In utero smoke exposure and impaired response to inhaled corticosteroids in children with asthma
Open accessAbstract
Background Few studies have examined the effects of in utero smoke exposure (IUS) on lung function in children with asthma, and there are no published data on the impact of IUS on treatment outcomes in children with asthma.Objectives To explore whether IUS exposure is associated with increased airway responsiveness among children with asthma and whether IUS modifies the response to treatment with inhaled corticosteroids (ICSs).Methods To assess the impact of parent-reported IUS exposure on airway responsiveness in childhood asthma, we performed a repeated-measures analysis of methacholine PC(20) data from the Childhood Asthma Management Program, a 4-year, multicenter, randomized, double-masked, placebo-controlled trial of 1041 children age 5 to 12 years comparing the long-term efficacy of ICS with mast cell stabilizing agents or placebo.Results Although improvement was seen in both groups, children with asthma and IUS exposure had on average 26% less of an improvement in airway responsiveness over time compared with unexposed children (P = .01). Moreover, while children who were not exposed to IUS who received budesonide experienced substantial improvement in PC(20) compared with untreated children (1.25-fold increase; 95% CI, 1.03-1.50; P = .02), the beneficial effects of budesonide were attenuated among children with a history of IUS exposure (1.04-fold increase, 95% CI, 0.65-1.68; P = .88).Conclusion In utero smoke exposure reduces age-related improvements in airway responsiveness among children with asthma. Moreover, IUS appears to blunt the beneficial effects of ICS use on airways responsiveness. These results emphasize the importance of preventing this exposure through smoking cessation counseling efforts with pregnant women.
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SHS exposure may impair the effectiveness of corticosteroids used for the treatment of small airway disease.
“SHS exposure may also impair the effectiveness of corticosteroids used for the treatment of small airway disease.21”
From Impact of Tobacco Smoke and Nicotine Exposure on Lung Development (2016) · cites this paper as [21]
The Results and Discussion report that children with asthma exposed to tobacco smoke in utero had a blunted response to inhaled budesonide. The claim extends that finding to SHS exposure generally and to treatment of small airway disease, neither of which the study establishes; current environmental tobacco smoke exposure was adjusted for, not identified as the exposure driving the result. Page numbers are unavailable in our copy. (LLM, conf=0.88)
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- Authors
- Cohen, R. T., Raby, B. A., Van Steen, K., Fuhlbrigge, A. L., Celedón, J. C., Rosner, B. A., Strunk, R. C., Zeiger, R. S., & Weiss, S. T.
- Affiliations
- Brigham and Women's Hospital (US)
- St. Louis Children's Hospital (US)
- Kaiser Permanente (US)
- Corresponding author
- Cohen, Robyn T.
- ORCID
- Venue
- Journal of Allergy and Clinical Immunology
- Publisher
- Elsevier BV
- Published
- 2010-09
- Volume
- 126
- Issue
- 3
- Pages
- 491-497
- ISSN
- 0091-6749 (ISSN-L)
- PMC
- PMC2937829
- OpenAlex
- W2102724659
- Cited by
- 76
- References
- 42
- Citations by year
- 2026: 1 · 2024: 3 · 2023: 3 · 2022: 3 · 2020: 6 · 2019: 2 · 2018: 4 · 2017: 1 · 2016: 1 · 2015: 11 · 2014: 11 · 2013: 6 · 2012: 6
- FWCI
- 6.42
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Allergy and Clinical Immunology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- Lirias (KU Leuven) (submittedVersion)
- ORBi (University of Liège) (submittedVersion)
- Funders
- National Institutes of Health (n01hr016044-011)
- U.S. Public Health Service (16049, 16052, 16051, 16048, 16045, 16047, 16050, 16046)
- National Heart, Lung, and Blood Institute (K08HL074193, N01 HR016044, N01-HR16044)
- National Center for Research Resources (M01RR02719-14, M01RR002719, M01RR000051, M01 RR0099718-24, RR.00036, M01RR000036)
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- childhood asthma, inhaled corticosteroids, airway responsiveness, methacholine PC20, budesonide, treatment response, maternal smoking, smoking cessation counseling, lung function
- MeSH terms
- Administration, Inhalation, Adrenal Cortex Hormones, Asthma, Child, Child, Preschool, Female, Functional Residual Capacity, Health, Humans, Longitudinal Studies, Male, Pregnancy, Prenatal Exposure Delayed Effects, Time Factors, Tobacco Smoke Pollution, Treatment Outcome, Budesonide
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