Chest
Volume 92, Issue 6, December 1987, Pages 1009-1012
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Smoking and the Increased Risk of Contracting Spontaneous Pneumothorax

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The relation between smoking habits and the occurrence of spontaneous pneumothorax (SP) was studied in a Swedish population, predominantly urban. The study group consisted of a consecutive series of 138 patients admitted to Huddinge University Hospital over ten years for treatment of their first spontaneous pneumothorax. Their smoking habits were routinely analyzed. The sample consisted of 15,204 persons domiciled in the same circumscribed area (County of Stockholm). The annual incidence of first SP in the admission area is 6/100,000 for women and 18/100,000 for men. The study showed that smoking increased the relative risk of contracting a first spontaneous pneumothorax approximately ninefold among women and 22-fold among men and that there is a striking, statistically significant (p<0.001) dose-response relationship between smoking and the occurrence of SP. The life span risk of contracting SP among lifelong heavily smoking men is roughly estimated to be 12 percent but only 1/1,000 among never smokers.

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MATERIAL AND METHODS

Ninety-five percent of all persons afflicted and diagnosed with SP in the County of Stockholm are registered and treated in hospital. This county is a geographically and administratively well-defined region, which is dominated by an urban population. The annual incidence (number of cases/100,000 inhabitants/year) of SP increased in this county between 1970 and 1984 among men from 19 to 28 and among women from 3 to 10.4

In this region there are three university hospitals with specialized

RESULTS

Data on 138 patients (103 men, 35 women) admitted for their first SP between 1975 and 1984 are displayed in Table 1, distributed by sex, age groups, and smoking habits. Seventeen of the 138 patients were nonsmokers at the time of their first SP.

Table 2 shows the reference group from the County of Stockholm distributed and stratified on the same basis. The reference material had a daily mean cigarette consumption of 3.65 cigarettes/day, 3.9 for men and 3.4 for women. Table 3 shows the age

DISCUSSION

The smoking habits of 138 SP patients compared with those of the reference group has shown that smoking increases the relative risk of contracting a first SP. This increase is of the same order of magnitude as smoking increases the risk of developing lung cancer. The relative risk for a hypothetical person who smoked more than 22 cigarettes/day between 18 and 75 years was 12.3 percent.

As far as we know this is the first documented evidence on a dose-response relationship between SP and smoking.

CONCLUSION

Patients with spontaneous pneumothorax are heavier smokers and are consequently much more exposed to the damaging effect of smoking. Smoking increases the relative risk of contracting a first SP approximately ninefold in women and 22-fold in men. The increase is especially large among heavy smokers.

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This study was aided by grants of the National Association Against Heart and Lung Diseases and National Association for Heart and Lung Patients.

Manuscript received June 16, 1986; revision accepted April 24.

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