一项哮喘患儿被动吸烟的调查――有关暴露因素的来源、双亲对于儿童暴露的认知以及双亲行为变化
2008/06/06
被动吸烟可导致儿童哮喘。了解有关暴露因素的来源，双亲的认识，以及改变被动吸烟的行为对于想制定干预被动吸烟的措施是非常重要的。Farber HJ等人就此进行的临床试验，筛查了519例被动吸烟的3～12岁哮喘患儿，取其尿样进行肌酐检测，并由家长们完成问卷调查。发现患儿双亲以及日间护理人员都没有吸烟的话，患儿的肌酐清除率（CCR）最低（平均为14），如果有一方吸烟则CCR值会有所增高（平均为22.1&26.3），如果双方都有吸烟，则CCR值最高（平均39.6，p<0.01）。父母对儿童被动吸烟的影响认识也与儿童的CCR有关（r2=0.11, p < 0.001）。大多数父母（58.3%）认为吸烟对孩子的哮喘有很少甚至没有不良影响。
实际上，那些想改变孩子们被动吸烟的现状的父母们做出的选择包括打算做、正准备执行，以及马上采取行动执行。而他们选择的具体干预措施包括：戒烟（61.3%），吸烟时远离孩子（72.7%），以及建造独立的儿童房（49.2%），如果没有空间建儿童房的则选择通风放烟（66.9%）。Farber的研究指出对于哮喘患儿，其父母以及日间护理人员吸烟是很重要的暴露因素。也用实验临床化验数据证实了这种暴露因素的严重性。尽管对被动吸烟的危险仍认识不足，但所多家长已经认识到或接受了这种理论，并打算付诸行动减少儿童被动吸烟。
（于娜 中国医科大学附属第一医院呼吸内科 110001 摘择）
（Chest.2008 Mar 13）
Second Hand Tobacco Smoke in Children with Asthma: Sources of and Parental Perceptions about Children’s Exposure, and Parental Readiness to Change.
Farber HJ， Knowles SB, Brown NL, Caine L, Luna V, Qian Y, Lavori P, Wilson SR.
a. Section of Pediatric Pulmonology, Baylor College of Medicine, Houston, TX; b. Palo Alto Medical Foundation Research Institute, Palo Alto, CA; c. Department of Pediatrics, Kaiser Permanente Vallejo Medical Center, Vallejo, CA; d. Stanford University School of Medicine, Palo Alto, CA.
BACKGROUND Secondhand smoke triggers childhood asthma. Understanding sources, parental beliefs about, and readiness to change that exposure are important for designing smoke exposure reduction interventions. METHODS As part of screening for a clinical trial of a smoke exposure reduction intervention, 519 smoke-exposed children 3-12 years with asthma provided urine specimens for cotinine testing and their primary caregivers completed questionnaires.
RESULTS The urine cotinine to creatinine ratio (CCR) was lowest if neither the primary caregiver nor day care provider smoked (mean CCR (standard deviation)=14.0 (14.4)), greater if either smoked (mean CCR (SD)=22.2 (21.3) and 26.3 (22.2) respectively), and greatest if both smoked (mean CCR (SD)=39.6 (27.5), p<0.01). Parental perception of their child’s exposure was weakly associated with the child’s CCR (r-square=0.11, p < 0.001). Most parents (58.3%) reported tobacco smoke exposure had small/no negative effect on their child’s asthma. Substantial proportions of those for whom a specific exposure reduction action was relevant were classified as contemplating, preparing or had recently taken action to reduce their child’s exposure, including smoking cessation (61.3%), keeping the child out of smoke-exposed places (72.7%), and making the child’s home (49.2%) and non-home areas smoke-free (66.9%).
CONCLUSIONS Smoking by the primary caregiver and day care provider are important sources of exposure for children with asthma. Parental assessment of their child’s exposure is associated with biologically confirmed exposure, but cannot be relied upon to assess that exposure. Although the harm of smoke exposure was frequently underestimated, many parents appeared receptive to considering action to reduce their child’s exposure. Clinical trial registered as NCT00217958 at clinicaltrials.gov.
Chest. 2008 Mar 13 [Epub ahead of print
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体重指数与哮喘严重程度的关系：美国全国哮喘调查
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哥斯达黎加儿童哮喘患者中父辈哮喘、霉菌暴露和气道反应性增加因素的研究
