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Biomedical subjects

R Pistelli

Publications and source records attributed to R Pistelli.

At least 37 records · Page 2Linked to original sources
PubMed2000

Quality control of spirometry in the elderly. The SA.R.A. study. SAlute Respiration nell'Anziano = Respiratory Health in the Elderly.

We evaluated the outcome of the spirometry quality control program of the SA.R.A. multicenter project, the aim of which is the multidimensional assessment of asthma and COPD in the elderly (>/= 65 yr). The factors determining this quality were also evaluated. The program was based on standardized procedures (ATS recommendations), performed by specifically trained and certified personnel; a fully-computerized spirometer with customized software was used for spirometry. A reference center made monthly controls. Overall, 638 cases and 984 controls were examined. Spirometric measurements were obtained in 607 cases and 912 controls; 508 and 747 tests with at least three acceptable curves were obtained in cases and in controls, respectively (NS). The percentage of reproducible tests ranged between 95.8% for FEV(1) in controls and 87.6% for FVC in cases. The average reproducibility for FEV(1) was 61.6 ml in cases and 58.3 ml in controls (NS). Cognitive impairment, shorter 6-min walk distance, and lower educational level were found to be independent risk factors for a poorer acceptability rate (logistic regression analysis). Male sex and age were risk factors for a poorer reproducibility of FEV(1). Reproducibility tended to improve with time (p < 0.001). Although spirometry becomes increasingly difficult in aging patients, a rigorous quality control program can ensure that reliable data are obtained in the majority of patients.

Age Factors↗
PubMed2000

Characteristics of nonsmoking women exposed to spouses who smoke: epidemiologic study on environment and health in women from four Italian areas.

The aim of this study was to evaluate whether risk factors associated with cardiovascular or respiratory diseases and lung cancer occur differently among nonsmoking women in Italy with and without exposure to environmental tobacco smoke (ETS) from husbands that smoke. We performed a cross-sectional study of 1,938 nonsmoking women in four areas of Italy. Data on respiratory and cardiovascular risk factors and on diet were collected using self-administered questionnaires. Medical examinations and blood tests were administered; urine cotinine levels were measured. Nonsmoking women ever exposed to husbands' smoking were compared with unexposed women for several factors: education, husband's education, household crowding, number of children, current or past occupation, exposure to toxic substances at work, parental diseases, self-perceived health status, physician-diagnosed hypertension, hypercholesterol, diabetes, osteoporosis, chronic respiratory diseases, blood pressure medications, lifestyle and preventive behaviors, dietary variables, systolic and diastolic blood pressure, body mass index, waist-hip ratio, triceps skin folds, plasma antioxidant (pro-) vitamins (- and ss-carotene, retinol, l-ascorbic acid, -tocopherol, lycopene), serum total and HDL cholesterol, and triglycerides. Women married to smokers were more likely to be less educated, to be married to a less educated husband, and to live in more crowded dwellings than women married to nonsmokers. Women married to smokers were significantly less likely to eat cooked [odds ratio (OR) = 0.72; 95% confidence interval (CI), 0.55-0.93] or fresh vegetables (OR = 0.63; CI, 0.49-0.82) more than once a day than women not exposed to ETS. Exposed women had significantly higher urinary cotinine than unexposed subjects (difference: 2.94 ng/mg creatinine). All the other variables were not more prevalent among exposed compared to unexposed subjects. The results regarding demographic factors are easily explained by the social class distribution of smoking in Italy. A lower intake of vegetables among exposed women in our study is consistent with the available literature. Overall, our results do not support previous claims of more frequent risk factors for cardiovascular and pulmonary diseases among ETS-exposed subjects. In Italy, as elsewhere in Europe and North America, women who have never smoked but are married to smokers are likely to be of lower social class than those married to never-smokers. However, once socioeconomic differences are considered, the possibility of confounding in studies on the health effects of ETS is minimal.

Adult↗
PubMed2000

Prevalence of nocturnal asthma in a general population sample: determinants and effect of aging.

