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Kit BK, Simon AE, Brody DJ, Akinbami LJ. US prevalence and trends in tobacco smoke exposure among children and adolescents with asthma. Pediatrics 2013; 131:407-14. [PMID: 23400612 DOI: 10.1542/peds.2012-2328] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine exposure to tobacco smoke products (TSPs), environmental tobacco smoke (ETS), and in-home smoke among youth with asthma in the United States. METHODS Nationally representative, cross-sectional data from 2250 youth aged 4 to 19 years with current asthma in the 1988-1994, 1999-2004, and 2005-2010 National Health and Nutrition Examination Survey (NHANES) were analyzed. Outcomes were use of TSPs (serum cotinine level >10 ng/mL or self-reported recent use of cigarettes, cigars, or pipes) and, among non-TSP users, ETS exposure (serum cotinine ≥0.05 ng/mL) and in-home smoke exposure (reported). Multiple logistic regression analyses assessed the associations between the outcomes and age, gender, race/ethnicity, and family income. RESULTS Among adolescents (aged 12-19 years) with asthma in 2005-2010, 17.3% reported TSP use. Among youth (aged 4-19 years) with asthma who did not use TSPs, 53.2% were exposed to ETS and 17.6% had in-home smoke exposure. Among low-income youth, 70.1% and 28.1% had exposure to ETS and in-home smoke, respectively. After controlling for sociodemographic factors, higher prevalence of exposure to ETS and in-home smoke persisted among low-income youth. Between 1988-1994 and 2005-2010, there was a decline in ETS and in-home smoke exposure (both P < .001). CONCLUSIONS ETS exposure among youth with asthma declined between 1988-1994 and 2005-2010, but a majority remained exposed in 2005-2010, with higher exposure among low-income youth. More than 1 in 6 youth with asthma in 2005-2010 were exposed to in-home smoke and a similar portion of adolescents used TSPs.
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Affiliation(s)
- Brian K Kit
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA.
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Lawson JA, Dosman JA, Rennie DC, Beach J, Newman SC, Senthilselvan A. Relationship of endotoxin and tobacco smoke exposure to wheeze and diurnal peak expiratory flow variability in children and adolescents. Respirology 2011; 16:332-9. [PMID: 21138498 DOI: 10.1111/j.1440-1843.2010.01911.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE The relationship between endotoxin exposure and asthma severity (wheeze and airways obstruction) is not well described. The effects of endotoxin and tobacco smoke exposure on self-reported wheeze and diurnal PEF variability (DV-PEF) were examined in children aged 6-18 years with asthma or wheeze. METHODS A cross-sectional study was performed in a rural area. From this study, children who reported wheeze in the previous 12 months or a physician diagnosis of asthma (n = 98) were selected for a case-control study. These subjects, who were the basis for the present analysis, completed: (i) a home environmental assessment, including dust collection to measure endotoxin levels: (ii) a clinic visit, including saliva collection to measure cotinine levels; and (iii) 2 week monitoring of twice daily symptom records, including wheeze, and PEF to calculate DV-PEF. RESULTS Among these children, 22.4% reported wheeze during the monitoring period. Greater DV-PEF was associated with higher endotoxin loads in play areas (P < 0.05). The association between salivary cotinine levels and high DV-PEF was modified by gender. In females, higher cotinine levels were associated with an increased risk of high DV-PEF compared with lower cotinine levels (P < 0.05), but this was not observed among males. CONCLUSIONS Higher endotoxin exposure was associated with greater DV-PEF among children with asthma or wheeze. While previous studies have suggested that endotoxin exposure protects against the development of asthma, individuals with the disease should avoid high exposure levels to limit exacerbations. The effect of tobacco smoke exposure on lung health may differ between male and female children.
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Affiliation(s)
- Joshua A Lawson
- Canadian Centre for Health and Safety in Agriculture, Department of Medicine College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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3
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O'Rourke JM, Kalish LA, McDaniel S, Lyons B. The effects of exposure to environmental tobacco smoke on pulmonary function in children undergoing anesthesia for minor surgery. Paediatr Anaesth 2006; 16:560-7. [PMID: 16677267 DOI: 10.1111/j.1460-9592.2005.01821.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The objectives of this study were to assess whether children exposed to environmental tobacco smoke (ETS) present for surgery with poorer pulmonary function, and experience a more pronounced deterioration in pulmonary function following anesthesia and surgery, than non-ETS-exposed children. METHODS Fifty-four children aged 5-15 years with a history of ETS exposure from one or both parents and 54 children with no such ETS history were included in the study. All participants were presenting for ambulatory surgery and were judged to conform to American Society of Anesthesiology class I or II. Spirometry was performed preoperatively, postoperatively in the recovery ward when the child met criteria for discharge (Aldrete score 8), and before discharge from the day ward. RESULTS The ETS-exposed group had a significantly lower mean preoperative peak expiratory flow rate (PEFR) (9.5 points lower percent predicted, 95% confidence interval -18.1 to -1.0, P = 0.03). Although not statistically significant, they also had lower percent predicted baseline mean values of the other spirometric variables that were measured (forced expiratory volume in 1 s -4.5%, P = 0.07; forced vital capacity -4.1%, P = 0.10; forced expiratory flow between 25% and 75%-3.6%, P = 0.44). Pulmonary function tests (PFTs) performed in recovery were between 8% and 14% worse than preoperative values, but the results were similar in the two groups of children. PFTs performed before hospital discharge demonstrated an near-complete recovery to baseline values. Again the pattern was similar in exposed and nonexposed children. CONCLUSIONS Environmental tobacco smoke exposure is associated with lower preoperative PEFR values, but does not impact on recovery from anesthesia for healthy children undergoing ambulatory anesthesia.
