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Original Research: Occupational and Environmental Lung Diseases |

Environmental Tobacco Smoke and Airway Obstruction in Children With Sickle Cell AnemiaEnvironmental Tobacco Smoke in Sickle Cell Anemia

Robyn T. Cohen, MD, MPH; Robert C. Strunk, MD; Joshua J. Field, MD; Carol L. Rosen, MD; Fenella J. Kirkham, MD; Susan Redline, MD; Janet Stocks, PhD; Mark J. Rodeghier, PhD; Michael R. DeBaun, MD, MPH
Author and Funding Information

From the Department of Pediatrics (Dr Cohen), Boston University School of Medicine, Boston, MA; Department of Pediatrics (Dr Strunk), Washington University School of Medicine, St. Louis, MO; Blood Research Institute (Dr Field), Blood Center of Wisconsin, Medical College of Wisconsin, Milwaukee, WI; Department of Pediatrics (Dr Rosen), School of Medicine, Case Western Reserve University, Cleveland, OH; Neurosciences Unit (Dr Kirkham) and Portex Respiratory Unit (Dr Stocks), UCL Institute of Child Health, London, England; Department of Medicine (Dr Redline), Harvard Medical School, Boston, MA; Rodeghier Consultants (Dr Rodeghier), Chicago, IL; and Department of Pediatrics (Dr DeBaun), Vanderbilt School of Medicine, Nashville, TN.

Correspondence to: Michael R. DeBaun, MD, MPH, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Department of Pediatrics, Vanderbilt University School of Medicine, 2200 Children’s Way, Room 11206DOT, Nashville, TN 37232-9000; e-mail: m.debaun@vanderbilt.edu


Funding/Support: This study was funded by the National Institutes of Health [R01 HL079937] to Drs Strunk, Rosen, Kirkham, Redline, Stocks, and Rodeghier.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(4):1323-1329. doi:10.1378/chest.12-1569
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Background:  The contribution of environmental tobacco smoke (ETS) exposure to pulmonary morbidity in children with sickle cell anemia (SCA) is poorly understood. We tested the hypothesis that children with SCA and ETS exposure would have an increased prevalence of obstructive lung disease and respiratory symptoms compared with children with SCA and no ETS exposure.

Methods:  Parent reports of ETS and respiratory symptom frequency were obtained for 245 children with SCA as part of a multicenter prospective cohort study. One hundred ninety-six children completed pulmonary function testing. Multivariable regression models were used to evaluate the associations between ETS exposure at different time points (prenatal, infant [birth to 2 years], preschool [2 years to first grade], and current) and lung function and respiratory symptoms.

Results:  Among the 245 participants, a high prevalence of prior (44%) and current (29%) ETS exposure was reported. Of the 196 children who completed pulmonary function testing, those with parent-reported infant and current ETS exposure were more likely to have airway obstruction (defined as an FEV1/FVC ratio below the lower limit normal) compared with unexposed children (22.0% vs 3.1%, P < .001). Those with ETS exposure also had a lower forced expiratory flow, midexpiratory phase/FVC ratio (0.82 vs 0.97, P = .001) and were more likely to have evidence of bronchodilator responsiveness (23% vs 11%, P = .03). Current and prior ETS exposure and in utero smoke exposure were associated with increased frequency of respiratory symptoms.

Conclusions:  ETS exposure is associated with evidence of lower airway obstruction and increased respiratory symptoms in SCA.

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