Department of Pediatrics and.
Department of Biomedical Data Sciences, Geisel School of Medicine, Hanover, New Hampshire.
Am J Respir Crit Care Med. 2023 Aug 15;208(4):428-434. doi: 10.1164/rccm.202303-0476OC.
It is not certain the extent to which childhood smoking adds chronic obstructive pulmonary disease (COPD) risk independent of lifetime cigarette exposure. We examined the association between age started smoking cigarettes regularly, current smoking status, smoking history, and risk of COPD. Cross-sectional survey of U.S. adults ⩾40 years old in the 2020 National Health Interview Survey. Respondents who were ever cigarette smokers were asked when they began smoking regularly. Multivariable analysis assessed self-report of COPD diagnosis as a function of age started smoking (<15 yr vs. ⩾15 yr) adjusting for current smoking, cigarette pack-years, and covariates. Overall, 7.1% reported that they had COPD, 2.6% for never-smokers compared with 23.1% and 11.6% for smoking onset <15 and ⩾15 years, respectively. Persons who began smoking regularly at <15 years of age had higher pack-years of smoking (median, 29 vs. 15, respectively), and higher smoking intensity (median, 20 cigarettes/d for <15 yr vs. 10 cigarettes/d for ⩾15 yr for current smokers). In the multivariable analysis, the relative risk for COPD among childhood smokers was 1.41 (95% confidence interval, 1.22-1.63) compared with later-onset smokers. Substituting smoking duration for pack-years confounded the association between current smoking and COPD but did not change the childhood smoking estimate. In a stratified analysis, higher risk for childhood smoking was found at all current smoking intensity levels. Among adults aged ⩾40 years, one-fifth of childhood smokers have COPD. Lifetime cigarette smoking explained some but not all of the higher risk. If replicated, this suggests a lung development window of enhanced vulnerability to cigarette smoking.
目前尚不清楚儿童吸烟在多大程度上独立于终生吸烟暴露而增加慢性阻塞性肺疾病（COPD）的风险。我们研究了开始定期吸烟的年龄、当前吸烟状况、吸烟史与 COPD 风险之间的关系。这是一项在美国 2020 年国家健康访谈调查中对 ⩾40 岁的成年人进行的横断面调查。曾吸烟的受访者被问及他们何时开始定期吸烟。多变量分析评估了根据当前吸烟、吸烟包年数和协变量，自我报告的 COPD 诊断与开始吸烟年龄（<15 岁与 ⩾15 岁）之间的关系。总体而言，有 7.1%的人报告患有 COPD，从不吸烟者为 2.6%，而吸烟开始年龄<15 岁和 ⩾15 岁的患者分别为 23.1%和 11.6%。开始定期吸烟年龄<15 岁的患者吸烟包年数（中位数分别为 29 和 15）和吸烟强度（中位数分别为 20 支/d 与<15 岁和 10 支/d 与 ⩾15 岁的当前吸烟者）更高。在多变量分析中，与晚发性吸烟者相比，儿童吸烟者患 COPD 的相对风险为 1.41（95%置信区间，1.22-1.63）。用吸烟持续时间代替吸烟包年数使当前吸烟与 COPD 之间的关联复杂化，但并未改变儿童吸烟的估计值。在分层分析中，在所有当前吸烟强度水平下，儿童吸烟的风险都更高。在 ⩾40 岁的成年人中，五分之一的儿童吸烟者患有 COPD。终生吸烟仅解释了部分而非全部更高的风险。如果得到证实，这表明吸烟可能会导致肺部发育脆弱期。
