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Tobacco Smoke Exposure, Airway Resistance, and Asthma in School-age Children: The Generation R Study
Herman T den Dekker1, Agnes M M Sonnenschein-van der Voort2, Johan C de Jongste3
1Generation R Study Group, Department of Pediatrics, Erasmus MC, Rotterdam, The Netherlands; Division of Respiratory Medicine, Erasmus MC, Rotterdam, The Netherlands.; Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.
Insights
Maternal smoking during pregnancy increases asthma risks in children. Childhood smoke exposure affects airway resistance, but birth factors may play a role.
Area of Science:
- Environmental Health
- Pediatric Respiratory Medicine
- Epidemiology
Background:
- Tobacco smoke exposure is linked to childhood asthma.
- Prenatal and childhood smoke exposure effects on respiratory health are not fully understood.
- Investigating the impact of smoke exposure on asthma development and respiratory markers in children is crucial.
Purpose of the Study:
- To assess associations between prenatal and childhood tobacco smoke exposure and wheezing, asthma, airway resistance (Rint), and fractional exhaled nitric oxide (Feno) in school-age children.
- To determine if birth characteristics mediate these associations.
- To provide insights into the long-term respiratory consequences of early-life smoke exposure.
Main Methods:
- Prospective population-based cohort study of 6,007 children.
- Data collected via questionnaires on maternal/paternal smoking during pregnancy and childhood secondhand smoke exposure.
- Wheezing patterns, asthma, Rint, and Feno assessed, with birth characteristics from registries.
Main Results:
- Continued maternal smoking during pregnancy linked to higher risks of early and persistent wheezing and asthma.
- Childhood smoke exposure associated with increased airway resistance (Rint), though this effect diminished after accounting for birth characteristics.
- No significant associations found between first-trimester maternal smoking, paternal smoking, and respiratory outcomes.
Conclusions:
- Continued maternal smoking during pregnancy is a significant risk factor for asthma outcomes in school-aged children.
- Childhood tobacco smoke exposure is associated with increased airway resistance.
- Birth characteristics may partially explain the observed associations between smoke exposure and respiratory health.
Background:
Tobacco smoke exposure has been associated with early childhood asthma symptoms. We assessed the associations of tobacco smoke exposure during pregnancy and childhood with wheezing patterns, asthma, airway interrupter resistance (Rint), and fractional exhaled nitric oxide (Feno) in school-age children and whether birth characteristics explained the associations.
Methods:
This study was embedded in a population-based prospective cohort study among 6,007 children. Paternal and maternal smoking during pregnancy (never, first trimester only, continued), secondhand tobacco smoke exposure during childhood, wheezing patterns, and asthma were prospectively assessed by questionnaires. Wheezing patterns were defined as never, early (≤ 3 years only), late (> 3 years only), and persistent (≤ 3 and > 3 years) wheezing. Rint and Feno were measured at age 6 years. Birth characteristics were available from registries.
Results:
Continued maternal smoking during pregnancy was associated with increased risks of early and persistent wheezing (OR: 1.24 [1.01, 1.52]; 1.48 [1.13, 1.95]) and asthma (1.65 [1.07, 2.55], for at least five cigarettes per day), but not with Rint or Feno. Birth characteristics did not explain these associations. Childhood tobacco smoke exposure was associated with higher Rint (difference z score: 0.45 [0.00, 0.90]), but this effect attenuated after adjustment for birth characteristics. Maternal smoking during first trimester only or paternal smoking during pregnancy was not associated with Rint, Feno, wheezing, or asthma.
Conclusions:
Continued maternal smoking during pregnancy was associated with increased risks of asthma outcomes in school-age children, whereas childhood tobacco smoke exposure was associated with higher Rint. Birth characteristics may explain part of these associations.
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