- Open Access
Analysis and evaluation of environmental tobacco smoke exposure as a risk factor for chronic cough
Cough volume 3, Article number: 6 (2007)
Exposure to environmental tobacco smoke (ETS) and active tobacco smoking has been shown to increase symptoms of bronchial asthma such as bronchoconstriction but effects on other respiratory symptoms remain poorly assessed. Current levels of exposure to tobacco smoke may also be responsible for the development of chronic cough in both children and adults. The present study analyses the effects of tobacco smoke exposure as potential causes of chronic cough. A panel of PubMed-based searches was performed relating the symptom of cough to various forms of tobacco smoke exposure. It was found that especially prenatal and postnatal exposures to ETS have an important influence on children's respiratory health including the symptom of cough. These effects may be prevented if children and pregnant women are protected from exposure to ETS. Whereas the total number of studies adressing the relationship between cough and ETS exposure is relatively small, the present study demonstrated that there is a critical amout of data pointing to a causative role of environmental ETS exposure for the respiratory symptom of cough. Since research efforts have only targeted this effect to a minor extent, future epidemiological and experimental studies are needed to further unravel the relation between ETS and cough.
Environmental tobacco smoke (ETS) or passive smoking, has been demonstrated to be causally associated with a large number of human diseases although the evidence is sometimes conflicting and the tobacco industry has probably tried to cover up research data over the past 30 years as suggested recently . With regard to the different diseases and symptoms associated with exposure to ETS, reliable evidence has been provided that exposure to ETS is linked with impaired lung function and aggravation of asthma in childhood and adulthood . Asthmatic children with mothers who smoke were found to have more severe asthma when compared with children of non-smoking mothers. Although, parental smoking has not consistently been reported to correlate with the risk of allergic sensitization in children, it has been suggested that maternal smoking during pregnancy or exposure of children to ETS might lead to asthma via an increase of bronchial hyperreactivity, increased sensitivity to allergens, alterations in circadian variations of pulmonary function, and irritant effects [3, 4]. Together, these mechanisms might be directly dependent on an increased inflammatory burden of the upper and lower respiratory tract due to an activation of neuroinflammatory reflexes, recruitment of inflammatory cells, and proinflammatory mediator release .
Whereas there seems to be a clear link between lung cancer and exposure to tobacco smoke , other respiratory symptoms such as mucus secretion or chronic cough have not been analysed in detail for the influence of tobacco smoke exposure. The symptom of cough is one of the most difficult respiratory symptoms to treat and only a little is known about the exact mechanisms in children and adults [6–8]. Pathophysiologically, coughing is coordinated by neuronal reflexes in order to protect the respiratory tract from noxious exogenous substances such as tobacco smoke or other factors [9–19] and numerous complex mechanisms underlie this phenomenon [20–24, 24, 25]. Recently, transient receptor potential vanilloid-1 has been suggested to play a major role in the pathophysiology of the cough reflex [26, 27] and numerous research efforts have been undertaken to optimize the diagnosis and treatment of the symptom [28–35].
Whereas exposure to ETS has been demonstrated to be associated with the occurrence of numerous pathological conditions, the link between ETS and the symptom of cough has not been analysed in great detail so far. Therefore, the present study aimed to analyse the association of ETS and cough on the basis of database searches and existing clinical and experimtenal studies [36–43, 20, 44–58].
Database searches were conducted using terms including "cough", "environmental", and various other terms related to tobacco smoke exposure. (date: 2006-03-03). The PubMed system was used. This is a service of the U.S. National Library of Medicine. It includes over 16 million citations from MEDLINE and other life science journals for biomedical articles back to the 1950s. PubMed includes links to full text articles and other related resources .
To further delineate the impact of research focussed on the symptom cough and its relation to tobacco smoke, all publication years dating back to 1969 were screened. The number of entries related to the terms tobacco and cough were assessed. Also, the different publication dates of the articles were analysed. Finally, articles were screened for their contents and relevant data was analysed.
