Fibrinogen Cholesterol Endothelium and Platelets

When฀ten฀healthy฀male฀non-smokers฀sat฀for฀20฀min฀in฀an฀open฀hospital฀corridor฀beside฀ two฀cigarette฀smokers฀already฀smoking฀there฀on฀their฀own฀initiative,฀the฀non-smokers’฀ plasma฀nicotine฀concentrations฀rose฀from฀0฀to฀2.8฀ngml.฀Concurrently,฀their฀platelet฀aggre- gate฀ratio฀fell฀from฀0.87฀to฀0.78,฀and฀their฀endothelial฀cell฀count฀increased฀from฀2.8฀to฀3.7฀ per฀counting฀chamber.฀As฀a฀result฀of฀ETS฀exposure,฀carboxyhaemoglobin฀levels฀increased฀ from฀0.9฀to฀1.3฀+44.฀Although฀these฀investigations฀were฀conducted฀in฀a฀small฀study฀ population,฀the฀indings฀have฀been฀conirmed฀by฀other฀workers฀ [15,฀54–56] . Platelet฀sensitivity฀to฀the฀anti-aggregatory฀properties฀of฀prostacyclin฀is฀lowered฀by฀ETS฀ [57] .฀Platelet฀aggregation฀increase฀in฀2,3-dinor-thromboxane฀B฀and฀in฀2,3-dinor-6-keto- prostaglandin฀F฀and฀oxidative฀stress฀measured฀by฀8-hydroxy-2’’-deoxyguanosine฀are฀ increased฀in฀passive฀smokers฀ [58] .

