Elsevier

The Lancet

Volume 358, Issue 9299, 22–29 December 2001, Pages 2103-2109
The Lancet

Articles
Effect of passive smoking on respiratory symptoms, bronchial responsiveness, lung function, and total serum IgE in the European Community Respiratory Health Survey: a cross-sectional study

https://doi.org/10.1016/S0140-6736(01)07214-2Get rights and content

Summary

Background

Passive smoking is widespread, and environmental tobacco smoke contains many potent respiratory irritants. This analysis aimed to estimate the effect of passive smoking on respiratory symptoms, bronchial responsiveness, lung function, and total serum IgE in the European Community Respiratory Health Survey.

Methods

This analysis included data from 7882 adults (age 20–48 years) who had never smoked, from 36 centres in 16 countries.Information on passive smoking, respiratory symptoms,asthma,and allergic rhinitis was gathered through a structured interview.Spirometry and methacholine challenge were carried out,and total and specific IgE were measured.The effect of passive smoking was estimated by means of logistic and multiple linear regression for each country and combined across countries by random-effects meta-analysis

Findings

In 12 of the 36 centres, more than half the participants were regularly involuntarily exposed to tobacco smoke. The prevalence of passive smoking in the workplace varied from 2·5% in Uppsala, Sweden, to 53·8% in Galdakao, Spain. Passive smoking was significantly associated with nocturnal chest tightness (odds ratio 1·28 [95% CI 1·02 to 1·60]), nocturnal breathlessness (1·30 [1·01 to 1·67]), breathlessness after activity (1·25 [1·07 to 1·47]), and increased bronchial responsiveness (effect −0·18 [−0·30 to −0·05]). Passive smoking in the workplace was significantly associated with all types of respiratory symptoms and current asthma (odds ratio 1·90 [95% CI 0·90 to 2·88]). No significant association was found between passive smoking and total serum IgE.

Interpretation

Passive smoking is common but the prevalence varies widely between different countries. Passive smoking increased the likelihood of experiencing respiratory symptoms and was associated with increased bronchial responsiveness. Decreasing involuntary exposure to tobacco smoke in the community, especially in workplaces, is likely to improve respiratory health.

Introduction

Passive smoking is widespread and causes exposure to many potent respiratory irritants.1, 2 In children, parental smoking is associated with respiratory symptoms and poorer lung function.3 The consequences of involuntary exposure to tobacco smoke have not been studied as extensively in adults as in children.4 Some studies have found that passive smoking in adulthood increases the risk and severity of asthma and respiratory symptoms.5, 6, 7 Several studies have indicated that involuntary exposure to tobacco in adults results in significant impairment of lung function.8, 9, 10 Passive smoking has also been associated with increased serum concentrations of total IgE.11, 12

Between 1990 and 1994, information on variation in asthma prevalence, known or suspected risk factors for atopy and asthma, and the management of asthma were collected in the European Community Respiratory Health Survey (ECRHS).13 The association between passive smoking and respiratory symptoms and asthma has so far been analysed in only one ECRHS study, which was based on data from the Swedish part of the survey; passive smoking in the workplace was found to increase the risk of symptomatic asthma in the workplace and asthma-related work disability.14

The aim of this analysis was to study the effect of passive smoking on respiratory symptoms, bronchial responsiveness, lung function, and total serum IgE in the ECRHS.

Section snippets

Population

The methods of the ECRHS have been described elsewhere.13 Participating centres selected an area defined by existing administrative boundaries with a population of at least 150 000. When possible, an appropriate local sampling frame was used to select randomly at least 1500 men and 1500 women, aged 20–44 years. In stage I, the ECRHS screening questionnaire was sent to participants. It asked about symptoms suggesting asthma, the use of medication for asthma, and the presence of hay-fever and

Results

The analysis included data from 36 centres in 16 countries. No data on bronchial responsiveness were available for two of the centres (Cardiff and Tartu). Altogether we included 3486 men and 4396 women (mean age 32·7 years [range 20–48]) who had never smoked. Of the 7882 questionnaire respondents included, spirometry was done for 6655, IgE measurements for 5985, and methacholine challenge for 5403. Data on occupational exposures in the current or last-held job were available from 30 of the 36

Discussion

The main findings in this investigation of adults who had never smoked are that reported passive smoking was common in all centres. However, the prevalence of passive smoking in the workplace varied more than 20-fold, with high rates in southern and central Europe and lower rates in New Zealand, Australia, the USA, and Sweden. Passive smoking increased the likelihood of experiencing respiratory symptoms and was also related to increased bronchial responsiveness. We found a positive association

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