Effect of cigarette tar content and smoking habits on respiratory symptoms in women

Standardized respiratory disease questionnaires (ATS-DLD-78) were administered to 5,686 adult women. Risk factors were evaluated by logistic analysis that adjusted for multiple potential confounding factors. Among current smokers, the number of cigarettes smoked per day was consistently the strongest risk factor for chronic cough, chronic phlegm, wheeze, and dyspnea. The odds ratios for these symptoms in a smoker of 25 or more cigarettes per day relative to a smoker of 1--14 cigarettes per day were 4.74, 4.21, 2.05, and 3.71, respectively. Ex-smokers showed risks between those of current and never smokers. Cigarette tar content was a significant independent risk factor for chronic cough (p = 0.005) and of borderline significance for chronic phlegm (p = 0.077). High tar cigarette smokers in this population (average, 22 mg) had an odds ratio of 2.01 for chronic cough and 1.59 for chronic phlegm relative to low tar cigarette smokers (average, 7 mg). The effect of cigarette tar was linear and independent of cigarettes smoked per day. Smoke inhalation was a significant risk factor for chronic cough (p = 0.029) and for chronic phlegm (p = 0.038). Tar content and smoke inhalation were not significant risk factors for wheeze or dyspnea. Cigarette particulate content (tar) appears to be causally linked to cough and phlegm production., but the association of cigarette smoking and symptoms of wheeze and dyspnea may be more strongly related to the vapor phase of cigarette smoke.