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Tobacco exposure causing asthma in children often denied by caregivers

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Most adults are aware that tobacco smoke exposure can trigger an asthma attack in a child; however, some smoke in the presence of an asthmatic child. What makes matters worse, a new study has found that when a caregiver was asked about tobacco exposure, the caregiver often denied it. The findings of the study were published online on January 20 in the journal Pediatrics by researchers at Penn State Milton S. Hershey Medical Center (Hershey, Pennsylvania),
Cincinnati Children’s Hospital Medical Center (Cincinnati, Ohio), and Boston Children’s Hospital (Boston, Massachusetts).

The researchers conducted a study to assess the relationship between tobacco smoke exposure and rates of readmission for children hospitalized for asthma. They queried caregivers about tobacco exposure and also measured cotinine levels in the blood and saliva of children. The presence of cotinine indicates exposure to nicotine.

The study group comprised 774 children aged 1 to 16 years who were admitted to the hospital for asthma or wheezing. The researchers determined the number of children who were readmitted at least once within the next year for asthma or wheezing. Caregivers were asked regarding any tobacco exposure at home, in a secondary residence, or in the car. The researchers measured serum and saliva cotinine levels with a technique known as mass spectrometry. They then conducted statistical analysis to assess the associations between tobacco exposure and readmissions.

The investigators obtained complete tobacco exposure data on 619 of the 774 children; 57% were African American and 76% had Medicaid. Among the children with complete data, 17% were readmitted within one year. Tobacco exposure rates were 35.1% by caregiver reporting,, 56.1% by serum cotinine level, and 79.6% by saliva cotinine level. Caregiver report of any tobacco exposure was not associated with readmission; however, having detectable serum or salivary cotinine was associated with increased odds of readmission (serum: 1.59-fold increased risk; saliva: 2.35-fold increased risk). Among the children whose caregivers reported no tobacco exposure, 39.1% had detectable serum cotinine and 69.9% had detectable salivary cotinine. Among the children with reported exposure, 87.6% had detectable serum cotinine and 97.7% had detectable salivary cotinine.

The authors concluded that detectable serum and salivary cotinine levels were common among children admitted for asthma and were associated with readmission; however, caregiver report of tobacco exposure was not.

Take home message:
If you smoke, do not expose your children to any level of the smoke. Children who are not asthmatic can be harmed by the exposure. If you employ a caregiver (friend, relative, or hired individual) who smokes, admonish them to avoid smoking around the child. Be aware that if your child has an asthma flare-up, the caregiver is likely to lie about exposure to tobacco smoke.