9.2.4 Markers of Inflammation

Cigarette฀smoking฀is฀known฀to฀produce฀chronic฀inlammatory฀responses฀in฀the฀bronchial฀ system,฀because฀of฀increased฀numbers฀of฀neutrophils฀and฀macrophages฀in฀the฀blood฀and฀ lungs฀ [59,฀60] ,฀leading฀in฀turn฀to฀oxidative฀membrane฀damage฀ [61–64] .฀Neutrophil฀func- tions฀were฀studied฀in฀eight฀passive฀smokers฀exposed฀to฀six฀active฀smokers฀consuming฀a฀ maximum฀of฀14฀cigarettes฀in฀a฀poorly฀ventilated฀room฀for฀3฀h.฀Passive฀smoking฀was฀asso- ciated฀with฀signiicant฀increases฀in฀leucocyte฀counts฀33,฀neutrophil฀chemotaxis฀57฀ and฀reactive-oxidant฀release฀71฀ [65] .฀The฀CO฀concentration฀in฀the฀room฀where฀the฀ experiment฀was฀conducted฀was฀between฀17฀and฀22฀ppm.฀Although฀the฀experimental฀condi- tions฀were฀not฀consistent฀with฀the฀home฀situation,฀they฀are฀comparable฀to฀some฀extent฀with฀ conditions฀in฀nightclubs฀and฀discotheques. 8 Ratio TCHDL-C 6 Continine 4 2 2.5 ngml 2.5 ngml � � � � � Fig. 9.4 ฀฀฀Cholesterol฀ratio฀ in฀passive฀smokers฀and฀ non-exposed฀non-smokers.฀ Ratio฀TCHDL-C.฀Asterisk฀ indicates฀outliers฀ [46] In฀ 79฀ children฀ exposed฀ to฀ ETS,฀ concentrations฀ of฀ IgE฀ and฀ interleukin-4฀ IL-4฀ and฀ eosinophil฀counts฀were฀higher฀in฀cases฀where฀the฀children฀experienced฀more฀frequent฀respi- ratory฀illness฀average฀3.4฀illnessesyear.฀In฀contrast,฀the฀children฀of฀non-smoking฀parents฀ only฀experienced฀1.2฀episodes฀of฀respiratory฀illnessyear฀and฀their฀IgE,฀IL-4฀and฀eosinophil฀ values฀were฀unchanged฀Table฀ 9.3 . Many฀studies฀have฀shown฀that฀cigarette฀smoking฀is฀associated฀with฀elevated฀concentra- tions฀of฀total฀serum฀IgE.฀Few฀studies,฀however,฀have฀examined฀total฀IgE฀in฀relation฀to฀passive฀ smoking฀exposure,฀especially฀in฀adults.฀In฀a฀cross-sectional฀study,฀Miyake฀et฀al.฀investigated฀ the฀association฀of฀active฀and฀passive฀smoking฀exposure฀with฀levels฀of฀total฀serum฀IgE฀in฀ Japan฀ [67] .฀They฀examined฀981฀pregnant฀women฀in฀Osaka฀and฀found฀out฀that฀current฀smok- ing฀of฀at฀least฀15฀cigarettes฀a฀day฀and฀8.0฀or฀more฀pack-years฀of฀smoking฀were฀independently฀ related฀to฀an฀increased฀prevalence฀of฀elevated฀total฀serum฀IgE฀฀aORs฀3.40฀and฀2.51,฀95฀CIs฀ 2.12–5.47฀and฀1.55–4.06,฀respectively,฀and฀both฀cigarette฀smoking฀status฀and฀pack-years฀of฀ smoking฀were฀signiicantly฀positively฀associated฀with฀total฀serum฀IgE฀levels,฀especially฀in฀ subjects฀with฀a฀positive฀familial฀allergic฀history.฀There฀was฀no฀measurable฀association฀of฀ exposure฀to฀ETS฀at฀home฀or฀at฀work฀with฀total฀serum฀IgE฀concentrations฀among฀those฀who฀ had฀never฀smoked.฀It฀was฀concluded฀that฀there฀is฀a฀positive฀relationship฀between฀active฀smok- ing฀and฀total฀serum฀IgE฀levels;฀however,฀this฀study฀failed฀to฀substantiate฀a฀positive฀association฀ of฀ETS฀exposure฀with฀total฀IgE.฀Investigations฀with฀more฀precise฀and฀detailed฀exposure฀mea- surements฀are฀warranted฀ [67] . Another฀study฀assessed฀the฀correlation฀of฀ETS฀exposure฀with฀the฀expression฀of฀pro- inlammatory฀mediators฀in฀airway฀secretions,฀including฀IFN-g฀and฀IL-12,฀as฀well฀as฀IL-5฀ and฀IL-13,฀in฀allergic฀asthmatic฀schoolchildren฀and฀healthy฀control฀subjects฀ [68] .฀By฀using฀ the฀nasopharyngeal฀aspiration฀technique,฀airway฀secretions฀were฀collected฀from฀24฀atopic฀ children฀with฀asthma฀age,฀6–16฀years฀and฀26฀healthy฀control฀subjects,฀and฀the฀concentra- tion฀of฀cytokines฀was฀measured฀with฀immunoenzymatic฀methods.฀It฀was฀shown฀that฀IL-13฀ levels฀were฀highly฀increased฀in฀patients฀with฀asthma฀฀p฀฀0.005,฀and฀parental฀tobacco฀ smoke฀ resulted฀ in฀ a฀ signiicant฀ increase฀ in฀ airway฀ IL-13฀ secretion฀ in฀ these฀ children฀ Group n฀ Infections year TLC฀฀ cmm 3 EC฀฀ cmm 3 IL-4฀฀ pgml IgE฀฀ IUml Children฀with฀ frequent฀฀ infections 41 4.5฀±฀1.1 a ฀ 7,889฀±฀989 a 651฀±฀121 a 1.8฀±฀0.5 605฀±฀365 Children฀with฀ infrequent฀ infections 29 2.0฀±฀0.6 6,771฀±฀1131 364฀±฀85 1.31฀±฀0.45 557฀±฀354 All฀children฀of฀ smoking฀parents 70 3.4฀±฀0.8 b 7,426฀±฀899 b 482฀±฀96 b 1.6฀±฀0.46 b 587฀±฀359 b Children฀of฀ non-smoking฀ parents 50 1.2฀±฀0.6 6,040฀±฀530 239฀±฀51 0.8฀±฀0.5 189฀±฀21 Table 9.3 ฀฀฀Recurrent฀respiratory฀tract฀infections:฀a฀comparison฀of฀selected฀inlammatory฀variables฀ in฀children฀aged฀9–11฀years฀of฀smoking฀and฀non-smoking฀parents฀ [66] TLC฀total฀leucocyte฀count;฀EC฀eosinophil฀count;฀IL-4฀interleukin-4;฀IgE฀immunoglobulin฀E a p฀฀0.05,฀between฀children฀of฀smoking฀parents b p฀฀0.05:฀group฀vs.฀control