1. Chia-Fang Wu 1 Ming-Tsang Wu 1-2 Inn-Wen Chong 3 Kuen-Yuh Wu 4 Chi-Kung Ho 1 Chien-Hung Lee 5 Jhi-Jhu Huang 3 Chia-Tsuan Huang 2 Chung-Ying Lee 2 Trong-Neng Wu 6 David C Christiani 7 1 Graduate Institute of Occupational Safety and Department of Occupational Medicine, Kaohsiung Medical University. 2 Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. 3 Division of Pulmonology, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. 4 Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Miaoli, Taiwan. 5 School of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan. 6 Graduate Institute of Environmental Health, China Medical University, Taichung, Taiwan. 7 Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA. Second-hand smoke and chronic bronchitis in Taiwanese women: A health-care based study 100bp Marker INTRODUCTION OBJECTIVE STUDY DESIGN SHS EXPOSURE RESULTS OUTCOME DISCUSSION CONCLUSION COPD is a major public health problem throughout the world. It is a chronically progressive disease characterized by the presence of airflow obstruction (including chronic bronchitis and emphysema). (ATS, 1995) GenderPrevalence of smoking in general population Taiwan a Caucasian b Men55 - 60%29.5% Women3 - 4%23.8% a.Bureau of Tobacco and Alcohol Monopoly, Taiwan Provincial Government, 1974-1996. b.The 1986 Adult Use of Tobacco Survey, Office on Smoking and Health, CDC. To investigate the association between second-hand smoke (SHS) exposure and chronic bronchitis risk in Taiwanese women conducting a health-care based case-control study. To use urinary cotinine to verify questionnaire data about SHS exposure from a subset of study subjects. Exposure definition - Subjects who reported smoking more than one cigarette per day for at least one year were defined as active smokers - Subjects who lived with a smoker and had been exposed for more than one cigarette per day at least one year were considered as second-hand smokers - Neither active smokers nor second-hand smokers were considered as non second-hand smokers SHS exposure evaluation ( ≦ 40years, > 40years, and lifetime status) - Have you ever lived / worked with a smoker and, on average, been exposed face-to-face more than one cigarette per day for at least one year? - What’s the number of cigarette you had been exposed per day? - What year you started and quitted to be exposed and how long had been exposed (in years)? Outcome definition - (1) a physician diagnosis of chronic bronchitis at least twice in year 1999 - (2) ATS criteria: the presence of cough and/or sputum production during the majority of days for at least 3 consecutive months in the previous 2 or more successive years Outcome classification - Chronic bronchitis (those who satisfied both criteria) - Probably chronic bronchitis (those who satisfied the first but not the second set of criteria) - Free of pulmonary disease (those who satisfied neither set of criteria) Fig 1. The distribution of natural log-transformed urine cotinine/creatinine levels among the groups of smokers (n=4), second-hand smokers (n=23), and non second-hand smokers (n=44). (*p<0.05, compared each other) Fig 2. Correlation between the urinary cotinine levels and number of cigarettes they reported themselves being exposed to SHS during the 3days leading up to the collection or urine specimens. We presents evidence that lifetime SHS exposure can increase the risk and severity of chronic bronchitis. Cigarette smoking and SHS exposure can explain 23.3% and 47.1% of chronic bronchitis among Taiwanese women. ReferenceSubjectsSHS exposureResults (95%CI) Case-control studies (all non-smoking women)(self-reported of spouse’s or household’s smoking habit as SHS exposure) 1986 UK Lee et al Chronic bronchitis: 17 Control: 318 Place: home + work + other Quantitative: index score AOR is 1.22 (non significantly) 1987 Greece Kalandidi et al COLD: 103 Control: 179 Place: home only Quantitative: pack/day AOR for