Effect of prenatal and postnatal exposure to tobacco in the development of acute bronchiolitis in the first two years of life.

INTRODUCTION: Environmental exposure to tobacco increases the risk of respiratory disease in infants. However, the impact of maternal smoking on the development of acute bronchiolitis has hardly been assessed. The aim of this study was to determine the incidence of acute bronchiolitis and to analyse the effect of prenatal and postnatal maternal smoking on the development of this disease. PATIENTS AND METHODS: A prospective, observational study was performed on healthy newborns from a third level hospital born between October 2015 and February 2016. Questionnaires were completed by the mothers at discharge from maternity and followed-up for two years. These collected information about prenatal and postnatal smoking, lifestyle, family and personal history, and the development of bronchiolitis. A bivariate and multivariate logistic regression analysis was performed. RESULTS: A total of 223 newborns were included, of whom 13.9% were exposed to tobacco smoking during gestation, 21.4% in the postnatal period, and 12.4% in both times. The incidence of bronchiolitis was 28.7% at one year of life, and 34.5% at two years. The multivariate analysis demonstrated that the prenatal and postnatal exposure to tobacco is an independent risk factor for the development of bronchiolitis (OR 4.38; 95% CI; 1.63-11.76), while prolonged breastfeeding is a protective factor (OR 0.13; 95% CI; 0.04-0.48). Other factors that were statistically significant were: atopic dermatitis (OR 2.91; 95% CI; 1.26-6.73), and gestational age (OR 1.42; 95% CI; 1.08-1.88). CONCLUSIONS: Children exposed to prenatal and postnatal maternal smoking have a higher risk of suffering bronchiolitis. Reducing the smoking habit in women that intend to become pregnant must be a priority in preventive medicine.

Efecto de la exposición prenatal y posnatal al tabaco en el desarrollo de bronquiolitis aguda durante los dos primeros años de vida / Effect of prenatal and postnatal exposure to tobacco in the development of acute bronchiolitis in the first two years of life

Introducción: La exposición ambiental al tabaco incrementa el riesgo de patología respiratoria en la infancia. Sin embargo, el impacto del tabaquismo materno en el desarrollo de bronquiolitis aguda ha sido escasamente evaluado. El objetivo del estudio fue determinar la incidencia de bronquiolitis aguda y analizar el efecto del tabaquismo materno prenatal y posnatal en el desarrollo de esta patología. Pacientes y métodos: Estudio observacional, prospectivo, que incluyó recién nacidos sanos de un hospital terciario entre octubre de 2015 y febrero de 2016. Se realizaron encuestas a las madres al alta de maternidad y seguimiento durante 2años, que recogieron información sobre tabaquismo prenatal y posnatal, estilo de vida, antecedentes familiares y personales, y desarrollo de bronquiolitis. Se realizó análisis de regresión logística bivariante y multivariante. Resultados: Se incluyeron 223 recién nacidos; el 13,9% estuvieron expuestos a tabaquismo durante la gestación, el 21,4% en período posnatal y el 12,4% en ambos momentos. La incidencia de bronquiolitis fue del 28,7% al año de vida y del 34,5% a los 2años. El análisis multivariante demostró que la exposición prenatal y posnatal al tabaco es un factor de riesgo independiente para el desarrollo de bronquiolitis (OR4,38; IC95%: 1,63-11,76), mientras que la lactancia materna prolongada es un factor protector (OR0,13; IC95%: 0,04-0,48). Otros factores que resultaron estadísticamente significativos fueron: dermatitis atópica (OR2,91; IC95%: 1,26-6,73) y edad gestacional (OR1,42; IC95%: 1,08-1,88). Conclusiones: Los niños expuestos a tabaquismo materno prenatal y posnatal presentan un mayor riesgo de padecer bronquiolitis. La disminución del hábito tabáquico en mujeres con intención de embarazo debe ser una prioridad en medicina preventiva. (AU)

