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Clinical Trial
. 2013 Mar;1(2):172-80.
doi: 10.1016/j.jaip.2012.11.006. Epub 2013 Jan 12.

Biologic mechanisms of environmental tobacco smoke in children with poorly controlled asthma: results from a multicenter clinical trial

Jason E Lang  1 , Allen J Dozor  2 , Janet T Holbrook  3 , Edward Mougey  4 , Sankaran Krishnan  2 , Shawn Sweeten  4 , Robert A Wise  5 , W Gerald Teague  6 , Christine Y Wei  3 , David Shade  3 , John J Lima  4 ; American Lung Association-Asthma Clinical Research Centers
Collaborators, Affiliations
Clinical Trial

Biologic mechanisms of environmental tobacco smoke in children with poorly controlled asthma: results from a multicenter clinical trial

Jason E Lang et al. J Allergy Clin Immunol Pract. 2013 Mar.

Abstract

Background: Environmental tobacco smoke (ETS) negatively affects children with asthma. The prevalence of ETS exposure among children with poor asthma control may be changing. Importantly, the mechanisms by which ETS worsens asthma control are poorly understood.

Objective: We describe how ETS affects gastroesophageal reflux (GER), respiratory infections, and leukotriene production among children with poor asthma control.

Methods: We analyzed data from 306 children between 6 and 17 years of age with poorly controlled asthma enrolled in a 6-month clinical trial. We evaluated prevalence and determinants of ETS exposure by interview, questionnaire, and urinary cotinine and the association of ETS exposure on leukotriene production, respiratory infections, GER, lung function, and asthma control. We used multivariable linear, logistic, and Poisson regressions to assess outcomes.

Results: ETS prevalence estimates ranged from 6% to 30%. Children with domestic indoor exposure had worse asthma control (c-Asthma Control Test, 17.8 vs 21.5; P = .04), worse FEV1 % predicted (84.1 vs 90.7; P = .02), and a trend for increased mean urinary leukotriene E4. ETS from any setting was associated with increased symptomatic respiratory infections (adjusted incidence rate ratio: 1.30; P = .02). However, children exposed to ETS did not have symptoms or pH probe results, suggestive of heightened GER.

Conclusions: Domestic smoking exposure was associated with both higher rates of symptomatic respiratory infection and poorer asthma control despite generally intensive controller therapy. ETS exposure is common among asthmatic children with poor control and may worsen asthma control by promoting respiratory infections. Further investigation is required to elucidate ETS mechanisms in poor asthma control.

Keywords: Asthma; Children; Environmental tobacco smoke; Gastroesophageal reflux; Leukotriene; Spirometry; respiratory infection.

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Conflict of interest statement

Conflicts of interest: J. E. Lang has received research support from James and Esther King Biomedical Research Program, Florida Department of Health, and National Institutes of Health/National Heart, Lung, and Blood Institute (NIH/NHLBI). A. J. Dozer has received research support and travel support from the American Lung Association. J. T. Holbrook has received research support from the National Institutes of Health and the American Lung Association and has received lecture fees and travel support from American Research in Vision and Ophthalmology. E. Mougey has received research support from James and Esther King Biomedical Research Program and Florida Department of Health. R. A. Wise has received consultancy fees from GlaxoSmithKline, Merck, BIPI Sunovion Pulmonx, and Spiration and has received research support from BIPI and GlaxoSmithKline. W. G. Teague has received research support from the NIH/NHLBI and the American Lung Association, has received consulting fees from Merck and Genentech/ Novartis, and has received payment for developing educational presentations from Not One More Life. D. Shade has received drug and masked placebo from TAP Pharmaceuticals. J. J. Lima has received research support from the American Lung Association and James and Esther King Biomedical Research Program of Florida. The rest of the authors declare that they have no relevant conflicts of interest.

Figures

Figure 1
Figure 1
Assessing environmental tobacco smoke exposure. The screening interview asked about smoke exposure at home or in workplace (BA25) and other places (BA26). The Home Smoking Questionnaire at visit 9 asked about smoking in child's home living room in the past 2 weeks and asked parent to quantify recent smoke exposure for child.
See this image and copyright information in PMC

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