Reported Smoke Exposure Research Articles

The effect of biomass smoke exposure on quality-of-life among Ugandan patients treated for tuberculosis: A cross-sectional analysis

More than half the global population burns biomass fuels for cooking and home heating, especially in low-middle income countries. This practice is a prominent source of indoor air pollution and has been linked to the development of a variety of cardiopulmonary diseases, including Tuberculosis (TB). The purpose of this cross-sectional study was to investigate the association between current biomass smoke exposure and self-reported quality of life scores in a cohort of previous TB patients in Uganda. We reviewed medical records from six TB clinics from 9/2019-9/2020 and conducted phone interviews to obtain information about biomass smoke exposure. A random sample of these patients were asked to complete three validated quality-of-life surveys including the St. Georges Respiratory Questionnaire (SGRQ), the EuroQol 5 Dimension 3 Level system (EQ-5D-3L) which includes the EuroQol Visual Analog Scale (EQ-VAS), and the Patient Health Questionnaire 9 (PHQ-9). The cohort was divided up into 3 levels based on years of smoke exposure–no-reported smoke exposure (0 years), light exposure (1–19 years), and heavy exposure (20+ years), and independent-samples-Kruskal-Wallis testing was performed with post-hoc pairwise comparison and the Bonferroni correction. The results of this testing indicated significant increases in survey scores for patients with current biomass exposure and a heavy smoke exposure history (20+ years) compared to no reported smoke exposure in the SGRQ activity scores (adj. p = 0.018) and EQ-5D-3L usual activity scores (adj. p = 0.002), indicating worse activity related symptoms. There was a decrease in EQ-VAS scores for heavy (adj. p = 0.007) and light (adj. p = 0.017) exposure groups compared to no reported exposure, indicating lower perceptions of overall health. These results may suggest worse outcomes or baseline health for TB patients exposed to biomass smoke at the time of treatment and recovery, however further research is needed to characterize the effect of indoor air pollution on TB treatment outcomes.

Hair nicotine at 15 months old, tobacco exposure and wheeze or asthma from 15 months to 6 years old.

To investigate the relationship between hair nicotine levels at 15 months of age and prior parent-reported smoking exposure, and the risk of wheezing and current asthma from 15 months to 6 years of age. We measured hair nicotine levels at 15 months of age in 376 of 535 infants enrolled in a prospective birth cohort in Christchurch, New Zealand. We obtained detailed information from parents about smoking exposure during pregnancy and in the home at 3 and 15 months of age. Data for demographics, wheezing, and asthma were obtained from yearly questionnaires up to age 6 years. We assessed hair nicotine levels in relation to reported smoke exposure in pregnancy and up to age 15 months, and the association between high levels of hair nicotine and annual reports of current wheeze and current asthma using multiple logistic regression. Hair nicotine increased with numbers of smokers and daily cigarettes smoked at home, and was also strongly associated with smoking in pregnancy. High level of hair nicotine was associated with increased risk of wheeze (Odds ratio 2.30, P = 0.001) and, though not significant, of current asthma (Odds ratio 2.02, P = 0.056) at 15 months of age, after controlling for socio-economic status, ethnicity, body mass index, respiratory infections in the first 3 months of life, and duration of exclusive breastfeeding. At older ages the associations were non-significant. In children aged 15 months hair nicotine level was related to smoking exposure, and was associated with increased risk of wheeze and asthma.

Biomass fuel use and the risk of asthma in Nigerian children

Biomass fuel smoke exposure contributes to respiratory infections in childhood, but its association with asthma has not been established. We studied the relationship of biomass fuel use with asthma symptoms and lung function in Nigerian children. A cross-sectional study was performed in 299 village children aged 5-11 years in North Central Nigeria. Data were collected regarding the cooking fuels used and duration of daily smoke exposure in the cooking area. Asthma symptoms were assessed with a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, and lung function was assessed with spirometry. The prevalence of a lifetime history of wheeze was 9.4% (95% CI: 6.3%-13.2%). Fourteen children (4.7%) had airway obstruction (FEV1/FEV6 <85%). Female subjects had lower FEV1 and FEV6 (110 % and 120% percent predicted, respectively) than males (121% and 130%, respectively, P <0.001 for both differences). Advancing age was associated with a relative decline in the predicted value of FEV1 of 7.8 % per year (r = -0.61; P < 0.001). Children in families that used firewood daily did not have a significantly increased likelihood of asthma-related symptoms (OR = 2.36, 95% CI: 0.66-8.44). Similarly, airway obstruction did not differ significantly between children in households that did and did not use firewood daily (mean FEV1/FEV6 of 0.95 and 0.97, respectively; P = 0.41). Reported smoke exposure was not associated with an increased risk of asthma symptoms or airway obstruction. However, lifetime smoke exposure may explain the reduction in spirometric values in female subjects and with advancing age.

