidestream smoke (SSS, respirable suspended particulate concentration 1.00 +/- 0.03 mg/m3, CO concentration 6.48 +/- 0.29 ppm). In the first of 3 studies, rats were exposed to filtered air (FA) or SSS for 6 hr/day, 5 days/week from day 2 to week 8 or week 15 of life (n = 6-8 in each group). SSS exposure did not change lung resistance (RL), dynamic lung compliance (CLdyn), lung weight/body weight ratio (LW/BW), pulmonary artery pressure (PPA), body weight, or airway reactivity to methacholine (all P > 0.2, 2-way ANOVA). Regardless of exposure, lungs from younger rats were relatively heavier and more reactive to methacholine than lungs from older rats (P < 0.05, 2-way ANOVA). In the second study, 15-week-old rats were exposed to FA or SSS for 3 hr or for 4 days (6 hr/day, n = 6 in each group). SSS exposure again had no effect on CLdyn, RL, LW/BW, PPA, or airway reactivity to methacholine (all P > 0.2, ANOVA). In the third study, rats were exposed to FA or SSS from day 2 to week 11 of life (n = 7 in each group). SSS exposure reduced airway (P = 0.004) but not pulmonary artery (P = 0.63) reactivity to serotonin.(ABSTRACT TRUNCATED AT 250 WORDS)

Environmental tobacco smoke and the risk of cancer in adults

The apparent effect of environmental tobacco smoke (ETS) exposure on cancer risk has become an important social and political issue. The risk of cancer in non-smokers is often the main reason for prohibiting or restricting smoking in public places. A number of epidemiological studies have shown an association between ETS exposure and lung cancer. However, the strength of this association has still to be estimated. Only a few studies have reported on ETS and cancer from sites other than the lung in adults. No definite conclusions can be drawn at present from a critical review of the epidemiological evidence, but the suggestion of an association is present for sinonasal cancer, while bladder cancer does not seem to be associated to ETS exposure. Positive studies are available for cancers from other sites, including the breast, the uterine cervix and the brain, but these are difficult to interpret.