Chest
Volume 116, Issue 1, July 1999, Pages 52-58
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Clinical Investigations
Asthma
Comparison of Lung Function in Infants Exposed to Maternal Smoking and in Infants With a Family History of Asthma

https://doi.org/10.1378/chest.116.1.52Get rights and content

Study objective

To compare lung function in infants exposed to maternal smoking with lung function in infants with a family history of asthma. There are no published studies comparing lung function in both groups.

Design

Cross-sectional study.

Setting

A tertiary pulmonary care center at a children's hospital. Patients: One hundred five infants with daily wheezing. Thirty-five infants had persistent exposure to maternal smoking, and 70 had a family history of asthma in parents or siblings.

Measurements

Infant pulmonary function tests were compared between the two groups. The ratio of terminal to peak expiratory flow at tidal breathing at 25% of the previous expiration remaining and the ratio of terminal to peak expiratory flow with forced expiration at 25% of the previous expiration remaining (FEF25/PFEF) were used to evaluate peripheral airflow. A > 25% improvement in FEF25/PFEF after a bronchodilator challenge test was considered a positive response.

Results

Most infants in both groups had evidence of peripheral airflow obstruction with forced expiration. In infants exposed to maternal smoking, only 4 of 35 (11.4%) responded to a bronchodilator, compared to 51 of 70 (72.9%) in the group with a family history of asthma (p < 0.0005). There was no statistically significant difference in total respiratory system compliance, total respiratory system resistance, tidal volume, and degree of peripheral airflow obstruction at tidal breathing or after forced expiration in both groups.

Conclusion

Infants with exposure to maternal smoking and infants with a family history of asthma have altered lung function, and a positive response to a bronchodilator is one variable that seems to differentiate the two groups.

Section snippets

Patient Population and Methods

One hundred five otherwise healthy infants (ages, 4 to 18 months old) included in this cross-sectional study were referred to Pediatric Pulmonary Medicine at Kosair Children's Hospital (Louisville, KY) between January 1994 and June 1997 for evaluation of daily wheezing. Inclusion criteria were either a history of both prenatal and postnatal exposure to maternal smoking or a family history of asthma in a sibling or a parent. A family history of asthma was considered positive if a physician

Results

In infants exposed to maternal smoking, the onset of respiratory symptoms was at the mean (± SD) age of 3.37 ± 3.08 months, and the mean duration of symptoms was 8.82 ± 6.52 months. The infant pulmonary function tests (IPFTs) were performed at a mean age of 12.22 ± 6.47 months. In infants with a family history of asthma, the onset of respiratory symptoms was at the mean age of 3.50 ± 2.70 months, the mean duration of symptoms was 5.81 ± 3.80 months, and IPFTs were performed at a mean age of

Discussion

In infants exposed to prenatal and postnatal cigarette smoking, studies evaluating different variables of infant lung function have determined that these infants have altered lung function.115161718192021 The data suggest that these limitations in lung function may be secondary to smaller lung size, and less maturity of lungs may be secondary to in utero lung growth retardation because of persistent exposure of the lungs to nicotine.363738 One study has also shown increased bronchial

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    This study was presented in part at the 1998 American Thoracic Society meeting in Chicago, IL.

    No funding from outside sources was used or solicited for the work in this paper

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