Abstract
STUDY OBJECTIVE--The aim was to explore the aetiological roles of smoking, occupational exposure, childhood respiratory illness, and atopy in persistent sputum production. DESIGN--This was a case-control study. Data were obtained using a questionnaire administered by two observers blind to the subjects' status. Information was sought on lifetime smoking, occupation, hospital admissions due to respiratory disease, and respiratory disease history. SETTING--Four general practices in south east England in 1990, with a total population of about 30,000. SUBJECTS--Cases were subjects aged 5 to 54 years with sputum production; one control was selected per case, matched by general practice, age, and sex, forming 210 matched pairs (88% response rate). MAIN RESULTS--Cigarette smoking remains an important cause of persistent sputum production: the odds ratio (95% confidence interval) for current smoking was 7.9 (3.6-20.4). A dose-response relationship was confirmed, with falling risk estimates after stopping smoking. The association of sputum production with occupational exposure to respiratory irritants, which was independent of smoking, was confined to men (odds ratio 2.4, 1.0-6.0) and largely attributable to very heavy exposure. Examination of the relationship with early respiratory disease suggested that much, though not all, was attributable to wheezing illnesses first manifest in childhood. CONCLUSIONS--Aetiological fractions derived from the results suggest that in the general population of south east England approximately 68% of all cases of persistent sputum production can be independently attributed to current cigarette smoking, 17% to heavy occupational exposure to respiratory irritants, and 13% to wheezing illnesses first manifest in early childhood.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- ANDERSON D. O., FERRIS B. G., Jr Role of tobacco smoking in the causation of chronic respiratory disease. N Engl J Med. 1962 Oct 18;267:787–794. doi: 10.1056/NEJM196210182671601. [DOI] [PubMed] [Google Scholar]
- Britten N., Wadsworth J. Long term respiratory sequelae of whooping cough in a nationally representative sample. Br Med J (Clin Res Ed) 1986 Feb 15;292(6518):441–444. doi: 10.1136/bmj.292.6518.441. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Brown C. A., Crombie I. K., Smith W. C., Tunstall-Pedoe H. The impact of quitting smoking on symptoms of chronic bronchitis: results of the Scottish Heart Health Study. Thorax. 1991 Feb;46(2):112–116. doi: 10.1136/thx.46.2.112. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Burrows B., Lebowitz M. D., Barbee R. A. Respiratory disorders and allergy skin-test reactions. Ann Intern Med. 1976 Feb;84(2):134–139. doi: 10.7326/0003-4819-84-2-134. [DOI] [PubMed] [Google Scholar]
- Cole P., MacMahon B. Attributable risk percent in case-control studies. Br J Prev Soc Med. 1971 Nov;25(4):242–244. doi: 10.1136/jech.25.4.242. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cullinan P. Persistent cough and sputum: prevalence and clinical characteristics in south east England. Respir Med. 1992 Mar;86(2):143–149. doi: 10.1016/s0954-6111(06)80231-3. [DOI] [PubMed] [Google Scholar]
- Gerrard J. W., Heiner D. C., Ko C. G., Mink J., Meyers A., Dosman J. A. Immunoglobulin levels in smokers and non-smokers. Ann Allergy. 1980 May;44(5):261–262. [PubMed] [Google Scholar]
- Korn R. J., Dockery D. W., Speizer F. E., Ware J. H., Ferris B. G., Jr Occupational exposures and chronic respiratory symptoms. A population-based study. Am Rev Respir Dis. 1987 Aug;136(2):298–304. doi: 10.1164/ajrccm/136.2.298. [DOI] [PubMed] [Google Scholar]
- Neugebauer R., Ng S. Differential recall as a source of bias in epidemiologic research. J Clin Epidemiol. 1990;43(12):1337–1341. doi: 10.1016/0895-4356(90)90100-4. [DOI] [PubMed] [Google Scholar]
- Strachan D. P., Anderson H. R., Bland J. M., Peckham C. Asthma as a link between chest illness in childhood and chronic cough and phlegm in young adults. Br Med J (Clin Res Ed) 1988 Mar 26;296(6626):890–893. doi: 10.1136/bmj.296.6626.890. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Terho E. O., Husman K., Vohlonen I., Heinonen O. P. Atopy, smoking, and chronic bronchitis. J Epidemiol Community Health. 1987 Dec;41(4):300–305. doi: 10.1136/jech.41.4.300. [DOI] [PMC free article] [PubMed] [Google Scholar]