Biologic Mechanisms of Environmental Tobacco Smoke in Children with Poorly Controlled Asthma: Results from a Multicenter Clinical Trial
Biologic Mechanisms of Environmental Tobacco Smoke in Children with Poorly Controlled Asthma: Results from a Multicenter Clinical Trial
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DOI：
10.1016/j.jaip.2012.11.006
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发表时间：
2013-03-01
影响因子：
9.4
通讯作者：
Lima, John J.
中科院分区：
文献类型：
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作者：
Lang, Jason E.;Dozor, Allen J.;Lima, John J.
背景：环境烟草烟雾（ETS）对儿童哮喘有负面影响。哮喘控制不佳的儿童暴露于ETS的流行率可能正在改变。重要的是，ETS恶化哮喘控制的机制尚不清楚。目的：我们描述了ETS如何影响哮喘控制不良儿童的胃食管反流（GER）、呼吸道感染和白三烯生成。方法：我们分析了306名6- 17岁哮喘控制不良儿童的数据，这些儿童参加了一项为期6个月的临床试验。我们通过访谈、问卷调查和尿可替宁评估ETS暴露的患病率和决定因素，以及ETS暴露与白三烯生成、呼吸道感染、GER、肺功能和哮喘控制的关系。我们使用多变量线性回归、逻辑回归和泊松回归来评估结果。结果：ETS的患病率估计在6%到30%之间。家庭室内暴露儿童哮喘控制较差（c-Asthma control Test, 17.8 vs 21.5; P = .04），预测FEV1 %较差（84.1 vs 90.7; P = .02），平均尿白三烯E-4有升高趋势。来自任何环境的ETS都与症状性呼吸道感染的增加相关（调整后的发病率比：1.30;P = 0.02）。然而，暴露于ETS的儿童没有症状或pH探针结果，提示GER升高。结论：尽管进行了普遍强化的控制治疗，但家庭吸烟暴露与症状性呼吸道感染的高发率和较差的哮喘控制有关。ETS暴露在控制不良的哮喘儿童中很常见，并可能通过促进呼吸道感染使哮喘控制恶化。需要进一步的研究来阐明ETS在不良哮喘控制中的机制。(C) 2013年美国过敏、哮喘与免疫学学会。
BACKGROUND: Environmental tobacco smoke (ETS) negatively affects children with asthma. The prevalence of ETS exposure among children with poor asthma control may be changing. Importantly, the mechanisms by which ETS worsens asthma control are poorly understood.OBJECTIVE: We describe how ETS affects gastroesophageal reflux (GER), respiratory infections, and leukotriene production among children with poor asthma control.METHODS: We analyzed data from 306 children between 6 and 17 years of age with poorly controlled asthma enrolled in a 6-month clinical trial. We evaluated prevalence and determinants of ETS exposure by interview, questionnaire, and urinary cotinine and the association of ETS exposure on leukotriene production, respiratory infections, GER, lung function, and asthma control. We used multivariable linear, logistic, and Poisson regressions to assess outcomes.RESULTS: ETS prevalence estimates ranged from 6% to 30%. Children with domestic indoor exposure had worse asthma control (c-Asthma Control Test, 17.8 vs 21.5; P = .04), worse FEV1 % predicted (84.1 vs 90.7; P = .02), and a trend for increased mean urinary leukotriene E-4. ETS from any setting was associated with increased symptomatic respiratory infections (adjusted incidence rate ratio: 1.30; P = .02). However, children exposed to ETS did not have symptoms or pH probe results, suggestive of heightened GER.CONCLUSIONS: Domestic smoking exposure was associated with both higher rates of symptomatic respiratory infection and poorer asthma control despite generally intensive controller therapy. ETS exposure is common among asthmatic children with poor control and may worsen asthma control by promoting respiratory infections. Further investigation is required to elucidate ETS mechanisms in poor asthma control. (C) 2013 American Academy of Allergy, Asthma & Immunology.