Early Rather than Recent Exposure to Tobacco Increases Bronchial Reactivity

Abstract

Background: Tobacco is well known to impair respiratory function of infants and children. This study was done to identify periods of increased vulnerability of the airways to tobacco products. Patients and methods: In 162 unselected schoolchildren maximum expiratory flow at 25 % of vital capacity (MEF25) was measured before and after cold air hyperventilation. Parental smoking habits were assessed by measurement of cotinine concentrations in children's urine and by interview. Results: Children, whose mothers had smoked during pregnancy, showed increased bronchial reactivity at school age compared to children whose mothers had not smoked during pregnancy (median MEF25 [25th, 75th percentile] after cold air challenge as percent of baseline: 83 % [76, 95] vs. 95 % [79, 100]; p = 0.03). Similar differences were found, when the study population was divided according to the maternal smoking status during the first six months of life. On the contrary, if the cotinine excretion exceeded the group median as a measure of recent exposure to tobacco smoke, bronchial reactivity was not increased (median MEF25 [25th, 75th percentile] as percent of baseline: 88 % [76, 100] vs. 93 % [79, 100]; p = 0.25). Conclusions: Pregnancy and early infancy were found to be periods of increased vulnerability of the airways to tobacco products.

Zusammenfassung

Hintergrund: Es bestehen keine Zweifel daran, dass Tabakrauch die Atemwege von Kindern schädigt. Ziel dieser Studie war es, Phasen mit erhöhter Empfindlichkeit der Atemwege gegenüber Tabakprodukten zu identifizieren. Patienten und Methode: Bei 162 unselektierten Schulkindern wurde der maximale expiratorische Fluss bei 25 % der Vitalkapazität (MEF25) vor und nach einer Kaltluftprovokation gemessen. Die elterlichen Rauchgewohnheiten wurden erfasst durch die Messung der Cotinin-Konzentration im Urin der Kinder und durch Befragung. Ergebnisse: Kinder, deren Mütter in der Schwangerschaft geraucht hatten, zeigten eine höhere bronchiale Reaktivität im Schulalter als Kinder, deren Mütter in der Schwangerschaft nicht geraucht hatten (Median des MEF25 [25. und 75. Perzentile] nach Kaltluftprovokation in Prozent des Ausgangswertes: 83 % [76, 95] vs. 95 % [79, 100]; p = 0,03). Ähnliche Unterschiede fanden sich, wenn die Studienpopulation gemäß dem mütterlichen Rauchstatus in den ersten 6 Lebensmonaten des Kindes aufgeteilt wurde. Im Gegensatz dazu war die bronchiale Reaktivität nicht erhöht, wenn die Cotinin-Ausscheidung den Gruppenmedian überschritt als Hinweis für kürzer zurückliegende Tabakexposition (Median des MEF25 [25. und 75. Perzentile] in Prozent des Ausgangswertes: 88 % [76, 100] vs. 93 % [79, 100]; p = 0,25). Schlussfolgerung: Die Schwangerschaft und die ersten 6 Lebensmonate erwiesen sich als Zeitraum mit erhöhter Verletzlichkeit der Atemwege gegenüber Tabakprodukten.

Environmental tobacco smoke - cold air challenge - bronchial reactivity

Passivrauchen - Kaltluftprovokation - Bronchiale Reaktivität

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