Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne.
Department of Respiratory and Sleep Medicine, Austin Hospital.
Respirology. 2016 Jul;21(5):911-9. doi: 10.1111/resp.12750. Epub 2016 Mar 11.
Existing evidence that supports maternal smoking to be a potential risk factor for chronic obstructive pulmonary disease (COPD) for adult offspring has barely been mentioned in major guideline documents, suggesting a need for more robust and consistent data. We aimed to examine whether such early life exposure can predispose to COPD in middle age, possibly through its interaction with personal smoking.
The fifth-decade follow-up of the Tasmanian Longitudinal Health Study cohort, which was first studied in 1968 (n = 8583), included a 2004 postal survey (n = 5729 responses) and subsequent laboratory attendance (n = 1389) for comprehensive lung function testing between 2006 and 2008. Multivariable linear and logistic regression models included sampling weights.
Post-bronchodilator airflow obstruction (less than fifth percentile) was detected for 9.3% (n = 123) of middle-aged offspring. Its association with heavy maternal smoking (>20 cigarettes/day) during childhood was 2.7-fold higher than for those without exposure (95% confidence interval [1.3, 5.7] P = 0.009). Maternal smoking per se approximately doubled the adverse effect of personal smoking on gas transfer factor (z-score -0.46 [-0.6 to -0.3] vs -0.25 [-0.4 to -0.1], P[interaction] = 0.048) and was paradoxically associated with reduced residual volumes for non-smokers.
Heavy maternal smoking during childhood appears to predispose to spirometrically defined COPD. The interplay between maternal and personal smoking on gas transfer factor suggests that early life exposure increases an individual's susceptibility to adult smoking exposure. These findings provide further evidence to suggest that maternal smoking might be a risk factor for COPD and reinforce the public health message advocating smoking abstinence.
现有的证据表明，母亲吸烟是导致成年子女患慢性阻塞性肺疾病（COPD）的潜在危险因素，但这一观点在主要的指南文件中几乎没有被提及，这表明需要更有力和一致的数据支持。我们旨在研究这种早期生活暴露是否会导致中年时患上 COPD，这种作用可能是通过其与个人吸烟的相互作用而产生的。
塔斯马尼亚纵向健康研究队列的第五个十年随访研究，该队列最初于 1968 年进行研究（n=8583），包括 2004 年的一次邮寄调查（n=5729 份回复）和随后在 2006 年至 2008 年期间进行的实验室随访（n=1389），以进行全面的肺功能测试。多变量线性和逻辑回归模型包括抽样权重。
中年子女中有 9.3%（n=123）存在支气管扩张剂后气流阻塞（低于第五百分位）。与无暴露者相比，儿童时期重度母亲吸烟（>20 支/天）的关联使患病风险增加了 2.7 倍（95%置信区间 [1.3，5.7]，P=0.009）。母亲吸烟本身使个人吸烟对气体转移因子的不良影响增加了近一倍（z 评分 -0.46 [-0.6 至 -0.3] 与 -0.25 [-0.4 至 -0.1]，P[交互] = 0.048），而且与非吸烟者的残气量减少有关。
儿童时期重度母亲吸烟似乎会导致肺功能检查定义的 COPD。母亲和个人吸烟对气体转移因子的相互作用表明，早期生活暴露会增加个体对成年吸烟暴露的易感性。这些发现为母亲吸烟可能是 COPD 的一个危险因素提供了进一步的证据，并强化了倡导戒烟的公共卫生信息。
