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Pulmonary effects of passive smoking: the Indian experience

By D Gupta, AN Aggarwal and SK Jindal


There are only a few studies done on pulmonary effects of passive smoking from India, which are summarized in this paper. Several vernacular tobacco products are used in India, bidis (beedis) being the commonest form of these. Bidis contain a higher concentration of nicotine and other tobacco alkaloids compared to the standard cigarettes (e.g., the sum of total nicotine and minor tobacco alkaloids was 37.5 mg in bidi compared to 14–16 mg in Indian or American cigarettes in one study). A large study performed on 9090 adolescent school children demonstrated environmental tobacco smoke (ETS) exposure to be associated with an increased risk of asthma. The odds ratio for being asthmatic in ETS-exposed as compared to ETS-unexposed children was 1.78 (95% CI: 1.33–2.31). Nearly one third of the children in this study reported non-specific respiratory symptoms and the ETS exposure was found to be positively associated with the prevalence of each symptom. Passive smoking was also shown to increase morbidity and to worsen the control of asthma among adults. Another study demonstrated exposure to ETS was a significant trigger for acute exacerbation of asthma. Increased bronchial hyper-responsiveness was also demonstrated among the healthy nonsmoking adult women exposed to ETS. Passive smoking leads to subtle changes in airflow mechanics. In a study among 50 healthy nonsmoking women passively exposed to tobacco smoke and matched for age with 50 unexposed women, forced expiratory volume in first second (FEV1) and peak expiratory flow (PEF) were marginally lower among the passive smokers (mean difference 0.13 L and 0.20 L-1, respectively), but maximal mid expiratory flow (FEF25–75%), airway resistance (Raw) and specific conductance (sGaw) were significantly impaired. An association between passive smoking and lung cancer has also been described. In a study conducted in association with the International Agency for Research on Cancer, the exposure to ETS during childhood was strongly associated with an enhanced incidence of lung cancer (OR = 3.9, 95% CI 1.9–8.2). In conclusions several adverse pulmonary effects of passive smoking, similar to those described from the western and developed countries, have been described from India

Topics: Review
Publisher: BioMed Central
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Provided by: PubMed Central

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  1. (1983). Adult passive smoking in the home environment: a risk factor for chronic airflow limitation.
  2. (1999). Bronchial hyper-responsiveness of women with asthma exposed to environmental tobacco smoke.
  3. (1985). Bronchial reactivity to inhaled histamine and annual rate of decline
  4. (1996). Bronchial responsiveness of non-smoking women exposed to environmental tobacco smoke or biomass fuel combustion.
  5. (2002). Chronic/recurrent cough in rural children in Ludhiana, Punjab. Indian Pediatrics
  6. (1988). Cigarette smoke-sensitive asthma: challenge studies.
  7. (1988). Cigarette smoking, airway hyperresponsiveness, and asthma. Chest
  8. (1993). Department of Health and Human Services, Environmental Protection Agency. Respiratory health effects of passive smoking: lung cancer and other disorders (Smoking and
  9. Department of Health and Human Services. The health consequences of involuntary smoking.
  10. (1998). Distribution of major and minor alkaloids in tobacco, mainstream and sidestream smoke of popular Indian smoking products. Food and Chemical Toxicology
  11. (1995). Do the nonsmoking daughters of smokers tend to marry smokers? Implications for epidemiological research on environmental tobacco smoke: The IARC collaborative study. Cancer Epidimiology, Biomarkers and Prevention
  12. (1987). Effects of passive smoking in the multiple risk factor intervention trial.
  13. (1995). Environmental tobacco smoke and asthma.
  14. (1997). Environmental tobacco smoke exposure precipitates acute exacerbation in non smoker asthmatics. Lung India
  15. (1990). Exposure of nonsmoking women to environmental tobacco smoke: a 10-country collaborative study. Cancer Causes and Control.
  16. (1995). Exposure-response relationship between passive smoking and adult pulmonary function.
  17. (2000). Factors associated with severe asthma. Indian Paediatrics
  18. (1975). Functional abnormalities in young asymptomatic smokers with special reference to flow volume curves breathing various gases. American Review of Respiratory Disease
  19. (1988). Health effects of involuntary smoking.
  20. (1994). Indices of morbidity and control of asthma in patients exposed to environmental tobacco smoke. Chest
  21. (1999). International Consultation on Environmental Tobacco Smoke (ETS) and Child Health,
  22. (1985). Involuntary smoking and incidence of respiratory illness during the first year of life. Paediatrics
  23. (1992). Lung cancer in India.
  24. (1995). Misclassification of smoking status among women in relation to exposure to environmental tobacco smoke.
  25. (1998). Parental smoking and childhood asthma: longitudinal and case control studies. Thorax
  26. (1989). Parental smoking and post-infancy wheezing in children: a prospective cohort study.
  27. (1989). Passive smoking and cardiorespiratory health in a general population in the west of Scotland.
  28. (1999). Passive smoking and lung cancer in Chandigarh, India. Lung Cancer
  29. (2001). Passive smoking and lung cancer: a cumulative meta analysis.
  30. (1994). Passive smoking in obstructive respiratory diseases in an industrialized urban population. Environmental Research
  31. (1998). Passive smoking, domestic fuels and lung function in north Indian children.
  32. (1981). Passive smoking. Effects on bronchial asthma. Chest
  33. (2000). Prevalence of asthma in North India using a standardized field questionnaire.
  34. (2001). Prevalence of Bronchial asthma and association with environmental tobacco smoke exposure in adolescent school children in Chandigarh, North India.
  35. Protection Agency. Respiratory health effects of passive smoking: Lung cancer and other disorders. Publication EPA/600/6-90/006F.Washington, DC: US Environmental Protection Agency, Office of Air and Radiation,
  36. (1999). Respiratory effects of secondhand smoke (letter).
  37. (2001). Risk factors associated with bronchial asthma in school going children of rural Haryana.
  38. (2001). Risk factors for lung cancer in
  39. (1993). Sasco AJ. Lung cancer: worldwide variation in occurrence and proportion attributable to tobacco use. Lung Cancer
  40. (1980). Small-airways dysfunction in nonsmokers chronically exposed to tobacco smoke.
  41. (1997). The accumulated evidence on lung cancer and environmental tobacco smoke.
  42. (1998). The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee: Worldwide variations in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis and atopic eczema: ISAAC. Lancet
  43. (1989). The role of allergy and nonspecific airway hyperresponsiveness in the pathogenesis of chronic obstructive pulmonary disease. American Review of Respiratory Disease
  44. (1988). Trends in and effects of smoking in the world. World Health Statistics Quarterly
  45. (2000). Volatile organic compounds in indoor environments in Mumbai, India. The Science of Total Environment

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