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Respir Res. 2019 Feb 14;20(1):33. doi: 10.1186/s12931-019-0996-z.

Second-hand smoke exposure in adulthood and lower respiratory health during 20 year follow up in the European Community Respiratory Health Survey.

Author information

1
Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany. claudia.flexeder@helmholtz-muenchen.de.
2
Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.
3
Universitat Pompeu Fabra (UPF), Barcelona, Spain.
4
CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
5
MRC-PHE Centre for Environment and Health, Imperial College London, London, UK.
6
National Heart and Lung Institute, Imperial College London, London, UK.
7
Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
8
University Hospital of Verona, Verona, Italy.
9
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
10
Department of Public Health, Aarhus University, Aarhus, Denmark.
11
Centre for International Health, University of Bergen, Bergen, Norway.
12
Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
13
Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
14
Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich (LMU), Munich, Germany.
15
Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.
16
Lung Clinic, Tartu University Clinics, Tartu, Estonia.
17
Servicio de Neumología del Complejo, Servicio de Salud de Castilla - La Mancha (SESCAM), Hospitalario Universitario de Albacete, Albacete, Spain.
18
Facultad de Medicina de Albacete, Universidad de Castilla - La Mancha, Albacete, Spain.
19
Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France.
20
Inserm, Sorbonne Université, Equipe EPAR - IPLESP, Paris, France.
21
Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
22
Department of Sleep, Landspitali National University Hospital of Iceland, Reykjavik, Iceland.
23
Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
24
Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
25
Department of Surgical and Perioperative Sciences, Surgery, Umea University, Umea, Sweden.
26
Institute for Advanced Biosciences, UGA-Inserm U1209-CNRS UMR 5309, Joint Research Center, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Site Santé - Allée des Alpes, 38700 La Tronche, Grenoble, France.
27
Inserm, UMR 1152, Pathophysiology and Epidemiology of Respiratory Diseases, Paris, France, UMR 1152, University Paris Diderot Paris, Paris, France.
28
Pulmonology Department, Galdakao-Usansolo Hospital, Galdakao, Biscay, Spain.
29
Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
30
Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.
31
Respiratory and Allergy Clinical Unit, Universitary Hospitalary Complex, Huelva, Spain.
32
Swiss Tropical and Public Health Institute, Basel, Switzerland.
33
Department of Public Health, University of Basel, Basel, Switzerland.
34
Pulmonary Department, Hospital Galdakao, Galdakao, Biscay, Spain.
35
Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
36
Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.

Abstract

BACKGROUND:

Early life exposure to tobacco smoke has been extensively studied but the role of second-hand smoke (SHS) for new-onset respiratory symptoms and lung function decline in adulthood has not been widely investigated in longitudinal studies. Our aim is to investigate the associations of exposure to SHS in adults with respiratory symptoms, respiratory conditions and lung function over 20 years.

METHODS:

We used information from 3011 adults from 26 centres in 12 countries who participated in the European Community Respiratory Health Surveys I-III and were never or former smokers at all three surveys. Associations of SHS exposure with respiratory health (asthma symptom score, asthma, chronic bronchitis, COPD) were analysed using generalised linear mixed-effects models adjusted for confounding factors (including sex, age, smoking status, socioeconomic status and allergic sensitisation). Linear mixed-effects models with additional adjustment for height were used to assess the relationships between SHS exposure and lung function levels and decline.

RESULTS:

Reported exposure to SHS decreased in all 26 study centres over time. The prevalence of SHS exposure was 38.7% at baseline (1990-1994) and 7.1% after the 20-year follow-up (2008-2011). On average 2.4% of the study participants were not exposed at the first, but were exposed at the third examination. An increase in SHS exposure over time was associated with doctor-diagnosed asthma (odds ratio (OR): 2.7; 95% confidence interval (95%-CI): 1.2-5.9), chronic bronchitis (OR: 4.8; 95%-CI: 1.6-15.0), asthma symptom score (count ratio (CR): 1.9; 95%-CI: 1.2-2.9) and dyspnoea (OR: 2.7; 95%-CI: 1.1-6.7) compared to never exposed to SHS. Associations between increase in SHS exposure and incidence of COPD (OR: 2.0; 95%-CI: 0.6-6.0) or lung function (β: - 49 ml; 95%-CI: -132, 35 for FEV1 and β: - 62 ml; 95%-CI: -165, 40 for FVC) were not apparent.

CONCLUSION:

Exposure to second-hand smoke may lead to respiratory symptoms, but this is not accompanied by lung function changes.

KEYWORDS:

Adults; Asthma; Bronchitis; ECRHS; Lung function; Respiratory symptoms; Smoking

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