Remote second-hand tobacco exposure in flight attendants is associated with systemic but not pulmonary hypertension

Division of Cardiology, California Pacific Medical Center, San Francisco, CA 94115, USA.
Cardiology journal (Impact Factor: 1.06). 02/2008; 15(4):338-43.
Source: PubMed


Second-hand tobacco smoke has been associated with cardiopulmonary dysfunction. We sought to examine the residual effects of remote second-hand smoke exposure on resting and exercise cardiopulmonary hemodynamics. We hypothesized that remote secondhand smoke exposure results in persistent cardiopulmonary hemodynamic abnormalities.
Participants were non-smoking flight attendants who worked in airline cabins prior to the in-flight tobacco ban. Participants underwent clinical evaluations and completed smoke exposure questionnaires. We used Doppler echocardiography to measure pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance (PVR) at rest and during supine bicycle ergometer exercise, using the validated formula TRV/VTIRVOT x 10 + 0.16, where VTIRVOT is the velocity time integral at the right ventricular outflow tract and TRV is the tricuspid regurgitation velocity. The group was divided into quartiles according to the degree of smoke exposure. Analysis of variance was used to determine the differences in hemodynamic outcomes.
Seventy-nine flight attendants were included in our analysis. Baseline characteristics among participants in each quartile of smoke exposure were similar except for history of systemic hypertension, which was more prevalent in the highest quartile. Peak exercise PASP rose to the same degree in all test groups (mean PASP 44 mm Hg, p = 0.25), and PVR increased by approximately 27% in all quartiles. There was no significant difference in pulmonary artery systolic pressure or pulmonary vascular resistance among quartiles of smoke exposure.
We found that remote heavy second-hand smoke exposure from in-flight tobacco is associated with systemic hypertension but does not have demonstrable pulmonary hemodynamic consequences.

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    • "In contrast, some studies have been inconsistent when showing significant cardiopulmonary effects caused by exposure to cigarette smoke. One of the first studies to evaluate cardiopulmonary hemodynamics and cardiopulmonary capacity related to residual effects of passive smoking, Ren et al. [14] studied 79 flight attendants exposed to cigarette smoke inside aircraft cabins for over five years reported that passive smoking was linked to SAH but did not cause hemodynamic, pulmonary or systemic consequences. However, in our study, there was evidence of significant differences in CPET results between passive smokers and non-smokers, as well as between non-smokers and active smokers groups. "
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    ABSTRACT: Background The aim of this study was to analyze the influence of active and passive smoking on cardiorespiratory responses in asymptomatic adults during a sub-maximal-exertion incremental test. Methods The participants (n = 43) were divided into three different groups: active smokers (n = 14; aged 36.5 ± 8 years), passive smokers (n = 14; aged 34.6 ± 11.9 years) and non-smokers (n = 15; aged 30 ± 8.1 years). They all answered the Test for Nicotine Dependence and underwent anthropometric evaluation, spirometry and ergospirometry according to the Bruce Treadmill Protocol. Results VO2max differed statistically between active and non-smokers groups (p < 0.001) and between non-smokers and passive group (p=0.022). However, there was no difference between the passive and active smokers groups (p=0.053). Negative and significant correlations occurred between VO2max and age (r = - 0.401, p = 0.044), percentage of body fat (r = - 0.429, p = 0.011), and waist circumference (WC) (r = - 0.382, p = 0.025). Conclusion VO2max was significantly higher in non-smokers compared to active smokers and passive smokers. However, the VO2max of passive smokers did not differ from active smokers.
    Multidisciplinary respiratory medicine 06/2014; 9(1):34. DOI:10.1186/2049-6958-9-34 · 0.15 Impact Factor
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    • "Never-smoking flight attendants working prior to the smoking ban have been shown to have airway obstruction and impaired diffusing capacity on pulmonary function testing [14]. In addition, amongst flight attendants, the highest levels of secondhand smoke exposure were associated with increased rates of hypertension [15]. "
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    ABSTRACT: Secondhand tobacco smoke (SHS) is associated with increased risk of respiratory illness, cancer, and cardiovascular disease. Prior to smoking bans on airlines in the late 1980s, flight attendants were exposed to a significant amount of SHS. In the present study, we examine associations between flight attendant SHS exposure and development of respiratory illnesses and cardiovascular disease. Between December 2006 and October 2010, three hundred sixty-two flight attendants completed an online questionnaire with information regarding experience as a flight attendant, medical history, smoking history, and SHS exposure. Rates of illnesses in flight attendants were compared with an age and smoking history matched population sample from NHANES 2005-2006. Logistic regression analysis was used to examine the association of reported medical conditions and pre-ban years of exposure. Compared with the sample from NHANES 2005-2006, flight attendants had increased prevalence of chronic bronchitis (11.7% vs. 7.2%, p < 0.05), emphysema/COPD (3.2% vs. 0.9%, p < 0.03), and sinus problems (31.5% vs. 20.9%, p < 0.002), despite a lower prevalence of medical illnesses including high blood pressure, diabetes, high cholesterol, heart failure, cancer, and thyroid disease. Amongst flight attendants who reported never smoking over their lifetimes, there was not a significant association between years of service as a flight attendant in the pre-smoking ban era and illnesses. However, in this same group, there was a significantly increased risk of daily symptoms (vs. no symptoms) of nasal congestion, throat, or eye irritation per 10-year increase of years of service as a flight attendant prior to the smoking ban (OR 2.14, 95% CI 1.41 - 3.24). Flight attendants experience increased rates of respiratory illnesses compared to a population sample. The frequency of symptoms of nasal congestion, throat or eye irritation is associated with occupational SHS exposure in the pre-smoking ban era.
    Environmental Health 09/2011; 10(1):81. DOI:10.1186/1476-069X-10-81 · 3.37 Impact Factor
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    ABSTRACT: To evaluate the association between secondhand smoke (SHS) exposure and depression. Tobacco smoking and depression are strongly associated, but the possible effects of SHS have not been evaluated. The 2005 to 2006 National Health and Nutrition Examination Survey (NHANES) is a cross-sectional sample of the noninstitutionalized civilian U.S. population. SHS exposure was measured in adults aged > or =20 years by serum cotinine and depressive symptoms by the Patient Health Questionnaire. Zero-inflated Poisson regression analyses were completed with adjustment for survey design and potential confounders. Serum cotinine-documented SHS exposure was positively associated with depressive symptoms in never-smokers, even after adjustment for age, race/ethnicity, gender, education, alcohol consumption, and medical comorbidities. The association between SHS exposure and depressive symptoms did not vary by gender, nor was there any association between SHS smoke exposure and depressive symptoms in former smokers. Findings from the present study suggest that SHS exposure is positively associated with depressive symptoms in never-smokers and highlight the need for further research to establish the mechanisms of association.
    Psychosomatic Medicine 11/2009; 72(1):68-72. DOI:10.1097/PSY.0b013e3181c6c8b5 · 3.47 Impact Factor
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