Introduction: Environmental exposure to tobacco increases the risk of respiratory disease in infants. However, the impact of maternal smoking on the development of acute bronchiolitis has hardly been assessed. The aim of this study was to determine the incidence of acute bronchiolitis and to analyse the effect of prenatal and postnatal maternal smoking on the development of this disease. Patients and methods: A prospective, observational study was performed on healthy newborns from a third level hospital born between October 2015 and February 2016. Questionnaires were completed by the mothers at discharge from maternity and followed-up for 2years. These collected information about prenatal and postnatal smoking, lifestyle, family and personal history, and the development of bronchiolitis. A bivariate and multivariate logistic regression analysis was performed. Results: A total of 223newborns were included, of whom 13.9% were exposed to tobacco smoking during gestation, 21.4% in the postnatal period, and 12.4% in both times. The incidence of bronchiolitis was 28.7% at one year of life, and 34.5% at 2years. The multivariate analysis demonstrated that the prenatal and postnatal exposure to tobacco is an independent risk factor for the development of bronchiolitis (OR4.38; 95%CI: 1.63-11.76), while prolonged breastfeeding is a protective factor (OR0.13; 95%CI: 0.04-0.48). Other factors that were statistically significant were: atopic dermatitis (OR2.91; 95%CI: 1.26-6.73), and gestational age (OR1.42; 95%CI: 1.08-1.88). Conclusions: Children exposed to prenatal and postnatal maternal smoking have a higher risk of suffering bronchiolitis. Reducing the smoking habit in women that intend to become pregnant must be a priority in preventive medicine. (AU)

Tackling second-hand exposure to tobacco smoke and aerosols of electronic cigarettes: the TackSHS project protocol.

OBJECTIVE: The TackSHS project aims to comprehensively elucidate the impact that exposure to second-hand smoke (SHS) from cigarettes and second-hand aerosols (SHA) from electronic cigarettes have on the respiratory health of the European population according to socioeconomic characteristics and other determinants. METHOD: The TackSHS project involves a series of coordinated studies carried out by 11 academic and public health organisations from six European countries. The project will investigate: a) the determinants of SHS and SHA exposure assessed at the individual level (surveys on representative general population samples) and in common environments (environmental sampling in specific settings); b) the overall disease burden, mortality and morbidity attributable to such exposure; and c) its economic impact in terms of direct health care costs. The project will also examine specific acute respiratory health changes in healthy individuals and patients with respiratory diseases exposed to SHS and SHA. In addition, the project will examine the effectiveness of a novel intervention to reduce SHS exposure in households where smoking is permitted. All these studies are inter-related and involve collaborative coordination among the participant organisations. CONCLUSION: The comprehensive, integrated approach of the TackSHS project will enable a significant step forward from the current status quo in the understanding of the impact of SHS and SHA exposure on health and provide the basis for health policy recommendations to help European countries to further reduce the harm caused by SHS and SHA exposure.

[Application of the Smoking Scale for Primary Care (ETAP) in clinical practice]. / Aplicación de la Escala de Tabaquismo para Atención Primaria (ETAP) en la práctica clínica.

OBJECTIVE: To determine if the ETAP smoking scale, which measures accumulated exposure to tobacco, both actively and passively, is applicable and effective in the clinical practice of Primary Care for the prevention of acute myocardial infarction (AMI). Location Barranco Grande Health Centre in Tenerife, Spain. DESIGN: A study of 61 cases (AMI) and 144 controls. Sampling with random start, without matching. COR-II curves were analysed, and effectiveness was estimated using sensitivity and negative predictive value (NPV). A questionnaire was provided to participating family physicians on the applicability of ETAP in the clinic. RESULTS: The opinion of the participating physicians was unanimously favourable. ETAP was easy to use in the clinic, required less than 3min per patient, and was useful to reinforce the preventive intervention. The ETAP COR-II curve showed that 20years of exposure was the best cut-off point, with an area under the curve of 0.70 (95%CI: 0.62-0.78), and a combination of sensitivity (98%) and NPV (96%) for AMI. When stratifying age and gender, all groups achieved sensitivities and NPVs close to 100%, except for men aged ≥55years, in whom the NPV fell to 75%. CONCLUSIONS: The results indicate that ETAP is a valid tool that can be applied and be effective in the clinical practice of Primary Care for the prevention of AMI related to smoking exposure.

