Secondhand Smoke Exposure in Childhood and Adulthood in Relation to Adult Mortality Among Never Smokers

Juan Carlos Ivancevich Sunday, 19 August 2018 22:25

September 2018 Volume 55, Issue 3, Pages 345–352

W. Ryan Diver, MSPH'Eric J. Jacobs, PhD,Susan M. Gapstur, PhD
Epidemiology Research Program, American Cancer Society, Atlanta, Georgia
 

Introduction

Secondhand smoke is known to have adverse effects on the lung and vascular systems in both children and adults. It is unknown if childhood exposure to secondhand smoke is associated with adult mortality.

Methods

The authors examined associations of childhood and adult secondhand smoke exposure with death from all causes, ischemic heart disease, stroke, and chronic obstructive pulmonary disease among 70,900 never smoking men and women, predominantly aged ≥50 years, from the Cancer Prevention Study–II Nutrition Cohort in 1992–1993. There were 25,899 participant deaths during follow-up through 2014. During 2016–2017, Cox proportional hazards regression models were used to calculate multivariable-adjusted hazard ratios and 95% CIs.

Results

Childhood secondhand smoke exposure was not associated with all-cause mortality. However, childhood secondhand smoke (living with a smoker for 16–18 years during childhood) was associated with higher mortality from chronic obstructive pulmonary disease (hazard ratio=1.31, 95% CI=1.05, 1.65). Adult secondhand smoke exposure of ≥10 hours/week at enrollment was associated with a higher risk of all-cause (hazard ratio=1.09, 95% CI=1.04, 1.14); ischemic heart disease (hazard ratio=1.27, 95% CI=1.14, 1.42); stroke (hazard ratio=1.23, 95% CI=1.04, 1.45); and chronic obstructive pulmonary disease (hazard ratio=1.42, 95% CI=0.97, 2.09) mortality.

Conclusions

These results suggest that childhood secondhand smoke exposure, as well as adult secondhand smoke exposure, increase the risk of chronic obstructive pulmonary disease death in adulthood. Consistent with previous studies, the results also show that adult secondhand smoke is meaningfully associated with higher mortality from vascular disease and all causes. Overall, these findings provide further evidence for reducing secondhand smoke exposure throughout life.

PDF (337 KB)

Asthma-like symptoms: is it always a pulmonary issue?

Juan Carlos Ivancevich Saturday, 04 August 2018 20:26
Case report - Open Access
Davide PiloniClaudio TirelliRita Di DomenicaValentina ConioAmelia GrossoVanessa RonzoniFilippo AntonacciPasquale Totaro and Angelo G. Corsico

Abstract

Background

Double aortic arch is a rare congenital and complete vascular ring around trachea and esophagus. It is usually diagnosed during infancy. The symptoms are generally related to respiratory and gastroesophageal tracts.

Case presentation

A 20-year-old female patient was referred to our outpatient clinic for persistent dry cough. She had a history of an episode of inhalation of food bolus as an infant and recurrent bronchitis, anorexia and allergic bronchial asthma since the childhood. Since the beginning, an intrathoracic obstruction was suspected at pulmonary function tests. After 1 month of complete asthma treatment, the cough was unchanged and the spirometry confirmed the presence of an intrathoracic obstruction. Then, she underwent a chest CT with contrast medium, a contrast transthoracic echocardiography, a fiberbronchoscopy and an esophageal radiography with contrast medium. The final diagnosis was made and a double aortic arch was found.

Conclusion

A careful observation of the flow/volume curve should always be guaranteed and the presence of congenital vascular anomalies should be suspected in case of difficult-to-treat asthma.

