We sought to quantify environmental tobacco smoke (ETS) exposure among patients treated for pulmonary arterial hypertension (PAH), and to determine whether ETS exposure is related to health status in these patients.
We enrolled consecutive patients referred to a tertiary care center for PAH. Criteria for inclusion were elevated mean pulmonary artery pressure (MPAP) >25 mmHg by right heart catheterization and medical stability on PAH therapy for ≥3 months. ETS exposure was assessed using a validated passive smoke exposure questionnaire, as well as by urine cotinine. Exercise capacity was assessed by six-minute walk (6MW) distance. Disease-specific quality-of-life was assessed using both the 20-item Airways Questionnaire (AQ20) and Minnesota Living with Heart Failure Questionnaire (MLHFQ).
We analyzed 91 patients with the following characteristics: mean age 49±13 yrs; 70% female; mean MPAP 50±14 mmHg; WHO class I-II (42%), III (51%), and IV (7%). Forty (44%) patients reported exposure to ETS. Urine cotinine was positive in 45 (57%) of 79 tested. Self-reported ETS exposure correlated significantly with urine cotinine level (r=0.42, p=0.0003). There was no significant correlation between self-reported ETS exposure and either 6MW distance (p=0.26) or quality-of-life (AQ20: p=0.80; MLHFQ: p=0.83). Similarly, there was no significant association between urine cotinine positivity and either 6MW distance (p=0.14) or quality-of-life (AQ20: p=0.77; MLHFQ: p=0.90).
ETS exposure is common among patients treated for PAH, however, its relationship with exercise capacity and quality-of-life remain uncertain.
Patients on PAH therapy should be encouraged to avoid ETS exposure until stronger evidence regarding its effects are available.
Hubert Chen, None.