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1-antitrypsin deficiency (PiZZ)
a Division of Lung Medicine, b Department of Medicine, c Lund University, University Hospital, S205 02 Malmö, Sweden Division of Respiratory Medicine, Department
of Medicine, Karolinska Institute, Stockholm, Sweden
Correspondence to: Professor S Eriksson.
Received 9 February 1998; Returned to authors 8 April 1998; Revised version received 18 May 1998; Accepted for publication 3 June 1998
BACKGROUND
Active smoking is the most important
risk factor for pulmonary emphysema in subjects with severe
1-antitrypsin (AAT) deficiency. The aim of this study
was to analyse the effects of environmental risk factors other than
active smoking on lung function and on respiratory symptoms in
non-smoking PiZZ individuals.
METHODSLifetime exposure to passive smoking,
domiciliary use of a kerosene (paraffin) heater or gas cooker, and all
occupations since leaving school were reported by 205 non-smoking PiZZ
individuals (95 men and 110 women) included in the Swedish AAT
deficiency register. Lung function test results and histories of
respiratory symptoms (chronic bronchitis, recurrent wheezing, and
exertional dyspnoea) were elicited from the AAT register records.
RESULTSAfter adjustment for age, agricultural
employment and domiciliary kerosene heater usage, but not gas cooker
usage or passive smoking, were both associated with significantly
decreased lung function. Multiple linear regression analysis showed
age, sex, kerosene heater usage, and agricultural employment to be
independent determinants of lung function impairment. Age and passive
smoking for 10 years or more, both at home and at the work place, were associated with the presence of chronic bronchitis. Age and
agricultural employment for 
10 years were associated with recurrent
wheezing and exertional dyspnoea.
CONCLUSIONSDomiciliary kerosene heater usage and
an agricultural occupation therefore appear to be environmental factors
associated with decreased lung function in non-smoking PiZZ
individuals, and passive smoking is associated with an increased
frequency of chronic bronchitis, but not with impaired lung function.
1-antitrypsin deficiency;
passive
smoking;
indoor air pollution;
occupational exposure;
emphysema
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