Article Text


Passive smoking and chronic obstructive pulmonary disease: cross-sectional analysis of data from the Health Survey for England
  1. Rachel E Jordan1,
  2. Kar Keung Cheng1,
  3. Martin R Miller2,
  4. Peymané Adab1
  1. 1Unit of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
  2. 2Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Rachel E Jordan; r.e.jordan{at}


Objectives There is increasing evidence that passive smoking is associated with chronic respiratory diseases, but its association with chronic obstructive pulmonary disease (COPD) requires more study. In this cross-sectional analysis of data from 3 years of the Health Survey for England, the association between passive smoking exposure and risk of COPD is evaluated.

Design Cross-sectional analysis of the 1995, 1996 and 2001 Health Surveys for England including participants of white ethnicity, aged 40+ years with valid lung function data. COPD was defined using the lower limit of normal spirometric criteria for airflow obstruction. Standardised questions elicited self-reported information on demography, smoking history, ethnicity, occupation, asthma and respiratory symptoms (dyspnoea, chronic cough, chronic phlegm, wheeze). Passive smoking was measured by self-report of hours of exposure to cigarette smoke per week.

Results Increasing passive smoke exposure was independently associated with increased risk of COPD, with adjusted OR 1.05 (95% CI 0.93 to 1.18) for 1–19 h and OR 1.18 (95% CI 1.01 to 1.39) for 20 or more hours of exposure per week. Similar patterns (although attenuated and non-significant) were observed among never smokers. More marked dose–response relationships were observed between passive smoking exposure and respiratory symptoms, but the most marked effects were on the development of clinically significant COPD (airflow obstruction plus symptoms), where the risk among never smokers was doubled (OR 1.98 (95% CI 1.03 to 3.79)) if exposure exceeded 20 h/week.

Conclusion This analysis adds weight to the evidence suggesting an association between passive smoking exposure and COPD.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • Correction notice The “To cite: …” information and running footer in this article have been updated with the correct volume number (volume 1).

  • To cite: Jordan RE, Cheng KK, Miller MR, et al. Passive smoking and chronic obstructive pulmonary disease: cross-sectional analysis of data from the Health Survey for England. BMJ Open 2011;1:e000153. doi:10.1136/bmjopen-2011-000153

  • Funding Dr Rachel Jordan is funded by a fellowship from the National Institute of Health Research, England (PDF/01/2008/023).

  • Competing interests None.

  • Contributors RJ, PA, KKC and MM contributed to and developed the initial idea. RJ undertook analyses of the HSE. RJ wrote the paper with input and advice from all authors. All authors take responsibility for the integrity of the data and accuracy of the data analysis.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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