How smoking, SES are linked to allergic, non-allergic asthma risk

In addition to independent risk factors, the interaction between smoking and socioeconomic status (SES) was found to be associated with the risk of respiratory diseases such as asthma, according to a new study.

“This study found putative interactions between smoking and several measures of SES in relation to the likelihood of respiratory disease,” the study researchers wrote. “Education and occupational classification, as different measures of SES, showed different patterns of smoking association with asthma, when the latter is divided by allergic status.”

The results of this population-based analysis have been published in respiratory medicine.

The researchers used data from the West Sweden Asthma Study (WSAS), which included 23,753 participants, and the Obstructive Lung Disease in Northern (OLIN) studies, which included 6,519 participants. All participants in the analysis were randomly selected adults aged 20 to 75 living in Sweden in 2016.

All participants received a questionnaire consisting of 3 parts, with questions about:

  • Respiratory symptoms, age, sex, smoking status and education
  • Occupations, occupational and environmental airborne exposure, SES and health status
  • Rhinitis, eczema, height and weight

In total, the final analysis sample included 30,123 participants:

  • Most participants with current asthma were female (60.7%), highly educated and had a high prevalence of comorbidities
  • Manual workers (20.8%) had the highest prevalence of allergic asthma cases with inherited lung diseases and exposure to home smoking (23.3%)
  • Participants with non-allergic asthma were mostly non-manual workers (19.5%) and highly educated manual workers.
  • Individuals with chronic obstructive pulmonary disease and/or chronic bronchitis were significantly older, worked in industry, had a low level of education and had a high prevalence of comorbidities and obesity (26.6%)

As a result, the study found that education and occupation showed different smoking associations between allergic and non-allergic asthma status.

Respiratory problems associated with smoking and allergic asthma were more severe in employed manual workers and intermediate non-manual workers than in highly skilled and executive workers. However, the prevalence of allergic asthma was higher in highly educated groups than in lower educated groups.

In contrast, negative effects of smoking and non-allergic asthma were more common in occupational workers compared to manual and home workers. However, the non-allergic asthma status was more common in low educated groups than in highly educated groups.

The results of this study suggest that certain high-risk social and occupational groups may benefit more from individualized smoking cessation interventions than others. In addition, the researchers believe that more research is needed to fully understand the mechanism behind the interaction between smoking and occupational exposure to reduce the risk of asthma across different SES and occupational settings.

In conclusion, this study showed that in addition to the independent role of smoking and SES in respiratory disease, in high-income countries such as Sweden, SES as measured by different socioeconomic classification systems and smoking interact in determining the risk of respiratory disease. in adults,” the researchers write. “A better understanding of this interaction may help identify social and occupational risk groups more in need of preventive intervention.”


Bashir MB, Basna R, Hedman L, et al. Interaction of smoking and social status on the risk of respiratory outcomes in a Swedish adult population: a Nordic epilung study. breathing medications. Published online March 9, 2023. doi:10.1016/j.rmed.2023.107192

How smoking, SES are linked to allergic, non-allergic asthma risk

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