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Correspondence |

Does Influence of Maternal Smoking on Childhood Asthma Differ by Age and Personal Smoking Habit? FREE TO VIEW

Masahiro Kashiura, MD; Hiroshi Uno, MD; Junji Kumasawa, MD
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

CORRESPONDENCE TO: Masahiro Kashiura, MD, Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo 130-8575, Japan


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


Chest. 2016;149(4):1105-1106. doi:10.1016/j.chest.2015.12.041
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We read with great interest the recent study published by Farber et al in CHEST (March 2016) on the relationship of maternal smoking and childhood asthma. The authors demonstrated that maternal smoking was associated with a diagnosis of asthma, prescription of quick-relief medication, and visit to the ED, even after adjusting several confounders including age, sex, ethnicity, and insurance type. However, we would like to bring up two points of concern.

First, childhood wheezing is categorized into several phenotypes based on distinct pathophysiological mechanisms,, and the dominant phenotype differs by generation. For example, “transient early wheeze,” which is associated less with sensitization to indoor environment than with late-onset wheeze or persistent wheeze, is more frequent in early childhood wheezing than in late childhood wheezing. In the study by Farber et al, children whose mothers smoked tended to be older than those whose mothers abstained; as such, the strength of the association between maternal smoking and children’s asthma may have been influenced by this age gap. We would therefore like to know whether the association between maternal smoking and childhood asthma is altered at all upon age-stratified analysis.

Second, we believe that a particularly important confounder was overlooked in the article. Smoking as a habit in children has been suggested to increase the risk of developing asthma as adolescents, especially in those exposed to maternal smoking in utero. This may overestimate the association between maternal smoking and childhood asthma. Therefore, analyses should be account for the personal smoking habits of children, assuming that details about who smokes at home are available.

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]
 
Lötvall J. .Akdis C.A. .Bacharier L.B. .et al Asthma endotypes: a new approach to classification of disease entities within the asthma syndrome. J Allergy Clin Immunol. 2011;127:355-360 [PubMed]journal. [CrossRef] [PubMed]
 
Savenije O.E. .Granell R. .Caudri D. .et al Comparison of childhood wheezing phenotypes in 2 birth cohorts: ALSPAC and PIAMA. J Allergy Clin Immunol. 2011;127:1505-1512.e14 [PubMed]journal. [CrossRef] [PubMed]
 
Gilliland F.D. .Islam T. .Berhane K. .et al Regular smoking and asthma incidence in adolescents. Am J Respir Crit Care Med. 2006;174:1094-1100 [PubMed]journal. [CrossRef] [PubMed]
 

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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]
 
Lötvall J. .Akdis C.A. .Bacharier L.B. .et al Asthma endotypes: a new approach to classification of disease entities within the asthma syndrome. J Allergy Clin Immunol. 2011;127:355-360 [PubMed]journal. [CrossRef] [PubMed]
 
Savenije O.E. .Granell R. .Caudri D. .et al Comparison of childhood wheezing phenotypes in 2 birth cohorts: ALSPAC and PIAMA. J Allergy Clin Immunol. 2011;127:1505-1512.e14 [PubMed]journal. [CrossRef] [PubMed]
 
Gilliland F.D. .Islam T. .Berhane K. .et al Regular smoking and asthma incidence in adolescents. Am J Respir Crit Care Med. 2006;174:1094-1100 [PubMed]journal. [CrossRef] [PubMed]
 
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