Results and Discussion
Frequency of research related to cough and tobacco smoke exposure
For the terms "cough" and "environment" a total of 984 entries were found in PubMed. While 370 entries contained the terms "cough" and "smoke" (Fig. 1), 306 entries contained "cough" and "tobacco" and 298 entries "cough" and "cigarette". Narrowing the research to ETS by using the terms "cough" and "environmental tobacco smoke" only 59 entries were found, suggesting that the relation of the symptom cough to ETS has not been focussed on in detail over the past few years. To further analyse the distribution of studies addressing cough and its relation to tobacco smoke, different publication dates were screened and a differential distribution was found. In this respect, an increasing frequency was found beginning from the year 1969 with one article increasing to 21 articles in the year 2005 (Fig. 2).
Environmental tobacco smoke
There has been increasing evidence that the exposure of adults and children to environmental tobacco smoke (ETS) is a general health hazard and exerts major deleterious effects on the cardio-respiratory system [2, 36, 60–65, 4, 66]. In this respect, significant associations have been found between ETS for respiratory diseases such as adult and pediatric asthma. Also a series of epidemiological analyses on parental smoking and respiratory health in children have been performed [60, 64, 65, 4, 66–71]. Overall there was a very consistent picture with odds ratios for respiratory illnesses and symptoms between 1.2 and 1.6 for either parent smoking, the odds usually being higher in pre-school than in school aged children. For cough, the odds ratio when both parents were smokers was 1.67 (1.48 to 1.89) [67–71].
To assess the number of studies linking cough and tobacco smoke exposure, different search terms were used and it was found that while there was a relatively high number of studies with both the terms "cough" and "smoke" (370 entries) or "cough and tobacco (306 entries), only 59 studies had both the terms "cough" and "environmental tobacco smoke".
Important methodological issues arise in the assessment of associations between ETS exposure and respiratory diseases such as chronic cough, as there is the possibility of confounding by variables related both to the exposure and the outcome of interest . By analyzing available data self-reported health conditions such as chronic cough can be related to ETS exposure in men (Table 1) and women (Table 1) who were never smokers of any tobacco products. Significant values were found for the association of chronic cough to heavy (> 40 hours/week) ETS exposure at home in men, for the association of chronic cough to heavy (> 40 hours/week) ETS exposure in small spaces, total ETS exposure, and large indoor areas in men. For women, significant values were found for heavy ETS exposure in small spaces and in large indoor areas and for total ETS exposure .
Other data describing the effects of ETS often used nonsmoking wives and smoking discordant husbands. Here, it was also shown that wives with never-smoked husbands had lower frequencies of chronic cough, next to a better socio-economic status and better indices of the family cohesiveness. These differences were largest when comparing wives of never-smoked vs. heavily smoking husbands (more than 20 cigarettes/day), suggesting a dose-response .
The association between the smoking status and the prevalence of chronic cough was also analyzed in the long-term ambient air pollution and respiratory symptoms in adults study (SAPALDIA) . This cross-sectional study in random population samples of adults in Switzerland reported prevalences of chronic cough in percent by smoking status and found 3.3 (2.8 – 3.8, 95% confidence interval) of never smokers (n = 4.229), 3.0 (2.3 – 3.7) of former smokers (n = 2.175) and 9.2 (8.2 – 10.2) of current smokers (n = 3.232) .
ETS exposure has been shown to increase symptoms of allergic bronchial asthma, but direct effects on the expression of inflammatory markers have not been analysed in detail previously. Therefore, a recent study assessed the correlation of ETS exposure with the expression of inflammatory mediators in airway secretions of children with asthma. IFN-gamma and IL-12, as well as IL-5 and IL-13 were analysed in allergic asthmatic children and healthy children . Using nasopharyngeal aspiration, airway secretions were collected from 24 atopic children with asthma (age, 6–16 years) and 26 healthy control subjects, and cytokine concentration was determined by means of immunoenzymatic methods. It was shown that IL-13 levels were highly increased in patients with asthma (P < .005). Also, a positive correlation between IL-13 levels and serum IgE concentrations (r(s) = 0.55) was found in children with allergic asthma. Parental tobacco smoking lead to a significant increase in airway IL-13 secretion compared with nonexposed children and healthy control subjects (median, 860 pg/mL vs 242 pg/mL and 125 pg/mL, respectively) . Together, these results indicate that ETS exposure augments the expression and secretion of IL-13 in allergic asthma. Measurements of IL-13 in secretions might be taken into account as a noninvasive marker of airway inflammation and to assess the detrimental effects of ETS.