Nocturnal asthma (NA) is important because of clinical and prognostic implications. Previous data on prevalence may be overestimated, because they are derived from selected series. Observations on monitoring of peak expiratory flow in elderly asthmatics suggested that prevalence of NA may increase with age. This study was designed to estimate the prevalence of NA-related symptoms in a sample drawn from a general population and evaluate the role of aging. Subjects (1,100, mean age 41.9, SD 22.8 years) were randomly selected from the lists of seven general practitioners. A questionnaire on nighttime and morning NA-associated symptoms was used and frequency of occurrence was rated as never, sometimes (less than once a week), and often (once a week or more). In the overall sample, symptoms were experienced "sometimes" by 2.3%-4.9% of subjects, whereas the response "often" was given by 0.9%-1.6% of subjects. Among subjects with a diagnosis of asthma, symptoms occurred sometimes in 16.7%-23.7% and often in 5%-15%. Symptoms reported the morning after were significantly more frequent among patients aged 65 years and older (p < 0.005), whereas the difference for nighttime symptoms was not statistically significant in different age groups, confirming an age-related blunted sensitivity. Logistic regression analysis shows that a diagnosis of asthma is the most important correlate of symptoms, with odds ratio (OR) up to 14.78 for cough; advanced age also proved to be an independent risk factor (OR 3.35-4.97). In conclusion, although the prevalence of NA was previously overestimated, our results indicate its importance, particularly among elderly patients who are exposed to a prominent risk of underdiagnosis and undertreatment.

Adult↗
PubMed2000

Current practice in assessment and treatment of bronchial asthma in young males in Italy.

The aim of the study was to evaluate, in a sample of young asthmatics in Italy, the current practice in assessment and treatment of asthma after the publication of guidelines. Young soldiers who declared bronchial asthma at the beginning of the compulsory military service were evaluated. One-hundred and thirty-eight subjects with confirmed asthma were selected. Sixty-seven subjects (48.5%) had had at last one spirometry, and only one subject had underwent peak flow monitoring at home; most of the subjects (96.8%) had had prick tests. More of the 50% of the subjects with bronchial obstruction or with severe bronchial hyperresponsiveness, with clinical moderate or severe asthma, had used only bronchodilators or no therapy at all in the preceding year. In this sample of young asthmatics, the lung function tests were still underutilized for the diagnosis and follow-up of bronchial asthma; moreover, the inhaled anti-inflammatory drugs were still underutilized.

Adult↗
PubMed2000

Accuracy of indirect estimation of oxyhaemoglobin saturation in patients with respiratory failure.

The indirect estimate of oxyhaemoglobin saturation (Sa,O2) is largely used in the management of patients with respiratory failure. The aim of this study was to evaluate the accuracy of the Sa,O2 values calculated by using both the Siggaard-Andersen (SA) and the Severinghaus (SE) equation, in comparison with the real Sa,O2 values measured by a co-oximeter. A total of 558 arterial blood samples were analysed. On average, only a slight overestimation was found for Sa,O2 estimated by the SA (2.35 +/- 5.75%) and the SE (2.37 +/- 5.65%) equations in comparison with the real values. However, a difference higher than 5% between estimated and real Sa,O2 values was demonstrated in more than 20% of the blood samples evaluated. This difference was higher than 10% in 9% of the samples, with similar results obtained with the two equations. The discrepancy between real and estimated values, probably due, at least in part, to errors in measurement of arterial oxygen tension (Pa,O2) and pH, was maximally evident for Sa,O2 values lower than 70%. An indirect estimate of Sa,O2 is not homogeneously accurate, and the clinical consequence of this finding might be especially dangerous in monitoring patients with severe respiratory failure.

Humans↗
PubMed1999

Electrocardiographic signs of chronic cor pulmonale: A negative prognostic finding in chronic obstructive pulmonary disease.

BACKGROUND: Chronic cor pulmonale (CCP) is a strong predictor of death in chronic obstructive pulmonary disease (COPD). The aims of this study were to assess the prognostic role of individual ECG signs of CCP and of the interaction between these signs and abnormal arterial blood gases. METHODS AND RESULTS: Two hundred sixty-three patients (217 men) with COPD, mean age 67+/-9 years, were grouped according to whether they had no ECG signs (group 1, n=100) or >/=1 ECG signs (group 2, n=163) of CCP and were followed up for 13 years after an exacerbation of respiratory failure. The median survival was significantly shorter in group 2 than in group 1 (2.58 versus 3. 45 years, respectively; Mantel-Cox test, 9.58; P=0.002). The Cox regression analysis identified S1S2S3 pattern, right atrial overload (RAO), and alveolar-arterial oxygen gradient (PAO2-PaO2) >48 mm Hg during oxygen therapy as the strongest predictors of death, with hazard rate (HR)=1.81 (95% CI, 1.22 to 2.69), HR=1.58 (95% CI, 1.15 to 2.18), and HR=1.96 (95% CI, 1.19 to 3.25), respectively. The median survivals of patients having both S1S2S3 pattern and RAO (n=14) and of patients having either S1S2S3 pattern or RAO (n=77) were 1.33 and 2.70 years, respectively (P=0.022). Group 2 patients had a 3-year survival of 18% or 53%, depending on whether their PAO2-PaO2 during oxygen therapy was or was not >48 mm Hg. CONCLUSIONS: Some ECG signs of CCP and PAO2-PaO2 >48 mm Hg during oxygen therapy qualified as a simple and inexpensive tool for targeting subsets of COPD patients with severe or very severe short-term prognosis.

