Chest
Volume 106, Issue 3, September 1994, Pages 746-749
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Clinical Investigations: Bronchial Reactivity
Indices of Morbidity and Control of Asthma in Adult Patients Exposed to Environmental Tobacco Smoke

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The study was undertaken to compare the indices of morbidity and control of asthma in 100 adult patients exposed to environmental tobacco smoke (ETS) inhalation (group 2), with 100 asthmatics not exposed (group 1). Exposure was established from the history of smoking by the patient's spouse and other close contacts. Asthma control and morbidity were assessed during their follow-up visits in the chest outpatient clinic by inquiring into the emergency department (ED) visits, hospitalization, acute episodes, requirement of parenteral drugs at home, corticosteroids, and maintenance bronchodilators in the preceding 1-year period. Index per patient was also calculated. Lung function was recorded by the measurement of forced expiratory flows on the same day of the follow-up visit. The mean age and disease duration were comparable, but the expiratory flows were lower in the patients exposed to ETS. More patients in group 2 required daily bronchodilators (66 percent) and intermittent corticosteroids (56 percent). The number of ED visits, acute episodes, and parenteral bronchodilators per patient were significantly more (p<0.01) in group 2 patients. Similarly, the number of weeks of absence from work and of corticosteroid requirement were more (p<0.01) in the ETS-exposed patients. We conclude that the control of asthma is poor and morbidity greater in adult patients with asthma exposed to ETS at home and/or at work.

Section snippets

Material and Methods

We studied 200 never-smoker patients with asthma of 15 to 50 years of age attending the chest outpatient clinic of our institute during a 1-year period during their follow-up visits. Patients were classified into group 1 or 2 depending on the history of absence or presence of ETS exposure. Enrollment of group 2 patients had to be continued for about 3 more months after group 1 to match the number of patients. At the time of the study, their conditions were fairly stable without any significant

Results

The mean age and disease duration of the two groups were comparable (Table 1). While mean VC (percent predicted) was almost similar, the forced expiratory flows such as FEV1 and FEF25-75% were lower (p<0.01) in group 2 than group 1 patients (Table I).

The number of patients requiring ED visits, hospitalization, and given parenteral injections of bronchodilators at home was similar in the two groups, but more patients in group 2 required daily maintenance bronchodilators and intermittent

Discussion

Although there is information available in children, there is a paucity of data on adverse effects of ETS exposure on lung function and disease severity in adults. Passive smoking in 276 children with asthma was positively associated with ED visits, but not hospitalization.10 The estimated mean annual increase in ED visits attributable to the presence of one or more smokers in the household was 1.34 ± 0.5, an increase of 63 percent over nonsmoking households.10 Passive smoking may also increase

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