In 79 children exposed to ETS, concentrations of IgE and interleukin-4 IL-4 and eosinophilcountswerehigherincaseswherethechildrenexperiencedmorefrequentrespi-
ratoryillnessaverage3.4illnessesyear.Incontrast,thechildrenofnon-smokingparents onlyexperienced1.2episodesofrespiratoryillnessyearandtheirIgE,IL-4andeosinophil
valueswereunchangedTable 9.3
. Manystudieshaveshownthatcigarettesmokingisassociatedwithelevatedconcentra-
tionsoftotalserumIgE.Fewstudies,however,haveexaminedtotalIgEinrelationtopassive smokingexposure,especiallyinadults.Inacross-sectionalstudy,Miyakeetal.investigated
theassociationofactiveandpassivesmokingexposurewithlevelsoftotalserumIgEin Japan
[67] .Theyexamined981pregnantwomeninOsakaandfoundoutthatcurrentsmok-
ingofatleast15cigarettesadayand8.0ormorepack-yearsofsmokingwereindependently relatedtoanincreasedprevalenceofelevatedtotalserumIgEaORs3.40and2.51,95CIs
2.12–5.47and1.55–4.06,respectively,andbothcigarettesmokingstatusandpack-yearsof smokingweresigniicantlypositivelyassociatedwithtotalserumIgElevels,especiallyin
subjectswithapositivefamilialallergichistory.Therewasnomeasurableassociationof exposuretoETSathomeoratworkwithtotalserumIgEconcentrationsamongthosewho
hadneversmoked.Itwasconcludedthatthereisapositiverelationshipbetweenactivesmok- ingandtotalserumIgElevels;however,thisstudyfailedtosubstantiateapositiveassociation
ofETSexposurewithtotalIgE.Investigationswithmorepreciseanddetailedexposuremea- surementsarewarranted
[67] .
AnotherstudyassessedthecorrelationofETSexposurewiththeexpressionofpro- inlammatorymediatorsinairwaysecretions,includingIFN-gandIL-12,aswellasIL-5
andIL-13,inallergicasthmaticschoolchildrenandhealthycontrolsubjects [68]
.Byusing thenasopharyngealaspirationtechnique,airwaysecretionswerecollectedfrom24atopic
childrenwithasthmaage,6–16yearsand26healthycontrolsubjects,andtheconcentra- tionofcytokineswasmeasuredwithimmunoenzymaticmethods.ItwasshownthatIL-13
levelswerehighlyincreasedinpatientswithasthmap0.005,andparentaltobacco smoke resulted in a signiicant increase in airway IL-13 secretion in these children
Group n
Infections year
TLC cmm
3
EC cmm
3
IL-4 pgml
IgE IUml
Childrenwith frequent
infections 41
4.5±1.1
a
7,889±989
a
651±121
a
1.8±0.5 605±365
Childrenwith infrequent
infections 29
2.0±0.6 6,771±1131 364±85
1.31±0.45 557±354 Allchildrenof
smokingparents 70
3.4±0.8
b
7,426±899
b
482±96
b
1.6±0.46
b
587±359
b
Childrenof non-smoking
parents 50
1.2±0.6 6,040±530
239±51 0.8±0.5
189±21
Table 9.3
Recurrentrespiratorytractinfections:acomparisonofselectedinlammatoryvariables inchildrenaged9–11yearsofsmokingandnon-smokingparents
[66]
TLCtotalleucocytecount;ECeosinophilcount;IL-4interleukin-4;IgEimmunoglobulinE
a
p0.05,betweenchildrenofsmokingparents
b
p0.05:groupvs.control
comparedwiththatseeninnon-exposedchildrenandhealthycontrolsubjectsmedian, 860 vs. 242 and 125 pgml, respectively. Furthermore, a positive correlation between
IL-13levelsandserumIgEconcentrationsrs=0.55wasfoundinchildrenwithallergic asthma.ThestudyindicatedthatETSaugmentstheexpressionandsecretionofIL-13in
allergicasthmaandthatnasopharyngealaspirationisasuitablemethodtoassesscytokine measurements in the airways of children. Measurements of IL-13 in secretions might
betakenintoaccountasanon-invasivemarkerofairwayinlammationandtoassessthe detrimentaleffectsofETS
[68] .
9.2.5 ETS and Drug Metabolism
Theinluenceofpassivesmokinginchildrenandadultsonthemetabolismofmedicinal drugsandtoxicsubstancescannotyetbegauged.Wheretheparentshadaminimum1-pack
dayhabit,ETS-exposedchildrendisplayedintensiiedmetabolismofmedicinessuchas theophylline.ComparedwithchildrenwithoutETSexposure,totalbodyclearanceoftheo-
phyllinewassigniicantlyelevated1.36±0.09vs.0.90±0.04mlminkg;p0.0001and serumconcentrationsweresigniicantlylower55.3±2.8vs.73.2±3.3µgml;p0.00001.
Hospitalstaytimeswerealsolongerinthegroupexposedtopassivesmoking4.4±2.6vs. 2.9±1.3days;p0.05
[69] .Theseindingssuggestthatthemetabolismofothermedici-
naldrugsmayalsobeacceleratedinchildrenexposedtoETS.
