Abstract
BACKGROUND—Impaired growth and development of the respiratory system during fetal and early postnatal life may have important implications for lung development and later lung health. The aim of this study was to examine the association of diminished premorbid airway function, prior wheezing, and maternal smoking with airway function at 1 year of age. METHODS—Respiratory function was measured at the end of the first year in 100 of 108 healthy term infants (93%) in whom similar measurements had been undertaken prior to any respiratory illness at 8 weeks. Physician diagnosed wheezing episodes were identified retrospectively from medical records. RESULTS—At 1 year specific airway conductance during end expiration (sGawEE; /s/kPa) was significantly diminished in those infants with prior wheezing (95% CI wheeze/no wheeze -0.76 to -0.14), mothers who smoked (95% CI smoke/no smoke -0.81 to -0.27), a family history of asthma (95% CI family history/no family history -0.62 to 0.00), or diminished premorbid sGawEE (95% CI -0.13 to -0.43/s/kPa per unit reduction sGawEE at 8 weeks). In a multivariate model only maternal smoking and diminished premorbid sGawEE were independently associated with diminished sGawEE at 1year. CONCLUSIONS—Diminished airway function at the end of the first year appears to be mediated by impaired airway development during early life as well as by exposure to maternal smoking. These findings are consistent with the hypothesis that, at a population level, diminished premorbid airway function provides the link between wheezing lower respiratory illness and diminished airway function at 1 year. Maternal smoking remains an important and avoidable cause of impaired airway development and function in infancy.
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- Becklake M. R., Kauffmann F. Gender differences in airway behaviour over the human life span. Thorax. 1999 Dec;54(12):1119–1138. doi: 10.1136/thx.54.12.1119. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Britton J., Martinez F. D. The relationship of childhood respiratory infection to growth and decline in lung function. Am J Respir Crit Care Med. 1996 Dec;154(6 Pt 2):S240–S245. doi: 10.1164/ajrccm/154.6_Pt_2.S240. [DOI] [PubMed] [Google Scholar]
- Dezateux C. A., Stocks J., Dundas I., Jackson E. A., Fletcher M. E. The relationship between tPTEF:tE and specific airway conductance in infancy. Pediatr Pulmonol. 1994 Nov;18(5):299–307. doi: 10.1002/ppul.1950180507. [DOI] [PubMed] [Google Scholar]
- Dezateux C., Stocks J., Dundas I., Fletcher M. E. Impaired airway function and wheezing in infancy: the influence of maternal smoking and a genetic predisposition to asthma. Am J Respir Crit Care Med. 1999 Feb;159(2):403–410. doi: 10.1164/ajrccm.159.2.9712029. [DOI] [PubMed] [Google Scholar]
- Dezateux C., Stocks J. Lung development and early origins of childhood respiratory illness. Br Med Bull. 1997 Jan;53(1):40–57. doi: 10.1093/oxfordjournals.bmb.a011605. [DOI] [PubMed] [Google Scholar]
- Dundas I., Dezateux C. A., Fletcher M. E., Jackson E. A., Stocks J. Comparison of single-breath and plethysmographic measurements of resistance in infancy. Am J Respir Crit Care Med. 1995 May;151(5):1451–1458. doi: 10.1164/ajrccm.151.5.7735599. [DOI] [PubMed] [Google Scholar]
- Elliot J., Vullermin P., Robinson P. Maternal cigarette smoking is associated with increased inner airway wall thickness in children who die from sudden infant death syndrome. Am J Respir Crit Care Med. 1998 Sep;158(3):802–806. doi: 10.1164/ajrccm.158.3.9709055. [DOI] [PubMed] [Google Scholar]