Regarding the mechanisms between smoke exposure and chronic cough, recent studies have assessed capsaicin responsiveness [75–77]. It was shown that cough reflex sensitivity is enhanced soon after smoking cessation. Therefore, it was suggested that diminished cough sensitivity in smokers results from chronic cigarette smoke-induced desensitization of airway cough receptors. In a further study, the cough reflex sensitivity to capsaicin (C(5)) was evaluated in 11 chronic smokers who had discontinued smoking for at least 2 weeks, and then resumed smoking. It was shown that two weeks after smoking cessation there was a significant enhancement of cough reflex sensitivity; mean (+/-SEM) log C(5) decreased from 1.77+/-0.18 to 1.47+/-0.14 (p = 0.01). The subjects resumed smoking after 2–12 weeks of abstinence and a repeat capsaicin cough challenge was performed 14–23 days after resumption of smoking. The mean log C(5) increased compared to the last value obtained during the smoking cessation period (1.42+/-0.15 vs. 1.77+/-0.16, p = 0.0004) and the mean log C(5) after resumption of smoking returned to almost exactly the baseline value. These data point to a dynamic phenomenon in the sensitivity of airway cough receptors. In this respect, they seem to be promptly affected and modulated by the presence or absence of cigarette smoke . Similar results were demonstrated in experimental animal models of passive ETS exposure .
The different reports clearly indicate an association between ETS and chronic cough. Whereas active tobacco smoking is without a doubt related to chronic cough and other more prominent diseases such as bronchial carcinoma, passive ETS may also be a relevant risk factor for chronic cough . The present analysis concerns environmental exposure to tobacco smoke. In this respect, it neglects chronic cough in active tobacco smokers. Issues related to active smoking that need to be analysed in the future are the association of active tobacco smoking on the symptom of chronic cough. This is of major interest because it needs to be determined whether cough or sputum production are predictors of COPD. This association may also be assessed by studies that focus at symptom modification after smoking cessation. It will also be important to address whether it is the active exposure or the resulting damage that is causing cough in chronic tobacco smokers.
Suspended particulate matter
A further important environmental factor contributing to chronic cough is displayed by suspended particulate matter (SPM)  and tobacco smoke products also belong to SPM fractions. 6 entries in the PubMed were found that linked cough to the term "particulate". Effects of SPM critically depend on the particle size and the concentration and may fluctuate with daily fluctuations in the PM10 or PM2.5 levels. The actual relationship between PM10 or PM2.5 exposure and health effects has been shown to be linear at concentrations below 100 micrograms/m3 and currently there are no threshold known below which no effects occur. Large variance in short-term health effects have been reported which may base on the influence of concomitant gaseous pollutants.
A study on the association between the indoor PM10 and chronic cough in 3,709 Chinese adults demonstrated highly significant differences between study areas in the prevalence of chronic cough. Median indoor concentrations of PM10 were much higher in Beijing (557 micrograms/m3), where the highest prevalence for chronic cough was also found .
In the Swiss SCARPOL study, reported symptom rates of chronic cough, nocturnal dry cough, and bronchitis, adjusted for individual risk factors, were positively associated with PM10, NO2, and SO2. In this study, the strongest relationship was observed for PM10 (adjusted odds ratio) between the most and the least polluted community with a value of 3.07 (95% CI: 1.62 to 5.81) for chronic cough .
Concerning ambient air pollution, a comparison of nonsmoking residents of lower- and higher-pollution zones, which were stratified according to socioeconomic levels and sex, showed that chronic cough but not wheeze was significantly more common in the higher-pollution zone in only some of the strata .
