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Paediatric origins of adult lung diseases • 4
Tobacco related lung diseases begin in childhood
  1. P N Le Souëf
  1. Department of Paediatrics, University of Western Australia, Princess Margaret Hospital for Children, GPO Box D184, Perth, Western Australia 6001
  1. Professor P N Le Souëfpeterles{at}paed.uwa.edu.au

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Tobacco related diseases are the most important cause of respiratory morbidity and mortality in adults. Adult tobacco related respiratory disease may begin in childhood in two ways. Firstly, long term lung damage could occur due to passive exposure from tobacco products reaching the fetus via the placental circulation in utero, and through the air in infants and children. Secondly, most adult smokers begin to smoke while they are children so that factors associated with initiation of smoking and failure of cessation during childhood are of major importance in determining long term adult morbidity from active smoking. There are several strategies to minimise smoking that have been shown to be effective and these should be adopted by educational and governmental agencies. Tobacco companies have played a major role in promoting their products to children and in lobbying politicians to limit effective preventative strategies.

Influence of passive smoke exposure on respiratory physiology and long term respiratory outcome

EFFECTS OF IN UTERO EXPOSURE

If the mother smokes, the level of exposure of the fetus to tobacco products from the time of conception is at the same level as active smokers. A study examining exposure by measurement of maternal urinary cotinine levels at the time of the first clinic visit to a medical practitioner reported levels that were comparable to those found in active smokers.1 Since cotinine diffuses freely through body fluids, the fetus would be exposed to similar levels and these are likely to be comparable to exposure of active smokers. Fetal exposure to tobacco products that cross the placenta has important deleterious effects to the fetus including increased miscarriage,2 3 ectopic pregnancies,4congenital malformations,5 and impaired placental function.6

PULMONARY FUNCTION MEASUREMENTS IN NEONATES AND IN EARLY LIFE

Lung growth and function is also adversely affected by maternal smoking during pregnancy.7-12 In studies in neonates the respiratory pattern, as evaluated by the ratio of time to maximal tidal expiratory flow over total time of …

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