Directly measured secondhand smoke exposure and COPD health outcomes.
Directly measured secondhand smoke exposure and COPD health outcomes.
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DOI：
10.1186/1471-2466-6-12
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发表时间：
2006-06-06
影响因子：
3.1
通讯作者：
Blanc, Paul D
中科院分区：
文献类型：
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作者：
Eisner, Mark D;Balmes, John;Blanc, Paul D
背景：尽管个人吸烟是慢性阻塞性肺疾病（COPD）最重要的病因和影响因素，但二手烟（SHS）暴露可能会影响该疾病的病程。尽管这个问题很重要，但二手烟暴露对慢性阻塞性肺疾病健康结局的影响仍然未知。
方法：我们使用了一项基于美国人群的多波慢性阻塞性肺疾病成年人队列研究中两轮的数据。77名被诊断患有慢性阻塞性肺疾病的非吸烟受访者基于尿可替宁和一个测量尼古丁的个人徽章完成了直接的二手烟监测。我们评估了二手烟暴露对慢性阻塞性肺疾病严重程度、身体健康状况、生活质量（QOL）以及随访一年时测量的呼吸困难的有效测量指标的纵向影响。
结果：通过尿可替宁测量的最高水平的二手烟暴露，在控制协变量后，与较差的慢性阻塞性肺疾病严重程度（平均得分增加4.7分；95%置信区间0.6到8.9）和呼吸困难（1.0分；95%置信区间0.4到1.7）在横断面研究中相关。在纵向分析中，基线可替宁的最高水平与更差的慢性阻塞性肺疾病严重程度（4.7分；95%置信区间 -0.1到9.4；p = 0.054）、疾病特异性生活质量（2.9分； -0.16到5.9；p = 0.063）以及呼吸困难（0.9分；95%置信区间0.2到1.6分；p < 0.05）相关，尽管置信区间并不总是排除无影响水平。
结论：直接测量的二手烟暴露似乎对慢性阻塞性肺疾病的健康结局有不利影响，且与个人吸烟无关。由于二手烟是一个可改变的风险因素，临床医生应该评估患者的二手烟暴露情况并建议避免接触。从公共卫生角度来看，二手烟暴露对这一脆弱亚人群的影响为禁止公共场所吸烟的法律提供了进一步的理论依据。
BACKGROUND: Although personal cigarette smoking is the most important cause and modulator of chronic obstructive pulmonary disease (COPD), secondhand smoke (SHS) exposure could influence the course of the disease. Despite the importance of this question, the impact of SHS exposure on COPD health outcomes remains unknown.METHODS: We used data from two waves of a population-based multiwave U.S. cohort study of adults with COPD. 77 non-smoking respondents with a diagnosis of COPD completed direct SHS monitoring based on urine cotinine and a personal badge that measures nicotine. We evaluated the longitudinal impact of SHS exposure on validated measures of COPD severity, physical health status, quality of life (QOL), and dyspnea measured at one year follow-up.RESULTS: The highest level of SHS exposure, as measured by urine cotinine, was cross-sectionally associated with poorer COPD severity (mean score increment 4.7 pts; 95% CI 0.6 to 8.9) and dyspnea (1.0 pts; 95% CI 0.4 to 1.7) after controlling for covariates. In longitudinal analysis, the highest level of baseline cotinine was associated with worse COPD severity (4.7 points; 95% CI -0.1 to 9.4; p = 0.054), disease-specific QOL (2.9 pts; -0.16 to 5.9; p = 0.063), and dyspnea (0.9 pts; 95% CI 0.2 to 1.6 pts; p < 0.05), although the confidence intervals did not always exclude the no effect level.CONCLUSION: Directly measured SHS exposure appears to adversely influence health outcomes in COPD, independent of personal smoking. Because SHS is a modifiable risk factor, clinicians should assess SHS exposure in their patients and counsel its avoidance. In public health terms, the effects of SHS exposure on this vulnerable subpopulation provide a further rationale for laws prohibiting public smoking.