Environmental tobacco smoke exposure does not only lead to lung cancer and cardiorespiratory disease but is also related to numerous respiratory symptoms. Whereas it has been known for a long time that exacerbations of bronchial asthma and chronic obstructive pulmonary disease might be aggravated by ETS exposure, only little knowledge has been accumulated concerning the relation of ETS and symptoms such as cough. The present study assessed this relation by analyzing the existing literature. The results clearly indicate that ETS exposure may lead to the symptom of cough. Since only a few experimental approaches exist to date to treat cough, further studies on the clinical, experimental and molecular basis are needed. These studies should analyze the pathophysioloical basis and identify genetic factors of chronic cough. Also, new options to treat this respiratory condition need to be evaluated.
Bitton A, Neuman MD, Barnoya J, Glantz SA: The p53 tumour suppressor gene and the tobacco industry: research, debate, and conflict of interest. Lancet. 2005, 365 (9458): 531-540.
Chilmonczyk BA, Salmun LM, Megathlin KN, Neveux LM, Palomaki GE, Knight GJ, Pulkkinen AJ, Haddow JE: Association between exposure to environmental tobacco smoke and exacerbations of asthma in children. N Engl J Med. 1993, 328 (23): 1665-1669. 10.1056/NEJM199306103282303.
DiFranza JR, Aligne CA, Weitzman M: Prenatal and postnatal environmental tobacco smoke exposure and children's health. Pediatrics. 2004, 113 (4 Suppl): 1007-1015.
Strachan DP, Cook DG: Health effects of passive smoking .5. Parental smoking and allergic sensitisation in children. Thorax. 1998, 53 (2): 117-123.
Floreani AA, Rennard SI: The role of cigarette smoke in the pathogenesis of asthma and as a trigger for acute symptoms. Curr Opin Pulm Med. 1999, 5 (1): 38-46. 10.1097/00063198-199901000-00007.
Haque RA, Chung KF: Cough: meeting the needs of a growing field. Cough. 2005, 1: 1-10.1186/1745-9974-1-1.
Chang AB: Cough: are children really different to adults?. Cough. 2005, 1: 7-10.1186/1745-9974-1-7.
McGarvey LP: Idiopathic chronic cough: a real disease or a failure of diagnosis?. Cough. 2005, 1: 9-10.1186/1745-9974-1-9.
Mazzone SB: An overview of the sensory receptors regulating cough. Cough. 2005, 1: 2-10.1186/1745-9974-1-2.
Yelin E, Katz P, Balmes J, Trupin L, Earnest G, Eisner M, Blanc P: Work Life of Persons with Asthma, Rhinitis, and COPD: A Study Using a National, Population-Based Sample. J Occup Med Toxicol. 2005, 1 (1): 2-10.1186/1745-6673-1-2.
Groneberg DA, Fischer A: Occupational Medicine and Toxicology. J Occup Med Toxicol. 2005, 1 (1): 1-10.1186/1745-6673-1-1.
Groneberg DA, Nowak D, Wussow A, Fischer A: Chronic cough due to occupational factors. J Occup Med Toxicol. 2005, 1 (1): 3-10.1186/1745-6673-1-3.
Groneberg DA, Wagner U, Chung KF: Mucus and fatal asthma. Am J Med. 2004, 116 (1): 66-67. 10.1016/j.amjmed.2003.08.023.
Chung KF, Groneberg DA: Effects of cigarette smoke on pulmonary homeostasis. Am J Respir Cell Mol Biol. 2005, 32 (2): 167-10.1165/rcmb.F288.
Chung KF, Caramori G, Groneberg DA: Airway obstruction in chronic obstructive pulmonary disease. N Engl J Med. 2004, 351 (14): 1459-1461. 10.1056/NEJM200409303511420.
Groneberg DA, Eynott PR, Lim S, Oates T, Wu R, Carlstedt I, Roberts P, McCann B, Nicholson AG, Harrison BD, Chung KF: Expression of respiratory mucins in fatal status asthmaticus and mild asthma. Histopathology. 2002, 40 (4): 367-373. 10.1046/j.1365-2559.2002.01378.x.