Aged↗
PubMed1999

Hypoxemia in young asthmatics with mild airway obstruction by methacholine challenge.

We studied 12 asymptomatic conscripts affected by bronchial asthma to evaluate the level of hypoxemia and its relationship with bronchial obstruction induced by methacholine (Mch) challenge. Arterial blood samples were obtained before and immediately after bronchial challenge. The range of decrease of forced expiratory volume/forced vital capacity x 100 in 1 second of expiration (FEV1), the absolute value reported as a percentage of the baseline value, after Mch challenge was from 21% to 36%. The mean decrease of arterial oxygen tension was 27 mm Hg (from 11.4 to 39.8 mm Hg), the mean decrease of hemoglobin saturation was 3.53% (from 0.4 to 7.2), and the mean increase of alveolar-arterial gradient for oxygen was 28.2 mm Hg. We found a significant correlation between the prechallenge and postchallenge differences of arterial oxygen tension and FEV1 (DFEV1P), which was expressed as a percentage of the predicted value. In conclusion, the Mch challenge seems to be a safe test, and the decrease of arterial oxygen tension can be sufficiently predicted by DFEV1P.

Adult↗
PubMed1998

Predicting cognitive decline in patients with hypoxaemic COPD.

The objective was to identify predictors of cognitive decline in patients with hypoxaemic COPD on continuous oxygen therapy. Eighty-four consecutive ambulatory hypoxaemic COPD patients in stable clinical conditions were prospectively studied over the course of 2 yr. Baseline multidimensional assessment included respiratory function tests, blood gas analysis, Mini Mental Status (MMS) test, Geriatric Depression Scale (GDS), Activities of Daily Living (ADLs) and Charlson's index of comorbidity. Reassessments were made 1 yr and 2 yr thereafter. Sequential changes in MMS, GDS and ADLs were assessed by Friedman's ANOVA by rank test. Forty patients completed the study (group A), while 44 died or were lost to follow-up (group B). Group B was characterized by more severe respiratory function impairment and worse performances on ADLs and GDS. In group A, MMS deteriorated from baseline to the 1 yr and 2 yr reassessments (27 +/- 2.9 vs. 25.8 +/- 4.1 and 25.4 +/- 4, P < 0.005), whereas GDS and ADLs did not change significantly; the 23 patients experiencing a decline of MMS had baseline lower percentage predicted FVC (52.3 +/- 17.1 vs. 66.9 +/- 13.4, P < 0.03) and FEV1 (27.2 +/- 8.6 vs. 44 +/- 26.8, P < 0.02) values and better affective status (GDS score: 11.9 +/- 7.7 vs. 16.5 +/- 5.6, P < 0.04). Two-year changes in MMS and in GDS scores were inversely correlated (Spearman's p = -0.32, P = 0.04). Cognitive decline is faster in the presence of severe bronchial obstruction and parallels the worsening of the affective status in COPD patients on oxygen therapy. The onset of depression rather than baseline depressive symptoms seems to be a risk factor for cognitive decline.

Activities of Daily Living↗
PubMed1998

Acute oxygen supplementation does not relieve the impairment of respiratory muscle strength in hypoxemic COPD.

STUDY OBJECTIVES: To verify whether hypoxemia affects respiratory muscle strength in the absence of malnutrition and whether such effect, if present, is reversible with an acute oxygen supplementation. DESIGN: Case series analysis, before-after trial. SETTING: Outpatient pneumology departments of two university hospitals. PATIENTS: One hundred twenty patients affected by COPD in stable conditions having actual to ideal body weight ratio of > or =90%. MEASUREMENTS AND RESULTS: Maximal inspiratory pressure (MIP) was measured at functional residual capacity level in the whole sample of subjects and during oxygen supplementation in 58 patients having a PaO2< or =60 mm Hg when breathing in room air. Predictors of MIP were assessed by a multivariate analysis. MIP values before and after oxygen supplementation were compared by a paired t test. MIP was independently correlated with FVC (p<0.001), PaO2 (p<0.01), and age (p<0.01). In the subgroup of hypoxemic patients, MIP values did not change significantly after oxygen supplementation (3.08+/-1.74 vs 3.03+/-1.91 kPa, t=0.43, not significant). CONCLUSIONS: Hypoxemia is an important negative correlate of MIP even in well-nourished COPD patients. Its effect is not reversible with an acute oxygen supplementation.

