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August 2012

Smoking During Pregnancy Increases the Risk of Wheeze and Asthma in Preschool Children

Maternal smoking during pregnancy is associated with wheeze and asthma inpreschool children, even among children who were not exposed to maternal smoking late inpregnancy or after birth, according to a new study.

“Epidemiological evidence suggests that exposure to maternal smoking during fetal andearly life increases the risk of childhood wheezing and asthma, but earlier studieswere not able to differentiate the effects of prenatal and postnatal exposure,” said lead author Åsa Neuman. MD, of the Institute of Environmental Medicine at the KarolinskaInstitutet in Stockholm, Sweden. “Our study, a large pooled analysis of eight birth cohorts with data on more than 21,000 children, included 735 children who were exposed to maternal smoking only during pregnancy.”

“These childrenwere at increased risk for wheeze and asthma at preschool age. Furthermore, the likelihood of developing wheeze and asthma increased in a significant dose-response pattern in relation to maternal cigarette consumption during the first trimester.”

The findings were published online ahead of print publication in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

The eight European birth cohorts included in the study included a total of 21,600 children. Exposure information and information on symptoms of wheeze and asthma were derived from parental questionnaires.

In analyses adjusted for sex, parental education, parental asthma, birth weight and siblings, maternal smoking only during pregnancy was associated with increased risks for wheeze (odd ratio 1.39, 95 % CI 1.08-1.77) and asthma (odds ratio 1.65, 1.18-2.31) at age four to six years. Moreover, maternal smoking during the first trimester of pregnancy, but not during the third trimester or the first year following birth, was associated with increased risks for subsequent wheeze and asthma.

“These results indicate that the harmful effects of maternal smoking on the fetal respiratory system begin early in pregnancy, perhaps before the women is even aware that she is pregnant,” said Dr. Neuman.

The study has some limitations, including the use of parental questionnaires to obtain exposure and outcome information.

“Our large pooled analysis confirms that maternal smoking during pregnancy, particularly duringthe first trimester, is associated with a greater risk of offspring developing wheeze and asthma when they reach preschool age,” concluded Dr. Neuman. “Teens and young women should be encouraged to quit smoking before getting pregnant.”

To read the article in full, please visit:http://www.thoracic.org/media/press-releases/resources/Neuman.pdf.

Contact for article:Anna Bergström, Institute of Environmental Medicine, KarolinskaInstitutet,Box 210,SE-171 77 Stockholm, Sweden
Phone: +46-8-524 874 56

Court Dismantles Cross-State Air Pollution Rule

“The American Thoracic Society is dismayed by the D.C. District Court of Appeals decision today to vacate the Environmental Protection Agency’s Cross-State Air Pollution Rule (CSAPR). CSAPR called for reduced sulfur and nitrogen emissions from industrial sources that travel “downwind” to cause air pollution problems in neighboring states.

“If left unchallenged, the court’s decision will leave no recourse to stop this dangerous pollution and force several downwind eastern states to breathe air pollution from smokestacks in neighboring states.

“Until the court’s decision is overturned, the EPA will continue to enforce the 2005 Clean Air Interstate Rule (CAIR), which the same court determined was flawed in 2008.

“CSAPR was issued in 2011 to address the flaws of CAIR. Combined with other state and EPA actions, the CSAPR would have reduced power plant SO2 emissions by 73 percent and NOX emissions by 54 percent from 2005 levels by 2014. CSAPR would have yielded $120 to $280 billion in annual health and environmental benefits in 2014, including the value of avoiding 13,000 to 34,000 premature deaths.

“But the path to these environmental and health and environmental benefits has been blocked by the D.C. District Court of Appeals decision today.

“Despite improvements in air quality, air pollution continues to be a national problem. Both ozone air pollution (smog) and particulate matter pollution (soot) continue to cause significant health problems, substantially adding to the number of asthma attacks, emergency room visits, heart attacks, missed school and work days and premature deaths each year.

“Several East Coast states have taken extraordinary measures to improve air quality but still can’t meet EPA standards because of air pollution blowing in from neighboring states. The court’s decision today will further hinder them from reaching their goals and keeping their communities safe.

“The ATS has long supported the EPA taking a strong leadership role in air pollution transport policy, and we strongly urge the EPA to appeal the court’s decision.”

Monica Kraft, MD
ATS President

More information about CSAPR can be found at http://www.epa.gov/airtransport/.

Contact for article: ATS President Monica Kraft, MD, professor of medicine and founding director of the Asthma, Allergy and Airway Center at Duke University Medical Center.
Phone: (919) 684-8401
Email: monica.kraft@duke.edu

Statement from ATS President Monica Kraft on the US Court of Appeals Smoking Warnings Decision

August 27, 2012—“Last week’s decision by the U.S. Court of Appeals for the D.C. Circuit to strike down the graphic warnings on cigarette packages required by the 2009 Family Smoking Prevention and Tobacco Control Act, passed by Congress with bipartisan support, defies logic and science.

“The FDA estimates that these warning labels, set to appear on all cigarette packages beginning in September, would have reduced the number of smokers by more than 200,000 people by 2013.

“In siding with Big Tobacco, the court majority decided that the ‘First Amendment requires the government not only to state a substantial interest justifying a regulation on commercial speech, but also to show that its regulation directly advances the goal’ of reducing smoking rates. That the court would find unconvincing the scores of scientific studies demonstrating the effectiveness of these graphic warning is very difficult to understand. If the warnings were ineffective, why would the tobacco industry be using every legal means possible to stop them?

“Unfortunately the court’s action—which can and must be appealed by the Justice Department—represents the latest campaign of deception by Big Tobacco to wage war on Americans’ health. As Circuit Judge Roberts noted in his dissent: ‘…it is beyond dispute that the tobacco companies have engaged in a decades-long campaign to deceive consumers....” and they have “spent more than $13 billion to attract new users, retain current users, increase current consumption, and generate favorable long-term attitudes toward smoking and tobacco use, often misleadingly portraying the use of tobacco as socially acceptable and healthful to minors.’

“Smoking is the No. 1 cause of preventable death in this country. The American people have indicated that they want to change that fact. Today’s decision directly contradicts their will and the will of their elected representatives.”

Contact for article: ATS President Monica Kraft, MD, professor of medicine and founding director of the Asthma, Allergy and Airway Center at Duke University Medical Center.
Phone: (919) 684-8401
Email: monica.kraft@duke.edu