摘要：Objectives. We assessed the effects of indoor risk factors, including smoking, on different types of cough and on cough and wheeze in combination. Methods. Our sample was composed of 1232 men and women residing in a semirural area of Chile. We used a standardized questionnaire, sensitization to 8 allergens, and bronchial hyperresponsiveness to methacholine to assess cough and wheeze characteristics. Information was gathered on dampness, mold, ventilation, heating, housing quality, smoking, and environmental tobacco smoke exposure. Results. Most exposures were associated with cough alone or cough in combination with wheeze. Smoking, past smoking, and environmental tobacco smoke exposure were strongly associated with dry cough and wheeze. The use of coal for heating was associated with dry cough. Leaks, mold, and lack of kitchen ventilation were associated with cough and wheeze. Nocturnal cough and productive cough were associated with specific types of sensitization, but dry cough was not. Productive cough was associated with hyperresponsiveness to methacholine. Conclusions. Several different types of indoor exposures, including environmental tobacco smoke exposure, are important contributors to morbidity associated with cough and wheeze. A vigorous preventive strategy designed to lower exposures to indoor risk factors would lower rates of respiratory morbidity. Cough is an important public health problem in Latin America because chronic obstructive pulmonary disease, smoking, and asthma symptoms are common. 1 – 3 However, epidemiological studies focusing on the etiology of cough in Latin America are rare. 4 Cough, a common symptom in many respiratory conditions, affects more than 10% of the population worldwide. 5 – 8 However, it has not been assessed systematically in relation to exposure to household risk factors such as environmental tobacco smoke, lack of ventilation, mold, dampness, and the use of particular heating and cooking fuels. 9 – 17 When cough has been assessed, it has been in the context of only 1 of several respiratory symptoms in reports focusing on a particular type of exposure. This approach has not disentangled the extent to which each type of exposure relates to a specific type of cough (productive, dry, or nocturnal). Indeed, whether a cough is productive or dry or whether it occurs during the daytime or nighttime may be indicative of different diseases and may be a specific response to a particular type of exposure. This lack of differential diagnosis was recognized in one population-based study of respiratory health in young European adults, 5 but that investigation primarily focused on variations associated with smoking and environmental tobacco smoke exposure between the study centers. The usual study approach has been to isolate cough from other symptoms, with the exception of phlegm, or restrict assessments to those with chronic bronchitis. 9 , 11 – 15 , 17 , 18 Little attention has been given to whether the cough’s presentation is isolated or accompanied by other respiratory symptoms such as wheeze in relation to exposure. 19 Such an approach would help determine whether responses to a set of exposures are specific in terms of the characteristics of cough and, if so, uncover the accompanying symptoms and reveal what objective tests, such as sensitization and bronchial hyperresponsiveness measures, would be relevant to particular types of cough. We used the standardized European Community Respiratory Health Survey (ECRHS) questionnaire to assess a series of respiratory symptoms among young adults living in a semirural area of Chile and collected information on types of housing, heating and cooking fuels, house dampness, mold presence, kitchen ventilation, smoking, and exposure to environmental tobacco smoke. 20 , 21 We assessed associations between these types of indoor exposures and types of cough (productive, dry, or nocturnal). Also, because wheeze is the most commonly studied asthma symptom, we analyzed the interrelations between each type of cough and particular exposures in the presence of wheeze in the past 12 months. In addition, we assessed whether each type of cough was associated with a particular type of sensitization.
