University of Cincinnati, Cincinnati, OH, United States.
Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave (MLC 5041), Cincinnati, OH 45229, United States; Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States.
J Cyst Fibros. 2023 Jul;22(4):694-701. doi: 10.1016/j.jcf.2023.04.020. Epub 2023 May 2.
Secondhand smoke exposure, an important environmental health factor in cystic fibrosis (CF), remains uniquely challenging to children with CF as they strive to maintain pulmonary function during early stages of growth and throughout adolescence. Despite various epidemiologic studies among CF populations, little has been done to coalesce estimates of the association between secondhand smoke exposure and lung function decline.
A systematic review was performed using PRISMA guidelines. A Bayesian random-effects model was employed to estimate the association between secondhand smoke exposure and change in lung function (measured as FEV% predicted).
Quantitative synthesis of study estimates indicated that second-hand smoke exposure corresponded to a significant drop in FEV (estimated decrease: -5.11% predicted; 95% CI: -7.20, -3.47). The estimate of between-study heterogeneity was 1.32% predicted (95% CI: 0.05, 4.26). There was moderate heterogeneity between the 6 analyzed studies that met review criteria (degree of heterogeneity: I=61.9% [95% CI: 7.3-84.4%] and p = 0.022 from the frequentist method.) CONCLUSIONS: Our results quantify the impact at the pediatric population level and corroborate the assertion that secondhand smoke exposure negatively affects pulmonary function in children with CF. Findings highlight challenges and opportunities for future environmental health interventions in pediatric CF care.
二手烟暴露是囊性纤维化（CF）的一个重要环境健康因素，对于正在成长和青春期的 CF 患儿来说，这一因素尤其具有挑战性。尽管在 CF 人群中进行了各种流行病学研究，但很少有人致力于综合评估二手烟暴露与肺功能下降之间的关联。
采用 PRISMA 指南进行系统评价。采用贝叶斯随机效应模型来估计二手烟暴露与肺功能变化（以 FEV%预计值衡量）之间的关联。
研究估计的定量综合结果表明，二手烟暴露与 FEV 显著下降有关（估计下降：-5.11%预计值；95%CI：-7.20，-3.47）。研究间异质性的估计值为 1.32%预计值（95%CI：0.05，4.26）。符合审查标准的 6 项分析研究之间存在中度异质性（异质性程度：I=61.9%[95%CI：7.3-84.4%]，来自频繁主义方法的 p=0.022）。
我们的研究结果量化了在儿科人群中的影响，并证实了二手烟暴露会对 CF 患儿的肺功能产生负面影响的说法。研究结果突出了在儿科 CF 护理中进行未来环境健康干预的挑战和机遇。
