Passivrauchen - aktueller Stand des Wissens

Zusammenfassung

Passivrauch ist vermutlich die quantitativ bedeutsamste inhalative Noxe der Innenraumluft. In bevölkerungsbezogenen Untersuchungen geben 30-60 % aller Befragten an, regelmäßig gegenüber Passivrauch exponiert zu sein. Passivrauch ist durch die Senatskommission zur Bewertung gesundheitsgefährdender Arbeitstoffe der Deutschen Forschungsgemeinschaft als erwiesenermaßen humankanzerogener Arbeitsstoff eingestuft worden. Im Jahre 2002 wurde die Arbeitsstättenverordnung um einen Paragraphen „Nichtraucherschutz” ergänzt.

In international publizierten Metaanalysen einer Vielzahl epidemiologischer Studien zeigten sich für Bronchialkarzinome Relative Risiken (RR) von 1,1 bis 1,3. Das RR für koronare Herzkrankheiten lag bei 1,25 bis 1,35. Auch das RR für Atemwegssymptome, Asthma und chronische Bronchitis war konsistent erhöht. Dabei kann in den am höchsten exponierten Subgruppen das Relative Risiko auf den Faktor 2 erhöht sein.

Da bei ähnlich großen Relativen Risiken Herzerkrankungen wesentlich häufiger auftreten als Bronchialkarzinome, werden die Absolutzahlen der durch Passivrauchen verursachten Erkrankungen des Herz- und Gefäßsystems um den Faktor 5 - 10 höher eingeschätzt als die für das Bronchialkarzinom.

Summary

Among all indoor pollutants, environmental tobacco smoke (ETS) might be the most important. In population-based studies 30 to 60 % of the participants reported regular exposure to ETS. ETS has been classified as carcinogenic by several national and international agencies. In 2002, a paragraph on restriction of smoking at the workplace has been added to the German Workplaces Ordinance.

International meta-analyses have been published on the potential health effects of ETS exposure. In these studies, the pooled relative risk (RR) for lung cancer has been estimated between 1.1 and 1.3. The pooled risk estimate for coronary heart disease (CHD) was slightly higher (1.25 - 1.35). The RR in the group with the highest exposure might be as high as 2. An increased risk has also be shown consistently for respiratory symptoms, asthma, and COPD. Because of the high incidence of CHD the public health impact of ETS exposure on CHD might be higher than the impact due to additional lung cancer cases.