9.3 Passive Smoking During and After Pregnancy
ETS-exposedchildrenborntomotherswhosmokeduringpregnancyare2–4-timesmore likelythanchildrenwithoutETSexposuretobebornsmallforgestationalagesee
Chap.8
[70] .A50–100increaseinacuterespiratorydisordershasbeenreportedinchildrenasa
resultofpassivesmoking [71]
.ChildrenborntomothersexposedtoETSduringpregnancy haveincreasednumberofnucleatedredbloodcells
[72] ,indicatingreducedO
2
supplies duringpregnancy
[73] .Thesameindinghasbeenmadeinchildrenborntowomenwho
wereactivesmokersduringpregnancy [69]
.Infantshavea2.5-foldincreasedriskofdying fromsuddeninfantdeathsyndromeSIDSwheretheirmotherscontinuetosmokeafter
givingbirth [1,74]
.Thepresenceofnicotineandcotinineinchildren’shairafterbirthisan importantmarkeroffoetalexposuretotobaccosmokeTable
9.4
[56] .Thedetectedpres-
enceofcotinine10-50to 50ngnlpericardiacluidinfourinfantsisindicativeofabsorp- tionduetopassivesmoking
[20] .However,itishighlyimprobablethatraisednicotineand
cotininelevelsinthepericardiacregionarecontributoryfactorsinSIDS [20]
. Whiletherearesuficientdataregardingthenegativeeffectofexposuretotheconstitu-
entsoftobaccosmokeonnewborninfants’birthweights,itisstillunclearwhetherthiseffect mayoriginateinearlypregnancy.Therefore,Hankeetal.evaluatedtheimpactofexposure
totobaccosmokecomponentsinearlypregnancy20–24weeksonfoetalbiometry [75]
.
Thestudypopulationcomprised183womenconsecutivelyenrolledat20–24weeksof pregnancyatthetwoantenatalcareunitsandultrasoundbiometricmeasurementsoffoetal
bi-parietaldiameterBPD,abdominalcircumferenceACandfemurlengthFLwere performed.Also,serumcotinineconcentrationwasdeterminedat20–24weeksofgesta-
tion by gas chromatography with mass spectrometry detector GCMS to assess ETS exposureduringthepreviouseveningandthemorningofthesamedaybloodcollection
at1,200–1,300h.ETSexposurepassivesmokingwasassumedtooccurwhenthelevel ofserumcotininerangedfrom2to10ngml.Theauthorsdemonstratedthatastatistically
signiicantnegativeassociationwaspresentbetweentheBPDandserumcotinineconcen- tration.Asimilarassociationwasidentiiedforsubjectswithserumcotinineconcentra-
tionsbelow10ngmlcorrespondingtopassivesmokingp=0.06.Aftercontrollingfor pregnancyduration,maternalpre-pregnancyweightandinfant’sgender,wefoundthat
serumcotininelevelsat20–24weeksofgestationwasinverselyassociatedwithinfant birthweightp=0.004.Forthesubjectswithserumcotininelevelsbelow10ngml,a
borderlineassociationp=0.09withinfantbirthweightwasfound.Itwasconcludedthat maternalexposuretotobaccosmokeinearlypregnancy,asmeasuredbyserumcotinine
concentrationsat20–24weeksofgestation,adverselyaffectsfoetalBPD [75]
. InchildrenwithlowbirthweightfollowingETSexposure,thevasodilatorresponse
followingforearmcuffocclusionandreleasewasstillreducedatage9–11yearscompared withthatinnormalbirthweightchildrenborntonon-smokingmothers.Thephysiological
vasodilatorresponseistriggeredbyNOreleasefromendothelialcells [76]
.Amongother things,thisharmfuleffecthasitsoriginsintheprenatalperiodandisrelatedtothesmok-
ingbehaviourofthemother-to-beduringpregnancy;itmanifestsitselfasearlyastheirst decadeoflifeasapreludetolateratherogenicchanges.Evidently,inthedevelopmental
phasescharacterisedbyrapidgrowthsuchasthefoetalperiod,theendothelialcellsalso undergoadversechangeswhichlimitphysiologicalfunction
[77] .
Urinarycotininelevelsweredeterminedin199ETS-exposedchildrenbetweentheages of4monthsand4yearswithobstructivebronchitis.Comparedwithhealthychildrenofthe
sameage,urinarycotininelevelswerefoundtobe5.7µgl,insteadof4.4µgl.Theriskof developingbronchitiswasincreasedinlinewiththeextentofpassivesmokingandtherise
inurinarycotinine.Thisriskwasincreasedthreefoldataurinarycotinineconcentrationof 20 µgl
[78] . Similar results have been reported in 69 children
[79] . The incidence of
Nicotinengml Cotininengml
Activesmokingwomenn=36 19.2
4.9 6.3
4.0 Newbornsofactivesmokingwomen
2.4 0.9
2.8 0.8
Passivesmokingwomen
a
n=23 3.2
0,8 0.9
0.3
b
Newbornsofpassivesmokingwomen 0.28
0.05 0.6
0.15 Non-smokingwomenn=35
1.2 0.4
0.3 0.06
Newbornsofnon-smokingwomen 0.4
0.09 0.26
0.04
Table 9.4
Hairconcentrationsmean±SEMofnicotineandcotinineinwomenandtheirnewborn infants
[56]
a
Deinedasregularandsteadygestationalexposuretootherperson’scigarettesmoke,eitherat homeorintheworkplace
b
p0.01whencomparedtonewbornsofactivesmokingwomenandnewbornsofnon-smokers