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Published ahead of print on November 20, 2003, doi:10.1164/rccm.200211-1357OC
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American Journal of Respiratory and Critical Care Medicine Vol 169. pp. 479-487, (2004)
© 2004 American Thoracic Society

Maternal and Personal Cigarette Smoking Synergize to Increase Airflow Limitation in Adults

Mark N. Upton, George Davey Smith, Alex McConnachie, Carole L. Hart and Graham C. M. Watt

Department of Social Medicine, University of Bristol, Canynge Hall, Bristol; Departments of General Practice and Public Health, University of Glasgow, Glasgow, United Kingdom

Correspondence and requests for reprints should be addressed to Mark Upton, M.B.B.S., B.Sc., M.Sc., Woodlands Family Medical Centre, 106 Yarm Lane, Stockton-on-Tees TS18 1YE, UK. E-mail: marknupton{at}aol.com

Susceptibility of the lungs to cigarette smoke is poorly understood. It is not known whether maternal smoking increases chronic obstructive pulmonary disease (COPD) risk. In 1998 we reported an inverse association between maternal smoking (prerecorded) and FEV1 in adults. Because FEV1 and FVC are strongly correlated, it is unclear whether the association in question reflects a link with lung volume, airflow limitation, or both. We extended our original analysis to investigate whether maternal and personal smoking synergize to increase airflow limitation. We estimated residual FEV1 to express FEV1 variation that was not associated with FVC. Maternal smoking was inversely associated with FVC and FEV1 irrespective of personal smoking. It was inversely associated with FEV1/FVC, forced midexpiratory flow rates (FEF25–75 [mean forced expiratory flow during the middle half of the FVC], FEF25–75/FVC), and residual FEV1 in current smokers but not in never or former smokers (heterogeneity p = 0.016, 0.024, 0.021, and 0.016, respectively). We tested the clinical relevance of findings in ever smokers without asthma: 10 cigarettes/day maternal smoking increased prevalent COPD by 1.7 (95% confidence interval: 1.2–2.5) after adjustment for covariates. Maternal smoking impairs lung volume irrespective of personal smoking and appears to synergize with personal smoking to increase airflow limitation and COPD.

Key Words: chronic obstructive pulmonary disease • disease susceptibility • smoking • passive smoking




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