Abstract
BackgroundEnvironmental tobacco smoke (ETS) has adverse effects on the health of asthmatics, however the harmful consequences of ETS in relation to asthma severity are unknown.MethodsIn a multicenter study of severe asthma, we assessed the impact of ETS exposure on morbidity, health care utilization and lung functions; and activity of systemic superoxide dismutase (SOD), a potential oxidative target of ETS that is negatively associated with asthma severity.FindingsFrom 2002–2006, 654 asthmatics (non-severe 366, severe 288) were enrolled, among whom 109 non-severe and 67 severe asthmatics were routinely exposed to ETS as ascertained by history and validated by urine cotinine levels. ETS-exposure was associated with lower quality of life scores; greater rescue inhaler use; lower lung function; greater bronchodilator responsiveness; and greater risk for emergency room visits, hospitalization and intensive care unit admission. ETS-exposure was associated with lower levels of serum SOD activity, particularly in asthmatic women of African heritage.InterpretationETS-exposure of asthmatic individuals is associated with worse lung function, higher acuity of exacerbations, more health care utilization, and greater bronchial hyperreactivity. The association of diminished systemic SOD activity to ETS exposure provides for the first time a specific oxidant mechanism by which ETS may adversely affect patients with asthma.
Highlights
Asthma is a chronic inflammatory disorder of the airways involving complex interactions of cells and mediators, which lead to oxidative and nitrosative modifications of airway proteins [1,2,3,4,5] that are relevant to the initiation and maintenance of inflammation [3,4,5,6,7]
Parental smoking is associated with poorer lung functions in asthmatic children, and the relative risk of asthma is greater in children exposed to cigarette smoking by both parents compared with smoking of neither parent [11,12,13,14,15]
A substantial portion of the nonsevere asthmatic group exposed to Environmental tobacco smoke (ETS) was of African heritage (41.3%) as compared to the ETS unexposed group (23.4%) (TABLE 1)
Summary
Asthma is a chronic inflammatory disorder of the airways involving complex interactions of cells and mediators, which lead to oxidative and nitrosative modifications of airway proteins [1,2,3,4,5] that are relevant to the initiation and maintenance of inflammation [3,4,5,6,7]. The protein modifications occur as a result of endogenous inflammatory processes in asthma and from inhalation of exogenous environmental oxidants. Environmental tobacco smoke (ETS) has adverse effects on the health of asthmatics, the harmful consequences of ETS in relation to asthma severity are unknown
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