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Published ahead of print on February 16, 2006, doi:10.1164/rccm.200510-1552OC

Am. J. Respir. Crit. Care Med., Volume 173, Number 11, June 2006, 1255-1263

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Submitted on October 3, 2005
Accepted on February 16, 2006

Parental Smoking and Lung Function in Children: an International Study

Hanns Moshammer1, Gerard Hoek2, Heike Luttmann-Gibson3, Manfred A Neuberger1*, Temenuga Antova4, Ulrike Gehring5, Frantiska Hruba6, Sam Pattenden7, Peter Rudnai8, Hana Slachtova9, Renata Zlotkowska10, and Tony Fletcher7

1 Institute of Environmental Health, Medical University, ZPH, Vienna, Austria, 2 Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands, 3 Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA, 4 Environmental Health Unit, National Center of Public Health Protection, Sofia, Bulgaria, 5 Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands; Institute of Epidemiology, GSF - National Research Center for Environment and Health, Neuherberg, Germany, 6 Department of Health Statistics and Informatics, Regional Authority of Public Health, Banska Bystrica, Slovakia (Slovak Republic), 7 Public and Environmental Health Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom, 8 National Institute of Environmental Health, 'Jozsef Fodor' National Center for Public Health, Budapest, Hungary, 9 Institute of Public Health, Ostrava, Czech Republic, 10 Department of Epidemiology, Institute of Occupational Medicine and Environmental Health, Sosnowiec, Poland

* To whom correspondence should be addressed. E-mail: manfred.neuberger{at}univie.ac.at.

Rationale: Both prenatal and postnatal passive smoking have been linked with respiratory symptoms and asthma in childhood. Their differential contributions to lung function growth in the general children population are less clear. Objective: To study the relative impact of pre-and postnatal exposure on respiratory functions of primary school children in a wide range of geographical settings we analyzed flow and volume data of more than 20,000 children (aged 6 to 12 years) from 9 countries in Europe and North America. Methods: Exposure information had been obtained by comparable questionnaires and spirometry followed a protocol of ATS/ERS. Linear and logistic regressions were used, controlling for individual risk factors and study area. Heterogeneity between study-specific results, and mean effects were estimated using meta-analytical tools. Main Results: Smoking during pregnancy was associated with decreases in lung function parameters between -1% (FEV1) and -6% (MEF25). A 4% lower MMEF corresponded to a 40% increase in the risk of poor lung function (MMEF less than 75% of expected). Associations with current passive smoking were weaker though still measurable with effects ranging from -0.5% (FEV1) to -2% (MEF50). Conclusions: Considering the high number of children exposed to maternal smoking in utero and the even higher number exposed to passive smoking after birth, this risk factor for reduced lung function growth remains a serious pediatric and public health issue.
Key words: spirometry, child, passive smoking, tobacco, pregnancy




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