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Original Research: Obstructive Lung Diseases |

Tobacco Smoke Exposure, Airway Resistance, and Asthma in School-age ChildrenSmoke Exposure and Asthma: The Generation R Study

Herman T. den Dekker, MD; Agnes M. M. Sonnenschein-van der Voort, PhD; Johan C. de Jongste, MD, PhD; Irwin K. Reiss, MD, PhD; Albert Hofman, MD, PhD; Vincent W. V. Jaddoe, MD, PhD; Liesbeth Duijts, MD, PhD
Author and Funding Information

From The Generation R Study Group (Drs den Dekker, Sonnenschein-van der Voort, and Jaddoe), Department of Pediatrics, Division of Respiratory Medicine (Drs den Dekker, Sonnenschein-van der Voort, de Jongste, and Duijts), Department of Epidemiology (Drs den Dekker, Sonnenschein-van der Voort, Hofman, Jaddoe, and Duijts), Department of Pediatrics, Division of Neonatology (Drs Reiss and Duijts), and Department of Pediatrics (Dr Jaddoe), Erasmus MC, Rotterdam, The Netherlands.

CORRESPONDENCE TO: Liesbeth Duijts, MD, PhD, Erasmus Medical Center-Sophia Children’s Hospital, Sp-3435, PO Box 2060, 3000 CB Rotterdam, The Netherlands; e-mail: l.duijts@erasmusmc.nl


FOR EDITORIAL COMMENT SEE PAGE 573

FUNDING/SUPPORT: The Generation R Study is made possible by financial support from the Erasmus MC Rotterdam, Erasmus University Rotterdam, and The Netherlands Organisation for Health Research and Development (ZonMw). Dr Sonnenschein-van der Voort is the recipient of a European Respiratory Society Fellowship [STRTF 93-2012] and received a grant from the Ter Meulen Fund, Royal Netherlands Academy of Arts and Sciences [TMF2012/228]. Dr Jaddoe received an additional grant from The Netherlands Organisation for Health Research and Development [ZonMw-VIDI]. The research leading to these results has received funding from The Lung Foundation Netherlands [No. 3.2.12.089; 2012].

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


Chest. 2015;148(3):607-617. doi:10.1378/chest.14-1520
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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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