spouse’s smoking- ≦ 1 pack/day: 2.5 (1.3-5.0) >1 pack/day: 1.5 (0.8-2.7) 2007 Taiwan In our study Chronic bronchitis: 33 Probably CB: 182 Control: 205 Place: home + work Quantitative: - (urinary cotinine) AOR is 3.72 (1.19-11.63) in chronic bronchitis and FEV 1 decreased 104 mL (p=0.01) Longitudinal studies 1989 USA Sandlerl et al 14,873 for 12 years 13 COPD deaths Place: home only Quantitative: - RR is 5.65 (1.19-26.8) 2003 USA Enstrom & Kabat 25,942 for 39 years 128 COPD deaths Place: home only Quantitative: - RR is 1.13 (0.80-1.58) 2005 Europe Vineis et al 123,479 for 7 years 14 COPD deaths Place: home + work Quantitative: - (plasma cotinine) Hazard ratio is 1.15 (0.71-1.86); OR is 1.46 (0.76-2.80) in the nested case-control study Table 3. Summary of epidemiologic studies on the relationship between SHS exposure and the risk of COPD among women. Acknowledgement This research was supported by grants from National Health Research Institutes, Taiwan (NHRI-EX93-9205PI). National Science Council, Taiwan (NSC 91-2320-B-037-053, 92-2320-B-037-008 & 95-2314-B-039-042) We gratefully thank of the Prof. Tzy-Jyun Yao and research assistant Jih-Shih Liu who help us to recruiting the study subjects at the data bank, and all of the interviewers do very hard work to conduct personal interviews to our study subjects in their home. Table 2. The effect of risk factors on lung function index “FEV1” in a multiple linear regression model by different age periods ( ≦ 40 years, >40 years, and lifetime) (n=417)*. VariablesSmoking status >40 yrs old Smoking status ≦ 40 yrs old Lifetime smoking status β (SE)p-valueβ (SE)p-valueβ (SE)p-value Intercept-0.094 (0.600)0.876-0.015 (0.610)0.981-0.085 (0.614)0.890 Age-0.022 (0.002)<0.0001-0.022 (0.002)<0.0001-0.022 (0.002)<0.0001 Height0.021 (0.004)<0.00010.020 (0.004)<0.00010.021 (0.004)<0.0001 Education levels Primary school Illiteracy (vs. ≧ junior high school) -0.040 (0.052) -0.068 (0.063) 0.441 0.274 -0.040 (0.052) -0.081 (0.063) 0.449 0.195 -0.046 (0.052) -0.082 (0.062) 0.382 0.192 Smoking status Second-hand smoker active smoker (vs. non) -0.086 (0.037) -0.230 (0.087) 0.021 0.009 -0.090 (0.039) -0.274 (0.087) 0.021 0.002 -0.104 (0.040) -0.245 (0.079) 0.010 0.002 Tea consumption yes (vs. no)0.018 (0.050)0.7160.094 (0.065)0.1460.026 (0.049)0.593 Burning incense yes (vs. no)-0.091 (0.037)0.015-0.091 (0.037)0.016-0.091 (0.037)0.016 Cooking status yes (vs. no)-0.043 (0.060)0.478-0.014 (0.075)0.8480.013 (0.093)0.886 Fig 3. Adjusted ORs and 95%CIs and population attributable risk percents for chronic bronchitis and probably chronic bronchitis associated with smoking status by different age periods. Table 1. Distribution of demographic characteristics and related variables in chronic bronchitis, probable chronic bronchitis, and free of pulmonary disease (n=420). VariablesChronic bronchitis (n=33) Probably chronic bronchitis (n=182) Free of pulmonary disease (n=205) p-value Age (yrs)65.2 ± 12.364.6 ± 9.164.5 ± 9.70.94 Height (cm)154.5 ± 4.3155.5 ± 5.7155.2 ± 4.80.59 Weight (kg)54.0 ± 10.057.7 ± 7.558.5 ± 7.50.01 BMI22.6 ± 3.923.9 ± 3.024.3 ± 3.10.01 FEV1 (L)1.33 ± 0.52*1.51 ± 0.401.64 ± 0.48<0.01 FVC (L)1.74 ± 0.58*1.94 ± 0.522.00 ± 0.620.05 Education levels ≧ junior high school Primary school Illiteracy 5 (15.2%) 16 (48.5%) 12 (36.4%) 32 (17.6%) 93 (51.1%) 57 (31.3%) 34 (16.6%) 117 (57.1%) 54 (26.3%) 0.67 Smoking status No Yes 25 (75.8%) 8 (24.2%) 172 (94.5%) 10 (5.5%) 197 (96.1%) 8 (3.9%) <0.0001** Alcohol consumption No Yes 33 (100.0%) 0 176 (96.7%) 6 (3.4%) 200 (97.6%) 5 (2.5%) 0.14** Tea consumption No Yes 31 (93.9%) 2 (6.1%) 152 (83.5%) 30 (16.5%) 164 (80.0%) 41 (20.0%) 0.13** Burning incense No Yes 14 (42.4%) 19 (57.6%) 81 (44.5%) 101 (55.5%) 89 (43.4%) 116 (56.6%) 0.96 Cooking status No Yes 2 (6.1%) 31 (93.9%) 9 (5.0%) 173 (95.1%) 6 (2.9%) 199 (97.1%) 0.50** * Three subjects did not have complete lung function test information. ** Fisher’s exact test