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. 2011 Jun 15;183(12):1660-5.
doi: 10.1164/rccm.201011-1802OC. Epub 2011 Mar 18.

Active and passive cigarette smoking and acute lung injury after severe blunt trauma

Carolyn S Calfee  1 , Michael A Matthay, Mark D Eisner, Neal Benowitz, Mariah Call, Jean-François Pittet, Mitchell J Cohen
Affiliations

Active and passive cigarette smoking and acute lung injury after severe blunt trauma

Carolyn S Calfee et al. Am J Respir Crit Care Med. .

Abstract

Rationale: Cigarette smoking has been demonstrated in laboratory studies to have effects on lung epithelial and endothelial function similar to those observed in acute lung injury (ALI). However, the association between active and passive cigarette smoke exposure and susceptibility to ALI has not been prospectively studied.

Objectives: We hypothesized that both active and passive cigarette smoke exposure would be associated with increased susceptibility to ALI after severe blunt trauma.

Methods: We measured levels of cotinine, a metabolite of nicotine and validated biomarker of tobacco use, in plasma samples obtained immediately on arrival at the emergency department from 144 adult subjects after severe blunt trauma. Patients were then followed for the development of ALI.

Measurements and main results: Increasing quartiles of plasma cotinine were associated with the development of ALI (odds ratio [OR] for developing ALI in highest cotinine quartile, 3.25; 95% confidence interval [CI], 1.22-8.68; P = 0.017 for trend across quartiles). Moderate to heavy passive smoke exposure was associated with nearly the same odds of developing ALI as active smoking (OR for moderate to heavy passive smoking compared with no exposure or low level exposure, 3.03; 95% CI, 1.15-8.04; OR for active smoking, 2.77; 95% CI, 1.28-5.99). This association persisted after adjusting for other predictors of ALI, including Injury Severity Score and alcohol abuse.

Conclusions: Both moderate to heavy passive smoking and active smoking are independently associated with the development of ALI after severe blunt trauma. This finding has important implications both for public health and for understanding the pathogenesis of ALI.

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Figures

Figure 1.
Figure 1.
Box-and-whisker plot demonstrating the range of plasma cotinine values in patients stratified by history of smoking. Horizontal line represents the cutoff value of 3.08 ng/ml, which accurately discriminates between active and passive smoking (23). The y axis is log-scale. Number in each group: Nonsmokers by history, n = 53; active smokers by history, n = 43; unknown smoking history, n = 48.
Figure 2.
Figure 2.
Bar chart demonstrating the proportion of patients who developed acute lung injury in increasing quartiles of plasma cotinine (n = 36 in each quartile; P value for trend = 0.017).
See this image and copyright information in PMC

Comment in

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