儿童环境烟草烟雾暴露及其与哮喘严重程度的关系

[Environmental tobacco smoke exposure in children and its relationship with the severity of asthma].

作者信息

Suárez López de Vergara R G, Galván Fernández C, Oliva Hernández C, Aguirre-Jaime A, Vázquez Moncholí C

机构信息

Dirección General de Salud Pública del Servicio Canario de la Salud, Servicio de Promoción de la Salud, Santa Cruz de Tenerife, España.

出版信息

An Pediatr (Barc). 2013 Jan;78(1):35-42. doi: 10.1016/j.anpedi.2011.12.008. Epub 2012 Feb 14.

DOI:10.1016/j.anpedi.2011.12.008

PMID:22341775

Abstract

INTRODUCTION

Environmental tobacco smoke (ETS) exposure produces serious respiratory problems in childhood. The aim of the study was to evaluate if environmental tobacco smoke affects the severity of asthma in asthmatic children.

MATERIAL AND METHODS

A prospective, multicentre study was conducted on asthmatic children and their parents in 2007-2008, using an exposure questionnaire, pulmonary function, level of cotinine in urine, and evaluation of the severity of asthma according to GEMA guide. The characteristics of the sample are summarised using the appropriate statistical tools, and the comparisons were made using the Pearson chi2 test, Mann-Whitney U test or Studentĭs t, according to the variable and number of groups compared.

RESULTS

Four hundred and eighty four households in 7 Autonomous Communities were included. The population included, 61% male children with asthma, 56% with a smoking caregiver in their home, 34% fathers, 31% mothers and 17% both. Home exposure was 37%, with 11% daily and 94% passive smokers since birth. There was 20% with exposure during whole period of pregnancy of 5±1 cigarettes/day. Children exposed to 6±1 cigarettes/day, 27%, up to 10 cigarettes/day, and 10% to more than 10. Severity of asthma during the survey was worse among those exposed (episodic-occasional 47%, episodic-frequent 35% and persistent-moderate 18% versus 59%, 25% and 16%, respectively, P=.040). Severity of asthma in the last year was worse in those exposed (episodic - occasional 22%, episodic - frequent 37% and persistent - moderate 50% versus 38%, 28% and 25% respectively, P=.037). The spirometry was abnormal in 64% of the exposed against to 36% in the non-exposed for FEV(1) (P=.003, 63% vs 38% for FVC (P=.038), and 54% vs 46% for the PEF (P=.050). The cotinine was higher in exposed: 51 (0-524) ng/ml vs 27 (0-116) ng/ml (P=.032). A relationship was observed between cotinine and level of exposure: 120 (0-590) ng/ml for >10 cigarettes/day as opposed to 44 (0-103) ng/ml ≤10 cigarettes/day (P=.035), which corroborates the consistency of the data collected.

CONCLUSIONS

The exposure of children with asthma to environmental tobacco smoke has a highly negative effect on the severity of their asthma.

摘要

引言

儿童接触环境烟草烟雾（ETS）会引发严重的呼吸问题。本研究旨在评估环境烟草烟雾是否会影响哮喘儿童的哮喘严重程度。

材料与方法

2007年至2008年，对哮喘儿童及其父母进行了一项前瞻性多中心研究，采用暴露问卷、肺功能、尿中可替宁水平，并根据德国哮喘和变态反应学会（GEMA）指南评估哮喘严重程度。使用适当的统计工具总结样本特征，并根据比较的变量和组数，采用Pearson卡方检验、Mann-Whitney U检验或Student's t检验进行比较。

结果

纳入了7个自治区的484户家庭。研究对象包括61%的男性哮喘儿童，56%的儿童家中有吸烟的照料者，其中34%是父亲，31%是母亲，17%父母均吸烟。家庭暴露率为37%，其中11%为每日暴露，94%的儿童自出生起即为被动吸烟者。在整个孕期，有20%的儿童暴露于每天5±1支香烟的环境中。27%的儿童暴露于每天6±1支香烟的环境中，10%的儿童暴露于每天超过10支香烟的环境中。在调查期间，暴露组儿童的哮喘严重程度更差（发作性-偶尔发作47%，发作性-频繁发作35%，持续性-中度发作18%，而未暴露组分别为59%、25%和16%，P = 0.040）。在过去一年中，暴露组儿童的哮喘严重程度也更差（发作性-偶尔发作22%，发作性-频繁发作37%，持续性-中度发作50%，而未暴露组分别为38%、28%和25%，P = 0.037）。暴露组儿童的肺功能检查异常率为64%，而未暴露组为36%（FEV(1)，P = 0.003）；FVC异常率分别为63%和38%（P = 0.038）；PEF异常率分别为54%和46%（P = 0.050）。暴露组儿童的可替宁水平更高：51（0 - 524）ng/ml，而未暴露组为27（0 - 116）ng/ml（P = 0.032）。观察到可替宁与暴露水平之间存在关联：每天超过10支香烟的儿童可替宁水平为120（0 - 590）ng/ml，而每天≤10支香烟的儿童为44（0 - 103）ng/ml（P = 0.035），这证实了所收集数据的一致性。