title: Environmental tobacco smoke and airway obstruction in children with sickle cell anemia.
abstract: BACKGROUND
  The contribution of environmental tobacco smoke (ETS) exposure to pulmonary morbidity in children with sickle cell anemia (SCA) is poorly understood. We tested the hypothesis that children with SCA and ETS exposure would have an increased prevalence of obstructive lung disease and respiratory symptoms compared with children with SCA and no ETS exposure.
  
  
  METHODS
  Parent reports of ETS and respiratory symptom frequency were obtained for 245 children with SCA as part of a multicenter prospective cohort study. One hundred ninety-six children completed pulmonary function testing. Multivariable regression models were used to evaluate the associations between ETS exposure at different time points (prenatal, infant [birth to 2 years], preschool [2 years to first grade], and current) and lung function and respiratory symptoms.
  
  
  RESULTS
  Among the 245 participants, a high prevalence of prior (44%) and current (29%) ETS exposure was reported. Of the 196 children who completed pulmonary function testing, those with parent-reported infant and current ETS exposure were more likely to have airway obstruction (defined as an FEV1/FVC ratio below the lower limit normal) compared with unexposed children (22.0% vs 3.1%, P &lt; .001). Those with ETS exposure also had a lower forced expiratory flow, midexpiratory phase/FVC ratio (0.82 vs 0.97, P = .001) and were more likely to have evidence of bronchodilator responsiveness (23% vs 11%, P = .03). Current and prior ETS exposure and in utero smoke exposure were associated with increased frequency of respiratory symptoms.
  
  
  CONCLUSIONS
  ETS exposure is associated with evidence of lower airway obstruction and increased respiratory symptoms in SCA.
authors.affiliation: Department of Pediatrics, Boston University School of Medicine, Boston, MA.
authors.forename: Robyn T
authors.initials: RT
authors.lastname: Cohen
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Strunk
authors.affiliation: Blood Research Institute, Blood Center of Wisconsin, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Field
authors.affiliation: Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OH.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Rosen
authors.affiliation: Neurosciences Unit, UCL Institute of Child Health, London, England.
authors.forename: Fenella J
authors.initials: FJ
authors.lastname: Kirkham
authors.affiliation: Department of Medicine, Harvard Medical School, Boston, MA.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.affiliation: Portex Respiratory Unit, UCL Institute of Child Health, London, England.
authors.forename: Janet
authors.initials: J
authors.lastname: Stocks
authors.affiliation: Rodeghier Consultants, Chicago, IL.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Rodeghier
authors.affiliation: Department of Pediatrics, Vanderbilt School of Medicine, Nashville, TN. Electronic address: m.debaun@vanderbilt.edu.
authors.forename: Michael R
authors.initials: MR
authors.lastname: DeBaun
mesh_terms: D000293:Adolescent; D000402:Airway Obstruction / Q000209:etiology*; D000755:Anemia, Sickle Cell / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*
chemical_list: D014028:Tobacco Smoke Pollution