TK665
    tF- 71 - (-,--
    REVIEW 398 CONFIDENTIAL
    Subject ref.8d
    "Passive smoking, potential atony and asthma
    in the first five -Years"
    C.D.Kershaw
    Journal of the Royal Society of Medicine(1987),80,683-6ag
    During a mult'l-centre risk-related sudden IwEant death syndrome
    intervention study carried out in Gosport, Hampshire during 1983-84,
    health visitors collected information relating to over a thousand
    children aged 5 or under. The information collected included:
    (a) smoking by the parents and other resident members of the
    household (an active smoker being defined as a smoker of >3
    cigarettes a day),
    (b) presence of asthma (defined by having 3 or more bouts of
    bronchitis or bronchiolitis in any six-aonth period) with either
    definite intermittent wheeze or chronic night cough.
    (c) presence of a family history of atopic svM10coms in first-degree
    relatives,
    (d) a personal history of allergic eczema or ==--caria,
    (a) level of serum ISE, and
    (f) whether civilian or 4,rmed Service families.
    91 children met the author's definition of asthma and after
    excluding 5 with specific other diagnoses (such as cystic fibrosis),
    the remainder were compared with 1199 asthma-free infants.
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    The study showed that, compared with the asthma-free children,
    the aschmatic children were significantly more likely to have a
    mother who smoked (59% vs. 38%) or any household member who smoked
    (83% vs. 60%). This excess was evident, and statistically
    significant in children from both Armed Service and Civilian families
    (see Table 1).
    Where there was no smoker in the household, the asthmatic
    children all had a positive family history of atopy (se Figure 2).
    The difference in passive smoking exposure between asthmatic and
    non-asthmatic children was thus even greater in non-atop,-c children
    (see Figure 3).
    Based on this study, and a brief review of the literature, the
    author concludes t:ha= "the evidence suggests that the unsolicited
    burden of passive smoking repraents a significant health hazard to
    children. In addition to facilitating the expression of as:hma in
    young potential atopics, it may be an impor=ant contributor7 cause of
    the more severe disease reported in so-called 'intrinsic'
    asthmatics."
    While the difference in maternal and household smoking of
    asthmatic and non-asthmatic children is reasonably clear, it is by no
    means clear that it represents a true causal effect of passive smoke
    exposure. The study has made no attempt to control for confounding
    factors correlated with maternal smoking. Nor Ls it clear that the
    effect is not due to cross-infection or from smoking in pregnancy,
    rather than any direct effect of enviro=ental tobacco smoke
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    xposure. However, it is a rather more plausible effec: of passive
    moke exposure than many of the health endpoints for ;inich an effect
    has been claimed.
    P.N.Lee
    23.3.88
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    BATCo document for Legal Services: Health Canada 19 October 1999