Environmental Tobacco Smoke
(ETS)
Health Signs or
Symptoms, Diagnostic Leads, and Remedial Action
From:
Health Problems Related To Environmental Tobacco Smoke
(ETS)
Co-sponsored by: The American Lung Association (ALA),
The Environmental Protection Agency (EPA),
The Consumer Product Safety Commission (CPSC), and
The American Medical Association (AMA)
U.S. Gov't Printing Office Publication No. 1994-523-217/81322
1994
Key Signs/Symptoms in Adults ...
- rhinitis/pharyngitis, nasal congestion, persistent cough
- conjunctival irritation
- headache
- wheezing (bronchial constriction)
- exacerbation of chronic respiratory conditions
... and in Infants and Children
- asthma onset
- increased severity of, or difficulty in controlling, asthma
- frequent upper respiratory infections and/or episodes of otitis
media
- persistent middle-ear effusion
- snoring
- repeated pneumonia, bronchitis
Diagnostic Leads
- Is individual exposed to environmental tobacco smoke on a regular
basis?
- Test urine of infants and small children for cotinine, a biomarker
for nicotine
Remedial
Action
While improved general ventilation of indoor spaces may
decrease the odor of environmental tobacco smoke (ETS), health risks
cannot be eliminated by generally accepted ventilation methods. Research
has led to the conclusion that total removal of tobacco smoke - a complex
mixture of gaseous and particulate components - through general
ventilation is not feasible.
The most effective solution is to eliminate all smoking
from the individual's environment, either through smoking prohibitions or
by restricting smoking to properly designed smoking rooms. These rooms
should be separately ventilated to the outside.
Some higher efficiency air cleaning systems, under select
conditions, can remove some tobacco smoke particles. Most air cleaners,
including the popular desk-top models, however, cannot remove the gaseous
pollutants from this source. And while some air cleaners are designed to
remove specific gaseous pollutants, none is expected to remove all of them
and should not be relied upon to do so.
Comment
Environmental tobacco smoke is a major source of indoor
air contaminants. The ubiquitous nature of ETS in indoor environments
indicates that some unintentional inhalation of ETS by nonsmokers is
unavoidable. Environmental tobacco smoke is a dynamic, complex mixture of
more than 4,000 chemicals found in both vapor and particle phases. Many of
these chemicals are known toxic or carcinogenic agents. Nonsmoker exposure
to ETS-related toxic and carcinogenic substances will occur in indoor
spaces where there is smoking.
All the compounds found in "mainstream" smoke,
the smoke inhaled by the active smoker, are also found in "sidestream"
smoke, the emission from the burning end of the cigarette, cigar, or pipe.
ETS consists of both sidestream smoke and exhaled mainstream smoke.
Inhalation of ETS is often termed "secondhand smoking",
"passive smoking", or "involuntary smoking."
The role of exposure to tobacco smoke via active smoking
as a cause of lung and other cancers, emphysema and other chronic
obstructive pulmonary diseases, and cardiovascular and other diseases in
adults has been firmly established. Smokers, however, are
not the only ones affected.
The U.S. Environmental Protection Agency (EPA) has
classified ETS as a known human (Group A) carcinogen and estimates that it
is responsible for approximately 3,000 lung cancer deaths per year among
nonsmokers in the United States.The U.S. Surgeon General, the
National Research Council, and the National Institute for Occupational
Safety and Health also concluded that passive smoking can cause lung
cancer in otherwise healthy adults who never smoked.
Children's lungs are even more susceptible to harmful
effects from ETS. In infants and young children up to three years,
exposure to ETS causes an approximate doubling in the incidence of
pneumonia, bronchitis, and bronchiolitis. There is also strong evidence of
increased middle ear effusion, reduced lung function, and reduced lung
growth. Several recent studies link ETS with increased incidence and
prevalence of asthma and increased severity of asthmatic symptoms in
children of mothers who smoke heavily. These respiratory illnesses in
childhood may very well contribute to the small but significant lung
function reductions associated with exposure to ETS in adults. The adverse
health effects of ETS, especially in children, correlate with the amount
of smoking in the home and are often more prevalent when both parents
smoke.
The connection of children's symptoms with ETS may not be
immediately evident to the clinician and may become apparent only after
careful questioning. Measurement of biochemical markers such as cotinine
(a metabolic nicotine derivative) in body fluids (ordinarily urine) can
provide evidence of a child's exposure to ETS.
The impact of maternal smoking on fetal development has
also been well documented. Maternal smoking is also associated with
increased incidence of Sudden Infant Death Syndrome, although it has not
been determined to what extent this increase is due to in utero
versus postnatal (lactational and ETS) exposure.
Airborne particulate matter contained in ETS has been
associated with impaired breathing, lung diseases, aggravation of existing
respiratory and cardiovascular disease, changes to the body's immune
system, and lowered defenses against inhaled particles. For
direct ETS exposure, measurable annoyance, irritation, and adverse health
effects have been demonstrated in nonsmokers, children and spouses in
particular, who spend significant time in the presence of smokers.
Acute cardiovascular effects of ETS include increased heart rate, blood
pressure, blood carboxyhemoglobin; and related reduction in exercise
capacity in those with stable angina and in healthy people. Studies have
also found increased incidence of nonfatal heart disease among nonsmokers
exposed to ETS, and it is thought likely that ETS increases the risk of
peripheral vascular disease, as well.
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