祖父母哮喘史与被动吸烟对儿童哮喘的影响效应

目的 探讨祖父母哮喘史与被动吸烟的交互作用对儿童哮喘及哮喘样症状的影响。方法 采用整群随机抽样法在辽宁省7个城市各抽取1所小学和2所幼儿园, 对所选学校所有在此居住时间≥2年且与祖父母居住时间≥3年的儿童的祖父母哮喘史、居住环境、被动吸烟等情况及呼吸系统疾病与症状的信息进行收集。采用Glimmix回归模型分析祖父母哮喘史与被动吸烟的交互作用对儿童哮喘及哮喘样症状(持续咳嗽、持续咳痰、喘鸣现患、过敏性鼻炎)的影响。结果 在调查的3 576名儿童中, 年龄为(8.11±2.87)岁, 祖父母有哮喘史的儿童有224名, 祖父母哮喘史率为6.26%;被动吸烟的儿童有970名, 被动吸烟率为27.13%。祖父母有哮喘史的儿童咳嗽、喘鸣现患和哮喘阳性率分别为16.07%(336/224), 14.29%(32/224)和13.39%(30/224), 祖父母无哮喘史的儿童为10.32%(346/3 352), 5.91%(198/3 352)和5.61%(188/3 352), 祖父母有哮喘史儿童发生咳嗽(OR=1.66, 95%CI:1.15～2.42)、喘鸣现患(OR=2.65, 95%CI:1.78～3.96)和哮喘(OR=2.60, 95%CI:1.72～3.93)的危险性较高。祖父母吸烟的儿童咳嗽和咳痰的阳性率分别为14.02%(136/970)和6.19%(60/970), 祖父母吸烟的儿童发生咳嗽(OR=1.56, 95%CI:1.25～1.96)和咳痰(OR=1.57, 95%CI:1.13～2.18)的危险性较高。Glimmix回归模型分析显示, 祖父母有哮喘史与被动吸烟对儿童哮喘及哮喘样症状存在交互影响:在儿童被动吸烟暴露下, 祖父母有哮喘史的儿童发生咳痰的危险性高于祖父母无哮喘史儿童(P<0.05)。结论 祖父母有哮喘史使被动吸烟的儿童发生哮喘及哮喘样症状的危险性升高。

Interaction effects of grandparent asthma status and passive smoking on asthma and asthma related symptoms among children.

Objective To evaluate the interaction effects of grandparent asthma status and passive smoking on children asthma and asthma related symptoms. Methods Using a cluster random sampling method, 2 elementary schools and 1 kindergarten were randomly selected from seven cities of Liaoning province.All children lived with grandparent for more than 3 years from the selected schools were recruited in this survey.The information about the children's respiratory diseases, grandparent asthma status, living environment and enviromental tobacco smoke (ETS) exposure were collected by an international standard questionnaire from American Thoracic Society.The generalized linear mixed models (GLMMs) were applied to explore the interaction effects of grandparent asthma status and passive smoking on asthma and asthma related symptoms (persistent cough, persistent phlegm, current wheeze and allergic rhinitis). Results A total of 3 576 children involved in this survey.There were 224 children with grandparent asthma status and 970 children with ETS.The percentage of children with grandparent asthma status was 6.26% and 13.39% with ETS exposure.The prevalence of cough, current wheeze and asthma were 16.07%(336/224), 14.29%(32/224) and 13.39%(30/224) in children with grandparent asthma status, while that in children without grandparents asthma status were 10.32%(346/3 352), 5.91%(198/3 352) and 5.61%(188/3 352) respectively.Compared to the children without grandparent asthma status, the children with grandparent asthma status had higher risk of cough(OR=1.66, 95%CI:1.15～2.42), current wheeze(OR=2.65, 95%CI:1.78～3.96) and asthma(OR=2.60, 95%CI:1.72～3.93).The prevalence of cough and expectoration in children with ETS were 14.02%(136/970) and 6.19%(60/970) respectively.The children with ETS increased the risk of cough(OR=1.56, 95%CI:1.25～1.96) and expectoration(OR=1.57, 95%CI:1.13～2.18) compared with the children without ETS.GLMMs analysis showed there were significant interaction effects between grandparent asthma status and passive smoking. Conclusion Grandparent asthma status may increase the detrimental effects of passive smoking on asthma and asthma related symptoms in children.