 Download PDF

 

Anti-inflammatory duration of action of fluticasone furoate/vilanterol trifenatate in asthma: A cross-over randomised controlled trial

Juan Carlos Ivancevich Sunday, 22 July 2018 12:30
Research - Open Access
George BardsleyPeter DaleyYatesAmanda BainesRodger KempsfordMathew WilliamsTony MallonIrene BraithwaiteKylie RiddellShashidhar JoshiPhilippe BareilleRichard BeasleyJames Fingleton on behalf of the study team

Abstract

Background

Fluticasone furoate/Vilanterol trifenatate (FF/VI) is an inhaled corticosteroid/long-acting beta-agonist combination with a prolonged bronchodilator duration of action. We characterised the time-course of onset and offset of airway anti-inflammatory action of FF/VI, as assessed by fraction of exhaled nitric oxide (FeNO), and compared this to the bronchodilator duration of action.

Methods

A single-centre, randomised, double-blind, placebo-controlled, two-period, crossover study was undertaken in 28 steroid-naïve adults with asthma. Participants with an FEV1 ≥ 60% predicted, reversible airway disease, and FeNO > 40 ppb received FF/VI 100/25 mcg or placebo once daily for 14 days. FeNO and peak expiratory flow were measured twice-daily during treatment and during a 21-day washout period. FEV1 was measured for five days from treatment cessation. The primary outcome measure was FeNO change from baseline ratio for 21 days following treatment cessation.

Results

In the 27 subjects who completed the study, median (range) baseline FeNO was 87 ppb (42–212). FF/VI 100/25 mcg reduced FeNO by day 3, ratio FF/VI versus placebo 0.72 (95% confidence interval 0.61–0.86) with the maximum reduction occurring at day 14, 0.32 (0.27–0.37). Following cessation of treatment FeNO remained suppressed for 18 days, ratio on day 18 0.77 (0.59–1.00), whereas improvements in FEV1 and peak flow were maintained for 3 to 4 days post-treatment.

Conclusions

The anti-inflammatory duration of action of FF/VI is consistent with the high glucocorticoid receptor affinity and long lung retention of fluticasone furoate. The anti-inflammatory effect of FF/VI was of greater duration than its bronchodilator effect in adults with mild asthma.

Download PDF

Agreement in reporting of asthma by parents or offspring – the RHINESSA generation study

Juan Carlos Ivancevich Monday, 30 July 2018 23:09
Research article,Open Access, Open Peer Review
Ingrid N. KuiperCecilie SvanesBryndis BenediktsdottirRandi J. BertelsenLennart BråbäckShyamali C. DharmageMathias HolmChrister JansonRain JögiAndrei MalinovschiMelanie MathesonJesús Martínez MoratallaFrancisco Gómez RealJosé Luis Sánchez-RamosVivi SchlünssenSigne Timm and Ane Johannessen

Open Peer Review reports

Abstract

Background

Self-report questionnaires are commonly used in epidemiology, but may be susceptible to misclassification, especially if answers are given on behalf of others, e.g. children or parents. The aim was to determine agreement and analyse predictors of disagreement in parents’ reports of offspring asthma, and in offspring reports of parents’ asthma.

Methods

In the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) generation study, 6752 offspring (age range 18–51 years) and their parents (age range 39–66 years) reported their own and each other’s asthma status. Agreement between asthma reports from offspring and parents was determined by calculating sensitivity, specificity, positive and negative predictive value and Cohen’s kappa. The participants’ own answers regarding themselves were defined as the gold standard. To investigate predictors for disagreement logistic regression analyses were performed to obtain odds ratios (OR) with 95% confidence intervals (CI) for sex, smoking status, education, comorbidity and severity of asthma.

