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J Allergy Clin Immunol. 2010 Sep;126(3):491-7. doi: 10.1016/j.jaci.2010.06.016. Epub 2010 Jul 31.

In utero smoke exposure and impaired response to inhaled corticosteroids in children with asthma.

Collaborators (259)

Shapiro GG, DuHamel TR, Lasley MV, Chinn T, Hinatsu M, Furukawa CT, Altman LC, Virant FS, Williams PV, Kennedy MS, Becker JW, White G, Bierman CW, Crawford D, Eliassen H, Hammond B, Minotti DA, Reagan C, Sharpe M, Wighton TG, Weiss S, Fuhlbrigge A, Plunkett A, Madden N, Barrant P, Darcy C, Thompson K, Torda W, Tata M, Babigian S, Benson L, Caicedo J, Calder T, DeFilippo A, Dorsainvil C, Erickson J, Fulton P, Grace M, Gilbert J, Greineder D, Haynes S, Higham M, Jakubowski D, Kelleher S, Koslof J, Mandel D, Martin P, Martinez A, McAuliffe J, Nakamoto E, Pacella P, Parks P, Sagarin J, Seligsohn K, Swords S, Syring M, Traylor J, Van Horn M, Wells C, Whitman A, MacLusky I, Reisman J, Levison H, Hall A, Chay J, Miki M, Sananes R, Benedet Y, Carpenter S, Collinson M, Finlayson-Kulchin J, Gore K, Holmes N, Klassen S, Quenneville J, Wasson C, Adkinson F Jr, Eggleston P, Aylward EH, Huss K, Plotnick L, Pulsifer M, Rand C, Bollers N, Bull D, Hamilton R, Hyatt K, Limb S, Pessaro M, Philips S, Wheeler B, Szefler S, Nelson HS, Bender B, Covar R, Liu A, Spahn J, Sundström D, Phillips M, White MP, Brelsford K, Bridges J, Ciacco J, Eltz M, Feeley J, Flynn M, Gleason M, Junk-Blanchard T, Hassell J, Hefner M, Hendrickson C, Hettleman D, Irvin CG, Jacobs J, Kamada A, Nimmagadda S, Kamada A, Sandoval K, Sheridan J, Washington T, Willcutt E, Carel K, Jain N, Leo H, Macomber B, Mjaanes C, Stewart L, Song B, Zeiger RS, Friedman N, Mellon MH, Schatz M, Harden K, Jenson EM, Panzlau S, Rodriguez E, Easton JG, Feinberg M, Galbreath LL, Gulczynski J, Hansen E, Jalowayski A, Lincoln A, Kaufman J, King S, Lopez B, Magiari-Ene M, Mostafa K, Moscona A, Nelle CA, Powers J, Sandoval K, Wilson NW, Kelly HW, Jacobs A, Spicher M, Raissy HH, Annett R, Archibeque T, Bashir N, Selda Bereket H, Braun M, Bush S, Clayton M, Colon-Semidey A, Devault S, Grad R, Hunt D, Larsson J, McClelland S, McWilliams B, Montoya E, Moreshead M, Murphy S, Ortega B, Weers D, Zayas J, Strunk RC, Bacharier L, Bloomberg GR, Corry JM, Rodgers D, Kertz L, Morgan V, Oliver-Welker T, White DK, Cherniack R, Tonascia J, Meinert C, Belt P, Collins K, Collison B, Colvin R, Dodge J, Donithan M, Harle J, Jackson R, Livingston H, Meinert J, Owens K, Smith M, Sternberg A, Van Natta M, Wild M, Wilson L, Wise R, Yates K, Taggart V, Eggers L, Kiley J, Zheng G, Albert P, Hurd S, Parker S, Randall P, Wu M, Eigen H, Cloutier M, Connett J, Cuttler L, Evans D, Kattan M, Menendez R, Simons FE, Davis CE, Leikin S, Strunk R, Szefler S, Taggart V, Tonascia J, Meinert C, Cherniack R, Strunk R, Adkinson NF, Annett R, Bender B, Caesar M, DuHamel TR, Kelly HW, Levison H, Lincoln A, MacLusky I, McWilliams B, Meinert CL, Parker S, Reisman J, Rodgers D, Seligsohn K, Shapiro GG, Sharpe M, Sundström D, Szefler S, Taggart V, Tata M, Tonascia J, Weiss S, Wheeler B, Wise R, Zeiger R.

Author information

Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, Massachussetts, USA.



Few studies have examined the effects of in utero smoke exposure (IUS) on lung function in children with asthma, and there are no published data on the impact of IUS on treatment outcomes in children with asthma.


To explore whether IUS exposure is associated with increased airway responsiveness among children with asthma and whether IUS modifies the response to treatment with inhaled corticosteroids (ICSs).


To assess the impact of parent-reported IUS exposure on airway responsiveness in childhood asthma, we performed a repeated-measures analysis of methacholine PC(20) data from the Childhood Asthma Management Program, a 4-year, multicenter, randomized, double-masked, placebo-controlled trial of 1041 children age 5 to 12 years comparing the long-term efficacy of ICS with mast cell stabilizing agents or placebo.


Although improvement was seen in both groups, children with asthma and IUS exposure had on average 26% less of an improvement in airway responsiveness over time compared with unexposed children (P = .01). Moreover, while children who were not exposed to IUS who received budesonide experienced substantial improvement in PC(20) compared with untreated children (1.25-fold increase; 95% CI, 1.03-1.50; P = .02), the beneficial effects of budesonide were attenuated among children with a history of IUS exposure (1.04-fold increase, 95% CI, 0.65-1.68; P = .88).


In utero smoke exposure reduces age-related improvements in airway responsiveness among children with asthma. Moreover, IUS appears to blunt the beneficial effects of ICS use on airways responsiveness. These results emphasize the importance of preventing this exposure through smoking cessation counseling efforts with pregnant women.

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