title: Active and passive cigarette smoking and acute lung injury after severe blunt trauma.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA 94143-0111, USA. carolyn.calfee@ucsf.edu
authors.forename: Carolyn S
authors.initials: CS
authors.lastname: Calfee
authors.forename: Michael A
authors.initials: MA
authors.lastname: Matthay
authors.forename: Mark D
authors.initials: MD
authors.lastname: Eisner
authors.forename: Neal
authors.initials: N
authors.lastname: Benowitz
authors.forename: Mariah
authors.initials: M
authors.lastname: Call
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Pittet
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Cohen
mesh_terms: D055371:Acute Lung Injury / Q000209:etiology*; D000328:Adult; D003367:Cotinine / Q000097:blood; D005260:Female; D006801:Humans; D055370:Lung Injury / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012907:Smoking / Q000009:adverse effects*; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D014949:Wounds, Nonpenetrating / Q000150:complications*
chemical_list: D014028:Tobacco Smoke Pollution; D003367:Cotinine