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. 2004 Aug;59(8):682–686. doi: 10.1136/thx.2003.010215

Childhood smoking is an independent risk factor for obstructive airways disease in women

B Patel 1, R Luben 1, A Welch 1, S Bingham 1, K Khaw 1, N Day 1, D Lomas 1, N Wareham 1
PMCID: PMC1747099  PMID: 15282389

Abstract

Objective: To assess whether starting to smoke in childhood increases the risk of obstructive airways disease (OAD) in adult life.

Methods: A retrospective cohort analysis was undertaken of 12 504 current and ex-smokers in the EPIC-Norfolk cohort. The main exposure was starting to smoke during childhood (age <16 years). Three definitions of OAD were used: doctor diagnosed asthma, doctor diagnosed bronchitis/emphysema, and "any OAD" (doctor diagnosed asthma or bronchitis/emphysema, or taking medication used in the treatment of OAD).

Results: Childhood smokers had significantly more pack years of exposure and poorer lung function than subjects who started to smoke in adulthood (⩾16 years). Compared with starting in adulthood, starting to smoke in childhood was associated with a greater risk of bronchitis/emphysema in female smokers (OR 1.79, 95% CI 1.25 to 2.56) and ex-smokers of both sexes (OR 1.29, 95% CI 1.07 to 1.55 in men and OR 1.40, 95% CI 1.05 to 1.85 in women), and of "any OAD" in female smokers (OR 1.72, 95% CI 1.24 to 2.38) and male and female ex-smokers (OR 1.20, 95% CI 1.03 to 1.40 in men and 1.34, 95% CI 1.07 to 1.57 in women). After adjustment for pack years, childhood smoking was associated with poorer lung function (FEV1 92.3% predicted in adult smokers and 89.5% in childhood smokers, p = 0.03) and a greater risk of bronchitis/emphysema (adjusted OR 1.55, 95% CI 1.08 to 2.24) and for "any OAD" (OR 1.54, 95% CI 1.10 to 2.13) in female smokers but not in male and female ex-smokers.

Conclusion: Starting to smoke in childhood is associated with an increased risk of airways disease because of the extra pack years smoked. In women, childhood smoking is itself an independent risk factor for the development of airways disease.

