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Harold J. Farber, MD, MSPH
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FINANCIAL/NONFINANCIAL DISCLOSURES: See earlier cited article for author conflicts of interest.

CORRESPONDENCE TO: Harold J. Farber, MD, MSPH, Pulmonary Medicine Service, Texas Children’s Hospital, 6701 Fannin, Ste 1040.00, Houston, TX 77030


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4):1106-1107. doi:10.1016/j.chest.2016.01.017
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I thank Kashiura and colleagues for their careful review of the article on the effect of maternal smoking on childhood asthma. They correctly note that there are different phenotypes of childhood wheezing, and that phenotype varies by age. In our sample, the mean age of children at which maternal smoking was reported was greater than the mean age with no maternal smoking. As our sample was selected from health plan members with a health-care encounter, it is possible that tobacco-related illness increases the need for medical attention disproportionately for older children.

Kashiura and colleagues asked whether the association between maternal smoking and childhood asthma is altered at all in age-stratified analysis, or, stated in statistical terms, where an interaction exists of maternal smoking and age group in the models presented. If there is a significant interaction, stratified analyses would be indicated. I reexamined the data set to determine whether the interaction of maternal smoking and age group was significant when it was added to the models presented in Tables 3 through 6. The interaction terms of maternal smoking and age group were not significant in any of the models (P > .25).

Kashiura and colleagues also voiced concern about possible confounding effects of active smoking by children. Tobacco dependence usually starts in adolescence, in utero smoke exposure increases risk for later development of tobacco dependence, and active smoking would affect a child’s respiratory symptoms. Our data set did not assess children’s active smoking. As the onset of tobacco use is not common before adolescence, if this were an important confounder of the association between maternal smoking and childhood asthma, I would expect to see a significant interaction of maternal smoking and age 12 to 18 years. On reanalysis of the data set, this interaction was not significant (P > .3) in any of the models. It is possible, however, that maternal smoking is a proxy measure for adolescents’ smoking; sorting out the independent effects of each would not be possible in our data set.

References

Farber H.J. .Batsell R.R. .Silveira E.A. .Calhoun R.T. .Giardino A.P. . The impact of tobacco smoke exposure on childhood asthma in a Medicaid managed care plan. Chest. 2016;149:721-728 [PubMed]journal. [CrossRef] [PubMed]
 
Farber H.J. . Optimizing maintenance therapy in pediatric asthma. Curr Opin Pulm Med. 2010;16:25-30 [PubMed]journal. [CrossRef] [PubMed]
 
Farber H.J. .Groner J. .Walley S. .Nelson K. . Section on Tobacco Control. Protecting children from tobacco, nicotine, and tobacco smoke. Pediatrics. 2015;136:e1439-e1467 [PubMed]journal. [CrossRef] [PubMed]
 

Figures

Tables

References

Farber H.J. .Batsell R.R. .Silveira E.A. .Calhoun R.T. .Giardino A.P. . The impact of tobacco smoke exposure on childhood asthma in a Medicaid managed care plan. Chest. 2016;149:721-728 [PubMed]journal. [CrossRef] [PubMed]
 
Farber H.J. . Optimizing maintenance therapy in pediatric asthma. Curr Opin Pulm Med. 2010;16:25-30 [PubMed]journal. [CrossRef] [PubMed]
 
Farber H.J. .Groner J. .Walley S. .Nelson K. . Section on Tobacco Control. Protecting children from tobacco, nicotine, and tobacco smoke. Pediatrics. 2015;136:e1439-e1467 [PubMed]journal. [CrossRef] [PubMed]
 
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