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Environmental tobacco smoke exposure & adult asthma

Institution: University of California, San Francisco
Investigator(s): Mark Eisner, M.D., M.P.H.
Award Cycle: 2001 (Cycle 10) Grant #: 10RT-0108 Award: $460,032
Subject Area: Epidemiology
Award Type: Research Project Awards
Abstracts

Initial Award Abstract
Asthma is a common chronic health condition, affecting 5% of the U.S. adult population. During the past decade, the prevalence of adult asthma has increased more than 50%. The mortality from asthma has approximately doubled. Understanding the factors contributing to asthma morbidity and mortality has important clinical and public health implications. In particular, identifying modifiable environmental factors that exacerbate asthma has become a priority.

Environmental tobacco smoke (ETS) exposure is widespread, affecting the majority of U.S. adults. Because it contains potent respiratory irritants, ETS is a potentially important exacerbating factor for adults with asthma. Despite the importance of the question, few studies have examined the effect of ETS exposure on adults with asthma.

In the proposed study, we will study the impact of ETS exposure on adults with severe asthma. To study persons with severe asthma, the proposed study would recruit adult Northern California Kaiser Permanente members who are admitted to the hospital for asthma, including persons who had severe asthma attacks requiring admission to an intensive care unit. After hospitalization, subjects will undergo telephone interviews to obtain information about their asthma, treatments for asthma, quality of life, and ETS exposure. In the proposed study, we would recruit 275 subjects who indicate no current personal smoking and residence with a smoker or recent ETS exposure (past 7 days) for personal biological monitoring. Target recruitment will include 100 subjects after ICU admission, 100 subjects after hospitalization without ICU admission, and 75 control subjects (including unexposed and non-asthmatic subjects). We will directly measure ETS exposure using a passive badge monitor that measures actual exposure to air-borne nicotine, an important component of ETS. To measure exposure that occurred farther in the past, we will also measure hair nicotine levels. Because hair grows slowly, hair nicotine can be used to measure exposure that occurred up to 3 months in the past. We will study how common ETS exposure is in this group of adults with severe asthma. We will also examine the impact of ETS exposure on asthma severity, quality of life, and future asthma attacks that require hospitalization. The goal is to determine whether ETS exposure has harmful effects on adults with asthma.

Adults with severe asthma are a population that may be particularly susceptible to the negative health effects of ETS exposure. The proposed study coincides with objectives established by the TRDRP, which focus on the effects of ETS on chronic disease exacerbation. The study would provide important information establishing the health effects of ETS in this population with adult asthma. Results from this study would be important for adults with asthma and health care providers who care for asthma patients. In addition, study results could be used to support public policy efforts that prohibit public smoking in California.
Publications

Environmental tobacco smoke exposure and pulmonary function among adults in NHANESIII: Impact on the general population and adults with current asthma.
Periodical: Environmental Health Perspectives Index Medicus:
Authors: Eisner MD ART
Yr: 2002 Vol: 110 Nbr: Abs: Pg: 765-770

Prevalence of ETS exposure among adults with severe asthma.
Periodical: TRDRP Annual Report to the State of California Legislature Index Medicus:
Authors: Eisner M, Blanc P, Boland M, Klein J, Iribarren C ABS
Yr: 2002 Vol: Nbr: Abs: Pg:

Exposure to indoor combustion and adult ashma outcomes: environmental tobacco smoke, gas stoves, and woodsmoke.
Periodical: Thorax Index Medicus:
Authors: Eisner MD, Yelin EH, Katz PP, Blanc PD ART
Yr: 2002 Vol: 57 Nbr: Abs: Pg: 973-978

Diiectly measured second hand smoke exposure and asthma health outcomes.
Periodical: Thorax Index Medicus:
Authors: Eisner MD, Klein J, Hammond SK, Koren G, Lactao G, Iribarren C ART
Yr: 2005 Vol: 60 Nbr: 10 Abs: Pg: 914 - 821