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      Tobacco smoke exposure in early life and adolescence in relation to lung function

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          Abstract

          Maternal smoking during pregnancy is associated with impaired lung function among young children, but less is known about long-term effects and the impact of adolescents' own smoking. We investigated the influence of maternal smoking during pregnancy, secondhand smoke exposure and adolescent smoking on lung function at age 16 years.

          The BAMSE (Barn/Child, Allergy, Milieu, Stockholm, Epidemiology) birth cohort collected information on participants' tobacco smoke exposure through repeated questionnaires, and measured saliva cotinine concentrations at age 16 years. Participants performed spirometry and impulse oscillometry (IOS) at age 16 years (n=2295).

          Exposure to maternal smoking during pregnancy was associated with reduced forced expiratory volume in 1 s (FEV 1)/forced vital capacity (FVC) ratio of −1.1% (95% CI −2.0 to −0.2%). IOS demonstrated greater resistance at 5–20 Hz ( R 5–20) in participants exposed to maternal smoking during pregnancy. Adolescents who smoked had reduced FEV 1/FVC ratios of −0.9% (95% CI −1.8 to −0.1%) and increased resistance of 6.5 Pa·L –1·s (95% CI 0.7 to 12.2 Pa·L –1·s) in R 5–20. Comparable associations for FEV 1/FVC ratio were observed for cotinine concentrations, using ≥12 ng·mL −1 as a cut-off for adolescent smoking.

          Maternal smoking during pregnancy was associated with lower FEV 1/FVC ratios and increased airway resistance. In addition, adolescent smoking appears to be associated with reduced FEV 1/FVC ratios and increased peripheral airway resistance.

          Abstract

          Maternal smoking in utero and teenage smoking are associated with indices of airway obstruction at age 16 years http://ow.ly/NwF030jFS2W

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          Most cited references29

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          Tobacco-Product Use by Adults and Youths in the United States in 2013 and 2014.

          Noncigarette tobacco products are evolving rapidly, with increasing popularity in the United States.
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            Short and long term health effects of parental tobacco smoking during pregnancy and lactation: a descriptive review

            A great deal of attention has been focused on adverse effects of tobacco smoking on conception, pregnancy, fetal, and child health. The aim of this paper is to discuss the current evidence regarding short and long-term health effects on child health of parental smoking during pregnancy and lactation and the potential underlying mechanisms. Studies were searched on MEDLINE® and Cochrane database inserting, individually and using the Boolean ANDs and ORs, ‘pregnancy’, ‘human lactation’, ‘fetal growth’, ‘metabolic outcomes’, ‘obesity’, ‘cardiovascular outcomes’, ‘blood pressure’, ‘brain development’, ‘respiratory outcomes’, ‘maternal or paternal or parental tobacco smoking’, ‘nicotine’. Publications coming from the reference list of studies were also considered from MEDLINE. All sources were retrieved between 2015-01-03 and 2015-31-05. There is overall consistency in literature about negative effects of fetal and postnatal exposure to parental tobacco smoking on several outcomes: preterm birth, fetal growth restriction, low birth weight, sudden infant death syndrome, neurodevelopmental and behavioral problems, obesity, hypertension, type 2 diabetes, impaired lung function, asthma and wheezing. While maternal smoking during pregnancy plays a major role on adverse postnatal outcomes, it may also cumulate negatively with smoking during lactation and with second-hand smoking exposure. Although this review was not strictly designed as a systematic review and the PRISMA Statement was not fully applied it may benefit the reader with a promptly and friendly readable update of the matter. This review strengthens the need to plan population health policies aimed to implement educational programs to hopefully minimize tobacco smoke exposure during pregnancy and lactation.
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              Measurement of FEF25-75% and FEF75% does not contribute to clinical decision making.

              The aim of this study was to determine the added value of measuring the forced expiratory flow at 25-75% of forced vital capacity (FVC) (FEF25-75%) and flow when 75% of FVC has been exhaled (FEF75%) over and above the measurement of the forced expiratory volume in 1 s (FEV1), FVC and FEV1/FVC ratio. We used spirometric measurements of FEV1, FVC and FEF25-75% from 11 654 white males and 11 113 white females, aged 3-94 years, routinely tested in the pulmonary function laboratories of four tertiary hospitals. FEF75% was available in 8254 males and 7407 females. Predicted values and lower limits of normal, defined as the fifth percentile, were calculated for FEV1, FVC, FEV1/FVC ratio, FEF25-75% and FEF75% using prediction equations from the Global Lung Function Initiative. There was very little discordance in classifying test results. FEF25-75% and FEF75% were below the normal range in only 2.75% and 1.29% of cases, respectively, whereas FEV1, FVC and FEV1/FVC ratio were within normal limits. Airways obstruction went undetected by FEF25-75% in 2.9% of cases and by FEF75% in 12.3% of cases. Maximum mid-expiratory flow and flow towards the end of the forced expiratory manoeuvre do not contribute usefully to clinical decision making over and above information from FEV1, FVC and FEV1/FVC ratio.
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                Author and article information

                Journal
                Eur Respir J
                Eur. Respir. J
                ERJ
                erj
                The European Respiratory Journal
                European Respiratory Society
                0903-1936
                1399-3003
                June 2018
                07 June 2018
                : 51
                : 6
                : 1702111
                Affiliations
                [1 ]Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
                [2 ]Sachs’ Children's and Youth Hospital, Södersjukhuset, Stockholm, Sweden
                [3 ]Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
                [4 ]Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
                [5 ]The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
                [6 ]Dept of Pediatrics, Central Hospital, Skövde, Sweden
                [7 ]These authors contributed equally
                Author notes
                Jesse D. Thacher, Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden. E-mail: Jesse.Thacher@ 123456ki.se
                Author information
                http://orcid.org/0000-0002-8248-0663
                Article
                ERJ-02111-2017
                10.1183/13993003.02111-2017
                6003782
                29748304
                b2285d2c-1372-4e53-b0a7-1081aaf5cd07
                Copyright ©ERS 2018.

                This article is open access and distributed under the terms of the Creative Commons Attribution Licence 4.0.

                History
                : 13 October 2017
                : 21 April 2018
                Categories
                Original Articles
                Paediatrics
                2
                9

                Respiratory medicine
                Respiratory medicine

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