Scientific Letter
Impact of Passive Smoking on Lung Function and Asthma Severity in Children
Impacto del tabaquismo pasivo en la función pulmonar y gravedad del asma en la población pediátrica
María López Blázquez
, Jimena Pérez Moreno, Sara Vigil Vázquez, Rosa Rodríguez Fernández
Corresponding author
Servicio de Pediatría y sus Áreas Específicas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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According to the World Health Organization, 40% of children are exposed to passive smoking in the home.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The prevalence of childhood asthma in Spain is estimated at 10%.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> Bronchial hyper-reactivity in these children makes them more vulnerable to environmental pollutants, such as tobacco smoke, which increases airway inflammation, bronchial secretion, and airflow limitation.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A multicenter study conducted by the Working Group on Smoking in Childhood and Adolescence of the Spanish Society of Pediatric Pulmonology found a prevalence of passive smoking of 37%, which was associated with exacerbations among children with asthma.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Few publications in our setting have objectively studied changes in lung function parameters and the severity of acute asthma exacerbations among asthmatic children exposed to passive smoking.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">4–7</span></a> Lung function impairment is known to be more common among infants born to mothers who smoke,<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">8,9</span></a> and children exposed to tobacco during their development have altered lung capacities and a greater risk of developing asthma.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">10,11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In this study, we analyzed the prevalence of passive smoking in asthmatic children and its effect on the severity of acute episodes and lung function. This was a retrospective analysis of patients aged 4–16 years who required hospitalization for acute asthma in the Hospital General Universitario Gregorio Marañón, Madrid, Spain, from 2011 to 2015. Asthma diagnosis, severity of exacerbations, and changes in lung function, such as FEV1/FVC ratio <80% according to the GEMA 2017 guidelines, were evaluated.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> Most variables included in the statistical analysis did not show a normal distribution. The statistical tests used were the Mann–Whitney <span class="elsevierStyleItalic">U</span> test and Kruskal–Wallis for continuous variables, and Fisher's test or Chi-squared test for categorical variables. The study was approved by the Clinical Research Ethics Committee.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The analysis included 365 patients. Median age was 5 years (IQR 4–7) and median length of stay was 4 days (IQR 3–5); 63% of the children were boys, and 45% had a previous diagnosis of asthma. Median body mass index (BMI) was 16<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>. Concomitant atopy was diagnosed in 65%.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Forty-one percent (<span class="elsevierStyleItalic">n</span>=151) were passive smokers (6%, mother smoked; 14%, father; 19%, both; 2%, other family members).</p><p id="par0040" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the analysis of some severity markers observed in asthmatic children, according to exposure to passive smoking. Patients exposed to passive smoking had lower oxygen saturation levels on admission, higher scores on the asthma exacerbation severity scale, worse lung function parameters, and more visits to emergency departments in the previous months (<span class="elsevierStyleItalic">P</span><.05).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Asthma exacerbations were more severe when the father was the smoker (PS 6; IQR 4.2–6.7), compared to the mother or both parents (PS 5, IQR 4–6); <span class="elsevierStyleItalic">P</span>=.05. Moreover, passive smokers had significantly more previous episodes of bronchiolitis (68% vs 56%, <span class="elsevierStyleItalic">P</span>=.02; OR 1.5) and bronchospasm (80% vs 65%, <span class="elsevierStyleItalic">P</span>=.02).</p><p id="par0050" class="elsevierStylePara elsevierViewall">Spirometry was performed in 55% of the children within 2 months following the acute episode to provide information on their baseline asthma severity,<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> and lung function impairment was detected in 25% (<span class="elsevierStyleItalic">n</span>=51).</p><p id="par0055" class="elsevierStylePara elsevierViewall">In the group of asthmatic children exposed to smoking, the FEV1/FVC ratio was lower if the smoker was the mother (median 86%, IRQ 83%–90%) than if the father was the smoker (89%, 85%-105%), both parents were smokers (87%, 77%–92%) or neither smoked (89%, 80%–95%), although these differences were not significant (<span class="elsevierStyleItalic">P</span>=.07). The proportion of cases with impaired lung function (FEV1/FVC<80%) was greater if both parents smoked (33.3%), than if only the father (7.7%) or the mother (13.3%) smoked (<span class="elsevierStyleItalic">P</span>=.03), irrespective of severity.</p><p id="par0060" class="elsevierStylePara elsevierViewall">A multivariate analysis was performed to evaluate the association between independent variables such as age, sex, and passive smoking, with impaired lung function as the dependent variable. The logistic regression model showed that the absence of passive smoking was an independent protective factor against impaired lung function (<span class="elsevierStyleItalic">P</span>=.029; OR 0.44; 0.204–0.919). A second multiple linear regression model was used to evaluate the association between age, sex, atopy, and passive smoking, with the severity score as the dependent variable. This showed that passive smoking (β 0.2, 0.032–0.98; <span class="elsevierStyleItalic">P</span>=.037) and atopy (β 0.3, 0.2–0.98; <span class="elsevierStyleItalic">P</span>=.002) were associated with higher severity scores.</p><p id="par0065" class="elsevierStylePara elsevierViewall">With respect to tobacco exposure in the home, while the literature has placed greater emphasis on the role of the mother,<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3,8</span></a> we found that asthma exacerbations were more severe when the father was the smoker (<span class="elsevierStyleItalic">P</span>=.05). This may be related with differential factors between parents, such as amount and type of tobacco smoked. Previous studies have shown an association between greater lung function impairment and a greater number of cigarettes smoked by fathers.