Measurement of environmental tobacco smoke exposure among adults with asthma
Measurement of environmental tobacco smoke exposure among adults with asthma
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DOI：
10.2307/3454823
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发表时间：
2001-08-01
影响因子：
10.4
通讯作者：
Blanc, PD
中科院分区：
文献类型：
--
作者：
Eisner, MD;Katz, PP;Blanc, PD
由于成人哮喘的发病率和死亡率一直在增加，因此识别加剧哮喘的可改变的环境暴露已成为当务之急。有限的证据表明，暴露于环境烟草烟雾 (ETS) 可能会对患有哮喘的成人产生不利影响。为了更好地研究 ETS 的影响，我们开发了一种调查工具来测量居住在加利福尼亚州北部的哮喘成人队列中的 ETS 暴露情况，该地区的公共室内吸烟受到限制。为了验证该调查工具，我们使用了被动徽章监视器来测量环境尼古丁的实际暴露量，这是 ETS 的直接且具体的测量方法。在这项验证研究中，我们从正在进行的纵向哮喘队列研究中招募了 50 名受试者，他们对 ETS 暴露或潜在暴露有积极的筛查问题。每个受试者佩戴被动尼古丁徽章监测器 7 天。个人监测期结束后，我们重新启用了 ETS 暴露调查工具。根据调查，自我报告的过去 7 天内接触 ETS 的总持续时间为 0 至 70 小时。根据上限，酒吧或夜总会（55 小时）和家庭（50 小时）是与最大自我报告暴露相关的场所。通过个人尼古丁徽章监测仪测量，7 天尼古丁浓度总体中位数为 0.03 mug/m(3)（第 25-75 个四分位数范围为 0-3.69 mug/m(3)）。在报告家庭暴露的人中测得的尼古丁浓度最高（中位数为 0.61 杯/米（3）），其次是工作暴露（0.03 杯/米（3））、其他（室外）暴露（0.025 杯/米（3））和无暴露（0 杯/米（3）；p = 0.03）。自我报告的 ETS 暴露持续时间与同一 7 天内直接测量的个人尼古丁浓度之间的 Spearman 等级相关系数为 0.47，支持了调查的有效性（p = 0.0006）。与没有测量暴露的人相比，水平较低[比值比 (OR) 1.9； 95% 置信区间 (CI)，0.4-8.8] 和较高水平的 ETS 暴露（OR 6.8；95% CI，1.4-32.3）与呼吸道症状风险增加相关。一个简短的、经过验证的调查工具可用于评估成人哮喘患者的 ETS 暴露，即使暴露水平较低。该仪器可能是研究 ETS 暴露对成人哮喘健康结果影响的宝贵工具。
Because the morbidity and mortality from adult asthma have been increasing, the identification of modifiable environmental exposures that exacerbate asthma has become a priority. Limited evidence suggests that exposure to environmental tobacco smoke (ETS) may adversely affect adults with asthma. To study the effects of ETS better, we developed a survey instrument to measure ETS exposure in a cohort of adults with asthma living in northern California, where public indoor smoking is limited. To validate this survey instrument, we used a passive badge monitor that measures actual exposure to ambient nicotine, a direct and specific measure of ETS. In this validation study, we recruited 50 subjects from an ongoing longitudinal asthma cohort study who had a positive screening question for ETS exposure or potential exposure. Each subject wore a passive nicotine badge monitor for 7 days. After the personal monitoring period, we readministered the ETS exposure survey instrument. Based on the survey, self-reported total ETS exposure duration ranged from 0 to 70 hr during the previous 7 days. Based on the upper-range boundary, bars or nightclubs (55 hr) and the home (50 hr) were the sites associated with greatest maximal self-reported exposure. As measured by the personal nicotine badge monitors, the overall median 7-day nicotine concentration was 0.03 mug/m(3) (25th-75th interquartile range 0-3.69 mug/m(3)). Measured nicotine concentrations were highest among persons who reported home exposure (median 0.61 mug/m(3)), followed by work exposure (0.03 mug/m(3)), other (outdoor) exposure (0.025 mug/m(3)), and no exposure (0 mug/m(3); p = 0.03). The Spearman rank correlation coefficient between self-reported ETS exposure duration and directly measured personal nicotine concentration during the same 7-day period was 0.47, supporting the survey's validity (p = 0.0006). Compared to persons with no measured exposure, lower-level [odds ratio (OR) 1.9; 95% confidence interval (CI), 0.4-8.8] and higher-level ETS exposures (OR 6.8; 95% Cl, 1.4-32.3) were associated with increased risk of respiratory symptoms. A brief, validated survey instrument can be used to assess ETS exposure among adults with asthma, even with low levels of exposure. This instrument could be a valuable tool for studying the effect of ETS exposure on adult asthma health outcomes.