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Published online before print April 16, 2008
Eur Respir J 2008, doi:10.1183/09031936.00132607
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ORIGINAL ARTICLE

Smoke exposure, airway symptoms and exhaled nitric oxide in infants: the Generation R Study

C. Gabriele 1, R. Asgarali 2, V.W. Jaddoe 3, A. Hofman 4, H.A. Moll 5, J.C. de Jongste 2*

1 For the Generation R Study group, (http://www.generationr.nl), Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, the Netherlands; and Erasmus Medical Center - Sophia Children's Hospital, Dept of paediatric Respiratory Medicine, Rotterdam, the Netherlands
2 Erasmus Medical Center - Sophia Children's Hospital, Dept of paediatric Respiratory Medicine, Rotterdam, the Netherlands
3 For the Generation R Study group, (http://www.generationr.nl), Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, the Netherlands; Dept of Epidemiology & Biostatistics, Erasmus Medical Center, Rotterdam, the Netherlands; and Dept of paediatrics, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
4 Dept of Epidemiology & Biostatistics, Erasmus Medical Center, Rotterdam, the Netherlands
5 Dept of paediatrics, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands

* To whom correspondence should be addressed. E-mail: j.c.dejongste{at}erasmusmc.nl.


  Abstract

We evaluated the effect of pre- and postnatal smoke exposure on exhaled nitric oxide (FENO) in infants and investigated the association between respiratory symptoms and FENO in the first 2 months of life. The Generation R Study is a population-based prenatally recruited birth cohort. Exposures were assessed by means of questionnaires prospectively administered during pregnancy and after birth. Successful off-line FENO measurements during tidal breathing were obtained in 187 infants (median age 6.9 weeks). The association between possible determinants and logFENO was investigated with multiple linear regression analysis. Infants exposed pre- and postnatally to smoke showed lower FENO than infants exposed only after birth (difference: 1.5 [1.0–2.1] ppb; p=0.042) and than never exposed infants (difference: 1.4 [1.0–1.8] ppb; p=0.052). FENO was reduced in infants with severe upper respiratory symptoms compared to infants with non-severe symptoms (difference: 1.6 [1.0–2.4] ppb; p=0.047). Infants with symptoms of the lower respiratory tract had lower FENO than asymptomatic infants (difference: 1.2 [1.0–1.5] ppb; p=0.046). We conclude that the nature of the association between smoke exposure and FENO is dependent on timing and intensity of exposure. The occurrence and the severity of respiratory symptoms in the first 2 months of life are associated with lower FENO.

Keywords:  Early respiratory morbidity, exhaled nitric oxide, prenatal and postnatal exposures, prospective birth cohort






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