ChiaFang Wu1 MingTsang Wu12 InnWen Chong3 KuenYuh Wu4 ChiKung Ho1 ChienHung Lee5 JhiJhu Huang3 ChiaT

1
Chia-Fang Wu1 Ming-Tsang Wu1-2 Inn-Wen Chong3
Kuen-Yuh Wu4 Chi-Kung Ho1 Chien-Hung
Lee5Jhi-Jhu Huang3 Chia-Tsuan Huang2
Chung-Ying Lee2 Trong-Neng Wu6 David C
Christiani7 1Graduate Institute of
Occupational Safety and Department of
Occupational Medicine, Kaohsiung Medical
University. 2Department of Family Medicine,
Kaohsiung Medical University Hospital, Kaohsiung,
Taiwan. 3Division of Pulmonology, Department of
Internal Medicine, Kaohsiung Medical University,
Kaohsiung, Taiwan. 4Division of Environmental
Health and Occupational Medicine, National Health
Research Institutes, Miaoli, Taiwan.5School of
Public Health, Kaohsiung Medical University,
Kaohsiung, Taiwan.6Graduate Institute of
Environmental Health, China Medical University,
Taichung, Taiwan.7Department 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
INTRODUCTION
RESULTS

• 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)

Table 1. Distribution of demographic
characteristics and related variables in chronic
bronchitis, probable chronic bronchitis, and free
of pulmonary disease (n420).

• Bureau of Tobacco and Alcohol Monopoly, Taiwan
  Provincial Government, 1974-1996.
• The 1986 Adult Use of Tobacco Survey, Office on
  Smoking and Health, CDC.

OBJECTIVE

• 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.

Three subjects did not have complete lung
function test information. Fishers exact test
STUDY DESIGN
Fig 3. Adjusted ORs and 95CIs and population
attributable risk percents for chronic bronchitis
and probably chronic bronchitis associated with
smoking status by different age periods.
Table 2. The effect of risk factors on lung
function index FEV1 in a multiple linear
regression model by different age periods (?40
years, gt40 years, and lifetime) (n417).
SHS EXPOSURE

• 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, gt 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?
• Whats 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)?

DISCUSSION
Table 3. Summary of epidemiologic studies on the
relationship between SHS exposure and the risk of
COPD among women.
Fig 1. The distribution of natural
log-transformed urine cotinine/creatinine levels
among the groups of smokers (n4), second-hand
smokers (n23), and non second-hand smokers
(n44). (plt0.05, 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.
100bp Marker
OUTCOME
CONCLUSION

• 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)

• 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.

• 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.