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

Publication ,  Journal Article
Lang, JE; Dozor, AJ; Holbrook, JT; Mougey, E; Krishnan, S; Sweeten, S; Wise, RA; Teague, WG; Wei, CY; Shade, D; Lima, JJ ...
Published in: J Allergy Clin Immunol Pract
March 2013

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.

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Published In

J Allergy Clin Immunol Pract

DOI

ISSN

2213-2198

Publication Date

March 2013

Volume

1

Issue

2

Start / End Page

172 / 180

Location

United States

Related Subject Headings

  • Tobacco Smoke Pollution
  • Poisson Distribution
  • Male
  • Logistic Models
  • Leukotrienes
  • Humans
  • Gastroesophageal Reflux
  • Female
  • Child
  • Asthma
 

Citation

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ICMJE
MLA
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Lang, J. E., Dozor, A. J., Holbrook, J. T., Mougey, E., Krishnan, S., Sweeten, S., … American Lung Association-Asthma Clinical Research Centers. (2013). Biologic mechanisms of environmental tobacco smoke in children with poorly controlled asthma: results from a multicenter clinical trial. J Allergy Clin Immunol Pract, 1(2), 172–180. https://doi.org/10.1016/j.jaip.2012.11.006
Lang, Jason E., Allen J. Dozor, Janet T. Holbrook, Edward Mougey, Sankaran Krishnan, Shawn Sweeten, Robert A. Wise, et al. “Biologic mechanisms of environmental tobacco smoke in children with poorly controlled asthma: results from a multicenter clinical trial.J Allergy Clin Immunol Pract 1, no. 2 (March 2013): 172–80. https://doi.org/10.1016/j.jaip.2012.11.006.
Lang JE, Dozor AJ, Holbrook JT, Mougey E, Krishnan S, Sweeten S, et al. Biologic mechanisms of environmental tobacco smoke in children with poorly controlled asthma: results from a multicenter clinical trial. J Allergy Clin Immunol Pract. 2013 Mar;1(2):172–80.
Lang, Jason E., et al. “Biologic mechanisms of environmental tobacco smoke in children with poorly controlled asthma: results from a multicenter clinical trial.J Allergy Clin Immunol Pract, vol. 1, no. 2, Mar. 2013, pp. 172–80. Pubmed, doi:10.1016/j.jaip.2012.11.006.
Lang JE, Dozor AJ, Holbrook JT, Mougey E, Krishnan S, Sweeten S, Wise RA, Teague WG, Wei CY, Shade D, Lima JJ, American Lung Association-Asthma Clinical Research Centers. Biologic mechanisms of environmental tobacco smoke in children with poorly controlled asthma: results from a multicenter clinical trial. J Allergy Clin Immunol Pract. 2013 Mar;1(2):172–180.
Journal cover image

Published In

J Allergy Clin Immunol Pract

DOI

ISSN

2213-2198

Publication Date

March 2013

Volume

1

Issue

2

Start / End Page

172 / 180

Location

United States

Related Subject Headings

  • Tobacco Smoke Pollution
  • Poisson Distribution
  • Male
  • Logistic Models
  • Leukotrienes
  • Humans
  • Gastroesophageal Reflux
  • Female
  • Child
  • Asthma