Groneberg DA, Eynott PR, Oates T, Lim S, Wu R, Carlstedt I, Nicholson AG, Chung KF: Expression of MUC5AC and MUC5B mucins in normal and cystic fibrosis lung. Respir Med. 2002, 96 (2): 81-86. 10.1053/rmed.2001.1221.
Springer J, Groneberg DA, Pregla R, Fischer A: Inflammatory cells as source of tachykinin-induced mucus secretion in chronic bronchitis. Regul Pept. 2005, 124 (1-3): 195-201. 10.1016/j.regpep.2004.07.017.
Groneberg DA, Peiser C, Dinh QT, Matthias J, Eynott PR, Heppt W, Carlstedt I, Witt C, Fischer A, Chung KF: Distribution of respiratory mucin proteins in human nasal mucosa. Laryngoscope. 2003, 113 (3): 520-524. 10.1097/00005537-200303000-00023.
Chung KF, Widdicombe J: Acute and chronic cough. Pulm Pharmacol Ther. 2004, 17 (6): 471-473. 10.1016/j.pupt.2004.09.026.
Carr MJ: Plasticity of vagal afferent fibres mediating cough. Pulm Pharmacol Ther. 2004, 17 (6): 447-451. 10.1016/j.pupt.2004.09.020.
Mazzone SB: Sensory regulation of the cough reflex. Pulm Pharmacol Ther. 2004, 17 (6): 361-368. 10.1016/j.pupt.2004.09.021.
Canning BJ, Mazzone SB, Meeker SN, Mori N, Reynolds SM, Undem BJ: Identification of the tracheal and laryngeal afferent neurones mediating cough in anaesthetized guinea-pigs. J Physiol. 2004, 557 (Pt 2): 543-558. 10.1113/jphysiol.2003.057885.
Widdicombe JG: Overview of neural pathways in allergy and asthma. Pulm Pharmacol Ther. 2003, 16 (1): 23-30. 10.1016/S1094-5539(02)00178-5.
Belvisi MG: Sensory nerves and airway inflammation: role of A delta and C-fibres. Pulm Pharmacol Ther. 2003, 16 (1): 1-7. 10.1016/S1094-5539(02)00180-3.
Trevisani M, Gazzieri D, Benvenuti F, Campi B, Dinh QT, Groneberg DA, Rigoni M, Emonds-Alt X, Creminon C, Fischer A, Geppetti P, Harrison S: Ethanol Causes Inflammation in the Airways by a Neurogenic and TRPV1-Dependent Mechanism. J Pharmacol Exp Ther. 2004
Groneberg DA, Niimi A, Dinh QT, Cosio B, Hew M, Fischer A, Chung KF: Increased expression of transient receptor potential vanilloid-1 in airway nerves of chronic cough. Am J Respir Crit Care Med. 2004, 170 (12): 1276-1280. 10.1164/rccm.200402-174OC.
Addington WR, Stephens RE, Widdicombe JG, Rekab K: Effect of stroke location on the laryngeal cough reflex and pneumonia risk. Cough. 2005, 1: 4-10.1186/1745-9974-1-4.
Barr RL, McCrystal DJ, Perry CF, Chang AB: A rare cause of specific cough in a child: the importance of following-up children with chronic cough. Cough. 2005, 1: 8-10.1186/1745-9974-1-8.
Fujimura M, Hara J, Myou S: Change in bronchial responsiveness and cough reflex sensitivity in patients with cough variant asthma: effect of inhaled corticosteroids. Cough. 2005, 1: 5-10.1186/1745-9974-1-5.
Coyle MA, Keenan DB, Henderson LS, Watkins ML, Haumann BK, Mayleben DW, Wilson MG: Evaluation of an ambulatory system for the quantification of cough frequency in patients with chronic obstructive pulmonary disease. Cough. 2005, 1: 3-10.1186/1745-9974-1-3.
