Epidemiology

• 4.5 million U.S. adolescents are cigarette smokers.

• Approximately 90 percent of smokers begin smoking before the age of 21.

Pathophysiology

• Maternal smoking during pregnancy is believed to affect the utero-placental flow, leading to an impaired nutrition and intrauterine growth retardation.

• Affects lung development, especially when there is a family history of asthma and hypertension.

• Adolescents with asthma have been shown to be more swayed by groups of smokers compared to other adolescents beginning to smoke.

• Some associations of asthma symptoms with smoking have been grouped with the same signs and symptoms of COPD.

Results

• Maternal smoking prenatally is important in the development of wheezing in the first two years of life, regardless of the exposure to smoking after birth. (Odds ratio 2.2)

• Current smokers had a higher prevalence of likely asthma compared to never smokers. (Odds ratio 1.59 (95% confidence interval (CI) 1.24 to 2.04).

• No difference in prevalence of asthma between ex smokers and never smokers (Odds Ratio 1.0 (0.75–1.35))

• The pooled odds ratios for either parent smoking were 1.21 (95% CI 1.10 to 1.34) for asthma, 1.24 (95% CI 1.17 to 1.31) for wheeze, 1.40 (95% CI 1.27 to 1.53) for cough, 1.35 (95% CI 1.13 to 1.62) for phlegm, and 1.31 (95% CI 1.08 to 1.59) for breathlessness.

• Mother’s smoking more significant than parental.

• Families smoking and friends smoking contribute synergistically.

Intervention at my Clinic

• Prenatal visits: all prospective mothers were strongly urged to quit smoking with lengthy discussions and possible interventions discussed. Risk factors including the affects on the child’s well being were noted.

• Postpartum/mothers: these individuals were identified through questioning and then subsequent questioning over the heath of their children. These patients were much more prevalent than expecting mothers.

• Discussed setting a date

• Medication: Wellbutrin, Chantix (partial agonist)

References

Strachan DP, Cook DG. “Parental smoking and lower respiratory illness in infancy and early childhood.” Thorax 1997, 52:905-914.

Lannero, E, et al. “Maternal smoking during pregnancy increases the risk of recurrent wheezing during the first years of life.” Respiratory Research. 2006, 7:3

Frank, P, et al. “Smoking, respiratory symptoms and likely asthma in young people: evidence from postal questionnaire surveys.” BMC Pulmonary Medicine 2006, 6:10.

Tercyak, K. “Social Risk Factors Predict Cigarette Smoking Progression Among Adolescents with Asthma.” Journal of Pediatric Psychology 31(3) pp. 246–251, 2006.

Category: Medicine Notes