Active smoking, environmental tobacco smoke and bronchitic symptoms among adolescents in Taiwan: A prospective cohort study

• We assessed the respiratory risks of smoking and exposure to ETS among adolescents.
• Smoking is associated with an increased risk of incident chronic cough and phlegm.
• Exposure to ETS is associated with an increased risk of newly-onset chronic cough.
• ETS exposure in asthmatics has an additional risk for newly-onset chronic phlegm.

ObjectiveThe study investigates the association between active smoking, exposure to environmental tobacco smoke (ETS) and the development of bronchitis and bronchitic symptoms among adolescents.MethodsA prospective cohort study was conducted with 4134 adolescents aged 12–14 from the Taiwan Children Health Study in 14 communities in Taiwan since 2007. Parents or guardians completed written questionnaires regarding demographic information, household ETS and respiratory symptoms at baseline. The adolescents themselves completed identical questionnaires on respiratory outcomes in the 2009 survey. Associations between active smoking, exposure to ETS and the 2-year incidence of respiratory outcomes were analyzed by multiple Poisson regression models, taking overdispersion into account.ResultsActive smoking was associated with an increased risk of developing chronic cough and chronic phlegm. We found significant dose–response associations between the duration of smoking, the numbers of cigarettes and the onset of bronchitic symptoms. Exposure to ETS was a significant risk factor for the development of chronic cough. Among asthmatic adolescents, exposure to ETS was associated with an additional risk for the onset of chronic phlegm.ConclusionThis study demonstrates that active smoking and exposure to ETS are associated with higher risks for developing bronchitic symptoms among adolescents.