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Selected References

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  1. Beck G. J., Doyle C. A., Schachter E. N. Smoking and lung function. Am Rev Respir Dis. 1981 Feb;123(2):149–155. doi: 10.1164/arrd.1981.123.2.149. [DOI] [PubMed] [Google Scholar]
  2. 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]
  3. Breslau N., Peterson E. L. Smoking cessation in young adults: age at initiation of cigarette smoking and other suspected influences. Am J Public Health. 1996 Feb;86(2):214–220. doi: 10.2105/ajph.86.2.214. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Burrows B., Cline M. G., Knudson R. J., Taussig L. M., Lebowitz M. D. A descriptive analysis of the growth and decline of the FVC and FEV1. Chest. 1983 May;83(5):717–724. doi: 10.1378/chest.83.5.717. [DOI] [PubMed] [Google Scholar]
  5. Burrows B., Knudson R. J., Camilli A. E., Lyle S. K., Lebowitz M. D. The "horse-racing effect" and predicting decline in forced expiratory volume in one second from screening spirometry. Am Rev Respir Dis. 1987 Apr;135(4):788–793. doi: 10.1164/arrd.1987.135.4.788. [DOI] [PubMed] [Google Scholar]
  6. Burrows B., Knudson R. J., Lebowitz M. D. The relationship of childhood respiratory illness to adult obstructive airway disease. Am Rev Respir Dis. 1977 May;115(5):751–760. doi: 10.1164/arrd.1977.115.5.751. [DOI] [PubMed] [Google Scholar]
  7. Camilli A. E., Burrows B., Knudson R. J., Lyle S. K., Lebowitz M. D. Longitudinal changes in forced expiratory volume in one second in adults. Effects of smoking and smoking cessation. Am Rev Respir Dis. 1987 Apr;135(4):794–799. doi: 10.1164/arrd.1987.135.4.794. [DOI] [PubMed] [Google Scholar]
  8. Chabrol H., Faury R., Callahan S. French adolescent smoking and perception of quitting. J Am Acad Child Adolesc Psychiatry. 1999 Jun;38(6):640–641. doi: 10.1097/00004583-199906000-00008. [DOI] [PubMed] [Google Scholar]
  9. Day N., Oakes S., Luben R., Khaw K. T., Bingham S., Welch A., Wareham N. EPIC-Norfolk: study design and characteristics of the cohort. European Prospective Investigation of Cancer. Br J Cancer. 1999 Jul;80 (Suppl 1):95–103. [PubMed] [Google Scholar]
  10. Dockery D. W., Speizer F. E., Ferris B. G., Jr, Ware J. H., Louis T. A., Spiro A., 3rd Cumulative and reversible effects of lifetime smoking on simple tests of lung function in adults. Am Rev Respir Dis. 1988 Feb;137(2):286–292. doi: 10.1164/ajrccm/137.2.286. [DOI] [PubMed] [Google Scholar]
  11. Dockery D. W., Ware J. H., Ferris B. G., Jr, Glicksberg D. S., Fay M. E., Spiro A., 3rd, Speizer F. E. Distribution of forced expiratory volume in one second and forced vital capacity in healthy, white, adult never-smokers in six U.S. cities. Am Rev Respir Dis. 1985 Apr;131(4):511–520. doi: 10.1164/arrd.1985.131.4.511. [DOI] [PubMed] [Google Scholar]
  12. Elders M. J., Perry C. L., Eriksen M. P., Giovino G. A. The report of the Surgeon General: preventing tobacco use among young people. Am J Public Health. 1994 Apr;84(4):543–547. doi: 10.2105/ajph.84.4.543. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Enjeti S., Hazelwood B., Permutt S., Menkes H., Terry P. Pulmonary function in young smokers: male-female differences. Am Rev Respir Dis. 1978 Oct;118(4):667–676. doi: 10.1164/arrd.1978.118.4.667. [DOI] [PubMed] [Google Scholar]
  14. Fletcher C., Peto R. The natural history of chronic airflow obstruction. Br Med J. 1977 Jun 25;1(6077):1645–1648. doi: 10.1136/bmj.1.6077.1645. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Foulds J., Godfrey C. Counting the costs of children's smoking. BMJ. 1995 Oct 28;311(7013):1152–1154. doi: 10.1136/bmj.311.7013.1152. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Global Youth Tabacco Survey Collaborative Group Tobacco use among youth: a cross country comparison. Tob Control. 2002 Sep;11(3):252–270. doi: 10.1136/tc.11.3.252. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Gold D. R., Wang X., Wypij D., Speizer F. E., Ware J. H., Dockery D. W. Effects of cigarette smoking on lung function in adolescent boys and girls. N Engl J Med. 1996 Sep 26;335(13):931–937. doi: 10.1056/NEJM199609263351304. [DOI] [PubMed] [Google Scholar]
  18. Hurt R. D., Croghan G. A., Beede S. D., Wolter T. D., Croghan I. T., Patten C. A. Nicotine patch therapy in 101 adolescent smokers: efficacy, withdrawal symptom relief, and carbon monoxide and plasma cotinine levels. Arch Pediatr Adolesc Med. 2000 Jan;154(1):31–37. [PubMed] [Google Scholar]
