Spirometric changes in children with asthma exposed to environmental tobacco smoke and treated with inhaled corticosteroids

Snezana Radic; Branislava Milenkovic; Branislav Gvozdenovic; Biljana Medjo; Sanja Dimic Janjic

doi:10.2298/VSP170306115R

Snezana Radic Childrenʼs Hospital for Respiratory Diseases and Tuberculosis, “Dr. Dragiša Mišović – Dedinje” University Medical Center, Belgrade, Serbia
Branislava Milenkovic Clinic for Pulmonary Diseases, Clinical Centre of Serbia, Belgrade, Serbia School of Medicine, University of Belgrade, Belgrade, Serbia
Branislav Gvozdenovic PPD Serbia, Pharmacovigilance Department, Belgrade, Serbia
Biljana Medjo University Children's Hospital, Belgrade, Serbia
Sanja Dimic Janjic Clinic for Pulmonary Diseases, Clinical Centre of Serbia, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP170306115R

Keywords: asthma, child, preschool, child, adolescent, parents, smoking, tobacco smoke pollution, respiratory function tests, fluticasone, administration, inhalation

Abstract

Abstract

Background/Aim. Corticosteroids are the most frequently prescribed anti-inflammatory treatment in asthma. A purpose of this study was to compare the spirometric parameters as a response to inhaled fluticasone propionate (FP) treatment in children with asthma, exposed and nonexposed to environmental tobacco smoke (ETS). Methods. The study included 527 children aged between 1 and 16 years with persistent asthma divided into the groups of ETS exposed (ETSE, n = 337) and ETS free (ETSF, n = 190) children. Spirometry was performed before (1st set of results) and after 6 months of FP treatment (2nd set of results). Good lung function (GLF) was defined as forced expiratory volume in one second (FEV₁)≥ 85%, and “poor lung function” (PLF) as FEV₁< 85%. Results. Among the ETSE children, 208 had one smoking parent, 129 had two, 228 had smoking mothers and 238 smoking fathers. The ETSE children received a higher FP dose (p < 0.0001) which was increased with the increase of the number of smokers in the family. The ETSE children had significantly lower lung function both in the 1st and 2nd sets of tests compared to the ETSF children (p < 0.05). After the FP treatment, both groups improved all spirometric parameters (p < 0.001). In the 2nd set of the spirometric tests, the children of smoking mothers had lower spirometry values compared to the children of smoking fathers (p < 0.05). The proportion of the children improving from the PLF to GLF after 6 months of FP was much higher among the ETSF than the ETSE children (p < 0.05). Conclusions. The ETSE children had lower spirometric values before FP. After 6-months of the FP treatment children in both groups improved the spirometric values, but the improvement was higher in the ETSF children.

References

REFERENCES

Oberg M, Jaakkola MS, Woodward A, Peruga A, Prüss-Ustün A. Worldwide burden of disease from exposure to second-hand smoke: A retrospective analysis of data from 192 countries. Lancet 2011; 377(9760): 139‒46.

United States Public Health Service. US Surgeon General report: The health consequences of involuntary exposure to tobacco smoke. Washington DC, USA: USPHS; 2006.

California Protection Environmental Agency. Proposed identification of environmental tobacco smoke as a toxic contaminant. Sacramento, CA, USA: California Protection Environmental Agency; 2005.

United States Public Health Service. US Surgeon General report World Health Organization: International consultation on environmental tobacco smoke (ETS) and child health: Consultation report. Geneva, Switzerland: WHO; 1999.

Moshammer H, Hoek G, Luttmann-Gibson H, Neuberger MA, Antova T, Gehring U, et al. Parental smoking and lung function in children: An international study. Am J Respir Crit Care Med 2006; 173(11): 1255‒63.

Comhair SA, Gaston BM, Ricci KS, Hammel J, Dweik RA, Teague WG, et al. Detrimental effects of environmental tobacco smoke in relation to asthma severity. PLoS One 201; 6(5): e18574.

Radic SD, Gvozdenovic BS, Pesic IM, Zivkovic ZM, Skodric-Trifunovic V.Exposure to tobacco smoke among asthmatic children: parents' smoking habits and level of education. Int J Tuberc Lung Dis 2011; 15(2): 276‒80, i.

Gergen PJ. Environmental tobacco smoke as a risk factor for respiratory disease in children. Respir Physiol 2001; 128(1): 39‒46.

Svanes C, Omenaas E, Jarvis D, Chinn S, Gulsvik A, Burney P. Parental smoking in childhood and adult obstructive lung disease: Results from the European Community Respiratory Health Survey. Thorax 2004; 59(4): 295‒302.

European Respiratory Society, European Lung Foundation. European lung white book. The first comprehensive survey on respiratory health in Europe. Sheffield, UK: ERSJ Ltd; 2003.

Barnes PJ. Corticosteroids: The drugs to beat. Eur J Pharmacol 2006; 533(1‒3): 2‒14.

Barnes PJ. Histone deacetylase-2 and airway disease. Ther Adv Respir Dis 2009; 3(5): 235‒43.

