CHEST Original Research OCCUPATIONAL AND ENVIRONMENTAL LUNG DISEASES

The adverse pulmonary effects of environmental tobacco smoke (ETS) exposure on children in the general population have been well described. 1 In utero smoke (IUS) exposure has been associated with wheez-ing, asthma, and reduced pulmonary function in infants and children. 2,3 Infants with postnatal ETS exposure in the home have increased incidences of wheez ing, lower respiratory tract infections, and changes in lung growth and airway fl ow. 4,5 Current ETS exposure has been associated with asthma prevalence and severity, with some studies showing an association between it and decreased pulmonary function. 2,6,7 The relationship between ETS and pulmonary mor-bidity among individuals with sickle cell anemia (SCA) is poorly defi ned. ETS may have particularly adverse consequences for children with SCA because researc