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">6,11</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Although some earlier observations found higher susceptibility to passive smoking in girls,<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> no differences were found in our series.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Other potential risk factors, such as age, sex, atopy, pets, and nutritional status, also occurred in our series.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> It is important to highlight that the multivariate analysis revealed only passive smoking as an independent risk factor for impaired lung function in asthma, and both passive smoking and atopy for exacerbation severity.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The study is limited by its retrospective nature, which prevented us from collecting data on the frequency and burden of smoking by parents in the home. Nor were cotinine levels determined in urine, as this test was not routinely available in our laboratory.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Not only is second-hand smoking a preventable risk factor,<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> it is also one of the main causes of worsening of asthma<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> and the main environmental determinant of lung function decline.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> In our series, 41% of the children were passive smokers, a proportion in line with previous studies, yet very high, considering these children were asthma patients.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Knowing that the quality of life of these children may be significantly compromised,<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> we believe it is essential to insist on measures to prevent passive smoking in the family environment.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as: Blázquez ML, Moreno JP, Vázquez SV, Fernández RR. Impacto del tabaquismo pasivo en la función pulmonar y gravedad del asma en la población pediátrica. Arch Bronconeumol. 2018;54:436–437.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Children Exposed to Passive Smoking (<span class="elsevierStyleItalic">n</span>=151) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Children not Exposed to Passive Smoking (<span class="elsevierStyleItalic">n</span>=214) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Significance (<span class="elsevierStyleItalic">P</span>)<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">O<span class="elsevierStyleInf">2</span> saturation on arrival in the emergency room \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">91% (IQR 89%–93%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">92% (IQR 90%–94%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pulmonary Score<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.5 (IQR 4–6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (IQR 4–6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Emergency room visit in 3 months before admission<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42% (63/151) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30% (64/214) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV1/FVC<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">86% (IQR 83%–90%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">89% (IQR 80%–95%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.17 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1820225.png" ] ] ] "notaPie" => array:4 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Pulmonary Score (PS): scale to evaluate severity of the asthma exacerbation, used in our study.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> A score of 0–3 is assigned to each of the sections analyzed (breathing, wheezing, and use of accessory muscles), providing a score of 0–9. Mild exacerbation: 0–3; moderate: 4–6; severe: 7–9.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Data expressed as a percentage of patients who attended at least 1 emergency room visit in the same hospital for any asthma-associated event in the 3 months prior to the exacerbation for which they were admitted. The remaining data in the table are expressed as median and interquartile range.</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">FEV1: forced expiratory volume in 1 second; FVC: forced vital capacity. Obstruction in children is defined as a FEV1/FVC ratio <80%.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a></p>" ] 3 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "d" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Statistical significance. A <span class="elsevierStyleItalic">P</span>-value of <.05 was considered statistically significant.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Bivariate Analysis of Severity Parameters of the Acute Asthma Episode in Study Patients (<span class="elsevierStyleItalic">n</span>=365) Associated With Passive Smoking.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of passive smoking on the growth of pulmonary function and respiratory symptoms in schoolchildren" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. Fernández-Plata" 1 => "R. Rojas-Martínez" 2 => "D. Martínez-Briseño" 3 => "C. García-Sancho" 4 => "R. Pérez-Padilla" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Inves Clin" "fecha" => "2016" "volumen" => "68" "paginaInicial" => "119" "paginaFinal" => "127" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0085" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Stabilization of asthma prevalence among adolescents and increase among schoolchildren (ISAAC phases I and III) in Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. García-Marcos" 1 => "A.B. Quirós" 2 => "G.G. Hernández" 3 => "F. Guillén-Grima" 4 => "C.G. Díaz" 5 => "I.C. Urena" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1398-9995.2004.00562.x" "Revista" => array:6 [ "tituloSerie" => "Allergy" "fecha" => "2004" "volumen" => "59" "paginaInicial" => "1301" "paginaFinal" => "1307" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15507099" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0090" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tabaquismo parental y función pulmonar en niños y adolescentes sanos" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.J. González-Barcala" 1 => "B. Takkouche" 2 => "L. Valdés" 3 => "E. Temes" 4 => "R. Leis" 5 => "R. Cabanas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2007" "volumen" => "43" "paginaInicial" => "81" "paginaFinal" => "85" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17288896" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0095" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Grupo de Trabajo sobre Tabaquismo en la Infancia y Adolescencia de la Sociedad Española de