A Randomized Trial of Parental Behavioral Counseling and Cotinine Feedback for Lowering Environmental Tobacco Smoke Exposure in Children With Asthma: Results of the LET'S Manage Asthma Trial

Secondhand tobacco smoke exposure impairs the control of pediatric asthma. Evidence of the efficacy of interventions to reduce children's exposure and improve disease outcomes has been inconclusive. Caregivers of 519 children aged 3 to 12 years with asthma and reported smoke exposure attended two baseline assessment visits, which involved a parent interview, sampling of the children's urine (for cotinine assay), and spirometry (children≥5 years). The caregivers and children (n=352) with significant documented exposure (cotinine≥10 ng/mL) attended a basic asthma education session, provided a third urine sample, and were randomized to the Lowering Environmental Tobacco Smoke: LET'S Manage Asthma (LET'S) intervention (n=178) or usual care (n=174). LET'S included three in-person, stage-of-change-based counseling sessions plus three follow-up phone calls. Cotinine feedback was given at each in-person session. Follow-up visits at 6 and 12 months postrandomization repeated the baseline data collection. Multivariate regression analyses estimated the intervention effect on the natural logarithm of the cotinine to creatinine ratio (lnCCR), use of health-care services, and other outcomes. In the sample overall, the children in the LET'S intervention had lower follow-up lnCCR values compared with the children in usual care, but the group difference was not significant (β coefficient=-0.307, P=.064), and there was no group difference in the odds of having>one asthma-related medical visit (β coefficient=0.035, P=.78). However, children with high-risk asthma had statistically lower follow-up lnCCR values compared with children in usual care (β coefficient=-1.068, P=.006). The LET'S intervention was not associated with a statistically significant reduction in tobacco smoke exposure or use of health-care services in the sample as a whole. However, it appeared effective in reducing exposure in children at high risk for subsequent exacerbations. ClinicialTrials.gov; No.: NCT00217958; URL: clinicaltrials.gov.

Domestic smoke exposure is associated with alveolar macrophage particulate load

Indoor air pollution is associated with impaired respiratory health. The pre-dominant indoor air pollutant to which two billion of the world's population is exposed is biomass fuel smoke. We tested the hypothesis that reported smoke exposure in men and women is associated with increased alveolar macrophage uptake of biomass smoke particulates. Healthy volunteers attending for research bronchoscopy in Malawi completed a questionnaire assessment of smoke exposure. Particulate matter visible in alveolar macrophages (AM) was quantified using digital image analysis. The geometric mean of the percentage area of the cytoplasm occupied by particulates in 50 cover-slip adherent AM was calculated and termed particulate load. In 57 subjects (40 men and 17 women) there was a significant difference between the particulate load in groups divided according to pre-dominant lighting form used at home (ANOVA P = 0.0009) and type of cooking fuel (P = 0.0078). Particulate load observed in macrophages is associated with the reported type of biomass fuel exposure. Macrophage function in relation to respiratory health should now be investigated in biomass smoke exposed subjects.

Air pollution and pulmonary function

Rationale Recent studies have attempted to demonstrate a correlation between pollutants in the air and pulmonary function. Some studies have reported ozone and particulate matter to induce airway inflammation, but others suggest that known pollutants such as ozone do not affect spirometric measurements. Methods In the summers of 2002 and 2003, the Galveston Beach Patrol lifeguards were recruited to have their pulmonary functions recorded at three different times during the day. We obtained data on temperature, ozone, nitric oxide, nitrogen dioxide, and fine particulate matter from regulated sites in Galveston. The participants were required to complete daily surveys pertaining to their health, cigarette smoke exposure, and medication use. Results In 2002, 45 participants between ages 16 and 27 completed the study. 13% reported a history of asthma, 39% reported smoke exposure, 44% reported having a recent respiratory illness, and less than 1% reported using asthma medications at any time during the study. We found a statistically significant reduction in FEV1 and FVC with increasing 2.5 micron particulate matter, but not with other pollution measurements. The FEV1/FVC ratio was not affected by particulate matter. Our 2003 data includes 54 subjects and shows similar results. Conclusions We conclude that elevated levels of 2.5 micron particulate matter adversely affects lung function in healthy individuals. Our data is consistent with previous studies. While our studies did not show that ozone affected pulmonary function, we experienced few days of high ozone.

Predictors of Cotinine Levels in US Children: Data From the Third National Health and Nutrition Examination Survey

Study objectiveTo determine what factors predict cotinine levels in US children. DesignCross-sectional study. SubjectsNationally representative sample of 5,653 US children, both with and without reported tobacco smoke exposure in their homes. MethodsWe stratified the children into those with reported passive smoke exposure at home and those without this exposure. We used regression models to predict the log of the cotinine level of the participants with the following independent covariates: age; race/ethnicity; number of rooms in the home; sex; parental education; family poverty index; family size; region; and, among children with reported passive smoke exposure, the number of cigarettes smoked in the home. ResultsChildren exposed to passive smoke had a mean cotinine level of 1.66 ng/mL, and children not exposed to passive smoke had a mean level of 0.31 ng/mL. Among children with reported smoke exposure, non-Mexican-American race/ethnicity, young age, low number of rooms in the home, low parental education, and an increasing number of cigarettes smoked in the home were predictors of increased serum cotinine levels. Among children with no reported smoke exposure, significant predictors of increased cotinine levels included black race, young age, Midwest region of the United States, low number of rooms in the home, low parental education, large family size, and low family poverty index. ConclusionWhile the reported number of cigarettes smoked in the home is the most important predictor of cotinine levels in children exposed to smoke and may provide an opportunity for clinical intervention, other demographic factors are important among children both with and without reported smoke exposure.

Letter To The Editor

Two studies have been published in which the major purpose was to reduce infant exposure to environmental tobacco smoke (ETS) by moving the source of the smoke away from the infant.1,2, Neither study showed a reduction in mean infant urine cotinine levels although Greenberg and associates did find a reduction in reported smoke exposure and a reduction in persistent respiratory symptoms in lower socioeconomic level children. One may interpret the data of Greenberg et al to mean that mothers in the intervention group knew the right thing to say in response to a survey.