  19. Hymowitz N., Cummings K. M., Hyland A., Lynn W. R., Pechacek T. F., Hartwell T. D. Predictors of smoking cessation in a cohort of adult smokers followed for five years. Tob Control. 1997;6 (Suppl 2):S57–S62. doi: 10.1136/tc.6.suppl_2.s57. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Jaakkola M. S., Ernst P., Jaakkola J. J., N'gan'ga L. W., Becklake M. R. Effect of cigarette smoking on evolution of ventilatory lung function in young adults: an eight year longitudinal study. Thorax. 1991 Dec;46(12):907–913. doi: 10.1136/thx.46.12.907. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Knudson R. J., Slatin R. C., Lebowitz M. D., Burrows B. The maximal expiratory flow-volume curve. Normal standards, variability, and effects of age. Am Rev Respir Dis. 1976 May;113(5):587–600. doi: 10.1164/arrd.1976.113.5.587. [DOI] [PubMed] [Google Scholar]
  22. Krzyzanowski M., Jedrychowski W., Wysocki M. Factors associated with the change in ventilatory function and the development of chronic obstructive pulmonary disease in a 13-year follow-up of the Cracow Study. Risk of chronic obstructive pulmonary disease. Am Rev Respir Dis. 1986 Nov;134(5):1011–1019. doi: 10.1164/arrd.1986.134.5.1011. [DOI] [PubMed] [Google Scholar]
  23. Lebowitz M. D., Holberg C. J., Knudson R. J., Burrows B. Longitudinal study of pulmonary function development in childhood, adolescence, and early adulthood. Development of pulmonary function. Am Rev Respir Dis. 1987 Jul;136(1):69–75. doi: 10.1164/ajrccm/136.1.69. [DOI] [PubMed] [Google Scholar]
  24. McFee R. B., Boykan R., Lasner H., Mazure B. Promoting adolescent smoking cessation is worth the effort. Arch Pediatr Adolesc Med. 2001 Mar;155(3):419–420. [PubMed] [Google Scholar]
  25. McNeill A. D. The development of dependence on smoking in children. Br J Addict. 1991 May;86(5):589–592. doi: 10.1111/j.1360-0443.1991.tb01813.x. [DOI] [PubMed] [Google Scholar]
  26. Morabia Alfredo, Costanza Michael C., Bernstein Martine S., Rielle Jean-Charles. Ages at initiation of cigarette smoking and quit attempts among women: a generation effect. Am J Public Health. 2002 Jan;92(1):71–74. doi: 10.2105/ajph.92.1.71. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Moran A., Maguire N., Howell F. Smoking and quitting among Irish teenage males. Ir Med J. 2000 Dec;93(9):272–273. [PubMed] [Google Scholar]
  28. Nelson D. E., Giovino G. A., Shopland D. R., Mowery P. D., Mills S. L., Eriksen M. P. Trends in cigarette smoking among US adolescents, 1974 through 1991. Am J Public Health. 1995 Jan;85(1):34–40. doi: 10.2105/ajph.85.1.34. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Neukirch F., Liard R., Cooreman J., Perdrizet S. Prevalence of respiratory symptoms in Parisian teenagers according to smoking habits. J Epidemiol Community Health. 1982 Sep;36(3):202–204. doi: 10.1136/jech.36.3.202. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Pope M., Ashley M. J., Ferrence R. The carcinogenic and toxic effects of tobacco smoke: are women particularly susceptible? J Gend Specif Med. 1999 Nov-Dec;2(6):45–51. [PubMed] [Google Scholar]
  31. Sherrill D. L., Holberg C. J., Enright P. L., Lebowitz M. D., Burrows B. Longitudinal analysis of the effects of smoking onset and cessation on pulmonary function. Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):591–597. doi: 10.1164/ajrccm.149.3.8118623. [DOI] [PubMed] [Google Scholar]
  32. Tager I. B., Muñoz A., Rosner B., Weiss S. T., Carey V., Speizer F. E. Effect of cigarette smoking on the pulmonary function of children and adolescents. Am Rev Respir Dis. 1985 May;131(5):752–759. doi: 10.1164/arrd.1985.131.5.752. [DOI] [PubMed] [Google Scholar]
  33. Wang X., Wypij D., Gold D. R., Speizer F. E., Ware J. H., Ferris B. G., Jr, Dockery D. W. A longitudinal study of the effects of parental smoking on pulmonary function in children 6-18 years. Am J Respir Crit Care Med. 1994 Jun;149(6):1420–1425. doi: 10.1164/ajrccm.149.6.8004293. [DOI] [PubMed] [Google Scholar]
  34. Wechsler H., Rigotti N. A., Gledhill-Hoyt J., Lee H. Increased levels of cigarette use among college students: a cause for national concern. JAMA. 1998 Nov 18;280(19):1673–1678. doi: 10.1001/jama.280.19.1673. [DOI] [PubMed] [Google Scholar]
  35. Xu X., Li B., Wang L. Gender difference in smoking effects on adult pulmonary function. Eur Respir J. 1994 Mar;7(3):477–483. doi: 10.1183/09031936.94.07030477. [DOI] [PubMed] [Google Scholar]

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