Hara J, Fujimura M, Myou S, Oribe Y, Furusho S, Kita T, Katayama N, Abo M, Ohkura N, Herai Y, Hori A, Ishiura Y, Nobata K, Ogawa H, Yasui M, Kasahara K, Nakao S: Comparison of cough reflex sensitivity after an inhaled antigen challenge between actively and passively sensitized guinea pigs. Cough. 2005, 1: 6-10.1186/1745-9974-1-6.
Ishiura Y, Fujimura M, Nobata K, Abo M, Oribe T, Myou S, Nakamura H: Phosphodiesterase 3 inhibition and cough in elderly asthmatics. Cough. 2005, 1: 11-10.1186/1745-9974-1-11.
Smith JA, Ashurst HL, Jack S, Woodcock AA, Earis JE: The description of cough sounds by healthcare professionals. Cough. 2006, 2: 1-10.1186/1745-9974-2-1.
Torrego A, Cimbollek S, Hew M, Chung KF: No effect of omeprazole on pH of exhaled breath condensate in cough associated with gastro-oesophageal reflux. Cough. 2005, 1: 10-10.1186/1745-9974-1-10.
Balmes J, Becklake M, Blanc P, Henneberger P, Kreiss K, Mapp C, Milton D, Schwartz D, Toren K, Viegi G: American Thoracic Society Statement: Occupational contribution to the burden of airway disease. Am J Respir Crit Care Med. 2003, 167 (5): 787-797. 10.1164/rccm.167.5.787.
Belvisi MG, Geppetti P: Cough. 7: Current and future drugs for the treatment of chronic cough. Thorax. 2004, 59 (5): 438-440. 10.1136/thx.2003.013490.
de Jongste JC, Shields MD: Cough . 2: Chronic cough in children. Thorax. 2003, 58 (11): 998-1003. 10.1136/thorax.58.11.998.
Dicpinigaitis PV: Cough. 4: Cough in asthma and eosinophilic bronchitis. Thorax. 2004, 59 (1): 71-72.
Fontana GA, Pistolesi M: Cough. 3: chronic cough and gastro-oesophageal reflux. Thorax. 2003, 58 (12): 1092-1095. 10.1136/thorax.58.12.1092.
McGarvey LP: Cough . 6: Which investigations are most useful in the diagnosis of chronic cough?. Thorax. 2004, 59 (4): 342-346. 10.1136/thx.2004.021832.
Morice AH, Kastelik JA: Cough. 1: Chronic cough in adults. Thorax. 2003, 58 (10): 901-907. 10.1136/thorax.58.10.901.
Morice AH, Geppetti P: Cough. 5: The type 1 vanilloid receptor: a sensory receptor for cough. Thorax. 2004, 59 (3): 257-258. 10.1136/thx.2003.013482.
Ahmedzai SH: Cough in cancer patients. Pulm Pharmacol Ther. 2004, 17 (6): 415-423. 10.1016/j.pupt.2004.09.015.
Chung KF, Widdicombe JG: Cough as a symptom. Pulm Pharmacol Ther. 2004, 17 (6): 329-332. 10.1016/j.pupt.2004.09.019.
Chung KF, Chang AB: Therapy for cough: active agents. Pulm Pharmacol Ther. 2002, 15 (3): 335-338. 10.1006/pupt.2002.0342.
Dicpinigaitis PV: Potential new cough therapies. Pulm Pharmacol Ther. 2004, 17 (6): 459-462. 10.1016/j.pupt.2004.09.010.
Fong J, Sandhu G, Ellaway P, Davey N, Strutton P, Murphy K, Guz A: What do we know about how humans cough?. Pulm Pharmacol Ther. 2004, 17 (6): 431-434. 10.1016/j.pupt.2004.09.007.
Fontana GA, Lavorini F, Geri P, Zanasi A, Piumelli R: Cough in children with congenital central hypoventilation syndrome. Pulm Pharmacol Ther. 2004, 17 (6): 425-429. 10.1016/j.pupt.2004.09.018.
