title: Remote second-hand tobacco exposure in flight attendants is associated with systemic but not pulmonary hypertension.
abstract: BACKGROUND
  Second-hand tobacco smoke has been associated with cardiopulmonary dysfunction. We sought to examine the residual effects of remote second-hand smoke exposure on resting and exercise cardiopulmonary hemodynamics. We hypothesized that remote secondhand smoke exposure results in persistent cardiopulmonary hemodynamic abnormalities.
  
  
  METHODS
  Participants were non-smoking flight attendants who worked in airline cabins prior to the in-flight tobacco ban. Participants underwent clinical evaluations and completed smoke exposure questionnaires. We used Doppler echocardiography to measure pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance (PVR) at rest and during supine bicycle ergometer exercise, using the validated formula TRV/VTIRVOT x 10 + 0.16, where VTIRVOT is the velocity time integral at the right ventricular outflow tract and TRV is the tricuspid regurgitation velocity. The group was divided into quartiles according to the degree of smoke exposure. Analysis of variance was used to determine the differences in hemodynamic outcomes.
  
  
  RESULTS
  Seventy-nine flight attendants were included in our analysis. Baseline characteristics among participants in each quartile of smoke exposure were similar except for history of systemic hypertension, which was more prevalent in the highest quartile. Peak exercise PASP rose to the same degree in all test groups (mean PASP 44 mm Hg, p = 0.25), and PVR increased by approximately 27% in all quartiles. There was no significant difference in pulmonary artery systolic pressure or pulmonary vascular resistance among quartiles of smoke exposure.
  
  
  CONCLUSIONS
  We found that remote heavy second-hand smoke exposure from in-flight tobacco is associated with systemic hypertension but does not have demonstrable pulmonary hemodynamic consequences.
authors.affiliation: Division of Cardiology, California Pacific Medical Center, San Francisco, CA 94115, USA. xiushui@yahoo.com
authors.forename: Xiushui
authors.initials: X
authors.lastname: Ren
authors.forename: Pamela Y F
authors.initials: PY
authors.lastname: Hsu
authors.forename: Fiona L
authors.initials: FL
authors.lastname: Dulbecco
authors.forename: Kirsten E
authors.initials: KE
authors.lastname: Fleischmann
authors.forename: Warren M
authors.initials: WM
authors.lastname: Gold
authors.forename: Rita F
authors.initials: RF
authors.lastname: Redberg
authors.forename: Nelson B
authors.initials: NB
authors.lastname: Schiller
mesh_terms: D000328:Adult; D017677:Age Distribution; D000401:Aircraft; D000704:Analysis of Variance; D001795:Blood Pressure Determination; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D006976:Hypertension, Pulmonary / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D011336:Probability; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D014028:Tobacco Smoke Pollution / Q000009:adverse effects* / Q000706:statistics & numerical data; D014655:Vascular Resistance
chemical_list: D014028:Tobacco Smoke Pollution