Rationale: Ongoing secondhand tobacco smoke (SHS) exposure is associated with worsened respiratory health, but little is known about the long-term impact decades after exposure ended. Objective: Determine the long-term consequences of SHS exposure on respiratory health. Methods: Population-based, cohort study in subjects ≥50 years old who had >1 year versus ≤1 year of airline occupational SHS-exposure. Measurements and Main Results: Respiratory health was the primary outcome measured by the St. Georges Respiratory Questionnaire (SGRQ). Key secondary outcomes included respiratory symptoms measured by COPD Assessment Test (CAT) and pre-bronchodilator lung function. The study enrolled 183 SHS-exposed and 59 unexposed subjects. SHS-exposed subjects were exposed to airline SHS for 16.1±9.3 years, which ended 27.5±9.4 years prior to enrollment. Prior SHS-exposure was associated with worse respiratory health based on a 6.7-unit increase in SGRQ (95% CI=[2.7, 10.7]; p=0.001) and 3-unit increase in CAT (95% CI=1.4, 4.6]; p<0.001) versus unexposed subjects, but was not associated with airflow obstruction defined by FEV1:FVC<0.7. Clinically-significant respiratory symptoms (CAT≥10) in SHS-exposed never smokers with preserved lung function (FEV1:FVC ≥0.7 and FVC ≥lower limit of normal) were associated with decreased respiratory and non-respiratory quality-of-life, reduced lung function that remained within the normal range, increased comorbidities and inhaled bronchodilator use, higher plasma CRP and SAA-1 and fewer sinonasal basal stem/progenitor cells versus asymptomatic (CAT<10) SHS-exposed subjects. Conclusion: SHS is associated with a phenotype of impaired respiratory health almost 3 decades after exposure ended, consistent with a symptomatic form of COPD with preserved lung function recently described in smokers.
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