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The impact of secondhand smoke exposure on COPD outcomes

Institution: University of California, San Francisco
Investigator(s): Mark Eisner, M.D., M.P.H. Paul Blanc, M.D., M.S.P.H.
Award Cycle: 2008 (Cycle 17) Grant #: 17RT-0101 Award: $492,890
Subject Area: Epidemiology
Award Type: Research Project Awards

Initial Award Abstract
Chronic obstructive pulmonary disease (COPD) is a major chronic health condition, affecting 10% of the U.S. population. Personal direct cigarette smoking is the most important single causal factor for developing COPD. Presuming that direct cigarette smoking is the sole meaningful factor in COPD, however, is a critically important misconception. Up to 2 in 10 cases of COPD cannot be attributable solely to the risk factor of direct voluntary smoking. Other exposures, particularly secondhand smoke (SHS) exposure and occupational exposure, are increasingly being recognized as potential risk factors for COPD. In terms of disease progression, other factors besides direct smoking, especially SHS, may also negatively influence the course of the disease. Despite the importance of these questions, the effects of SHS have not been systematically examined in relation to COPD.

Our project utilizes the FLOW study, an ongoing NIH-funded study of 1,202 adults with COPD that aims to elucidate risk factors for disability. Specifically, we will build on this study to directly measure personal SHS exposure using urine cotinine and hair measurements of nicotine and cotinine. Using these SHS exposure data, we will examine the effect of directly measured SHS exposure on the risk of adverse health outcomes in COPD.

In particular, we will estimate how commonly adults with COPD are exposed to SHS. We will then study how SHS exposure affects their disease, including severity of COPD, medication use, and quality of life. The study will also elucidate the longer-term effect of SHS exposure on the risk of severe attacks of COPD that require emergency department visits or hospitalizations.

Findings from the proposed study would address important gaps in our current understanding of SHS exposure in this susceptible population. Results from our proposed study could provide substantive additional impetus to create smoke-free workplaces and other public places in order to protect those who are especially vulnerable to SHS exposure.