Active Smoking Habit Research Articles

Cosinor Analysis of Circadian Peak Expiratory Flow Variability in Normal Subjects, Passive Smokers, Heavy Smokers, Patients with Chronic Obstructive Pulmonary Disease and Patients with Interstitial Lung Disease

Peak expiratory flow (PEF) presents a circadian rhythm with a maximum in the afternoon, and a significant variability in its diurnal variations has been reported in normal subjects and in chronic obstructive pulmonary disease (COPD). In order to investigate whether passive smoking, active tobacco smoking, COPD and interstitial lung disease (ILD) are associated with changes in the circadian rhythm of PEF, five groups of adult male subjects, comparable for age, weight and height, were studied: group A: 30 clinically healthy subjects who never smoked, group B: 30 subjects passively exposed to tobacco smoking, group C 30 heavy smokers (> 20 cigarettes daily for at least 5 years), group D: 30 patients with nonasthmatic COPD (emphysema and/or chronic bronchitis), and group E: 15 patients with ILD (pneumoconiosis). Active tobacco smoking and exposure to passive smoking were assessed by the determination of the urinary cotinine concentration. A portable spirometer was used to measure PEF over a whole day, at 0.00, 6.00, 8.00, 10.00, 12.00, 14.00, 16.00, 18.00, 20.00, 22.00, and 24.00 h, all subjects leading a normal life. The 'mean cosinor' method was used for statistical analyses; the PEF variability was evaluated by the amplitude percent mesor (daily mean). All groups showed diurnal fluctuations in PEF values with significant (p < 0.05) circadian rhythms. The peaks of PEF rhythms occurred in the early afternoon, without significant (p > 0.05) differences between the groups. The cosinor mean was significantly (p < 0.05) lower in heavy smokers, in passive smokers, and in COPD patients than in controls. Controls, passive smokers, heavy smokers, COPD and ILD patients presented a PEF amplitude percent mesor (95% confidence limits) of 6.26% (range 4.57-7.95), 7.79% (range 5.07-10.51), 12.60% (range 7.61-17.59), 17.19% (range 10.18-23.50), and 3.98% (range 2.09-5.87), respectively, with significant differences (p < 0.05) between all groups, except between controls and passive smokers. These data suggest that tobacco smoke, both passive and active, does not modify the circadian peak of PEF, but modifies significantly its mesor and amplitude. In this respect, heavy smokers have the same pattern of COPD: lower mesor and greater amplitude; passive smokers present an intermediate situation. An increased diurnal variability in PEF could be considered as an early index of tobacco smoke damage and of developing COPD. When studying diurnal PEF variability, active and passive smoking habits should be considered.

Progetto ATENA, a study on the etiology of major chronic diseases in women: design, rationale and objectives.

In spite of their important impact on populations, a number of diseases--all types of cancer and coronary heart disease in women--are "rare" events for statistical analysis and often analyzed in designs affected by selection and information biases, such as case-control studies. Large cohort studies based on the storage of biological specimens appear to be the most suitable solution for identifying risks for those diseases. Progetto ATENA, a study on the etiology of major chronic diseases in women is based on this design. Ten thousand women, aged 30-69 years, living in the area of the city of Naples, free of cancer and cardiovascular disease, are being recruited over a four-year period. Ten per cent of the cohort is being randomly selected from the electoral roles, the rest will be volunteers. Information on dietary habits, reproductive history, familiarity for chronic disease, active smoking habits and passive smoking exposure, physical activity, and socio-demographic data are being collected. Clinical data such as blood pressure, anthropometry, and electrocardiogram are also taken. All the participants provide biological samples of blood (fasting drawing) and urine (timed morning spot). The biological samples are processed in order to explore the main areas under study (nutritional markers, metabolism, endocrinology, genetics, environmental exposure markers, thrombogenesis). The samples are stored in liquid nitrogen (-196 degrees C) as soon as the blood and urine processing have been finished. An appropriate follow-up information system on the health status of the participants is being set up to estimate incidence and mortality rates.