Age Factors↗
PubMed1998

Prevalence of sinusitis in young asthmatics and its relation to bronchial asthma.

In this paper, we present data on the prevalence of sinusitis and its relationship to bronchial asthma in 120 young male asthmatics evaluated without exacerbations of their disease. All patients reported respiratory symptoms during the preceding year, and in the most of them (74%), the severity of asthma was mild. Sinusitis was observed in 52 patients (43.3%), and the maxillary sinus was involved in 36 asthmatics. Sixteen of 52 patients with sinusitis had never had nasal symptoms of rhinitis. In all patients, physical examination of the lung was negative for wheezing. All patients had FEV1 (forced expiratory volume/forced vital capacity x 100 in 1 second of expiration) values in the normal range, and bronchial hyperresponsiveness was detected in 101 asthmatics (84.2%). One hundred sixteen patients (96.6%) were found to be skin reactors. We did not find statistical differences between asthmatics with or without sinusitis with regard to severity of asthma, basal lung function, and bronchial hyperresponsiveness. We suggest that antibiotic therapy for sinusitis should be given only to asthmatics with worsening respiratory symptoms and obvious signs of chronic sinusitis.

Adult↗
PubMed1998

Accuracy of a pulse oximeter in the measurement of the oxyhaemoglobin saturation.

The aim of the present study was to evaluate the accuracy, in comparison with a reference method, of the Nellcor N-20P pulse oximeter in the assessment of oxyhaemoglobin saturation (Sa,O2). Sa,O2 was monitored at rest by the Nellcor N-20P pulse oximeter in 100 subjects (82 males, mean age 68+/-12 yrs) consecutively enroled. At the same time, an arterial blood sample was collected for the measurement of Sa,O2, carboxyhaemoglobin, and methaemoglobin by an IL-282 Co-oximeter. A significant difference was found between Sa,O2 values measured with the two methods (t=11.78, p<0.05), but the two series of measurements were significantly correlated (r=0.97). Both the level and the limits of agreement between the two methods were satisfactory when the more appropriate Bland and Altman method was applied. Nevertheless, a lack of accuracy of the pulse oximeter was found, but only for Sa,O2 values <82% and >94%, as demonstrated by the Youden index. In conclusion, these data show that Nellcor N-20P is sufficiently reliable for the assessment and monitoring of oxyhaemoglobin saturation. The lack of accuracy does not seem clinically relevant since it is appreciable only for values at the extremes of the oxyhaemoglobin saturation range.

Aged↗
PubMed1997

Potential use of iodine-123 metaiodobenzylguanidine radioaerosol as a marker of pulmonary neuroadrenergic function.

Iodine-123 metaiodobenzylguanidine (123I-MIBG) radioaerosol is of potential use in the investigation of the neuroadrenergic function of the lungs; however, before the method can be successfully employed the following issues need to be clarified: (1) Does the nebulization affect the radiochemical purity of 123I-MIBG? (2) Is the pulmonary distribution of inhaled 123I-MIBG homogeneous in normal subjects? (3) Does the pulmonary clearance of inhaled 123I-MIBG reflect the functional status of the neuroadrenergic system of the lungs? In this study we performed: (1) a chromatographic study of nebulized 123I-MIBG; (2) a quantitative evaluation of the lung distribution of 123I-MIBG radioaerosol in normal subjects as compared with that of technetium-99m diethylene triamine penta-acetic acid (99mTc-DTPA) and (3) an assessment of 123I-MIBG lung clearance both under control conditions and after pharmacologically induced beta-blockade, again compared with 99mTc-DTPA. For these purposes, eight normal subjects were divided randomly into an "MIBG group" and a "DTPA group" (four subjects each) and submitted to three scintigraphic studies each: a baseline study, and studies after the administration of a low (80 mg) and a high (160 mg) dose of propranolol. Radiochemical purity of nebulized 123I-MIBG ranged between 97.18% and 98.70%. The lung distribution of 123I-MIBG, as judged by the aerosol penetration index, was identical to that of 99mTc-DTPA under all study conditions. The 123I-MIBG clearance rate was slower than that of 99mTc-DTPA under baseline conditions (135+/-32 min vs 69+/-27 min, P<0.01) and increased significantly after propranolol administrations, while the 99mTc-DTPA clearance did not change. The following conclusions were drawn: (1) the nebulization does not affect the radiochemical purity of 123I-MIBG; (2) the lung distribution of 123I-MIBG is homogeneous in normal subjects; (3) the pulmonary clearance of 123I-MIBG reflects the functional status of the neuroadrenergic system of the lungs. Thus this scintigraphic method is suitable for research and perhaps for future clinical use.

