Article Text

Original article
Understanding the impact of second-hand smoke exposure on clinical outcomes in participants with COPD in the SPIROMICS cohort
  1. Nirupama Putcha1,
  2. R Graham Barr2,
  3. Meilan K Han3,
  4. Prescott G Woodruff4,
  5. Eugene R Bleecker5,
  6. Richard E Kanner6,
  7. Fernando J Martinez7,
  8. Benjamin M Smith2,
  9. Donald P Tashkin8,
  10. Russell P Bowler9,
  11. Mark D Eisner4,10,
  12. Stephen I Rennard11,
  13. Robert A Wise1,
  14. Nadia N Hansel1,
  15. for the SPIROMICS Investigators
  1. 1Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2Columbia University School of Medicine, New York, New York, USA
  3. 3University of Michigan School of Medicine, Ann Arbor, Michigan, USA
  4. 4University of California San Francisco School of Medicine, San Francisco, California, USA
  5. 5Wake Forest University Center for Genomics and Personalized Medicine Research, Winston-Salem, North Carolina, USA
  6. 6University of Utah Health Sciences Center, Salt Lake City, Utah, USA
  7. 7Weill Cornell Medical College, New York City, New York, USA
  8. 8University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
  9. 9National Jewish Health, Denver, Colorado, USA
  10. 10Genentech, Inc., South San Francisco, California, USA
  11. 11University of Nebraska Medical Center, Omaha, Nebraska, USA
  1. Correspondence to Dr Nirupama Putcha, 5501 Hopkins Bayview Circle, JHAAC 3B.22, Baltimore, MD 21224, USA; Nputcha1{at}


Background Second-hand smoke (SHS) exposure has been linked to the development of and morbidity from lung disease. We sought to advance understanding of the impact of SHS on health-related outcomes in individuals with COPD.

Methods Among the participants with COPD in SPIROMICS, recent SHS exposure was quantified as (1) hours of reported exposure in the past week or (2) reported living with a smoker. We performed adjusted regression for SHS with outcomes, testing for interactions with gender, race, smoking and obesity.

Results Of the 1580 participants with COPD, 20% reported living with a smoker and 27% reported exposure in the past week. Living with a smoker was associated with worse St George's Respiratory Questionnaire score (SGRQ, β 3.10; 95% CI 0.99 to 5.21), COPD Assessment Test score (β 1.43; 95% CI 0.52 to 2.35) and increased risk for severe exacerbations (OR 1.51, 95% CI 1.04 to 2.17). SHS exposure in the past week was associated with worse SGRQ (β 2.52; 95% CI 0.47 to 4.58), nocturnal symptoms (OR 1.58; 95% CI 1.19 to 2.10), wheezing (OR 1.34; 95% CI 1.02 to 1.77), chronic productive cough (OR 1.77; 95% CI 1.33 to 2.35) and difficulty with cough and sputum (Ease of Cough and Sputum scale, β 0.84; 95% CI 0.42 to 1.25). SHS was associated with increased airway wall thickness on CT but not emphysema. Active smokers, obese individuals and individuals with less severe airflow obstruction also had higher susceptibility to SHS for some outcomes.

Conclusion Individuals with COPD, including active smokers, have significant SHS exposure, associated with worse outcomes and airway wall thickness. Active smokers and obese individuals may have worse outcomes associated with SHS.

Trial registration number NCT01969344 (

  • COPD epidemiology
  • Tobacco and the lung

Statistics from

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.