Neumología Pediátrica. Exposición al humo de tabaco del niño asmático y su asociación con la gravedad del asma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.G. Suárez" 1 => "C. Galván" 2 => "C. Oliva" 3 => "A. Aquirre-Jaime" 4 => "C. Vázquez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr" "fecha" => "2013" "volumen" => "78" "paginaInicial" => "35" "paginaFinal" => "42" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0100" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Advances in asthma 2016: designing individualized approaches to management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "W.C. Anderson" 1 => "A. Apter" 2 => "C.M. Dutmer" 3 => "D.A. Searing" 4 => "S.J. Szefler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaci.2017.06.015" "Revista" => array:6 [ "tituloSerie" => "J Allergy Clin Immunol" "fecha" => "2017" "volumen" => "140" "paginaInicial" => "671" "paginaFinal" => "680" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28709967" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0105" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effects of low-level environmental tobacco smoke exposure on pulmonary function test in preschool children with asthma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Valsamis" 1 => "S. Krishnan" 2 => "A.J. Dozor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/02770903.2014.894054" "Revista" => array:6 [ "tituloSerie" => "J Asthma" "fecha" => "2014" "volumen" => "51" "paginaInicial" => "685" "paginaFinal" => "690" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24575853" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0110" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of passive smoking on respiratory health in children and adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. Janson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Tuberc Lung Dis" "fecha" => "2004" "volumen" => "8" "paginaInicial" => "510" "paginaFinal" => "516" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15137524" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0115" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary effects of maternal smoking on the fetus and child: effects on lung development. Respiratory morbidities, and life long lung health" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.T. McEvoy" 1 => "E.R. Spindel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.prrv.2016.08.005" "Revista" => array:6 [ "tituloSerie" => "Paediatr Respir Rev" "fecha" => "2017" "volumen" => "21" "paginaInicial" => "27" "paginaFinal" => "33" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27639458" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0120" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Combined effects of in utero and adolescent tobacco smoke exposure on lung function in C57Bl/6J mice" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Drummond" 1 => "M. Baravalle-Einaudi" 2 => "G. Lezmi" 3 => "S. Vibhushan" 4 => "M.L. Franco-Montoya" 5 => "A. Hadchouel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1289/EHP54" "Revista" => array:6 [ "tituloSerie" => "Environ Health Perspect" "fecha" => "2017" "volumen" => "125" "paginaInicial" => "392" "paginaFinal" => "399" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27814244" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0125" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The association between environmental tobacco smoke exposure and childhood respiratory disease: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Vanker" 1 => "R.P. Gie" 2 => "H.J. Zar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/17476348.2017.1338949" "Revista" => array:6 [ "tituloSerie" => "Expert Rev Respir Med" "fecha" => "2017" "volumen" => "11" "paginaInicial" => "661" "paginaFinal" => "673" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28580865" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0130" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exposure-response relationship between paternal smoking and children's pulmonary function" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.A. Venners" 1 => "X. Wang" 2 => "C. Chen" 3 => "B. Wang" 4 => "J. Ni" 5 => "Y. Jin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.164.6.2009063" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2001" "volumen" => "164" "paginaInicial" => "973" "paginaFinal" => "976" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11587981" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0135" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "GEMA 2017. Guía Española para el Manejo del Asma (GEMA 4.2). Available from: <a id="intr0010" class="elsevierStyleInterRef" href="http://www.gemasma.com/">www.gemasma.com</a> (accessed 10.08.17)." ] ] ] 12 => array:3 [ "identificador" => "bib0140" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early smoke exposure is associated with asthma and lung function deficits in adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "X. Dai" 1 => "S.C. Dharmage" 2 => "A.J. Lowe" 3 => "K.J. Allen" 4 => "P.S. Thomas" 5 => "J. Perret" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/02770903.2016.1253730" "Revista" => array:6 [ "tituloSerie" => "J Asthma" "fecha" => "2017" "volumen" => "54" "paginaInicial" => "662" "paginaFinal" => "669" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27791435" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0145" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Urinary cotinine concentrations in preschool children showed positive associations with smoking fathers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Y. Wang" 1 => "M. Yang" 2 => "Z. Huang" 3 => "L. Tian" 4 => "L. Niu" 5 => "S. Xiao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/apa.13637" "Revista" => array:6 [ "tituloSerie" => "Acta Paediatr" "fecha" => "2017" "volumen" => "106" "paginaInicial" => "67" "paginaFinal" => "73" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27748973" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0150" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Parental smoking and childhood asthma: clinical implications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K.H. Carlsen" 1 => "K.C. Lødrup Carlsen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Treat Respir Med" "fecha" => "2005" "volumen" => "4" "paginaInicial" => "337" "paginaFinal" => "346" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16137191" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005400000008/v1_201808020514/S1579212918301800/v1_201808020514/en/main.assets" "Apartado" => array:4 [ "identificador" => "49861" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005400000008/v1_201808020514/S1579212918301800/v1_201808020514/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212918301800?idApp=UINPBA00003Z" ]
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