3-Iodobenzylguanidine↗
PubMed1997

Socioeconomic status, number of siblings, and respiratory infections in early life as determinants of atopy in children.

Asthma and allergic disorders have been on the increase in recent decades, especially among children living in affluent countries; some aspects of the "Western" way of life may explain this trend. We evaluated the relation of aeroallergen skin test reactivity with socioeconomic status, number of siblings, and respiratory infections in early life. We examined a total of 2,226 schoolchildren, ages 7-11 years, in three areas of Lazio, Italy. Skin prick tests were performed to assess atopic status, and self-administered questionnaires were completed by the parents. The prevalence of prick test positivity was greater among children whose fathers were in the highest educational level than among those in the lowest [prevalence ratio (PR) = 1.58; 95% confidence interval (CI) = 1.21-2.06]. There was also a lower prevalence of atopy among larger sibships (PR = 0.38 for subjects with four or more siblings vs those without siblings; 95% CI = 0.14-0.99). A history of bronchitis or bronchiolitis before age 2 years was weakly associated with an increased risk of atopy, whereas a history of pertussis or pneumonia was not. Both the effect of father's education and the influence of larger sibship size remained when we adjusted for several potential confounding factors, including respiratory infections in early life. We infer that higher socioeconomic status and lower sibling number are determinants of atopy in this Italian population. Protection arising from early severe respiratory infections does not explain this association, although we cannot exclude a role for other viral infections.

Age of Onset↗
PubMed1997

Evaluation of pulmonary ventilation and diaphragmatic movement in idiopathic scoliosis using radioaerosol ventilation scintigraphy.

Regional distribution of lung ventilation and diaphragmatic movement were evaluated using a non-invasive scintigraphic method in patients with idiopathic scoliosis. Twenty-four non-smoking patients aged 20 +/- 9 years (mean +/- S.D.), all with a right convex dorsal curve (mean Cobb's angle of 65.1 +/- 26.4 degrees), underwent lung ventilation scintigraphy after inhalation of 99Tcm-labelled human albumin microspheres. The distribution of the inhaled aerosol was assessed and scored based on four scintigraphic patterns, ranging from homogeneous distribution (score = 1) to diffuse severe hypoventilation (score = 4). Diaphragmatic movement, evaluated in 11 of the 24 patients, was assessed using an index (DM-Index) computed for each hemi-diaphragm by the normalization and subtraction of two digital scans obtained during maximal inspiration and expiration respectively. The left lung, situated on the concave side of the scoliotic curve, showed a more uneven distribution of ventilation (scintigraphic score: 2.62 +/- 1.17 vs 1.50 +/- 1.02, P < 0.01) and a reduced hemi-diaphragm movement (DM-Index: 29.2 +/- 4.0 vs 35.9 +/- 2.9, P < 0.001). A significant inverse correlation was found between Cobb's angle and both the right and left DM-Index (r = -0.82 and -0.66 respectively). In a stepwise multiple-regression analysis, the scintigraphic score correlated significantly with the functional index of distribution of inspired gas (IDI) derived from the multiple-breath nitrogen washout curve (P = 0.02). We conclude that lung ventilation scintigraphy provides information on the regional distribution of ventilation and on diaphragmatic movement in idiopathic scoliosis. The pulmonary function derangements in scoliotic patients were mainly localized in the lung on the concave side of the scoliotic curve and were related to the severity of the spinal curvature.

Adult↗
PubMed1997

Co-morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease.