- Freeman J. V., Cole T. J., Chinn S., Jones P. R., White E. M., Preece M. A. Cross sectional stature and weight reference curves for the UK, 1990. Arch Dis Child. 1995 Jul;73(1):17–24. doi: 10.1136/adc.73.1.17. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Godfrey K., Robinson S., Barker D. J., Osmond C., Cox V. Maternal nutrition in early and late pregnancy in relation to placental and fetal growth. BMJ. 1996 Feb 17;312(7028):410–414. doi: 10.1136/bmj.312.7028.410. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hanrahan J. P., Tager I. B., Segal M. R., Tosteson T. D., Castile R. G., Van Vunakis H., Weiss S. T., Speizer F. E. The effect of maternal smoking during pregnancy on early infant lung function. Am Rev Respir Dis. 1992 May;145(5):1129–1135. doi: 10.1164/ajrccm/145.5.1129. [DOI] [PubMed] [Google Scholar]
- Hole D. J., Watt G. C., Davey-Smith G., Hart C. L., Gillis C. R., Hawthorne V. M. Impaired lung function and mortality risk in men and women: findings from the Renfrew and Paisley prospective population study. BMJ. 1996 Sep 21;313(7059):711–716. doi: 10.1136/bmj.313.7059.711. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hoo A. F., Henschen M., Dezateux C., Costeloe K., Stocks J. Respiratory function among preterm infants whose mothers smoked during pregnancy. Am J Respir Crit Care Med. 1998 Sep;158(3):700–705. doi: 10.1164/ajrccm.158.3.9711057. [DOI] [PubMed] [Google Scholar]
- Illi S., von Mutius E., Lau S., Bergmann R., Niggemann B., Sommerfeld C., Wahn U., MAS Group Early childhood infectious diseases and the development of asthma up to school age: a birth cohort study. BMJ. 2001 Feb 17;322(7283):390–395. doi: 10.1136/bmj.322.7283.390. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Jarvis M. J., Tunstall-Pedoe H., Feyerabend C., Vesey C., Saloojee Y. Comparison of tests used to distinguish smokers from nonsmokers. Am J Public Health. 1987 Nov;77(11):1435–1438. doi: 10.2105/ajph.77.11.1435. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Leeder S. R., Corkhill R. T., Wysocki M. J., Holland W. W. Influence of personal and family factors on ventilatory function of children. Br J Prev Soc Med. 1976 Dec;30(4):219–224. doi: 10.1136/jech.30.4.219. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Macklem P. T. The physiology of small airways. Am J Respir Crit Care Med. 1998 May;157(5 Pt 2):S181–S183. doi: 10.1164/ajrccm.157.5.rsaa-2. [DOI] [PubMed] [Google Scholar]
- Margetts B. M., Jackson A. A. Interactions between people's diet and their smoking habits: the dietary and nutritional survey of British adults. BMJ. 1993 Nov 27;307(6916):1381–1384. doi: 10.1136/bmj.307.6916.1381. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Martinez F. D., Morgan W. J., Wright A. L., Holberg C. J., Taussig L. M. Diminished lung function as a predisposing factor for wheezing respiratory illness in infants. N Engl J Med. 1988 Oct 27;319(17):1112–1117. doi: 10.1056/NEJM198810273191702. [DOI] [PubMed] [Google Scholar]
- Martinez F. D., Wright A. L., Taussig L. M., Holberg C. J., Halonen M., Morgan W. J. Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med. 1995 Jan 19;332(3):133–138. doi: 10.1056/NEJM199501193320301. [DOI] [PubMed] [Google Scholar]