Results

Agreement was good for parental report of offspring early onset asthma (< 10 years, Cohen’s kappa 0.72) and moderate for offspring later onset asthma (Cohen’s kappa 0.46). Specificity was 0.99 for both, and sensitivity was 0.68 and 0.36, respectively. For offspring report of maternal and paternal asthma the agreement was good (Cohen’s kappa 0.69 and 0.68), specificity was 0.96 and 0.97, and sensitivity was 0.72 and 0.68, respectively. The positive predictive value (PPV) was lowest for offspring report of maternal asthma (0.75), and highest for parents’ report of early onset asthma in the offspring (0.83). The negative predictive value (NPV) was high for all four groups (0.94–0.97). In multivariate analyses current smokers (OR = 1.46 [95% CI 1.05, 2.02]) and fathers (OR = 1.31 [95% CI 1.08, 1.59]) were more likely to report offspring asthma incorrectly. Offspring wheeze was associated with reporting parental asthma incorrectly (OR = 1.60 [95% CI 1.21, 2.11]), both under- and over reporting.

Conclusions

Asthma reports across generations show moderate to good agreement, making information from other generations a useful tool in the absence of direct reports.

Download PDF

Do airway inflammation and airway responsiveness markers at the start of apprenticeship predict their evolution during initial training? A longitudinal study among apprentice bakers, pastry makers and hairdressers

Juan Carlos Ivancevich Friday, 20 July 2018 20:50
BMC Pulmonary Medicine Research article - Open Access - Open Peer Review
Valérie Demange, Denis Zmirou-NavierAbraham Bohadana and Pascal Wild

Abstract

Background

The natural history of airway inflammation and symptoms in occupations at risk of asthma is still not fully understood. We aimed to study the evolution during apprenticeship of inflammation markers, bronchial hyperresponsiveness (BHR) and symptoms in at-risk subgroups as defined from measurements of markers made shortly after the start of training.

Methods

Respiratory symptoms, FEV1 and airway resistance post-bronchial challenge (MBC) test results, fractional exhaled nitric oxide (FeNO) measurements, and eosinophils in nasal lavage fluid were investigated in apprentice bakers, pastry-makers and hairdressers. Four visits were conducted: at the start of the training and every six months thereafter. Four baseline risk groups were defined, based on, (i) a high level of FeNO (NO), (ii) eosinophils > 1% (Eosino), (iii) a ≥ 15% decrease in FEV1 during the MBC test (HR), and (iv) a ≥ 50% increase in the resistance (Resist). The statistical analysis relied on mixed models.

Results

At baseline, the inflammation markers were related to the MBC markers. There was no evidence to suggest that the baseline risk groups predict a differential evolution of the airway inflammation and bronchial responsiveness markers, or the asthma-like symptoms considered. The baseline risk groups defined from MBC test predicted the levels of MBC markers. Similarly, the baseline risk groups based on eosinophilic inflammation predicted the levels of markers for eosinophilia. These results were similar in the three training tracks, with the exception of the FeNO levels which were not different according to the Eosino risk group. Twelve possible new asthma cases were identified, only the HR risk group predicted their occurrence.

Conclusions

Among this young population, at-risk groups based on initial high levels of inflammation markers did not experience any worsening during the follow-up. However, initial BHR predicted consistently high levels of all markers considered and occurrence of possible asthma.

Download PDF

Interasma on Twitter

Interasma Top story: European Academy of Allergy and Clinical Immunology calls for improved food allergy labelling to protect… https://t.co/BoO5npfZel
2hreplyretweetfavorite
Interasma RT @Aller_MD: My Tweeted Times https://t.co/36WLWcQjoy - top stories by @DrLindaMD, @GavinPrestonMD
4hreplyretweetfavorite
Interasma RT @Aller_MD: Top story: Percentage of young U.S. children who don’t receive any vaccines has quadrupled since 2001 - The Washington Post h…
5hreplyretweetfavorite
Interasma RT @ProfGRoberts: European Academy of Allergy and Clinical Immunology calls for improved food allergy labelling to protect consumers with f…
5hreplyretweetfavorite

Editor: Juan C. Ivancevich, MD

Copyright © Interasma 2003-2017  •  Terms of Use  •  Privacy Policy  •  Contact Us  •  Sitemap

Powered by FREI SA

InterAsma