Effect of secondhand smoke exposure on lung function among non-smoking population


  • Aravind C. Department of General Medicine, Sri Lakshmi Narayana Institute of Medical Sciences, Pondicherry, India
  • Ragul B. Department of General Medicine, Indira Gandhi Medical College and Research Institute, Pondicherry, India
  • Monisha . Department of General Medicine, Sri Lakshmi Narayana Institute of Medical Sciences, Pondicherry, India




Lung function, Second-hand smoke, Urinary cotinine


Background: Secondhand Smoke (SHS) exposure is known to be associated with various cardiovascular and respiratory problems but its effect on pulmonary function remains unexplored. This study was done to evaluate the effect of Secondhand Smoke (SHS) exposure on lung function among non-smoking population.

Methods: This cross-sectional study was conducted in Bahour, Pondicherry from 2017-2018.  350 participants, age 40 year and older, with no respiratory symptoms or prior lung diseases were included in this study. Both self-reported history and measurement of urinary cotinine level were used to evaluate the smoking status. Spirometry data, including FVC and FEV1 were used to assess lung function. Diverse variables between groups were compared using T- test and Chi-square test. Analysis of covariance (ANCOVA) adjusted for age, height, alcohol consumption, and level of exercise was used to see any statistical differences in lung function parameters between non-SHS exposed and SHS-exposed groups.

Results: Among 350 non-smokers, 120 were SHS-exposed. The urinary cotinine levels clearly distinguished SHS exposure, and the mean urinary cotinine levels were 7±0.3 and 11±0.4 in non-SHS exposed group vs SHS-exposed group, respectively. However, both groups had no significant difference in lung function and was found normal.

Conclusions: SHS exposure urinary cotinine is a valuable marker.


National Toxicology Program. NTP 12th Report on Carcinogens. Report on carcinogens: carcinogen profiles. 2011;12.

Hirayama T. Non-smoking wives of heavy smokers have a higher risk of lung cancer: a study from Japan. Br Med J (Clin Res Ed). 1981 17;282(6259):183-5.

Eisner MD, Klein J, Hammond SK, Koren G, Lactao G, Iribarren C. Directly measured secondhand smoke exposure and asthma health outcomes. Thorax. 2005;60(10):814-21.

Taylor AE, Johnson DC, Kazemi H. Environmental tobacco smoke and cardiovascular disease. A position paper from the Council on Cardiopulmonary and Critical Care, Am Heart Assoc. Circulat. 1992;86(2):699-702.

Couraud S, Zalcman G, Milleron B, Morin F, Souquet PJ. Lung cancer in never smokers–a review. Euro J Cancer. 2012;48(9):1299-311.

US Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Available at: http://www.surgeongeneral.gov/library/reports/secondhandsmoke/fullreport.pdf. Accessed on 2013.

Eisner MD, Balmes J, Katz PP, Trupin L, Yelin EH, Blanc PD. Lifetime environmental tobacco smoke exposure and the risk of chronic obstructive pulmonary disease. Environ Health. 2005;4(1):7;4(1):7.

Gray LA, Leyland AH, Benzeval M, Watt GC. Explaining the social patterning of lung function in adulthood at different ages: the roles of childhood precursors, health behaviours and environmental factors. J Epidemiol Comm Health. 2013;67(11):905-11.

Lebowitz MD. Influence of passive smoking on pulmonary function: a survey. Preventive med. 1984;13(6):645-55.

Kentner M, Triebig G, Weltle D. The influence of passive smoking on pulmonary function-a study of 1,351 office workers. Prevent Med. 1984;13(6):656-69.

Piitulainen E, Tornling G, Eriksson S. Environmental correlates of impaired lung function in non-smokers with severe α1-antitrypsin deficiency (PiZZ). Thorax. 1998;53(11):939-43.

Eisner MD. Environmental tobacco smoke exposure and pulmonary function among adults in NHANES III: impact on the general population and adults with current asthma. Environmental Health Perspectives. 2002;110(8):765-70.

Kauffmann F, Dockery DW, Speizer FE, Ferris Jr BG. Respiratory symptoms and lung function in relation to passive smoking: a comparative study of American and French women. Int J Epidemiol. 1989;18(2):334-44.

Florescu A, Ferrence R, Einarson T, Selby P, Soldin O, Koren G. Methods for quantification of exposure to cigarette smoking and environmental tobacco smoke: focus on developmental toxicol. Therapeut Drug Monitor. 2009;31(1):14.

Haufroid V, Lison D. Urinary cotinine as a tobacco-smoke exposure index: a minireview. Int Arch Occup Environ Health. 1998;71(3):162-8.

Pomerleau CS, Pomerleau OF, Snedecor SM, Mehringer AM. Defining a never-smoker: results from the nonsmokers survey. Addictive Behaviors. 2004;29(6):1149-54.

Jung S, Lee IS, Kim SB, Moon CS, Jung JY, Kang Y, et al. Urine cotinine for assessing tobacco smoke exposure in Korean: analysis of the Korea National Health and Nutrition Examination Survey (KNHANES). Tubercul Respirat Dis. 2012;73(4):210-8.

Jordan RE, Cheng KK, Miller MR, Adab P. Passive smoking and chronic obstructive pulmonary disease: cross-sectional analysis of data from the Health Survey for England. BMJ open. 2011;1(2):e000153.

Arjomandi M, Haight T, Redberg R, Gold WM. Pulmonary function abnormalities in never smoking flight attendants exposed to secondhand tobacco smoke in the aircraft cabin. J occup and environ med/Am College Occup Environ Med. 2009;51(6):639.

Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, et al. General considerations for lung function testing. Euro Resp J. 2005;26(1):153-61.

Flouris AD, Koutedakis Y. Immediate and short-term consequences of secondhand smoke exposure on the respiratory system. Current opinion in Pulmon Med. 2011;17(2):110-5.






Original Research Articles