Tabaquismo materno como un factor posiblemente implicado en el desarrollo de la obesidad infantil / Possible effects of maternal smoking during pregnancy on the development of childhood obesity

El tabaquismo es la adicción al tabaco provocada principalmente por diversos componentes activos y tóxicos como la nicotina. El consumo de cigarrillo durante la gestación puede provocar desprendimiento de placenta, placenta previa, embarazo ectópico y aborto espontáneo, como también inducir alteraciones en el feto. En la presente revisión de la literatura se recopiló información en bases de datos como Pub-Med, Embase y Google Académico, concerniente a los posibles efectos del tabaquismo materno durante la gestación sobre el desarrollo de la obesidad infantil. Fueron seleccionados 38 artículos escritos en el idioma inglés y español, publicados a partir de año de 1988 hasta el año 2015, que incluyeron metaanálisis, artículos originales, y revisiones de tema. Se encontró que la exposición al humo del tabaco durante la gestación ha sido ampliamente descrita como un factor de riesgo para la manifestación de alteraciones en el desarrollo fetal como retardo del crecimiento intrauterino y bajo peso al nacer. Además, se ha asociado ampliamente con trastornos del desarrollo infantil en etapas avanzadas, como preescolares y escolares, manifestados en un aumento del índice de masa corporal con respecto al percentil adecuado para la edad; incremento de la incidencia de sobrepeso y obesidad en el infante. Se concluye que la exposición al humo del cigarrillo durante la gestación se relaciona con alteraciones en el crecimiento del niño y en el desarrollo de enfermedades prevalentes asociadas a la obesidad.

Most smokers use tobacco regularly because they are addicted to various active and toxic compounds such as nicotine. Cigarette smoking during pregnancy can cause abruption, placenta previa, ectopic pregnancy and spontaneous abortion, as well as induce alterations in the fetus. In this review, information was collected in databases such as PubMed, Embase and Google Scholar, concerning the possible effects of maternal smoking during pregnancy on the development of childhood obesity. Thirty-eigth articles written in English and Spanish published from year 1988 to 2015, which included meta-analysis, original articles and reviews were selected topic. It was found that exposure to cigarette smoke during pregnancy has been widely described as a risk factor for alterations in fetal development such as intrauterine growth retardation and low birth weight. In addition, it has been widely associated with disorders of child development in advanced stages, preschool and school age: increased body mass index regarding the appropriate percentile for age, and increase in childhood overweight and obesity. It is concluded that exposure to cigarette smoke during pregnancy is associated with changes in child growth and development of prevalent diseases associated with obesity.

Tabaquismo pasivo y recurrencia de crisis en niños asmáticos de edad escolar / Passive smoking and crisis relapsing in asthmatic children in preschool age

Introducción: el humo ambiental del tabaco es un riesgo significativo para la salud de los niños pequeños. Se pretende estudiar el papel del tabaquismo pasivo en el padecimiento de asma en niños. Objetivo: identificar la presencia de tabaquismo pasivo y su asociación con la recurrencia de crisis en niños asmáticos de edad escolar. Métodos: estudio longitudinal de casos y controles (n= 320) en el servicio de Alergología del Hospital Pediátrico Universitario William Soler de La Habana, en el período comprendido entre febrero 2014 y enero 2015. Se aplicó una encuesta de factores ambientales a todos los sujetos participantes. La construcción y validación de la misma se realizó por un grupo de expertos. Se utilizaron medidas de resumen para variables cualitativas (porcentajes). Para valorar la asociación entre factores de riesgo se aplicó la prueba de X2 y razón de momios (Odds Ratio, OR), como medida de la fuerza de esa relación con su estimación puntual y por intervalos de confianza de 95 por ciento. Se fijó un nivel de significación de 0,05. Resultados: la exposición al humo del tabaco estuvo presente en el 75 por ciento de los niños con recurrencia de crisis de asma, con OR de 3,6; de ellos el 72,5 por ciento tenían padres fumadores, con un OR de 4,89. Conclusiones: el tabaquismo pasivo, con especial significación la presencia de padres fumadores, fue el factor de riesgo más importante para la recurrencia de las crisis de asma en el grupo de estudio(AU)

Introduction: environmental tobacco smoke is a significant risk for the health of younger children. We intend to study the role of passive smoking to asthma suffering in children. Objective: to identify the presence of passive smoking and its association with relapsing crisis in asthmatic preschool children. Methods: longitudinal case-control study (n=320) at the Allergology service of William Soler University Pediatric Hospital of Havana, in the time from February 2014 and January 2015. We conducted an environmental factors survey to all the participant individuals. Construction and validation of such survey was carried out by a group of experts. We used summarizing measures for qualitative variables (percentages). To assess the association among risk factors we applied the chi-square test and the odds ratio, as to measure the strength of the relation with it score estimate and by confidence intervals at 95 percent. We fixed a significance level of 0.05. Results: exposition to tobacco smoke was present in 75 percent of the children with asthmatic crisis relapsing, with OR of 3.6; out of which 72.5 percent had smoking parents, with OR of 4.89. Conclusions: passive smoking, specially the presence of smoking parents, was the most important risk factor for the relapse of asthmatic crisis in the studied group(AU)

