Whilst some of the effects on children whose mothers smoked whilst pregnant are known, there have been no published data on the impact of _in utero_ smoke exposure on treatment effectiveness in children with asthma. This has changed recently, with an important research project in which Kristel Van Steen has taken part.

It is difficult to believe that anyone today is unaware of the nefarious effects of smoking. We are a long way from the cinema of the 1950s and 1960s, when it seemed almost compulsory for every actor on the screen to be holding a cigarette and when camera operators must have had difficulties zooming in for a close-up through the thick clouds of blue tinted smoke. Smoking in public spaces has been subject to various acts of legislation in most if not all European countries in recent years, even if that legislation has different effects depending on the country. In Belgium this backlash has even impacted on the annual Formula One race at Spa Francorchamps, very popular for spectators and drivers alike, which has at times been threatened with being stripped of a place on the international calendar due to the omnipresence of tobacco advertising in the F1 circus. And the life size statue of the iconic Lucky Luke which adorns the entrance to the Belgian Comic Strip Centre in Brussels has long since seen its trademark cigarette removed from the hero’s lips!

The effects of passive smoking have in the past decade or so have also started to impact on public awareness. For a long time this aspect was to some extent pushed to the margins of the debate, perhaps partly due to ambivalent arguments over an individual smoker’s rights and freedoms to do as they wish where they wish, as long as they remain within legal boundaries, and also due in part to resistance on the part of the brewery companies, who were worried about seeing people stay away from bars and pubs in which people smoked, and thus seeing their revenues drop. But the harmful effects of passive smoking are now as generally recognised as those of direct smoking.

And yet.  Despite all this greater awareness and general agreement about the negative impact of smoking, people persist in taking guilty or not so guilty pleasures from a cigarette, and included in this category are also sometimes women who are pregnant. Passive smoking is obviously of major concern in terms of pregnant women smoking, with major worries about the short term and long term effects of their smoking on their children. Given the obvious effects of smoke and nicotine inhalation on the lungs of adult smokers, and the large incidence of lung cancers amongst long term smokers, it is surprising that few studies have examined the effects of in utero smoke exposure (IUS) on lung function in children with asthma, and there have been few published data on the impact of IUS on treatment outcomes in children with asthma. A recent article published in 2010 in The Journal of Allergy and Clinical Immunology (1) has gone some way to alleviating this gap. The article publishes the results of a long term study carried out in the United States, and gained much media attention when it was published. Kristel Van Steen, an associate professor of bioinformatics at the University of Liège, has played a key role in this research, bringing to it her expertise in bio-statistics. Studies had already shown that children whose mothers had smoked during pregnancy may have an increased risk of developing asthma. The importance of this new study shows that these children may also get less benefit from the inhaled steroid medications which are primarily used to prevent asthma attacks.

 (1) ‘In utero Smoke Exposure and Impaired Response to Inhaled Corticosteroids in Children with Asthma’ in The Journal of Allergy and Clinical Immunology, septembre 2010 : Vol. 126