University of California, San Francisco San Francisco, CA
Correspondence to: Mark D. Eisner, MD, MPH, FCCP, Associate Professor of Medicine, 350 Parnassus Ave, Suite 609, San Francisco, CA 94143-0924; e-mail: email@example.com
Larsson and colleagues (September 2001)1examined the relation between childhood environmental tobacco smoke (ETS) exposure and the prevalence of self-reported asthma in adulthood. As the authors point out, the effect of ETS exposure on childhood asthma induction is not in doubt. Based on > 40 epidemiologic studies, extensive data support a causal association between ETS exposure and induction of asthma in children.2However, the relationship between ETS exposure and adult-onset asthma has received less attention.3
The study of Larsson et al1 contributes to the literature linking ETS exposure with a greater risk of asthma. Unfortunately, the study does not clearly advance our understanding of how childhood ETS exposure affects the onset of asthma during adulthood. The study presents two alternate definitions of asthma, both of which measure lifetime prevalence of asthma. In other words, the prevalence of ever having asthma or having a physician diagnosis of asthma could reflect onset of asthma during childhood or adulthood. Without knowing the age of asthma onset, the observed association between childhood ETS exposure and adult asthma prevalence could be explained by the well-known relation between ETS exposure and childhood asthma.
Based on the available epidemiologic literature and strong biologic plausibility, ETS exposure is a likely cause of adult-onset asthma.3–7 To better define this relationship, future studies should evaluate incident, rather than prevalent, adult asthma cases.
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