Small-airways dysfunction in nonsmokers chronically exposed to tobacco smoke

We evaluated the effect of long-term passive smoking (involuntary inhalation of tobacco smoke by nonsmokers) and long-term voluntary smoking on specific indexes of pulmonary function in 2100 middle-aged subjects. Regardless of sex, nonsmokers chronically exposed to tobacco smoke had a lower forced mid-expiratory flow rate (FEF 25 to 75 per cent) and forced end-expiratory flow rate (FEF 75 to 85 per cent) than nonsmokers not exposed (P less than 0.005). In addition, values in passive smokers were not significantly different from those in light smokers and smokers who did not inhale (P less than 0.005). When we looked at the extent to which smoke exposure is related to graded abnormality, we found that nonsmokers in smoke-free working environments have the highest scores on the spirometric tests; passive smokers, smokers who do not inhale, and light smokers score similarly and significantly lower; and heavy smokers score the lowest (P less than 0.005). We conclude that chronic exposure to tobacco smoke in the work environment is deleterious to the nonsmoker and significantly reduces small-airways function.