title: Detrimental effects of environmental tobacco smoke in relation to asthma severity.
abstract: BACKGROUND
  Environmental tobacco smoke (ETS) has adverse effects on the health of asthmatics, however the harmful consequences of ETS in relation to asthma severity are unknown.
  
  
  METHODS
  In a multicenter study of severe asthma, we assessed the impact of ETS exposure on morbidity, health care utilization and lung functions; and activity of systemic superoxide dismutase (SOD), a potential oxidative target of ETS that is negatively associated with asthma severity.
  
  
  RESULTS
  From 2002-2006, 654 asthmatics (non-severe 366, severe 288) were enrolled, among whom 109 non-severe and 67 severe asthmatics were routinely exposed to ETS as ascertained by history and validated by urine cotinine levels. ETS-exposure was associated with lower quality of life scores; greater rescue inhaler use; lower lung function; greater bronchodilator responsiveness; and greater risk for emergency room visits, hospitalization and intensive care unit admission. ETS-exposure was associated with lower levels of serum SOD activity, particularly in asthmatic women of African heritage.
  
  
  CONCLUSIONS
  ETS-exposure of asthmatic individuals is associated with worse lung function, higher acuity of exacerbations, more health care utilization, and greater bronchial hyperreactivity. The association of diminished systemic SOD activity to ETS exposure provides for the first time a specific oxidant mechanism by which ETS may adversely affect patients with asthma.
authors.affiliation: Departments of Pathobiology, Cleveland Clinic, Cleveland, Ohio, United States of America.
authors.forename: Suzy A A
authors.initials: SA
authors.lastname: Comhair
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Gaston
authors.forename: Kristin S
authors.initials: KS
authors.lastname: Ricci
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hammel
authors.forename: Raed A
authors.initials: RA
authors.lastname: Dweik
authors.forename: W Gerald
authors.initials: WG
authors.lastname: Teague
authors.forename: Deborah
authors.initials: D
authors.lastname: Meyers
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Ampleford
authors.forename: Eugene R
authors.initials: ER
authors.lastname: Bleecker
authors.forename: William W
authors.initials: WW
authors.lastname: Busse
authors.forename: William J
authors.initials: WJ
authors.lastname: Calhoun
authors.forename: Mario
authors.initials: M
authors.lastname: Castro
authors.forename: Kian Fan
authors.initials: KF
authors.lastname: Chung
authors.forename: Douglas
authors.initials: D
authors.lastname: Curran-Everett
authors.forename: Elliot
authors.initials: E
authors.lastname: Israel
authors.forename: W Nizar
authors.initials: WN
authors.lastname: Jarjour
authors.forename: Wendy
authors.initials: W
authors.lastname: Moore
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Peters
authors.forename: Sally
authors.initials: S
authors.lastname: Wenzel
authors.forename: Stanley L
authors.initials: SL
authors.lastname: Hazen
authors.forename: Serpil C
authors.initials: SC
authors.lastname: Erzurum
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000097:blood / Q000139:chemically induced* / Q000503:physiopathology*; D002648:Child; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012129:Respiratory Function Tests; D013482:Superoxide Dismutase / Q000097:blood; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D014028:Tobacco Smoke Pollution; D013482:Superoxide Dismutase