The aim of this study was to assess the prognostic role of co-morbidity in severe chronic obstructive pulmonary disease (COPD). A cohort of 270 COPD patients, mean (+/-SD) age 67+/-9 yrs, consecutively discharged from a University Hospital after an acute exacerbation was studied. Mean (+/-SD) forced expiratory volume in one second (FEV1) was 34+/-16% of predicted and FEV1/forced vital capacity (FVC) was 40.5+/-13.8%. The most common co-morbid diseases were: hypertension (28%), diabetes mellitus (14%), and ischaemic heart disease (10%). Clinical, electrocardiogram (ECG), and respiratory function data taken at the time of discharge were collected from the clinical records. The Charlson's index was used to quantify co-morbidity. Follow-up was conducted by means of telephone calls. Multivariate survival analysis was used to identify the independent predictors of death. The median survival of the cohort was 3.1 yrs. Death was predicted by the following variables: age (hazard rate (HR) 1.04; 95% confidence intervals (95% CI) 1.02-1.05), ECG signs of right ventricular hypertrophy (HR 1.76; 95% CI 1.30-2.38), chronic renal failure (HR 1.79; 95% CI 1.05-3.02), ECG signs of myocardial infarction or ischaemia (HR 1.42; 95% CI 1.02-1.96), FEV1 < 590 mL (HR 1.49; 95% CI 0.97-2.27). A score based upon these variables predicted mortality at 5 yrs with a sensitivity of 63% and a specificity of 77%. Selected co-morbid diseases and electrocardiogram signs of right ventricular hypertrophy play a major prognostic role in advanced chronic obstructive pulmonary disease. The clinical assessment of patients with chronic obstructive pulmonary disease should include these important and easily measurable variables.

Age Distribution↗
PubMed1996

A longitudinal evaluation of bronchial responsiveness to methacholine in children: role of baseline lung function, gender, and change in atopic status.

A longitudinal study was done to evaluate the determinants of bronchial responsiveness (BR) to methacholine in children and adolescents. A cohort of 892 7- to 11-yr-old schoolchildren was restudied after a 3.5-yr interval. The same protocol for methacholine challenge (up to 64.0 mg/ml) and skin prick testing was employed at both the baseline survey and follow-up. An overall decline in the level of BR was observed, the geometric mean slope (percent decline in FEV1 per mg/ml of methacholine) decreasing from 0.68 (95% CI=0.61 to 0.75) to 0.51 (95% CI=0.46 to 0.57) (p<0.001). At both surveys, the strongest determinants of slope were baseline pulmonary function level (FEF25-75) and degree of atopic status. After adjusting for log FEF25-75, no gender difference was found in the first survey, whereas girls had greater BR than boys at follow-up. Longitudinal changes in skin prick test reactivity were associated with the BR level. Subjects in whom an initially positive skin prick test became negative (5.3%) had an increased slope at baseline but a follow-up slope similar to that of never skin-reactors. Conversely, those whose skin prick test converted from negative to positive (13.0%) had a slope similar to that of never-reactors at baseline but became stronger responders to methacholine than never-reactors at follow-up. Finally, responsiveness was highest in the presence of persistently positive skin prick testing (13.5%). In conclusion, BR declines from childhood to adolescence, paralleling the increase in lung function during this period; the decline is less pronounced in females. Changes in atopic status are associated with modifications in the BR level.

Adolescent↗
PubMed1996

Lung function in children and adolescents with occasional exposure to environmental tobacco smoke.

We investigated the effects of occasional exposure to environmental tobacco smoke (ETS) on lung function in children. A total of 317 healthy 12- to 15-yr-old nonsmoking children and adolescents, living in households in which none of the adults were active smokers, were selected for the present analysis. The urinary cotinine:creatinine ratio (CCR) was taken as the biologic indicator of exposure, and children were classified according to CCR quartiles. The ratio between FEV1 and FVC (FEV1/FVC) and both early (peak expiratory flow [PEF]) and midexpiratory flow rates (FEF25-75) were lower in children with higher CCR values. In percent terms, the decrease in adjusted lung function for children belonging to the second, third, and fourth quartiles in comparison with those in the first quartile was -1.37, -2.12, and -1.94 for FEV1/FVC (p for trend = 0.012); 0.98, -3.31, and -4.54 for PEF (p for trend = 0.024); and -0.05, -4.85, and -6.13 for FEF25-75 (p for trend = 0.022), respectively. The effects remained significant when possible confounding by father's education and urinary creatinine level had been taken into account, and when children whose parents' smoking status may have been misclassified were excluded. This study suggests an adverse effect on lung function from even low-level exposure to ETS among nonsmoking children living with reportedly nonsmoking parents.

Adolescent↗