- Owen L., McNeill A., Callum C. Trends in smoking during pregnancy in England, 1992-7: quota sampling surveys. BMJ. 1998 Sep 12;317(7160):728–728. doi: 10.1136/bmj.317.7160.728. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rona R. J., Gulliford M. C., Chinn S. Effects of prematurity and intrauterine growth on respiratory health and lung function in childhood. BMJ. 1993 Mar 27;306(6881):817–820. doi: 10.1136/bmj.306.6881.817. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Shaheen S., Barker D. J. Early lung growth and chronic airflow obstruction. Thorax. 1994 Jun;49(6):533–536. doi: 10.1136/thx.49.6.533. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Stein R. T., Holberg C. J., Sherrill D., Wright A. L., Morgan W. J., Taussig L., Martinez F. D. Influence of parental smoking on respiratory symptoms during the first decade of life: the Tucson Children's Respiratory Study. Am J Epidemiol. 1999 Jun 1;149(11):1030–1037. doi: 10.1093/oxfordjournals.aje.a009748. [DOI] [PubMed] [Google Scholar]
- Stein R. T., Sherrill D., Morgan W. J., Holberg C. J., Halonen M., Taussig L. M., Wright A. L., Martinez F. D. Respiratory syncytial virus in early life and risk of wheeze and allergy by age 13 years. Lancet. 1999 Aug 14;354(9178):541–545. doi: 10.1016/S0140-6736(98)10321-5. [DOI] [PubMed] [Google Scholar]
- Stick S. M., Burton P. R., Gurrin L., Sly P. D., LeSouëf P. N. Effects of maternal smoking during pregnancy and a family history of asthma on respiratory function in newborn infants. Lancet. 1996 Oct 19;348(9034):1060–1064. doi: 10.1016/s0140-6736(96)04446-7. [DOI] [PubMed] [Google Scholar]
- Stocks J., Dezateux C. A., Jackson E. A., Hoo A. F., Costeloe K. L., Wade A. M. Analysis of tidal breathing parameters in infancy: how variable is TPTEF:TE? Am J Respir Crit Care Med. 1994 Nov;150(5 Pt 1):1347–1354. doi: 10.1164/ajrccm.150.5.7952563. [DOI] [PubMed] [Google Scholar]
- Stocks J., Henschen M., Hoo A. F., Costeloe K., Dezateux C. Influence of ethnicity and gender on airway function in preterm infants. Am J Respir Crit Care Med. 1997 Dec;156(6):1855–1862. doi: 10.1164/ajrccm.156.6.9607056. [DOI] [PubMed] [Google Scholar]
- Stocks J. Respiratory physiology during early life. Monaldi Arch Chest Dis. 1999 Aug;54(4):358–364. [PubMed] [Google Scholar]
- Tager I. B., Ngo L., Hanrahan J. P. Maternal smoking during pregnancy. Effects on lung function during the first 18 months of life. Am J Respir Crit Care Med. 1995 Sep;152(3):977–983. doi: 10.1164/ajrccm.152.3.7663813. [DOI] [PubMed] [Google Scholar]
- Upton M. N., Watt G. C., Davey Smith G., McConnachie A., Hart C. L. Permanent effects of maternal smoking on offsprings' lung function. Lancet. 1998 Aug 8;352(9126):453–453. doi: 10.1016/s0140-6736(05)79187-x. [DOI] [PubMed] [Google Scholar]
- Watkins C. J., Burton P., Leeder S., Sittampalam Y., Wever A. M., Wiggins R. Doctor diagnosis and maternal recall of lower respiratory illness. Int J Epidemiol. 1982 Mar;11(1):62–66. doi: 10.1093/ije/11.1.62. [DOI] [PubMed] [Google Scholar]
- Young S., Arnott J., O'Keeffe P. T., Le Souef P. N., Landau L. I. The association between early life lung function and wheezing during the first 2 yrs of life. Eur Respir J. 2000 Jan;15(1):151–157. doi: 10.1183/09031936.00.15115100. [DOI] [PubMed] [Google Scholar]
- Young S., Le Souëf P. N., Geelhoed G. C., Stick S. M., Turner K. J., Landau L. I. The influence of a family history of asthma and parental smoking on airway responsiveness in early infancy. N Engl J Med. 1991 Apr 25;324(17):1168–1173. doi: 10.1056/NEJM199104253241704. [DOI] [PubMed] [Google Scholar]