22. Xu X, Dockery DW, Ware JH, Speizer FE, Ferris BG Jr. Effects of cigarette smoking on rate of loss of pulmonary function in adults: a longitudinal assessment. ;146:-
Percent differences and 95 percent confidence intervals are plotted for groups of children with differing levels of smoking as compared with children of identical age and log height who had never smoked, with adjustment for age, log height at each age, residence, parental education, and maternal smoking status. Never denotes never having smoked; Former, formerly having smoked; Light, 1/2 to 4 cigarettes per day; Medium, 5 to 14 cigarettes per day; and Heavy, 15 or more cigarettes per day. FVC denotes the forced vital capacity, FEV1 the forced expiratory volume in one second, and FEF25–75 the forced expiratory flow between 25 and 75 percent of FVC.
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It was not possible to evaluate differences between the sexes in the maximal level of lung function attained or in the effects of smoking on the decline of lung function. Since boys attain their maximal pulmonary function in their early 20s, we were not able to observe the effects of smoking once the growth of pulmonary function ceased. Although our findings suggest that girls who smoke attain a lower maximal level of pulmonary function than nonsmokers and have an earlier decline in pulmonary function, this apparent trend could not be analyzed in girls beyond the age of 18 because of the lack of follow-up data.
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For adolescent girls and boys, we found that relatively small amounts of cigarette smoke cause similar deficits in levels of both FEV1/FVC and FEF25–75, measures described in many studies as the earliest spirometric indicators of airway obstruction and small-airway disease in adult smokers. Our findings also suggest that although smoking may slow the growth of lung function in both girls and boys, the deficits may be greater in girls. The effects of smoking on the growth of lung function were greater in girls in absolute as well as percentage terms, despite the fact that boys had larger forced expiratory volumes and reported that they smoked more cigarettes. Tager and colleagues demonstrated associations between smoking and both a lower level and slower growth of lung function in both female and male adolescents from East Boston, Massachusetts; the size of the sample limited the study's capacity to examine sex-specific differences. Previous studies of adults from the same six areas of the United States as the children in our study suggested that cigarette smoke had a larger effect on lung function in men; the effect on lung function of smoking one pack of cigarettes per day for a year (one pack-year) was a 0.36 percent annual loss of FEV1 for men and a 0.29 percent annual loss for women. This sex-specific difference may relate not to heightened sensitivity of men's lungs to cigarette smoke but to a cohort effect, since women had fewer cumulative pack-years of smoke exposure and began smoking at later ages. In a cross-sectional study from Canada, women had greater deficits in lung function per pack-year of cigarettes smoked.
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Excluding children with a history of asthma from the analysis did not significantly alter the sex-specific relations between cigarette smoking and the level or growth of pulmonary function. For girls, but not for boys, there was an interaction between current wheezing and cigarette smoking. Girls who wheezed when they smoked five or more cigarettes per day had a 2.84 percent lower FEV1/FVC ratio (95 percent confidence interval, 2.12 to 3.55) and a 6.69 percent lower FEF25–75 level (95 percent confidence interval, 4.15 to 9.16) than nonsmoking girls without wheezing symptoms, after adjustment for age and height.
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In analyses expressing each child's age relative to the age at peak growth in height, smoking was also associated with a greater absolute deficit in the growth of FVC and FEV1 for girls than for boys, despite the fact that boys in adolescence had significantly higher values for FVC (suggesting larger lung volumes) and FEV1 (suggesting larger airways) than girls. For FVC, smoking five or more cigarettes per day, as compared with never smoking, was associated with growth that was 25 ml per year slower in girls (95 percent confidence interval, 10 to 39); the estimated effect in boys was not significant (growth was 1 ml per year slower; 95 percent confidence interval, -13 to 15; P = 0.03 for the difference between the sexes). For FEV1, smoking five or more cigarettes per day was associated with growth of lung function that was 31 ml per year slower in girls (95 percent confidence interval, 16 to 46) and 9 ml per year slower in boys (95 percent confidence interval, -6 to 24) (P = 0.05 for the difference between the sexes). As with percentage growth, the effect of smoking in slowing the absolute growth of FEF25–75 in boys and girls was similar (for boys, 48 ml per second per year; 95 percent confidence interval, 14 to 81; for girls, 38 ml per second per year; 95 percent confidence interval, 3 to 80). For all the measures of lung function considered, estimates of the effects of cigarette smoking on absolute growth in lung function were similar in analyses with and without adjustment for peak growth in height.