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Copyright ©ERS Journals Ltd 2002
Lung function of school children with low levels of 
1-antitrypsin and tobacco smoke exposure
1 University Children's Hospital Munich, Munich, 2 Children's Hospital, Technical University Dresden, 3 Clinical Laboratory Becker, Olgemöller & Partner, Munich, 4 Dept of Epidemiology, University of Ulm, Ulm and 5 Dept of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
CORRESPONDENCE: E. von Mutius, Lindwurmstr.4, D-80337, München, Germany. Fax: 49 8951604452. E-mail: Erika.Von.Mutius@kk-I.med.uni-muenchen.de
Keywords: 
1-Antitrypsin, children, environmental tobacco smoke, epidemiology, pulmonary function
Received: December 13, 2000
Accepted January 17, 2002
This Work was supported by the Bundesministerium für Bildung, Forschung und Technologie (German Ministry for the Sciences and Technology) and the Center for Environment and Health (Project Environment and Health, Baden-Württemberg).
Exposure to environmental tobacco smoke (ETS) and other air pollutants has been associated with small decrements in lung function. The susceptibility to pollution exposure may, however, vary substantially between individuals. Children with an impaired protease-antiprotease balance may be particularly vulnerable. Therefore this study aimed to investigate the effects of ETS exposure on children with reduced levels of
Random samples of school children (aged 9–11 yrs) (n=3,526) were studied according to the International Study of Asthma and Allergies in Childhood (ISAAC) phase II protocol, including parental questionnaires, pulmonary function and allergy testing. Blood samples were obtained to measure plasma levels of
Children with low levels of
These findings suggest that school children with low levels of
1-antitrypsin (1-AT). 1-AT and to genotype for pleomorphic protein inhibitor (Pi)Z and PiS alleles. 1-AT (
116 mg·dL–1) showed significant, albeit small decrements in baseline lung function. When exposed to ETS, pronounced decrements of pulmonary function, particularly in measures of mid- to end-expiratory flow rates, were seen in these children as compared to exposed children with normal levels of 1-AT. The mean levels of % predicted±se in both groups were: maximum expiratory flow at 50% of vital capacity 79.4±7.2 versus 99.0±1.5, maximum expiratory flow at 25% of vital capacity 67.4±10.0 versus 100.3±2.1, maximal midexpiratory flow 73.7±8.6 versus 99.9±1.7. 1-antitrypsin are at risk of developing pronounced decrements in pulmonary function, particularly if they are exposed to environmental tobacco smoke. Parents of children with heterozygous 1-antitrypsin deficiency resulting in significantly reduced blood concentrations should be advised to prevent their children from being exposed to environmental tobacco smoke and dissuade them from taking up smoking.
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