Moshammer Hanns, Hoek Gerard, Luttmann-Gibson Heike, Neuberger Manfred A, Antova Temenuga, Gehring Ulrike, Hruba Frantiska, Pattenden Sam, Rudnai Peter, Slachtova Hana, Zlotkowska Renata, Fletcher Tony
Institute Environmental Health, ZPH, Medical University, Vienna, Austria.
Am J Respir Crit Care Med. 2006 Jun 1;173(11):1255-63. doi: 10.1164/rccm.200510-1552OC. Epub 2006 Feb 16.
Both prenatal and postnatal passive smoking have been linked with respiratory symptoms and asthma in childhood. Their differential contributions to lung function growth in the general children's population are less clear.
To study the relative impact of pre- and postnatal exposure on respiratory functions of primary school children in a wide range of geographic settings, we analyzed flow and volume data of more than 20,000 children (aged 6-12 yr) from nine countries in Europe and North America.
Exposure information had been obtained by comparable questionnaires, and spirometry followed a protocol of the American Thoracic Society/European Respiratory Society. Linear and logistic regressions were used, controlling for individual risk factors and study area. Heterogeneity between study-specific results and mean effects were estimated using meta-analytic tools.
Smoking during pregnancy was associated with decreases in lung function parameters between -1% (FEV1) and -6% maximal expiratory flow at 25% of vital capacity left (MEF25). A 4% lower maximal midexpiratory flow (MMEF) corresponded to a 40% increase in the risk of poor lung function (MMEF < 75% of expected). Associations with current passive smoking were weaker though still measurable, with effects ranging from -0.5% (FEV1) to -2% maximal expiratory flow (MEF50).
Considering the high number of children exposed to maternal smoking in utero and the even higher number exposed to passive smoking after birth, this risk factor for reduced lung function growth remains a serious pediatric and public health issue.
产前和产后被动吸烟都与儿童期的呼吸道症状和哮喘有关。它们对普通儿童群体肺功能增长的不同影响尚不清楚。
为了研究产前和产后暴露对广泛地理区域内小学生呼吸功能的相对影响，我们分析了来自欧洲和北美的9个国家的20000多名儿童（6 - 12岁）的流量和容积数据。
通过可比问卷获取暴露信息，肺活量测定遵循美国胸科学会/欧洲呼吸学会的方案。使用线性和逻辑回归，控制个体风险因素和研究区域。使用荟萃分析工具估计研究特定结果与平均效应之间的异质性。
孕期吸烟与肺功能参数下降有关，第一秒用力呼气容积（FEV1）下降1%，肺活量剩25%时的最大呼气流量（MEF25）下降6%。最大中期呼气流量（MMEF）降低4%相当于肺功能差（MMEF <预期值的75%）风险增加40%。与当前被动吸烟的关联较弱，但仍可测量，影响范围从FEV1下降0.5%到最大呼气流量（MEF50）下降2%。
鉴于大量儿童在子宫内暴露于母亲吸烟，以及更多儿童在出生后暴露于被动吸烟，这种导致肺功能增长降低的风险因素仍然是一个严重的儿科和公共卫生问题。
