Passive Smoking and Adult Asthma

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Asthma is a common chronic health condition, affecting 5% of the United States adult population. In most developed countries, the prevalence of asthma and its severity continues to increase. Understanding the factors contributing to asthma morbidity and mortality has important clinical and public health implications. This article evaluates the evidence that secondhand smoke exposure is a risk factor for new-onset asthma among adults and exacerbates pre-existing adult asthma, resulting in greater symptom burden and morbidity.

Section snippets

Prevalence of secondhand smoke exposure

In the United States, there has been significant progress in reducing passive smoke exposure. During the period from 1988 to 2002, SHS exposure, as measured by serum cotinine, declined by 70% [4]. Nonetheless, nearly half of all Americans continue to have evidence of recent SHS exposure.

Although they might be expected to avoid SHS, many United States adults with asthma actually experience significant exposure. In a cohort of adults with asthma living in Northern California, 29% reported regular

Secondhand smoke exposure and asthma induction in adults

Extensive data support a causal association between SHS exposure and induction of asthma in children [3]. In a recent meta-analysis of 85 studies conducted by the California Environmental Protection Agency (EPA), passive smoking was associated with an increase in childhood asthma incidence of between 21% and 37% [2]. The literature was deemed to be sufficient to infer a causal relationship between passive smoking and childhood asthma induction. Until recently, however, the relationship between

Secondhand smoke exposure and exacerbation of pre-existing adult asthma

Because adults with asthma have chronic airway inflammation, they may be particularly susceptible to the effects of SHS exposure. Both the California EPA and United States EPA have affirmed a causal connection between passive smoke exposure and exacerbation of pre-existing asthma among children [2]. Adults with asthma commonly report SHS exposure as a trigger for asthma exacerbation [55], [56]. However, the impact of SHS exposure on adults with asthma has received less research than in children.

Summary

The long-term health consequences of SHS exposure have been established over the past two decades. Consistent epidemiologic evidence links SHS exposure with serious chronic health effects, including lung cancer and cardiovascular disease [3], [65], [66]. In the present article, the evidence suggests a causal relationship between SHS exposure and new-onset asthma and asthma exacerbation among adults. Despite the growing knowledge of SHS-related health effects, smoking is still permitted in many

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