Harrison NK: Idiopathic pulmonary fibrosis: a nervous cough?. Pulm Pharmacol Ther. 2004, 17 (6): 347-350. 10.1016/j.pupt.2004.09.029.
Ing AJ: Cough and gastro-oesophageal reflux disease. Pulm Pharmacol Ther. 2004, 17 (6): 403-413. 10.1016/j.pupt.2004.09.023.
McGarvey LP, Ing AJ: Idiopathic cough, prevalence and underlying mechanisms. Pulm Pharmacol Ther. 2004, 17 (6): 435-439. 10.1016/j.pupt.2004.09.012.
McGarvey LP, Nishino T: Acute and chronic cough. Pulm Pharmacol Ther. 2004, 17: 351-354. 10.1016/j.pupt.2004.09.017.
Morice AH: Post-nasal drip syndrome--a symptom to be sniffed at?. Pulm Pharmacol Ther. 2004, 17 (6): 343-345. 10.1016/j.pupt.2004.09.005.
Niimi A, Chung KF: Airway inflammation and remodelling changes in patients with chronic cough: do they tell us about the cause of cough?. Pulm Pharmacol Ther. 2004, 17 (6): 441-446. 10.1016/j.pupt.2004.09.004.
Page C, Reynolds SM, Mackenzie AJ, Geppetti P: Mechanisms of acute cough. Pulm Pharmacol Ther. 2004, 17 (6): 389-391. 10.1016/j.pupt.2004.09.028.
Pavord ID: Cough and asthma. Pulm Pharmacol Ther. 2004, 17 (6): 399-402. 10.1016/j.pupt.2004.09.009.
Smith JA, Calverley PM: Cough in chronic obstructive pulmonary disease. Pulm Pharmacol Ther. 2004, 17 (6): 393-398. 10.1016/j.pupt.2004.09.006.
Iribarren C, Friedman GD, Klatsky AL, Eisner MD: Exposure to environmental tobacco smoke: association with personal characteristics and self reported health conditions. J Epidemiol Community Health. 2001, 55 (10): 721-728. 10.1136/jech.55.10.721.
Kritz H, Schmid P, Sinzinger H: Passive smoking and cardiovascular risk. Arch Intern Med. 1995, 155 (18): 1942-1948. 10.1001/archinte.155.18.1942.
Ciruzzi M, Pramparo P, Esteban O, Rozlosnik J, Tartaglione J, Abecasis B, Cesar J, De Rosa J, Paterno C, Schargrodsky H: Case-control study of passive smoking at home and risk of acute myocardial infarction. Argentine FRICAS Investigators. Factores de Riesgo Coronario en America del Sur. J Am Coll Cardiol. 1998, 31 (4): 797-803. 10.1016/S0735-1097(98)00017-5.
Cardenas VM, Thun MJ, Austin H, Lally CA, Clark WS, Greenberg RS, Heath CW: Environmental tobacco smoke and lung cancer mortality in the American Cancer Society's Cancer Prevention Study. II. Cancer Causes Control. 1997, 8 (1): 57-64. 10.1023/A:1018483121625.
Strachan DP, Cook DG: Health effects of passive smoking. 1. Parental smoking and lower respiratory illness in infancy and early childhood. Thorax. 1997, 52 (10): 905-914.
Strachan DP, Cook DG: Health effects of passive smoking. 6. Parental smoking and childhood asthma: longitudinal and case-control studies. Thorax. 1998, 53 (3): 204-212.
Strachan DP, Cook DG: Health effects of passive smoking. 4. Parental smoking, middle ear disease and adenotonsillectomy in children. Thorax. 1998, 53 (1): 50-56.
Cook DG, Strachan DP: Health effects of passive smoking. 3. Parental smoking and prevalence of respiratory symptoms and asthma in school age children. Thorax. 1997, 52 (12): 1081-1094.
Cook DG, Strachan DP: Parental smoking, bronchial reactivity and peak flow variability in children. Thorax. 1998, 53 (4): 295-301.
