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Published ahead of print on November 20, 2003, doi:10.1164/rccm.200211-1357OC

Am. J. Respir. Crit. Care Med., Volume 169, Number 4, February 2004, 479-487

A more recent version of this article appeared on February 15, 2004
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Submitted on November 27, 2002
Accepted on November 20, 2003

Maternal and personal cigarette smoking synergize to increase airflow limitation in adults

Mark N Upton1*, George Davey Smith2, Alex McConnachie3, Carole L Hart4, and Graham C.M. Watt3

1 Social Medicine, University of Bristol, Bristol, United Kingdom; General Practice, University of Glasgow, Glasgow, United Kingdom, 2 Social Medicine, University of Bristol, Bristol, United Kingdom, 3 General Practice, University of Glasgow, Glasgow, United Kingdom, 4 Public Health, University of Glasgow, Glasgow, United Kingdom

* To whom correspondence should be addressed. 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 (pre-recorded) and forced expiratory volume in one second (FEV1) in adults. Because FEV1 and forced vital capacity (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 (RESFEV1) 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 mid-expiratory flow rates (FEF25-75, FEF25-75/FVC) and RESFEV1 in current smokers, but not in never or former smokers (heterogeneity P=0.016, 0.024, 0.021, 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%CI: 1.2 to 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: COPD, Smoking, Passive smoking, Disease susceptibility




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