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Comparison of Lung Function in Infants Exposed to Maternal Smoking and in Infants With a Family History of Asthma^*

^* From the Division of Pediatric Pulmonary, Department of Pediatrics (Drs. Sheikh and Eid, and Ms. Howell) and the ²Health Science Biostatistics Center (Dr. Goldsmith), University of Louisville, Louisville, KY; and the Infant Pulmonary Function Laboratory, Kosair Children's Hospital, Alliant Health System (Ms. Parry) Louisville, KY.

Correspondence to: Shahid Sheikh, MD, Allergy & Pediatric Pulmonary Medicine, Department of Pediatrics, Allegheny University Hospitals-Allegheny General, 320 East North Avenue, Pittsburgh, PA 15212-4772

Study objective: To compare lung function in infants exposed to maternal smoking with lung function in infants with a family history of asthma. There are no published studies comparing lung function in both groups.

Design: Cross-sectional study.

Setting: A tertiary pulmonary care center at a children's hospital. Patients: One hundred five infants with daily wheezing. Thirty-five infants had persistent exposure to maternal smoking, and 70 had a family history of asthma in parents or siblings.

Measurements: Infant pulmonary function tests were compared between the two groups. The ratio of terminal to peak expiratory flow at tidal breathing at 25% of the previous expiration remaining and the ratio of terminal to peak expiratory flow with forced expiration at 25% of the previous expiration remaining (FEF₂₅/PFEF) were used to evaluate peripheral airflow. A > 25% improvement in FEF₂₅/PFEF after a bronchodilator challenge test was considered a positive response.

Results: Most infants in both groups had evidence of peripheral airflow obstruction with forced expiration. In infants exposed to maternal smoking, only 4 of 35 (11.4%) responded to a bronchodilator, compared to 51 of 70 (72.9%) in the group with a family history of asthma (p < 0.0005). There was no statistically significant difference in total respiratory system compliance, total respiratory system resistance, tidal volume, and degree of peripheral airflow obstruction at tidal breathing or after forced expiration in both groups.

Conclusion: Infants with exposure to maternal smoking and infants with a family history of asthma have altered lung function, and a positive response to a bronchodilator is one variable that seems to differentiate the two groups.

Key Words: family history of asthma • infants • maternal smoking • pulmonary function test • wheezing

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