Passive smoking linked with adverse pulmonary effects in adults

By Anthony J. Brown, MD

NEW YORK (Reuters Health) – Passive smoking in adulthood is associated with the development of respiratory symptoms and with increased bronchial responsiveness, according to a report published in the December 22/29 issue of The Lancet.

The report also indicates that passive smoking is common, but that the rates vary greatly among different countries. Passive smoking in the workplace appears to be a major problem in many European countries.

Dr. Christer Janson, from Uppsala University in Sweden, and colleagues analyzed data from 7882 adults who had never smoked to determine the prevalence and effects of passive smoking. The participants were drawn from 36 centers in 16 countries.

More than half of the participants from 12 of the centers were regularly and involuntarily exposed to second-hand smoke, the authors note. Passive smoking rates in the workplace ranged from 2.5% in Uppsala, Sweden, to 53.8% in Galdakao, Spain.

Subjects exposed to second-hand smoke were significantly more likely than nonexposed subjects to experience nocturnal chest tightness, nocturnal breathlessness, breathlessness after activity, and increased bronchial responsiveness. Exposure in the workplace was associated with the development of these symptoms and with current asthma.

"Passive smoking has been studied a lot in children," Dr. Janson told Reuters Health. "We know that if parents smoke, their children are more likely to develop asthma and airway infections," he added. "However, passive smoking hasn't really been studied in much detail in adults."

Dr. Janson observed "a dose-dependent relationship between respiratory symptoms and passive smoking." Also, "bronchial hyperresponsiveness, a more objective measure of airway disease, was also tied to passive smoking," he added.

"We also identified a large variation in passive smoking between different countries," Dr. Janson said. "The US, some Scandinavian countries, Australia, and New Zealand had low rates, while Spain and Italy had high rates," he noted. "The strongest relationship between respiratory symptoms and passive smoking occurred in the workplace."

Dr. Janson emphasized that "the current findings highlight the importance of having work places that are smoke-free." The present "data is from 1992 to 1994, so it is possible that the work place smoking rates identified may have improved," he said.

Lancet 2001;358:2103-2109.

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