Inhaled medication usage in post-menopausal women and lifetime tobacco smoke exposure: The Women's Health Initiative Observational Study.
OBJECTIVE
While active smoking is a causal agent in respiratory disease, the independent role of secondhand smoke (SHS) merits further investigation. We investigated associations between lifetime active smoking and exposure to secondhand smoke - studied independently - and current use of 1 or more inhaled medications as a surrogate for prevalent pulmonary disease in post-menopausal women.


METHODS
Information on lifetime active and passive tobacco exposure and inhaled pulmonary medication usage at enrollment was collected from 88,185 postmenopausal women aged 50-79 enrolled in the Women's Health Initiative Observational Study from 1993 to 1998 at 40 centers in the United States. Participants were recruited from localities surrounding the study centers using a variety of methods, including informational mailings and mass media campaigns.


METHODS
Multivariate adjusted regression models were used to estimate odds ratios and 95% CI according to levels of active smoking and SHS exposure, and trends were tested across categories.


RESULTS
Ever active smokers had an overall OR of 1.97 (95% CI 1.58-2.45) for having one or more prescribed inhaled medication compared with never-smoking women not exposed to active or passive smoke. The overall OR for using inhalers for never-smoking women exposed to any SHS compared with the same reference group was 1.33 (95% CI 1.07-1.65). In a quantified analysis of SHS, never-smoking women with the highest levels of lifetime SHS exposure had an estimated risk of inhaled medication usage of 1.74 (95% CI 1.32-2.30).


CONCLUSIONS
The risk of requiring one or more prescribed inhaled medications for pulmonary disease was significantly higher in post-menopausal women who ever smoked or who had lifetime exposure to SHS.
Roswell Park Cancer Institute, Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Buffalo, NY 14263, USA.
Kenneth M
KM
Piazza
University at Buffalo, Department of Epidemiology and Environmental Health, Buffalo NY, 14214, USA.
Jean
J
Wactawski-Wende
University of Tennessee Health Science Center, Department of Preventive Medicine, Memphis TN, 38163, USA.
Margaret W
MW
DeBon
University at Buffalo, Department of Epidemiology and Environmental Health, Buffalo NY, 14214, USA.
Kathleen M
KM
Hovey
Roswell Park Cancer Institute, Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Buffalo, NY 14263, USA.
Cheryl L
CL
Rivard
Roswell Park Cancer Institute, Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Buffalo, NY 14263, USA. Electronic address: danielle.smith@roswellpark.org.
Danielle M
DM
Smith
Roswell Park Cancer Institute, Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Buffalo, NY 14263, USA.
Andrew J
AJ
Hyland
D000280:Administration, Inhalation; D000368:Aged; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000188:drug therapy* / Q000453:epidemiology*; D008875:Middle Aged; D009330:Nebulizers and Vaporizers / Q000706:statistics & numerical data*; D016017:Odds Ratio; D017698:Postmenopause; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D014028:Tobacco Smoke Pollution; D016387:Women's Health
D014028:Tobacco Smoke Pollution
Asthma; COPD; Inhaler; Post-menopausal; Secondhand smoke; Tobacco