Open Access Research article

Second-hand smoke and chronic bronchitis in Taiwanese women: a health-care based study

Chia-Fang Wu1, Nan-Hsiung Feng2, Inn-Wen Chong3, Kuen-Yuh Wu4, Chien-Hung Lee5, Jhi-Jhu Hwang3, Chia-Tsuan Huang6, Chung-Ying Lee6, Shao-Ting Chou2, David C Christiani7 and Ming-Tsang Wu1689*

Author Affiliations

1 Graduate Institute of Occupational Safety and Health, Kaohsiung Medical University, Kaohsiung, Taiwan

2 Chest Medicine, Medical Department, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan

3 Division of Pulmonology, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

4 Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Miaoli, Taiwan

5 School of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan

6 Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

7 Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA

8 Department of Occupational Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan

9 Center of Excellence for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

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BMC Public Health 2010, 10:44  doi:10.1186/1471-2458-10-44

Published: 28 January 2010



Cigarette smoking cannot fully explain the epidemiologic characteristics of chronic obstructive pulmonary disease (COPD) in women, particularly for those who rarely smoke, but COPD risk is not less than men. The aim of our study is to investigate the relationship between second-hand smoke (SHS) exposure and chronic bronchitis in Taiwanese women.


We used Taiwan's National Health Insurance Bureau claims data in 1999, and cross-checked using criteria set by the American Thoracic Society; there were 33 women with chronic bronchitis, 182 with probable chronic bronchitis, and 205 with no chronic bronchitis during our interview time between 2000 and 2005. We measured second-hand smoke (SHS) exposure by self-reported measures (household users and duration of exposure), and validated this by measuring urinary cotinine levels of a subset subjects. Classification of chronic bronchitis was also based on spirometry defined according to the GOLD guidelines to get the severity of COPD.


Women who smoked and women who had been exposed to a lifetime of SHS were 24.81-fold (95% CI: 5.78-106.38) and 3.65-fold (95% CI: 1.19-11.26) more likely to have chronic bronchitis, respectively, than those who had not been exposed to SHS. In addition, there was a significant increasing trend between the severity of COPD and exposure years of SHS (p < 0.01). The population attributable risk percentages of chronic bronchitis for smokers and those exposed to SHS were 23.2 and 47.3% respectively.


These findings indicate that, besides cigarette smoking, exposure to SHS is a major risk factor for chronic bronchitis in Taiwanese women.