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Ills From Passive Smoking Found World-Wide

A world-wide study of men and women who have never smoked but who are exposed to environmental tobacco smoke, found a significant association with respiratory symptoms among them.

This emerges from a study in 36 centres in 13 European countries, Australia, New Zealand, and the United States which aimed to estimate the effect of passive smoking on respiratory symptoms.

Assessments were made of respiratory symptoms, bronchial responsiveness, lung function, and total serum IgE in the European Community Respiratory Health Survey.

Some previous studies showed that passive smoking among adults increases the risk and severity of asthma and respiratory symptoms, the researchers point out. Other studies have indicated that involuntary exposure results in significant impairment of lung function, and passive smoking has also been associated with increased serum concentrations of total IgE.

In the meta analysis, data was from 7,882 adults aged between 20 and 48 who had never smoked, from 36 centers in 16 countries. Information on passive smoking, respiratory symptoms, asthma, and allergic rhinitis was assessed through structured interviews; spirometry and methacholine challenge were carried out, and total and specific IgE were measured.

Effects of passive smoking was estimated by means of logistic and multiple linear regression for each country and combined across countries by random-effects meta-analysis.

In 12 of the 36 centres, more than half the participants were regularly involuntarily exposed to tobacco smoke. The prevalence of passive smoking in he workplace varied from 2.5 percent in Uppsala, Sweden, to 53.8 percent in Galdakao, Spain. Overall, the prevalence of passive smoking in the workplace varied more than 20-fold, with high rates in southern and central Europe and lower rates in New Zealand, Australia, the United States and Sweden.

Passive smoking was significantly associated with nocturnal chest tightness, nocturnal breathlessness , breathlessness after activity , and increased bronchial responsiveness. Passive smoking in the workplace was significantly associated with all types of respiratory symptoms and current asthma.

No significant association was found between passive smoking and total serum IgE.

The researchers declare that their analyses "indicate that the geographical variation in passive smoking is mainly related to the community prevalence of smoking. Differences in legislation and compliance with legislation between countries may also explain some of the variation in passive smoking in the workplace. A low community prevalence of smoking probably also facilitates legislation against involuntary tobacco exposure in the workplace."

Data from a recent World Health Organization report show that during the 1990s the prevalence of tobacco smoking decreased in some countries, such as Britain, France, and Sweden, whereas it remained stable in countries like Spain and Italy.

The investigators conclude:" Decreasing involuntary exposure to tobacco smoke in the community, especially in workplaces, is likely to improve respiratory health."

This study was directed by Dr Christer Janson, Department of Respiratory Medicine, Akademiska Sjukhuset, Uppsala, Sweden.
Lancet 2001; 358: 2103-09. "Effect of passive smoking on respiratory symptoms, bronchial responsiveness, lung function, and total serum IgE in the European Community Respiratory Health Survey: a cross-sectional study"

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