Secondhand smoke continues to vex children with asthma

Despite longstanding recommendations for children with asthma to avoid tobacco smoke, many youths are still exposed to secondhand smoke and their health suffers because of it, according to a study to be presented Tuesday, May 1, at the Pediatric Academic Societies (PAS) annual meeting in Boston.

"National asthma guidelines have advised avoidance of environmental tobacco smoke (ETS) for patients with asthma for decades, but it is unclear to what degree these recommendations are being followed and what the impact of exposure has been in an era of increased awareness of the effects of ETS exposure," said lead author Lara J. Akinbami, MD, FAAP, medical officer, National Center for Health Statistics, Centers for Disease Control and Prevention.

Researchers undertook this investigation after co-author Brian Kit, MD, MPH, conducted a study showing that 53 percent of children with asthma were exposed to smoke from cigarettes, cigars or pipes from 2005 to 2010. These findings also will be presented at the PAS meeting on Saturday, April 28.

Investigators analyzed data from the 2003-2010 National Health and Nutrition Examination Survey (NHANES) for 972 children ages 6-19 years who had been diagnosed by a doctor with asthma and who reported having asthma at the time of the survey. They looked at the association between exposure to ETS and the following effects of wheezing in the past year:

number of days of school or work missed;
number of health care visits to a doctor's office or emergency department (ED);
number of days with sleep disturbed;
amount of activity limitation; and
any wheezing with exercise or physical activity.

NHANES consists of health interviews and examinations at a mobile center. During the health interviews, respondents were asked about demographic characteristics, smoking in the household, personal smoking habits (ages 12 and above) and asthma history. Blood samples were taken to assess serum cotinine, which measures exposure to ETS or personal use of tobacco products.

Results showed that 53 percent of the children were exposed to ETS. After adjusting for differences in age, sex, race and poverty status, exposure to ETS was associated with higher odds of having three or more visits (vs. no visits) to a physician's office or ED due to wheezing in the past year; sleep disturbed by wheezing one or more nights per week (vs. none); and activity limitations (fair amount, moderate amount or a lot vs. none) due to wheezing.

There was no significant association between ETS exposure and missing school or work due to wheezing or wheezing during exercise.

"Although this advice is certainly not new, discussing avoidance of environmental tobacco smoke with asthma patients remains critical," Dr. Akinbami said. "New tools are needed to help families achieve the goal of reducing exposure, both inside the home and in other environments."###