Associations of smoking with hospital-based care and quality of life in patients with obstructive airway disease

Study objectives: To investigate the relationship between direct or environ mental tobacco smoke (ETS) exposure and both hospital-based care (HBC) and quality of life (QOL) among subjects with asthma. Study design: We report baseline cross-sectional data on 619 subjects with asthma, including direct or ETS exposure and QOL, and prospective longitudi nal data on HBC using administrative databases for 30 months following base line evaluation, Setting and patients: Participants were health maintenance organization members with physician-diagnosed asthma involved in a longitu dinal study of risk factors for hospital-based asthma care. Measurements: Demographic characteristics and QOL were assessed with admini stered questionnaires, including the Marks Asthma Quality-of-Life (AQLQ) an d SF-36 questionnaires. HBC was defined as episodes per person-year of hosp ital-based asthma care, which included emergency department and urgency car e visits, and hospitalizations for asthma, Results: Current smokers reported significantly worse QOL than never-smoker s in two of five domains of the AQLQ (p < 0.05), Subjects with ETS exposure also reported significantly worse QOL than those without ETS exposure in t wo domains (p < 0.05). On the SF-36, current smokers reported significantly worse QOL than never-smokers in five of nine domains (p < 0.05). Subjects with ETS exposure reported significantly worse QOL than those without ETS e xposure in three domains (p < 0.05), Current smokers used significantly mor e hospital-based asthma care than never-smokers (adjusted relative risk [RR ], 1.40; 95% confidence interval [CI], 1.01 to 1.95) while ex-smokers did n ot exhibit increased risk compared with nonsmokers (adjusted RR, 0.94; 95% CI, 0.7 to 1.3). Also, subjects with ETS exposure used significantly more h ospital-based asthma care than those without ETS exposure (RR, 2.34; 95% CI , 1.80 to 3.05), Conclusions: Direct or environmental tobacco exposure prospectively predict ed increased health-care utilization for asthma and reduced QOL in patients with asthma, These findings add to our existing knowledge of the detriment al effects of tobacco smoke and are of relevance specifically to patients w ith asthma.