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Effects of Early Onset Asthma and In Utero Exposure to Maternal Smoking on Childhood Lung Function

Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California

Correspondence and requests for reprints should be addressed to Frank Gilliland, M.D., Department of Preventive Medicine, USC Keck School of Medicine, 1540 Alcazar Street, CHP 236, Los Angeles, CA 90033. E-mail: gillilan{at}usc.edu

Both in utero exposures to maternal smoking and asthma are associated with chronic deficits in lung function. We hypothesized that in utero exposure affects lung function in children without asthma and synergistically affects children with early onset asthma. To investigate effects of in utero exposure and age at asthma diagnosis on lung function, we examined longitudinal medical history, tobacco smoke exposure, and lung function data from 5,933 participants in the Children's Health Study. We found that children exposed in utero, but without asthma, showed decreased FEV₁/FVC, FEF_25–75, and FEF_25–75/FVC ratio. Among children without in utero exposure, early asthma diagnosis was associated with larger decreases in FEV₁, FEF_25–75, and FEV₁/FVC ratio compared with later diagnosed asthma. Children with in utero exposure alone and early onset asthma showed deficits in FEV₁ (-13.6%; 95% confidence interval [CI], -18.9 to -8.2) and FEF_25–75 (-29.7%; 95% CI, -37.8 to -20.5) among boys; and FEF_25–75 (-26.6%; 95% CI, -36.4 to -15.1) and FEV₁/FVC (-9.3%; 95% CI, -12.9 to -5.4) among girls. The absolute differences in FEF_25–75 associated with in utero exposure increased with age in children with early onset asthma. We found little evidence for effects from environmental tobacco smoke exposure alone. In summary, deficits in lung function were largest among children with in utero exposure and early onset asthma.

Key Words: asthma • children • ETS • maternal smoking

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