Tabaquismo pasivo y recurrencia de crisis en niños asmáticos de edad escolar / Passive smoking and crisis relapsing in asthmatic children in preschool age

Introducción: el humo ambiental del tabaco es un riesgo significativo para la salud de los niños pequeños. Se pretende estudiar el papel del tabaquismo pasivo en el padecimiento de asma en niños. Objetivo: identificar la presencia de tabaquismo pasivo y su asociación con la recurrencia de crisis en niños asmáticos de edad escolar. Métodos: estudio longitudinal de casos y controles (n= 320) en el servicio de Alergología del Hospital Pediátrico Universitario "William Soler" de La Habana, en el período comprendido entre febrero 2014 y enero 2015. Se aplicó una encuesta de factores ambientales a todos los sujetos participantes. La construcción y validación de la misma se realizó por un grupo de expertos. Se utilizaron medidas de resumen para variables cualitativas (porcentajes). Para valorar la asociación entre factores de riesgo se aplicó la prueba de X2 y razón de momios (Odds Ratio, OR), como medida de la fuerza de esa relación con su estimación puntual y por intervalos de confianza de 95 por ciento. Se fijó un nivel de significación de 0,05. Resultados: la exposición al humo del tabaco estuvo presente en el 75 por ciento de los niños con recurrencia de crisis de asma, con OR de 3,6; de ellos el 72,5 por ciento tenían padres fumadores, con un OR de 4,89. Conclusiones: el tabaquismo pasivo, con especial significación la presencia de padres fumadores, fue el factor de riesgo más importante para la recurrencia de las crisis de asma en el grupo de estudio(AU)

Introduction: environmental tobacco smoke is a significant risk for the health of younger children. We intend to study the role of passive smoking to asthma suffering in children. Objective: to identify the presence of passive smoking and its association with relapsing crisis in asthmatic preschool children. Methods: longitudinal case-control study (n=320) at the Allergology service of William Soler University Pediatric Hospital of Havana, in the time from February 2014 and Janu8ary 2015. We conducted an environmental factors survey to all the participant individuals. Construction and validation of such survey was carried out by a group of experts. We used summarizing measures for qualitative variables (percentages). To assess the association among risk factors we applied the chi-square test and the odds ratio, as to measure the strength of the relation with it score estimate and by confidence intervals at 95 percent. We fixed a significance level of 0.05. Results: exposition to tobacco smoke was present in 75 percent of the children with asthmatic crisis relapsing, with OR of 3.6; out of which 72.5 percent had smoking parents, with OR of 4.89. Conclusions: passive smoking, specially the presence of smoking parents, was the most important risk factor for the relapse of asthmatic crisis in the studied group(AU)

Effects of passive smoking associated with physical exercise in the skeletal muscles of rats during pregnancy and lactation / Efectos del tabaquismo pasivo asociado con el ejercicio físico en los músculos esqueléticos de ratas durante la gestación y lactancia

The objective of this study was to analyze the effects of passive smoking, in soleus and gastrocnemius muscles associated with physical exercise by swimming during pregnancy and lactation of rats. Twenty-four rats were divided: GF (exposed to cigarette smoke), GC (control), GFN (underwent to the swimming program and exposed to cigarette smoke) and GN (underwent to the swimming program). On the first day of pregnancy procedure of exposure to cigarette smoke began, consisting in 30 minutes twice a day for six weeks. During the same period the swimming program began, which lasted 60 min every day untilthe 21st day of lactation. Soleus and gastrocnemius muscles, were obtained for histological, histochemical, morphometric analysis and fiber profiling. In histology, the groups GF and GFN showed infiltrations, necrotic and phagocytized fibers, centralized nuclei, splittings and coiling; in GN changes were observed due to exercise adaptations, infiltrations, sarcolemal lesion, polymorphic, atrophic and angular fibers. In the histochemical analysis of the groups GF and GFN there was enzymatic activity and amorphous formazan aggregates in subsarcolemmal positions, however in GN the same changes were found in lower frequency and intensity. In regard to the measureof the cross-sectionofmuscle fibers there weren't significant differences among the groups, as well as, in the frequency of types of fibers of the gastrocnemius. It is concluded that aerobic exercise is not enough to impede morphological and histochemical changes caused in an animal model of pregnant and lactating associated with smoking, and the stress not influence the types and size of muscle fibers.

