Sippel J M, Pedula K L, Vollmer W M, Buist A S, Osborne M L
Division of Pulmonary and Critical Care Medicine, Portland Veterans Administration Medical Center, OR 97207, USA.
Chest. 1999 Mar;115(3):691-6. doi: 10.1378/chest.115.3.691.
To investigate the relationship between direct or environmental tobacco smoke (ETS) exposure and both hospital-based care (HBC) and quality of life (QOL) among subjects with asthma.
We report baseline cross-sectional data on 619 subjects with asthma, including direct or ETS exposure and QOL, and prospective longitudinal data on HBC using administrative databases for 30 months following baseline evaluation.
Participants were health maintenance organization members with physician-diagnosed asthma involved in a longitudinal study of risk factors for hospital-based asthma care.
Demographic characteristics and QOL were assessed with administered questionnaires, including the Marks Asthma Quality-of-Life (AQLQ) and SF-36 questionnaires. HBC was defined as episodes per person-year of hospital-based asthma care, which included emergency department and urgency care visits, and hospitalizations for asthma.
Current smokers reported significantly worse QOL than never-smokers in two of five domains of the AQLQ (p < 0.05). Subjects with ETS exposure also reported significantly worse QOL than those without ETS exposure in two domains (p < 0.05). On the SF-36, current smokers reported significantly worse QOL than never-smokers in five of nine domains (p < 0.05). Subjects with ETS exposure reported significantly worse QOL than those without ETS exposure in three domains (p < 0.05). Current smokers used significantly more hospital-based asthma care than never-smokers (adjusted relative risk [RR], 1.40; 95% confidence interval [CI], 1.01 to 1.95) while ex-smokers did not exhibit increased risk compared with nonsmokers (adjusted RR, 0.94; 95% CI, 0.7 to 1.3). Also, subjects with ETS exposure used significantly more hospital-based asthma care than those without ETS exposure (RR, 2.34; 95% CI, 1.80 to 3.05).
Direct or environmental tobacco exposure prospectively predicted increased health-care utilization for asthma and reduced QOL in patients with asthma. These findings add to our existing knowledge of the detrimental effects of tobacco smoke and are of relevance specifically to patients with asthma.
探讨哮喘患者直接接触或暴露于环境烟草烟雾（ETS）与医院护理（HBC）及生活质量（QOL）之间的关系。
我们报告了619例哮喘患者的基线横断面数据，包括直接接触或暴露于ETS及QOL情况，并使用行政数据库报告了基线评估后30个月内HBC的前瞻性纵向数据。
参与者为健康维护组织成员，经医生诊断患有哮喘，参与了一项关于医院哮喘护理危险因素的纵向研究。
通过发放问卷评估人口统计学特征和QOL，包括马克斯哮喘生活质量（AQLQ）问卷和SF - 36问卷。HBC定义为每人每年的医院哮喘护理次数，包括急诊科和紧急护理就诊以及哮喘住院治疗。
在AQLQ的五个领域中的两个领域，当前吸烟者报告的QOL显著低于从不吸烟者（p < 0.05）。暴露于ETS的受试者在两个领域报告的QOL也显著低于未暴露于ETS的受试者（p < 0.05）。在SF - 36问卷中，当前吸烟者在九个领域中的五个领域报告的QOL显著低于从不吸烟者（p < 0.05）。暴露于ETS的受试者在三个领域报告的QOL显著低于未暴露于ETS者（p < 0.05）。当前吸烟者使用的医院哮喘护理显著多于从不吸烟者（调整后相对风险[RR]，1.40；95%置信区间[CI]，1.01至1.95），而与非吸烟者相比，既往吸烟者未表现出风险增加（调整后RR，0.94；95% CI，0.7至1.3）。此外，暴露于ETS的受试者使用的医院哮喘护理显著多于未暴露于ETS的受试者（RR，2.34；95% CI，1.80至3.05）。
直接接触或暴露于环境烟草烟雾可前瞻性预测哮喘患者医疗保健利用率增加及QOL降低。这些发现增加了我们对烟草烟雾有害影响的现有认识，并且对哮喘患者具有特别的相关性。