Exposure of nonsmoking women to environmental tobacco smoke: a 10-country collaborative study

The interpretation and interpretability of epidemiologic studies of environmental tobacco smoke (ETS) depend largely on the validity of self-reported exposure. To investigate to what extent questionnaires can indicate exposure levels to ETS, an international study was conducted in 13 centers located in 10 countries, and 1,369 nonsmoking women were interviewed. The present paper describes the results of the analysis of self-reported recent exposure to ETS from any source in relation to urinary concentrations of cotinine. Of the total, 19.7 percent of the subjects had nondetectable cotinine levels, the median value was 6 ng/mg, and the cut-point of the highest decile was 24 ng/mg. The proportion of subjects misreporting their active smoking habit was estimated at between 1.9 and 3.4 percent, depending on whether cut-points of 50 or 100 ng/mg creatinine were used. Large and statistically significant differences were observed between centers, with the lowest values in Honolulu, Shanghai, and Chandigarh, and the highest in Trieste, Los Angeles, and Athens. Mean cotinine/creatinine levels showed a clear linear increase from the group of women not exposed either at home or at work, to the group of those exposed both at home and at work. Values were significantly higher for women exposed to ETS from the husband but not at work, than for those exposed at work but not from the husband. The results of linear regression analysis indicated that duration of exposure and number of cigarettes to which the subject reported being exposed were strongly related to urinary cotinine. ETS exposure from the husband was best measured by the number of cigarettes, while exposure at work was more strongly related to duration of exposure. After adjustment of number of cigarettes for volume of indoor places, a similar increase in cotinine (5 ng/mg) was predicted by the exposure to 7.2 cigarettes/8 h/40 m3 from the husband and 17.9 cigarettes/8 h/40 m3 at work. The results indicate that, when appropriately questioned, nonsmoking women can provide a reasonably accurate description of ETS exposure. Assessment of individual exposure to ETS should focus on daily duration and volume of indoor places where exposure occurred.

Zur Klinik und Pathogenese des ,,on-off"-Phänomens beim Parkinson-Syndrom

It was the aim of our study based on a group of 460 patients suffering from Parkinson's disease to find out possible pathogenetic linkups for the so-called "on-off" phenomenon. The method was based on two questionnaires of different structure, and in 90 cases we also called personally on the patient in his home. The patients were either known from neurological treatment they received at the Department of Neurology of the University of Essen, or were approached on-target via their membership in the German Parkinson Association. After evaluation, 43 patients with an on-off phenomenon and 81 with end-of-dose akinesia, as well as 336 patients without fluctuations of motility, could be classified and evaluated further. All patients with an on-off phenomenon or end-of-dose akinesia had received L-dopa treatment for several years; the average treatment period was 8.4 years in a patient with on-off phenomenon and 7.3 years in case of end-of-dose akinesia. Compared therewith, patients without fluctuations had only an average L-Dopa intake period of 5 years. It is a striking fact that in the patient group without fluctuations (n = 336) 51 patients (15.7%) had never taken an L-dopa preparation. 72.1% of the on-off group suffered from hyperkinesia before abrupt onset of the phase, while at the same time a recession of L-dopa efficacy was seen after several years of treatment. In about 40% of the questioned on-off patients we found that end-of-dose akinesia had preceded the on-off condition, and that the time correlation of the akinesia with the intake of the preparation was gradually abandoned. The age of the patients with on-off or end-of-dose patterns was, at the time of diagnosis, 55.6 or 54.2 years respectively. These patients were therefore much younger on the average than those of the comparative group without any disturbance of motility (60.1 years). On-off patients suffered comparatively more often from concomitant cardiovascular disease and their more active smoking habits were very noticeable. Taking the pathological specialities into consideration, it is recommended to critically reconsider the early use of L-dopa in relatively young patients with concomitant cardiovascular diseases, and to give preference in case of an indication for L-dopa to a combination treatment especially with MAO-B inhibitors and dopamin antagnonists in order to keep the daily L-dopa dose low. Arguments against L-dopa to be taken three times daily are discussed, as are the pros and cons of concomitant therapy.