Literatur

• 1 Asgary S, Naderi G H, Sarrafzadegan N, Gharypur M. In vitro effect of nicotine and cotinine on the susceptibility of LDL oxidation and hemoglobin glycosylation.  Mol Cell Biochem. 2003;  246 117-120
• 2 Boffetta P. Involuntary smoking and lung cancer.  Scand J Work Environ Health. 2002;  28 30-40 (Suppl 2)
• 3 Burney P. The European Community Respiratory Health Survey II.  Eur Respir J. 2002;  20 1071-1079
• 4 California-EPA (Environmental Protection Agency) . Health Effects of Exposure to Environmental Tobacco Smoke.  Smoking and Tobacco Control Monograph. 1999;  10 2-47
• 5 Danuser B, Weber A, Hartmann A L, Krueger H. Effects of a bronchoprovocation challenge test with cigarette sidestream smoke on sensitive and healthy adults.  Chest. 1993;  103 353-358
• 6 Glantz S A, Parmley W W. Passive smoking and heart disease. Mechanisms and risk.  JAMA. 1995;  273 1047-1053
• 7 Greim H. Passivrauchen. Weinheim, VCH-Verlagsgesellschaft In: Greim H (Hrsg.) Gesundheitsschädliche Arbeitsstoffe - Toxikologisch-arbeitsmedizinische Begründungen von MAK-Werten 1998 27. Auflage: 1-36
• 8 Greim H. MAK- und BAT-Werte Liste 2002. Weinheim, Deutsche Forschungsgemeinschaft 2002 38. Auflage
• 9 He J, Vupputuri S, Allen K, Prerost M R, Hughes J, Whelton P K. Passive smoking and the risk of coronary heart disease - a meta-analysis of epidemiologic studies.  N Engl J Med. 1999;  340 920-926
• 10 Husgafvel-Pursiainen K. Biomarkers in the assessment of exposure and the biological effects of environmental tobacco smoke.  Scand J Work Environ Health. 2002;  28 21-29 (Suppl 2)
• 11 International Agency for Research on Cancer (IARC) .Tobacco Smoke and Involuntary Smoking. IARC Monographs 2002 Volume 83
• 12 Iso H, Shimamoto T, Sato S, Koike K, Iida M, Komachi Y. Passive smoking and plasma fibrinogen concentrations.  Am J Epidemiol. 1996;  144 1151-1154
• 13 Jaakkola J J, Jaakkola M S. Effects of environmental tobacco smoke on the respiratory health of children.  Scand J Work Environ Health. 2002;  28 71-83 (Suppl 2)
• 14 Jaakkola M S, Jaakkola J J. Effects of environmental tobacco smoke on the respiratory health of adults.  Scand J Work Environ Health. 2002;  28 52-70 (Suppl 2)
• 15 Jaakkola M S, Jaakkola J J, Becklake M R, Ernst P. Effect of passive smoking on the development of respiratory symptoms in young adults: an 8-year longitudinal study.  J Clin Epidemiol. 1996;  49 581-586
• 16 Janson C, Chinn S, Jarvis D, Zock J P, Toren K, Burney P. Effect of passive smoking on respiratory symptoms, bronchial responsiveness, lung function, and total serum IgE in the European Community Respiratory Health Survey: a cross-sectional study.  Lancet. 2001;  358 2103-2109
• 17 Jarvis M J, Goddard E, Higgins V, Feyerabend C, Bryant A, Cook D G. Children’s exposure to passive smoking in England since the 1980 s: cotinine evidence from population surveys.  BMJ. 2000;  321 343-345
• 18 Jarvis M J, Russell M A. Measurement and estimation of smoke dosage to non-smokers from environmental tobacco smoke.  Eur J Respir Dis Suppl. 1984;  133 68-75
• 19 Jarvis M J, Tunstall-Pedoe H, Feyerabend C, Vesey C, Saloojee Y. Comparison of tests used to distinguish smokers from nonsmokers.  Am J Public Health. 1987;  77 1435-1438
• 20 Jockel K H, Pohlabeln H, Ahrens W, Krauss M. Environmental tobacco smoke and lung cancer.  Epidemiology. 1998;  9 672-675
• 21 Jousilahti P, Helakorpi S. Prevalence of exposure to environmental tobacco smoke at work and at home - 5-year trends in Finland.  Scand J Work Environ Health. 2002;  28 16-20 (Suppl 2)
• 22 Jousilahti P, Patja K, Salomaa V. Environmental tobacco smoke and the risk of cardiovascular disease.  Scand J Work Environ Health. 2002;  28 41-51 (Suppl 2)
• 23 Kreuzer M, Heinrich J, Kreienbrock L, Rosario A S, Gerken M, Wichmann H E. Risk factors for lung cancer among nonsmoking women.  Int J Cancer. 2002;  100 706-713
• 24 Leaderer B P, Samet J M. Passive smoking and adults: new evidence for adverse effects.  Am J Respir Crit Care Med. 1994;  150 1216-1218
• 25 Lee C H, Ko Y C, Goggins W. et al . Lifetime environmental exposure to tobacco smoke and primary lung cancer of non-smoking Taiwanese women.  Int J Epidemiol. 2000;  29 224-231
• 26 Leuenberger P, Schwartz J, Ackermann-Liebrich U. et al . Passive smoking exposure in adults and chronic respiratory symptoms (SAPALDIA Study). Swiss Study on Air Pollution and Lung Diseases in Adults, SAPALDIA Team.  Am J Respir Crit Care Med. 1994;  150 1222-1228
• 27 Maziak W, Rzeh ak P, Keil U, Weiland S K. Smoking among adolescents in Münster, Germany: increase in prevalence (1995 - 2000) and relation to tobacco advertising.  Prev Med. 2003;  36 172-176
• 28 Nafstad P, Magnus P, Jaakkola J J. Early respiratory infections and childhood asthma.  Pediatrics. 2000;  106 E38
• 29 Nowak D, Jorres R, Martinez-Muller L. et al . Effect of 3 hours of passive smoke exposure in the evening on inflammatory markers in bronchoalveolar and nasal lavage fluid in subjects with mild asthma.  Int Arch Occup Environ Health. 1997;  70 85-93
• 30 Nowak D, Jorres R, Schmidt A, Magnussen H. Effect of 3 hours’ passive smoke exposure in the evening on airway tone and responsiveness until next morning.  Int Arch Occup Environ Health. 1997;  69 125-133
• 31 Nowak D, Schön S. Medikamentöse Verfahren zur Raucherentwöhnung.  Suchtmed Forsch Prax. 2002;  4 189-199
• 32 Nyberg F, Pershagen G. Passive smoking and lung cancer. Accumulated evidence on lung cancer and environmental tobacco smoke.  BMJ. 1998;  317 347-348
• 33 Pirkle J L, Flegal K M, Bernert J T, Brody D J, Etzel R A, Maurer K R. Exposure of the US population to environmental tobacco smoke: the Third National Health and Nutrition Examination Survey, 1988 to 1991.  JAMA. 1996;  275 1233-1240
• 34 Radon K, Busching K, Heinrich J. et al . Passive smoking exposure: a risk factor for chronic bronchitis and asthma in adults?.  Chest. 2002;  122 1086-1090
• 35 Sapigni T, Biavati P, Simoni M. et al . The Po River Delta Respiratory Epidemiological Survey: an analysis of factors related to level of total serum IgE.  Eur Respir J. 1998;  11 278-283
• 36 Schwartz J, Zeger S. Passive smoking, air pollution, and acute respiratory symptoms in a diary study of student nurses.  Am Rev Respir Dis. 1990;  141 62-67
• 37 Strachan D P, Cook D G. Health effects of passive smoking. 6. Parental smoking and childhood asthma: longitudinal and case-control studies.  Thorax. 1998;  53 204-212
• 38 Tarlo S M, Broder I. Irritant-induced occupational asthma.  Chest. 1989;  96 297-300
• 39 Wells A J. Heart disease from passive smoking in the workplace.  J Am Coll Cardiol. 1998;  31 1-9
• 40 Wells A J, English P B, Posner S F, Wagenknecht L E, Perez-Stable E J. Misclassification rates for current smokers misclassified as nonsmokers.  Am J Public Health. 1998;  88 1503-1509
• 41 Wichmann H E, Jockel K H, Becher H. Gesundheitliche Risiken durch Passivrauchen - Bewertung der epidemiologischen Daten.  Umweltmed Forsch Prax. 1999;  4 28-42