EL objetivo fue analizar los efectos del tabaquismo pasivo sobre los músculos sóleo y gastrocnemio asociado con el entrenamiento corporal de natación durante la preñez y lactancia de ratas. Veinticuatro ratas se dividieron en grupos: GF (expuestos al humo de cigarrillo), GC (control), GFN (sometido al programa de natación y expuesto al humo del cigarrillo) y GN (sometido al programa de natación). El procedimiento de exposición al humo del cigarrillo comenzó primer día de preñez, durante 30 min dos veces al día por seis semanas. Durante el mismo período, comenzó el programa de natación, con una duración de 60 min todos los días hasta el día 21 de lactancia. Se extrajeron los músculos sóleo y gastrocnemio, y se realizó el análisis histológico, morfométrico histoquímico y de perfiles de fibra. En la histología, los grupos GF y GFN mostraron infiltraciones, fibras necróticas y fagocitadas, núcleos centralizados, divisiones y enrollamientos; en GN se observaron cambios debido a las adaptaciones de ejercicio tales como infiltraciones, lesión del sarcolema, y fibras polimórficas, atróficas y angulares. En el análisis histoquímico de los grupos GF y GFN hubo actividad enzimática y se formaron agregados amorfos en posiciones subsarcolemales; en el grupo GN se encontraron los mismos cambios en menor frecuencia e intensidad. No hubo diferencias en las medidas de las secciones transversales de las fibras musculares entre los grupos, así como en la frecuencia de los tipos de fibras del músculo gastrocnemio. Se concluye que el ejercicio aeróbico no es suficiente para impedir los cambios morfológicos e histoquímicos causados en un modelo animal de ratas preñadas en periodo de lactancia asociados con el tabaquismo, y el estrés no influye en el tipo y tamaño de las fibras musculares.

Prevalencia del tabaquismo en España: el papel de la legislación / Smoking prevalence in Spain: the role of legislation

A lo largo de este artículo presentaremos datos que muestran los cambios ocurridos en la prevalencia de tabaquismo activo y pasivo en España como consecuencia de la implantación de las dos normativas nacionales que se han aprobado en nuestro país entre los 2006 y el 2011. Los datos hablan de una importante reducción en la prevalencia de tabaquismo pasivo tanto a nivel global ( que se redujo desde 49,5 por ciento en el año 2005 hasta un 21 por ciento en el 2011) como en los distintos ambientes ( laboral, escolar, hogares, bares y restaurantes).El artículo, también, muestra algunos datos que relacionan la disminución de la morbilidad por infarto agudo de miocardio y otras formas de cardiopatía isquémica, así como en el asma, con la disminución de la prevalencia de tabaquismo pasivo...

Throughout this article, we present data showing changes in the prevalence of active and passive smoking in Spain as a result of the implementation of the two national standards that have been adopted in our country between 2006 and 2011. The figures show a significant reduction in the prevalence of passive smoking both globally (down from 49 percent in 2005 to 21 percent in 2011) and in individual (work, school, homes, bars environments and restaurants).The article also shows some evidence linking the reduction of morbidity from acute myocardial infarction and other forms of ischemic heart disease, stroke and asthma, with decreasing prevalence of passive smoking...

[Impact of the Spanish smoking laws on the exposure to environmental tobacco smoke in Galicia (2005-2011)]. / Impacto de las leyes de control del tabaquismo en la exposición al humo ambiental de tabaco en Galicia (2005-2011).

