Effects of Passive Smoking on Spirometric Values and Plasma Level of Inflammatory Markers in Healthy School Children in Khartoum

Abstract

Background: Exposure of children to environmental tobacco smoke at home has been linked to many complications including respiratory symptoms, airway inflammation and impaired lung ventilatory functions; however, factors like housing conditions and genetic predisposition may influence the development of these complications. Objectives: To determine the effects of passive smoking on spirometric values and plasma level of inflammatory markers in healthy male schoolchildren. Methods: This is an observational case control study conducted in year 2009 among 135 male school-pupils (69 cases and 66 controls), aged 9-14 (mean 11.6 ± 1.3) years, selected randomly from three governmental primary schools for boys in Khartoum. Information about smoking history, its impact on child’s health and the attitude of parents towards passive smoking was collected from each pupil and his parents using a questionnaire. Spirometric measurements were performed using Clement Clarke All-flow Spirometer. Plasma CRP, IL4 and TNFα were measured using ELISA kits. Results: Fathers were responsible for 67.5% of second-hand smoke at home; mothers were responsible for 2.5% whereas relatives like brothers and uncles were responsible for 30%. The group of cases showed a significant rise in plasma TNFα and IL4 and a significant reduction in FVC and FEV1 by about (7-8%). The rise in plasma TNFα and IL4 was higher in those with high degree of tobacco smoke exposure than those with low exposure, indicating a dose dependent effect. No significant difference was V found in frequencies of hospital admissions, surgical operations and respiratory tract infections during the last year; however, snoring during sleep was significantly higher among cases (8.2%) than controls (2.2%). The majority of fathers in the study group did not smoke or allow smoking near their wives during pregnancy (90%). Conclusion & recommendation: Passive smoking has a significant negative impact on lung function of healthy male school-pupils in Khartoum and a significant dose dependent effect on plasma TNFα and IL4.Educational programs are highly recommended to increase awareness of parents about the negative impact of passive smoking on child’s health.