Marwick JA, Ito K, Adcock IM, Kirkham PA. Oxidative stress and steroid resistance in asthma and COPD: Pharmacological manipulation of HDAC-2 as a therapeutic strategy. Expert Opin Ther Targets 2007; 11(6): 745‒55.

Barnes PJ, Ito K, Adcock IM. Corticosteroid resistance in chronic obstructive pulmonary disease: Inactivation of histone deacetylase. Lancet 2004 ;363(9410): 731‒3.

O'Byrne PM, Lamm CJ, Busse WW, Tan WC, Pedersen S. The effects of inhaled budesonide on lung function in smokers and nonsmokers with mild persistent asthma. Chest 2009; 136(6): 1514‒20.

Cohen RT, Raby BA, Van Steen K, Fuhlbrigge AL, Celedón JC, Rosner BA, et al. In utero smoke exposure and impaired response to inhaled corticosteroids in children with asthma. J Allergy Clin Immunol 2010; 126(3): 491‒7.

Global Initiative for Asthma, GINA. Global Strategy for Asthma Management and Prevention. 2010. Available from: http://www.ginasthma.org/documents/5/documents_variants/35.

Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, et al. General considerations for lung function testing. Eur Respir J 2005; 26(1): 153‒61.

Zapletal A, Paul T, Samánek M. Significance of contemporary methods of lung function testing for the detection of airway obstruction in children and adolescents (author's transl). Z Erkr Atmungsorgane 1977; 149(3): 343‒71. (German)

Proceedings of the ATS workshop on refractory asthma: Current understanding, recommendations, and unanswered questions. American Thoracic Society. Am J Respir. Crit Care Med 2000; 162(6): 2341‒51.

Heinzerling LM, Burbach GJ, Edenharter G, Bachert C, Bindslev-Jensen C, Bonini S, et al. GA(2)LEN skin test study I: GA(2)LEN harmonization of skin prick testing: novel sensitization patterns for inhalant allergens in Europe. Allergy 2009; 64(10): 1498‒506.

Fagerström K. The nicotine market: An attempt to estimate the nicotine intake from various sources and the total nicotine consumption in some countries. Nicotine Tob Res 2005; 7(3): 343‒50.

Janovski N, Pešić I, Janovski-Lutovac T, Vušović R, Danilović M, Basara Z. Study on children smokers in Serbia. Eur Respir J 1996; 9(Suppl23): s93.

World Health Organization. Global Youth Tobacco Survey (GYTS). Geneva, Switzerland: WHO. 2008.

Mackay J, Crofton J. Tobacco and the developing world. Br Med Bull 1996; 52(1): 206‒21.

Radić S, Zivković Z, Erdeljan N, Cerović S, Jocić-Stojanović J. Influence of environmental tobacco smoke on characteristics of childhood asthma. Srp Arh Celok Lek 2009; 137(3‒4): 152‒9. (Serbian)

Bergmann RL, Schulz J, Günther S, Dudenhausen JW, Bergmann KE, Bauer CP, et al. Determinants of cord-blood IgE concentrations in 6401 German neonates. Allergy 1995; 50(1): 65‒71.

Magnusson C. Maternal smoking influences cord serum IgE and IgD levels and increases the risk for subsequent infant allergy. J Allergy Clin Immunol 1986; 78(5 Pt 1): 898‒904.

Strachan DP, Cook DG. Health effects of passive smoking .5. Parental smoking and allergic sensitisation in children. Thorax 1998; 53(2): 117‒23.

Strachan DP, Cook DG. Health effects of passive smoking. 6. Parental smoking and childhood asthma: Longitudinal and case-control studies. Thorax 1998; 53(3): 204‒12.

Farooqi IS, Hopkin JM. Early childhood infection and atopic disorder. Thorax 1998; 53(11): 927‒32.

Radić S, Zivković Z, Erdeljan N, Smiljanić S, Laković G. Influence of smoking habit on respiratory function in young asthmatics: follow-up study from 16-30 years of age. Srp Arh Celok Lek 2006; 134 Suppl 2: 100‒3. (Serbian)

Zivković Z, Radić S, Cerović S, Vukasinović Z. Asthma School Program in children and their parents. World J Pediatr 2008; 4(4): 267‒73.

Andersen RM, Leroux BG, Bricker JB, Rajan KB, Peterson AV. Antismoking parenting practices are associated with reduced rates of adolescent smoking. Arch Pediatr Adolesc Med 2004; 158(4): 348‒52.

Jackson C, Dickinson D. Can parents who smoke socialise their children against smoking? Results from the Smoke-free Kids intervention trial. Tob Control 2003; 12(1): 52‒9.

Milton B, Cook PA, Dugdill L, Porcellato L, Springett J, Woods SE. Why do primary school children smoke? A longitudinal analysis of predictors of smoking uptake during pre-adolescence. Public Health 2004; 118(4): 247‒55.

Taylor AL, Bettcher DW. WHO Framework Convention on Tobacco Control: A global “good” for public health. Bull World Health Organ 2000; 78(7): 920‒9.