Irander Kristina, Borres Magnus P, Palm Jörgen P
Allergy Centre, ENT Section, University Hospital, 58185 Linköping, Sweden.
Int J Pediatr Otorhinolaryngol. 2011 Feb;75(2):177-81. doi: 10.1016/j.ijporl.2010.10.029.
This study aimed to analyze upper and lower airway function and the impact of smoking habits in a cohort of allergic and healthy adolescents. The influence of smoking habits on the outcomes of rhinitis and asthma is well documented, but only few reports are available showing smoke related upper airway impairment by rhinometric measurements, and none with focus on early changes in adolescents.
A cohort followed from infancy was re-examined at the age of 18 years concerning allergy development. Acoustic rhinometry (VOL2), spirometry (FEV(1)) and measurements of nitric oxide levels from the upper (nNO) and lower airways (eNO) were performed before and after physical exercise, and smoking habits were registered.
Active smoking habits were reported by 4/21 subjects suffering from allergic rhinitis, by 1/4 from probable allergic rhinitis, by 0/3 subjects with atopic dermatitis and by 2/10 healthy controls. Smoking habits were reported as daily by 2 and occasional by 5 of the 7 active smokers. VOL2 did not increase in smokers after exercise as in non-smokers, resulting in a post-exercise group difference (7.3±1.1cm(3) vs. 8.8±1.5cm(3); p=0.02), and FEV(1) values were lower in smokers compared to non-smokers (89±7% vs. 98±8%; p=0.02). The nNO and eNO levels were, however, only slightly reduced in smokers. Airway allergy was discerned only in subjects with current allergen exposure by increased eNO levels compared to healthy controls (41±44ppb vs. 13±5ppb). The levels of VOL2, nNO and FEV(1) did not differentiate allergic subjects from healthy controls.
Low levels of tobacco smoke exposure resulted in reduced airway functions in this adolescent cohort. Acoustic rhinometry and spirometry were found to be more sensitive methods compared to nitric oxide measurements in early detection of airway impairment related to smoke exposure. A possible difference in airway vulnerability between allergic and healthy subjects due to smoke exposure remains to be evaluated in larger study groups.
本研究旨在分析一组过敏和健康青少年的上、下气道功能以及吸烟习惯的影响。吸烟习惯对鼻炎和哮喘结局的影响已有充分记录，但仅有少数报告通过鼻阻力测量显示与吸烟相关的上气道损害，且没有关注青少年早期变化的报告。
对一组从婴儿期开始随访的队列在18岁时重新进行过敏发展情况检查。在体育锻炼前后进行鼻声反射测量（VOL2）、肺功能测定（FEV(1)）以及上气道（nNO）和下气道（eNO）一氧化氮水平测量，并记录吸烟习惯。
21名过敏性鼻炎患者中有4人报告有主动吸烟习惯，可能患有过敏性鼻炎的4人中有1人，特应性皮炎患者3人中有0人，健康对照者10人中有2人。7名主动吸烟者中，2人报告每天吸烟，5人偶尔吸烟。与不吸烟者不同，吸烟者运动后VOL2未增加，导致运动后组间差异（7.3±1.1cm(3) 对8.8±1.5cm(3)；p = 0.02），吸烟者的FEV(1)值低于不吸烟者（89±7%对98±8%；p = 0.02）。然而，吸烟者的nNO和eNO水平仅略有降低。与健康对照者相比，仅在当前有过敏原暴露的受试者中，通过eNO水平升高可发现气道过敏（41±44ppb对13±5ppb）。VOL2、nNO和FEV(1)水平无法区分过敏受试者和健康对照者。
在这个青少年队列中，低水平的烟草烟雾暴露导致气道功能下降。在早期检测与烟雾暴露相关的气道损害方面，发现鼻声反射测量和肺功能测定比一氧化氮测量更敏感。由于烟雾暴露，过敏和健康受试者之间气道易损性的可能差异仍有待在更大的研究组中进行评估。
