• S Jean Hsieh, Hanjing Zhuo, Neal L Benowitz, B Taylor Thompson, Kathleen D Liu, Michael A Matthay, Carolyn S Calfee, National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network, and National Heart Lung and Blood Institute Acute Respiratory Distress Syndrome Network.
• 1Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. 2Cardiovascular Research Institute, University of California, San Francisco, CA. 3Division of Clinical Pharmacology and Experimental Therapeutics, University of California, San Francisco, CA. 4Center for Tobacco Control Research and Education, University of California, San Francisco, CA. 5Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. 6Division of Nephrology, Department of Medicine, University of California, San Francisco, CA. 7Department of Anesthesia, University of California, San Francisco, CA. 8Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, CA.
• Crit. Care Med. 2014 Sep 1; 42 (9): 2058-68.

ObjectivesCigarette smoke exposure has recently been found to be associated with increased susceptibility to trauma- and transfusion-associated acute respiratory distress syndrome. We sought to determine 1) the incidence of cigarette smoke exposure in a diverse multicenter sample of acute respiratory distress syndrome patients and 2) whether cigarette smoke exposure is associated with severity of lung injury and mortality in acute respiratory distress syndrome.DesignAnalysis of the Albuterol for the Treatment of Acute Lung Injury and Omega Acute Respiratory Distress Syndrome Network studies.SettingAcute Respiratory Distress Syndrome Network hospitals.PatientsThree hundred eighty-one patients with acute respiratory distress syndrome.InterventionsNone.Measurements And Main Results4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanol, a validated tobacco-specific marker, was measured in urine samples from subjects enrolled in two National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network randomized controlled trials. Urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol levels were consistent with active smoking in 36% of acute respiratory distress syndrome patients and with passive smoking in 41% of nonsmokers (vs 20% and 40% in general population, respectively). Patients with 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol levels in the active smoking range were younger and had a higher incidence of alcohol misuse, fewer comorbidities, lower severity of illness, and less septic shock at enrollment compared with patients with undetectable 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol levels. Despite this lower severity of illness, the severity of lung injury did not significantly differ based on biomarker-determined smoking status. Cigarette smoke exposure was not significantly associated with death after adjusting for differences in age, alcohol use, comorbidities, and severity of illness.ConclusionsIn this first multicenter study of biomarker-determined cigarette smoke exposure in acute respiratory distress syndrome patients, we found that active cigarette smoke exposure was significantly more prevalent among acute respiratory distress syndrome patients compared to population averages. Despite their younger age, better overall health, and lower severity of illness, smokers by 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol had similar severity of lung injury as patients with undetectable 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol. These findings suggest that active cigarette smoking may increase susceptibility to acute respiratory distress syndrome in younger, healthier patients.

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