Cook DG, Strachan DP: Health effects of passive smoking-10: Summary of effects of parental smoking on the respiratory health of children and implications for research. Thorax. 1999, 54 (4): 357-366.
Cook DG, Strachan DP, Carey IM: Health effects of passive smoking. 9. Parental smoking and spirometric indices in children. Thorax. 1998, 53 (10): 884-893.
Cook DG, Strachan DP, Carey IM: Health effects of passive smoking. Thorax. 1999, 54 (5): 469-
Koo LC, Ho JH, Rylander R: Life-history correlates of environmental tobacco smoke: a study on nonsmoking Hong Kong Chinese wives with smoking versus nonsmoking husbands. Soc Sci Med. 1988, 26 (7): 751-760. 10.1016/0277-9536(88)90066-4.
Zemp E, Elsasser S, Schindler C, Kunzli N, Perruchoud AP, Domenighetti G, Medici T, Ackermann-Liebrich U, Leuenberger P, Monn C, Bolognini G, Bongard JP, Brandli O, Karrer W, Keller R, Schoni MH, Tschopp JM, Villiger B, Zellweger JP: Long-term ambient air pollution and respiratory symptoms in adults (SAPALDIA study). The SAPALDIA Team. Am J Respir Crit Care Med. 1999, 159 (4 Pt 1): 1257-1266.
Feleszko W, Zawadzka-Krajewska A, Matysiak K, Lewandowska D, Peradzynska J, Dinh QT, Hamelmann E, Groneberg DA, Kulus M: Parental tobacco smoking is associated with augmented IL-13 secretion in children with allergic asthma. J Allergy Clin Immunol. 2006, 117 (1): 97-102. 10.1016/j.jaci.2005.09.008.
Dicpinigaitis PV: Cough reflex sensitivity in cigarette smokers. Chest. 2003, 123 (3): 685-688. 10.1378/chest.123.3.685.
Dicpinigaitis PV, Sitkauskiene B, Stravinskaite K, Appel DW, Negassa A, Sakalauskas R: Effect of smoking cessation on cough reflex sensitivity. Eur Respir J. 2006, 28 (4): 786-790. 10.1183/09031936.06.00007806.
Sitkauskiene B, Stravinskaite K, Sakalauskas R, Dicpinigaitis PV: Changes in cough reflex sensitivity after cessation and resumption of cigarette smoking. Pulm Pharmacol Ther. 2007, 20 (3): 240-243. 10.1016/j.pupt.2006.08.005.
Bergren DR: Chronic tobacco smoke exposure increases cough to capsaicin in awake guinea pigs. Respir Physiol. 2001, 126 (2): 127-140. 10.1016/S0034-5687(01)00193-1.
Venners SA, Wang B, Ni J, Jin Y, Yang J, Fang Z, Xu X: Indoor air pollution and respiratory health in urban and rural China. Int J Occup Environ Health. 2001, 7 (3): 173-181.
Braun-Fahrlander C, Vuille JC, Sennhauser FH, Neu U, Kunzle T, Grize L, Gassner M, Minder C, Schindler C, Varonier HS, Wuthrich B: Respiratory health and long-term exposure to air pollutants in Swiss schoolchildren. SCARPOL Team. Swiss Study on Childhood Allergy and Respiratory Symptoms with Respect to Air Pollution, Climate and Pollen. Am J Respir Crit Care Med. 1997, 155 (3): 1042-1049.
Chhabra SK, Chhabra P, Rajpal S, Gupta RK: Ambient air pollution and chronic respiratory morbidity in Delhi. Arch Environ Health. 2001, 56 (1): 58-64.
About this article
Cite this article
Groneberg-Kloft, B., Feleszko, W., Dinh, Q.T. et al. Analysis and evaluation of environmental tobacco smoke exposure as a risk factor for chronic cough. Cough 3, 6 (2007). https://doi.org/10.1186/1745-9974-3-6
- Tobacco Smoke
- Suspended Particulate Matter
- Environmental Tobacco Smoke
- Chronic Cough