SRCosmos:

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Keywords	Pulmonary Disease, Chronic Obstructive, Chronic Bronchitis, Pulmonary Emphysema, Tobacco smoke pollution
Abstract	Background: Exposure to environmental tobacco smoke (ETS), which contains potent respiratory irritants, may lead to chronic airway inflammation and obstruction. Although ETS exposure appears to cause asthma in children and adults, its role in causing COPD has received limited attention in epidemiologic studies. Methods: Using data from a population-based sample of 2,113 U.S. adults aged 55 to 75 years, we examined the association between lifetime ETS exposure and the risk of developing COPD. Participants were recruited from all 48 contiguous U.S. states by random digit dialing. Lifetime ETS exposure was ascertained by structured telephone interview. We used a standard epidemiologic approach to define COPD based on a self-reported physician diagnosis of chronic bronchitis, emphysema, or COPD. Results: Higher cumulative lifetime home and work exposure were associated with a greater risk of COPD. The highest quartile of lifetime home ETS exposure was associated with a greater risk of COPD, controlling for age, sex, race, personal smoking history, educational attainment, marital status, and occupational exposure to vapors, gas, dusts, or fumes during the longest held job (OR 1.55; 95% CI 1.09 to 2.21). The highest quartile of lifetime workplace ETS exposure was also related to a greater risk of COPD (OR 1.36; 95% CI 1.002 to 1.84). The population attributable fraction was 11% for the highest quartile of home ETS exposure and 7% for work exposure. Conclusion: ETS exposure may be an important cause of COPD. Consequently, public policies aimed at preventing public smoking may reduce the burden of COPD-related death and disability, both by reducing direct smoking and ETS exposure.
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Name	Affiliation	Home page	e-mail	Total pubs
Balmes J	Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, UCSF Box 0924, San Francisco, CA 94113-0924, USA			1
Blanc PD	Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, UCSF Box 0924, San Francisco, CA 94113-0924, USA			2
Eisner MD	Department of Medicine, University of California, San Francisco, UCSF Box 0924, San Francisco, CA 94113-0924, USA			2
Katz PP	nstitute for Health Policy Studies, University of California, San Francisco, UCSF Box 0920, San Francisco, CA 94113-0920, USA			2
Trupin L	Department of Medicine, University of California, San Francisco, UCSF Box 0924, San Francisco, CA 94113-0924, USA		laura.trupin@ucsf.edu	2
Yelin EH	Institute for Health Policy Studies, University of California, San Francisco, UCSF Box 0920, San Francisco, CA 94113-0920, USA			2