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. 2015 Sep;43(9):1790-7.
doi: 10.1097/CCM.0000000000001089.

Cigarette Smoke Exposure and the Acute Respiratory Distress Syndrome

Carolyn S Calfee  1 , Michael A Matthay, Kirsten N Kangelaris, Edward D Siew, David R Janz, Gordon R Bernard, Addison K May, Peyton Jacob, Christopher Havel, Neal L Benowitz, Lorraine B Ware
Affiliations

Cigarette Smoke Exposure and the Acute Respiratory Distress Syndrome

Carolyn S Calfee et al. Crit Care Med. 2015 Sep.

Abstract

Objective: The association between cigarette smoke exposure and the acute respiratory distress syndrome in patients with the most common acute respiratory distress syndrome risk factors of sepsis, pneumonia, and aspiration has not been well studied. The goal of this study was to test the association between biomarker-confirmed cigarette smoking and acute respiratory distress syndrome in a diverse cohort.

Design: Prospective cohort.

Setting: Tertiary care center.

Patients: Four hundred twenty-six critically ill patients with acute respiratory distress syndrome risk factors (excluding trauma and transfusion)

Interventions: : None.

Measurements and main results: We obtained smoking histories and measured urine 4-(methylnitrosamino)-1-(3-pyridyl)-1- butanol (a biomarker of cigarette smoke exposure) on urine samples obtained at the time of study enrollment. The association between cigarette smoke exposure and acute respiratory distress syndrome differed based on acute respiratory distress syndrome risk factor (p < 0.02 for interaction). In patients with nonpulmonary sepsis as the primary acute respiratory distress syndrome risk factor (n = 212), 39% of those with acute respiratory distress syndrome were current smokers by history compared with 22% of those without acute respiratory distress syndrome (odds ratio, 2.28; 95% CI, 1.24-4.19; p = 0.008). Likewise, cigarette smoke exposure as measured by urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol was significantly associated with acute respiratory distress syndrome in this group. The increased risk of acute respiratory distress syndrome in nonpulmonary sepsis was restricted to patients with 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol levels consistent with active smoking and was robust to adjustment for other acute respiratory distress syndrome predictors. Cigarette smoke exposure as measured by history or 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol was not associated with acute respiratory distress syndrome in patients with other risk factors (e.g., pneumonia and aspiration).

Conclusions: Cigarette smoking measured both by history and biomarker is associated with an increased risk of acute respiratory distress syndrome in patients with nonpulmonary sepsis. This finding has important implications for tobacco product regulation and for understanding the pathogenesis of acute respiratory distress syndrome.

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Conflict of interest statement

CONFLICTS OF INTEREST

The authors have no conflicts of interest relevant to the work under consideration for publication. Drs. Calfee and Matthay have received research funding from Glaxo Smith Kline and served on advisory boards for Glaxo Smith Kline. Dr. Ware has served on advisory boards for Glaxo Smith Kline. Dr. Benowitz has consulted for Pfizer and Glaxo Smith Kline and has served as a paid expert witness in litigation against tobacco companies. All other authors have no interests to report.

The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1
Figure 1. NNAL Levels By Smoking History in Entire Cohort (n=426)
Urine NNAL levels ≥ 47.3 pg/ml were considered consistent with active smoking.
Figure 2
Figure 2. Association between NNAL and ARDS in patients with non-pulmonary sepsis (n=212)
This figure demonstrates a locally weighted scatterplot smoothing (Lowess) analysis in which the continuous relationship between NNAL levels on the x-axis (log-scale) and development of ARDS on the y-axis is depicted (line). Dots represent individual patients; those at the top of the figure have ARDS, those at the bottom do not.
See this image and copyright information in PMC

Comment in

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