The Role of Environmental Tobacco Smoke in Asthma Induction and Exacerbation in Children and Adults

THE ROLE OF ENVIRONMENTALTOBACCO SMOKE IN ASTHMAINDUCTION AND EXACERBATIONIN CHILDREN AND ADULTS......Page 3
NOTICE TO THE READER......Page 6
CONTENTS......Page 7
LIST OF TABLES......Page 9
LIST OF FIGURES......Page 13
SUPPLEMENTARY MATERIAL......Page 15
ABBREVIATIONS......Page 17
ETS EXPOSURE......Page 21
2.2. ASTHMA EXACERBATION......Page 23
2.3. ASTHMA INDUCTION......Page 24
2.6. ADDITIONAL INFORMATION......Page 26
3.1.2. The New Orleans Studies......Page 27
3.1.3. The Hamburg Studies......Page 31
3.1.4. The Other Studies......Page 36
3.1.5. Summary of the Studies......Page 38
3.2.1. Symptoms of Asthma......Page 43
3.2.2. Airway Responsiveness......Page 45
3.2.3. Lung Function......Page 47
3.2.4. A Physiological or a Psychological Response?......Page 51
3.3.1. Summary......Page 52
3.3.2. Other Published Reviews of the Evidence......Page 53
3.4. REFERENCES......Page 54
4.1.1. Introduction......Page 59
4.1.2. Description of the Studies......Page 60
4.1.3. Summary of the Studies......Page 65
4.2.1. Asthma Exacerbation and Severity......Page 67
4.3.1. Summary......Page 72
4.3.2. Other Published Reviews of the Evidence......Page 73
4.4. REFERENCES......Page 75
5.1.1. Introduction......Page 79
5.1.2. Description of the Studies – USA......Page 80
5.1.3. Description of the Studies – Canada......Page 93
5.1.4. Description of the Studies – Europe......Page 96
5.1.5. Description of the Studies – Asia (Including Turkey)......Page 104
5.1.6. Description of the Studies – Other Areas......Page 107
5.1.7. Summary of the Studies......Page 109
5.2.2. Lung Function......Page 122
5.2.3. Bronchial Responsiveness......Page 143
5.3.1. Summary......Page 144
5.3.2. Other Reviews of the Evidence......Page 146
5.4. REFERENCES......Page 150
EXACERBATION OF ASTHMA –OVERALL ASSESSMENT......Page 157
7.1. IDENTIFYING THE STUDIES......Page 159
7.2. DATABASE STRUCTURE......Page 160
7.4. STRUCTURE OF THE STUDY DATABASE......Page 161
7.6. PROBLEMS WITH OVERLAPPING STUDIES......Page 163
7.8. IDENTIFYING WHICH RELATIVE RISKS TO ENTERON THE DATABASE......Page 164
7.8.1. Passive Smoking Indices for Children......Page 165
7.8.3. Asthma Type......Page 168
7.9. DERIVATION OF THE RELATIVE RISKS......Page 169
7.10.1. Process of Selecting the Relative Risks for the Meta-analyses......Page 171
7.10.2. Combining the Relative Risks......Page 172
7.10.3. Layout of Output......Page 173
7.10.4. General Restrictions to the Analyses......Page 174
7.10.5. Defining the Outcome and the Exposure......Page 175
7.10.6. Factors Considered......Page 177
7.10.8. Meta-analysis of Results by Age......Page 180
7.11. REFERENCES......Page 181
8.1.3. Overlapping Studies......Page 183
8.1.4. Study Characteristics......Page 185
8.2. THE RELATIVE RISKS......Page 192
8.3.1. Introduction......Page 199
8.3.2. Risk from any Exposure – Table A and Appendix Table A......Page 200
8.3.3. Risk by Amount of Exposure – Table B and Appendix Table B......Page 207
8.4.2. Evidence of a Dose-response Relationship......Page 210
8.4.3. Consistency of Findings......Page 211
8.4.5. Diagnostic Bias......Page 212
8.4.7. Misclassification of Exposure......Page 213
8.4.9. Confounding......Page 214
8.4.10. Smoking in Pregnancy......Page 215
8.4.11. Exacerbation or Induction?......Page 216
8.5.1. Methods Used to Collect and Analyse the Data and Scope of theInformation Obtained......Page 217
8.5.2. Results......Page 218
8.5.3. Other Reviews......Page 219
8.6. REFERENCES......Page 223
9.1.2. The Study Data......Page 243
9.1.3. Overlapping Studies......Page 254
9.1.4. Study Characteristics......Page 256
9.2. THE RELATIVE RISKS......Page 272
9.3.1. Introduction......Page 284
9.3.2. Risk from Exposure in the Child’s Lifetime (Irrespective of In UteroExposure) – Table C and Appendix Table C......Page 285
9.3.3. Risk by Amount of Exposure in Life – Table D and Appendix Table D......Page 304
9.3.4. Risk from In Utero Exposure (Irrespective of In-life Exposure) –Table E and Appendix Table E......Page 310
9.3.5. Risk by Amount of Exposure In Utero – Table F and Appendix F......Page 313
9.3.6. Separating Effects of In-life and In Utero Exposure – Table G andAppendix Table G......Page 315
9.4.2. Evidence of a Dose-response Relationship......Page 325
9.4.3. Consistency of Findings......Page 326
9.4.4. Publication Bias......Page 327
9.4.5. Diagnostic Bias......Page 328
9.4.6. Representativeness......Page 329
9.4.8. Smoking by the Child......Page 330
9.4.9. Confounding......Page 331
Untitled......Page 334
9.4.12. Smoking in Pregnancy......Page 335
9.4.13. Exacerbation or Induction?......Page 337
9.5.1. Methods Used to Collect and Analyse the Data and Scope of theInformation Obtained......Page 339
9.5.2. Results......Page 341
9.5.3. Other Reviews......Page 342
9.6. REFERENCES......Page 350
INDUCTION OF ASTHMA – OVERALL ASSESSMENT......Page 453
FINAL CONCLUSIONS......Page 455
ACKNOWLEDGEMENTS......Page 457
INDEX......Page 459