OBJECTIVE: Prevalence of exposure to environmental tobacco smoke is a valuable index to assess the impact of the laws for tobacco control. The objective of this work is to analyse variations in the prevalence of exposure to environmental tobacco smoke in Galicia (Spain) between 2005, before the Law 28/2005, and 2011, after the law 42/2010. METHODS: Data were obtained from five population-based independent cross-sectional studies, telephone surveys, developed in Galicia between 2005 and 2011 among population aged 16 to 74 (n=34.419). Self-reported exposure among population aged between 16 and 74 was analysed by setting and tobacco consumption by prevalence with 95% confidence intervals. RESULTS: Environmental tobacco smoke exposure decreased dramatically in Galicia between 2005 and 2011. In 2005, before the Law 28/2005, 95% of the population reported exposure to environmental tobacco smoke compared to 28% in 2011, after the Law 42/2010. Decrease was greater in workplaces in 2006 and in leisure time venues in 2011. After an initial decrease in 2006, exposure at home remains unchanged. CONCLUSIONS: An important reduction in self-reported exposure to environmental tobacco smoke occurred in Galicia in the period 2005-2011, specially after the introduction of Laws 28/2005 and 42/2010. Nevertheless, one in four of the population aged 16 to 74 remained exposed in 2011.

Efectos clínicos de la exposición directa e indirecta a tabaco en los niños / Health effects of passive smoking exposure on children

El tabaquismo es fuente importante de contaminación intra domiciliaria. La prevención de la exposición al humo de tabaco tiene un impacto significativo en morbilidad y mortalidad en aquellos expuestos en forma indirecta, especialmente cuando se trata de un individuo en desarrollo activo como ocurre en la vida intrauterina y durante los primeros años de vida. La evidencia es contundente respecto del riesgo que existe en la disminución de la función pulmonar, aparición de sibilancias recurrentes, asma, neumonía y muerte súbita. La exposición al humo de tabaco en los niños debe recibir mayor atención de parte del equipo de salud, especialmente del pediatra.

Sintomatología respiratoria y enfermedad pulmonar obstructiva crónica y su asociación a contaminación intradomiciliaria en el área metropolitana de Santiago: estudio platino / Association between indoor pollution, respiratory symptoms and COPD in Santiago, Chile: platino study

The aim of this study is to report the association between indoor pollution (IP), chronic respiratory symptoms (CRS) and chronic obstructive pulmonary disease (COPD). Data provided from PLATINO study considering a sample of 1.208 subjects 40 and over years old population in Santiago, Chile. Analyses regarding indoor air pollution variables, smoking, environmental tobacco smoke (ETS) and lifetime exposure to occupational dust and CRS and COPD as main outcomes was performed. Crude and adjusted prevalence odds ratios (POR) were calculated using logistic regression, adjusting for potential confounders. Variables explaining higher COPD risk were age > 60 years (POR 3.94, CI95 percent 2.87-5.41, p < 0.01) and males (POR 2.08, CI95 percent 1.53-2.83, p < 0.01). Exposure to coal IP was associated with CRS (POR 1.41, CI95 percent 1.05-1.89; p = 0.024), as well as exposure to firewood IP (POR 1.42, CI95 percent 1.04-1.93; p = 0.029) and ETS (POR 2.15, CI95 percent 1.24-3.73, p = 0.006). Exposure to coal, firewood and ETS are independent risk factors for CRS. Association between exposure to IP and COPD was not observed.

El objetivo de la comunicación fue evaluar la asociación entre contaminación intradomiciliaria (CID) y la presencia de síntomas respiratorios crónicos (SRC) y Enfermedad Pulmonar Obstructiva Crónica (EPOC). Se analizó información del estudio de prevalencia Platino en base a una muestra de población general de 1.208 sujetos de 40 y más años de Santiago, Chile. Se analizó la CID derivada del uso de combustibles sólidos, exposición a humo ambiental (EHAT) y el reporte de exposición previa a polvo de origen ocupacional calculando Odds Ratio de Prevalencia (ORP) crudos y ajustados por potenciales variables confundentes. Las variables que determinan mayor riesgo de EPOC fueron edad mayor 60 años (ORP 3,9; IC95 por ciento 2,9-5,4; p < 0,01) y sexo masculino (OR 2,08; IC95 por ciento 1,5-2,8; p < 0,01). La CID derivada de carbón se asoció con síntomas respiratorios crónicos (ORP 1,4; IC95 por ciento 1,05-1,89; p = 0,024), al igual que el antecedente de exposición a humo de leña (ORP 1,4, IC95 por ciento 1,04-1,9; p = 0,029) y EHAT (ORP 2,1, IC95 por ciento 1,2-3,7; p = 0,006). La exposición a carbón, leña y EHAT constituyen factores de riesgo independientes para presentar SRC. No se encontró asociación entre CID y EPOC.