Gilliland Frank D, Berhane Kiros, Li Yu-Fen, Rappaport Edward B, Peters John M
Department of Preventive Medicine, USC Keck School of Medicine, 1540 Alcazar Street, CHP 236, Los Angeles, CA 90033, USA.
Am J Respir Crit Care Med. 2003 Mar 15;167(6):917-24. doi: 10.1164/rccm.200206-616OC. Epub 2002 Dec 12.
Both in utero exposures to maternal smoking and asthma are associated with chronic deficits in lung function. We hypothesized that in utero exposure affects lung function in children without asthma and synergistically affects children with early onset asthma. To investigate effects of in utero exposure and age at asthma diagnosis on lung function, we examined longitudinal medical history, tobacco smoke exposure, and lung function data from 5,933 participants in the Children's Health Study. We found that children exposed in utero, but without asthma, showed decreased FEV1/FVC, FEF25-75, and FEF25-75/FVC ratio. Among children without in utero exposure, early asthma diagnosis was associated with larger decreases in FEV1, FEF25-75, and FEV1/FVC ratio compared with later diagnosed asthma. Children with in utero exposure alone and early onset asthma showed deficits in FEV1 (-13.6%; 95% confidence interval [CI], -18.9 to -8.2) and FEF25-75 (-29.7%; 95% CI, -37.8 to -20.5) among boys; and FEF25-75 (-26.6%; 95% CI, -36.4 to -15.1) and FEV1/FVC (-9.3%; 95% CI, -12.9 to -5.4) among girls. The absolute differences in FEF25-75 associated with in utero exposure increased with age in children with early onset asthma. We found little evidence for effects from environmental tobacco smoke exposure alone. In summary, deficits in lung function were largest among children with in utero exposure and early onset asthma.
子宫内暴露于母亲吸烟以及哮喘均与肺功能的慢性缺陷有关。我们推测，子宫内暴露会影响无哮喘儿童的肺功能，并协同影响早发性哮喘儿童。为了研究子宫内暴露和哮喘诊断年龄对肺功能的影响，我们检查了儿童健康研究中5933名参与者的纵向病史、烟草烟雾暴露情况和肺功能数据。我们发现，子宫内暴露但无哮喘的儿童，其第一秒用力呼气容积/用力肺活量（FEV1/FVC）、25%至75%用力呼气流量（FEF25-75）以及FEF25-75/FVC比值均降低。在无子宫内暴露的儿童中，与晚发性哮喘相比，早发性哮喘诊断与FEV1、FEF25-75以及FEV1/FVC比值的更大降幅相关。仅子宫内暴露且早发性哮喘的男孩中，FEV1下降了13.6%（95%置信区间[CI]，-18.9至-8.2），FEF25-75下降了29.7%（95%CI，-37.8至-20.5）；女孩中，FEF25-75下降了26.6%（95%CI，-36.4至-15.1），FEV1/FVC下降了9.3%（95%CI，-12.9至-5.4）。早发性哮喘儿童中，与子宫内暴露相关的FEF25-75的绝对差异随年龄增加。我们几乎没有发现仅环境烟草烟雾暴露产生影响的证据。总之，子宫内暴露且早发性哮喘的儿童肺功能缺陷最大。
