Effects of maternal smoking during pregnancy and environmental tobacco smoke on asthma and wheezing in children
Effects of maternal smoking during pregnancy and environmental tobacco smoke on asthma and wheezing in children
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DOI：
10.1164/ajrccm.163.2.2006009
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发表时间：
2001-02-01
影响因子：
24.7
通讯作者：
Peters, JM
中科院分区：
文献类型：
--
作者：
Gilliland, FD;Li, YF;Peters, JM
在居住在南加州12个社区的5,762名学龄儿童中调查了母亲在怀孕期间吸烟和儿童环境烟草烟雾（ETS）暴露对哮喘和喘息的影响。通过对4年级、7年级和10年级学生家长完成的自填问卷的回答，确定患有喘息或医生诊断的哮喘的儿童。通过对家庭成员过去和现在的吸烟史以及怀孕期间母亲吸烟史的回答，评估了终生家庭烟草烟雾暴露。Logistic回归模型拟合横断面数据，以估计宫内暴露于母亲吸烟和以前和目前的ETS暴露对喘息和医生诊断的哮喘患病率的影响。母亲在子宫内吸烟而没有随后的产后ETS暴露与医生诊断的哮喘患病率增加相关（OR，1.8; 95% CI，1.1 - 2.9），哮喘伴当前症状（OR，2.3; 95% CI，1.3 - 4.0），哮喘需要在过去12个月内使用药物（OR，2.1; 95% CI，1.2 - 3.6），一生中有喘息史（OR，1.8; 95% CI，1.2 - 2.6），当前有喘息伴感冒（OR，2.1; 95% CI，1.3 - 3.4）和无感冒（OR，2.5; 95% CI，1.4 - 4.4），持续喘息（OR，3.1; 95% CI，1.6 - 6.1），运动性喘息（OR，2.4 95% CI; 1.3 - 4.3），喘息发作导致呼吸短促（OR，2.4; 95% CI，1.3 - 4.4）或在过去12个月内夜间觉醒（OR，3.2; 95% CI，1.7 - 5.8）和需要药物治疗的喘息（OR 2.1; 95% CI，1.2至3.7）或前一年内急诊室就诊（OR，3.4; 95% CI，1.4至7.8）。相比之下，目前和以前的ETS暴露与哮喘患病率无关，但始终与喘息的亚类相关。目前的ETS暴露与终生喘息有关（OR，1.3; 95% CI，1.1 - 1.5），当前有喘息伴感冒（OR，1.6; 95% CI，1.3 - 2.0）和无感冒（OR，1.5; 95% CI，1.1 - 1.9），运动性喘息（OR，1.7; 95% CI，1.3 - 2.2），喘息发作导致呼吸短促（OR，1.6; 95% CI，1.2 - 2.1）或夜间觉醒（OR，1.5; 95% CI，1.1 - 2.0）和需要药物治疗的喘息（OR，1.4; 95% CI，1.1 - 1.8）或前一年内急诊室就诊（OR，1.9; 95% CI，1.2 - 3.0）。当前ETS暴露对喘息亚类的影响在暴露于两个或更多吸烟者的儿童中最为明显，并且在调整母亲怀孕期间吸烟后仍然显着。我们的结论是，母亲在怀孕期间吸烟会增加儿童时期医生诊断的哮喘和喘息的发生率。相比之下，目前的ETS暴露与喘息有关，但与医生诊断的哮喘无关。综上所述，我们的研究结果支持了这样一个假设，即ETS作为一个辅因子与其他侮辱，如并发感染的触发喘息发作，而不是作为一个因素，诱发哮喘，而在子宫内暴露的行为，以增加医生诊断的哮喘。
The effects of maternal smoking during pregnancy and childhood environmental tobacco smoke (ETS) exposure on asthma and wheezing were investigated in 5,762 school-aged children residing in 12 Southern California communities. Responses to a self-administered questionnaire completed by parents of 4th, 7th, and 10th grade students were used to ascertain children with wheezing or physician-diagnosed asthma. Lifetime household exposures to tobacco smoke were assessed using responses about past and current smoking histories of household members and any history of maternal smoking during pregnancy. Logistic regression models were fitted to cross-sectional data to estimate the effects of in utero exposure to maternal smoking and previous and current ETS exposure on the prevalence of wheezing and physician-diagnosed asthma. In utero exposure to maternal smoking without subsequent postnatal ETS exposure was associated with increased prevalence of physician-diagnosed asthma (OR, 1.8; 95% CI, 1.1 to 2.9), asthma with current symptoms (OR, 2.3; 95% CI, 1.3 to 4.0), asthma requiring medication use in the previous 12 mo (OR, 2.1; 95% CI, 1.2 to 3.6), lifetime history of wheezing (OR, 1.8; 95% CI, 1.2 to 2.6), current wheezing with colds (OR, 2.1; 95% CI, 1.3 to 3.4) and without colds (OR, 2.5; 95% CI, 1.4 to 4.4), persistent wheezing (OR, 3.1; 95% CI, 1.6 to 6.1), wheezing with exercise (OR, 2.4 95% CI; 1.3 to 4.3), attacks of wheezing causing shortness of breath (OR, 2.4; 95% CI, 1.3 to 4.4) or awakening at night in the previous 12 mo (OR, 3.2; 95% CI, 1.7 to 5.8), and wheezing requiring medication (OR 2.1; 95% CI, 1.2 to 3.7) or emergency room visits during the previous year (OR, 3.4; 95% CI, 1.4 to 7.8). In contrast, current and previous ETS exposure was not associated with asthma prevalence, but was consistently associated with subcategories of wheezing. Current ETS exposure was associated with lifetime wheezing (OR, 1.3; 95% CI, 1.1 to 1.5), current wheezing with colds (OR, 1.6; 95% CI, 1.3 to 2.0) and without colds (OR, 1.5; 95% CI, 1.1 to 1.9), wheezing with exercise (OR, 1.7; 95% CI, 1.3 to 2.2), attacks of wheezing causing shortness of breath (OR, 1.6; 95% CI, 1.2 to 2.1) or awakening at night (OR, 1.5; 95% CI, 1.1 to 2.0), and wheezing requiring medication (OR, 1.4; 95% CI, 1.1 to 1.8) or emergency room visits within the previous year (OR, 1.9; 95% CI, 1.2 to 3.0). The effects of current ETS exposure on subcategories of wheezing were most pronounced among children exposed to two or more smokers and remained significant after adjusting for maternal smoking during pregnancy. We conclude that maternal smoking during pregnancy increases the occurrence of physician-diagnosed asthma and wheezing during childhood. In contrast, current ETS exposure is associated with wheezing, but not physician-diagnosed asthma. Taken together, our findings support the hypothesis that ETS operates as a cofactor with other insults such as intercurrent infections as a trigger of wheezing attacks, rather than as a factor that induces asthma, whereas in utero exposure acts to increase physician-diagnosed asthma.