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Affiliation(s)
- James M O'Rourke
- Department of Anesthesiology, Medical & Surgical ICU, Children's Hospital Boston, Boston, MA, USA.
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Bornehag CG, Sundell J, Bonini S, Custovic A, Malmberg P, Skerfving S, Sigsgaard T, Verhoeff A. Dampness in buildings as a risk factor for health effects, EUROEXPO: a multidisciplinary review of the literature (1998-2000) on dampness and mite exposure in buildings and health effects. INDOOR AIR 2004; 14:243-57. [PMID: 15217478 DOI: 10.1111/j.1600-0668.2004.00240.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
UNLABELLED The scientific literature on health effects from dampness in buildings, including mite exposure over the period 1998-2000 has been reviewed by an European group (EUROEXPO) of eight scientists in experience from medicine, epidemiology, toxicology and engineering. Forty studies deemed relevant have been the foundation for the conclusions. Dampness in buildings is a risk factor for health effects among atopics and non-atopics both in domestic and in public environments. However, the literature is not conclusive in respect of causative agents, e.g. mites, microbiological agents and organic chemicals from degraded building materials. There is a strong need for more multidisciplinary studies including expertise from all relevant areas. A general conclusion from the work was that there is a strong need for multidisciplinary reviews in scientific journals of articles dealing with associations between indoor environmental factors and health effects. PRACTICAL IMPLICATIONS There is good evidence for a true association between dampness in buildings and health. As the causative factors behind this association are not known, the main focus in practical investigations should be on finding out and remediate the reasons for the humidity problem.
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Affiliation(s)
- C G Bornehag
- Swedish National Testing and Research Institute, Boras, Sweden.
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Mannino DM, Albalak R, Grosse S, Repace J. Second-hand smoke exposure and blood lead levels in U.S. children. Epidemiology 2004; 14:719-27. [PMID: 14569189 DOI: 10.1097/01.ede.0000081998.02432.53] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lead is a component of tobacco and tobacco smoke, and smokers have higher blood lead levels than do nonsmokers. METHODS We examined the relation between second-hand smoke exposure and blood lead levels in a nationally representative sample of 5592 U.S. children, age 4-16 years, who participated in the Third National Health and Nutrition Examination Survey (1988-1994). Linear and logistic regression modeling was used to adjust for known covariates. RESULTS Geometric mean blood lead levels were 1.5 mug/dL, 1.9 mug/dL, and 2.6 mug/dL for children with low, intermediate, and high cotinine levels, respectively. The adjusted linear regression model showed that geometric mean blood lead levels were 38% higher (95% confidence interval [CI] = 25-52%) in children with high cotinine levels compared with children who had low cotinine levels. The logistic regression models showed that children with high cotinine levels were more likely to have blood lead levels >/=10 mug/dL than were children with low cotinine levels (odds ratio [OR] = 4.4; CI = 1.9-10.5). CONCLUSIONS Second-hand smoke could be associated with increased blood lead levels in U.S. children aged 4-16 years.
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Affiliation(s)
- David M Mannino
- Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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McQuaid EL, Walders N, Borrelli B. Environmental tobacco smoke exposure in pediatric asthma: overview and recommendations for practice. Clin Pediatr (Phila) 2003; 42:775-87. [PMID: 14686549 DOI: 10.1177/000992280304200903] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Elizabeth L McQuaid
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, Rhode Island, USA
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Mannino DM, Homa DM, Redd SC. Involuntary smoking and asthma severity in children: data from the Third National Health and Nutrition Examination Survey. Chest 2002; 122:409-15. [PMID: 12171810 DOI: 10.1378/chest.122.2.409] [Citation(s) in RCA: 151] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
STUDY OBJECTIVES We sought to determine the indicators of asthma severity among children in the United States with high and low levels of tobacco smoke exposure. DESIGN Cross-sectional study. SETTING Nationally representative survey of participants in the Third National Health and Nutrition Examination Survey (from 1988 to 1994). PARTICIPANTS Five hundred twenty-three children with physician-diagnosed asthma. MEASUREMENTS AND RESULTS We stratified the study participants into tertiles on the basis of serum levels of cotinine (a metabolite of nicotine that indicates tobacco smoke exposure). We used logistic and linear regression modeling, adjusting for known covariates, to determine the effect of high environmental tobacco smoke exposure on the following outcomes: asthma severity (determined using reported symptom and respiratory illness frequency); lung function; physician visits; and school absence. Among our study sample, 78.6% of children had mild asthma, 6.8% of children had moderate asthma, and 14.6% of children had severe asthma. Asthmatic children with high levels of smoke exposure, compared with those with low levels of exposure, were more likely to have moderate or severe asthma (odds ratio, 2.7 95% confidence interval [CI], 1.1 to 6.8) and decreased lung function, with a mean FEV(1) decrement of 213 mL or 8.1% (95% CI, -14.7 to -3.5). CONCLUSIONS Involuntary smoke exposure is associated with increased asthma severity and worsened lung function in a nationally representative group of US children with asthma.
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Affiliation(s)
- David M Mannino
- Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Payne DNR, Balfour-Lynn IM, Biggart EA, Bush A, Rosenthal M. Subcutaneous terbutaline in children with chronic severe asthma. Pediatr Pulmonol 2002; 33:356-61. [PMID: 11948980 DOI: 10.1002/ppul.10081] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A continuous subcutaneous infusion of terbutaline (CSIT) was used to treat 8 children with chronic severe asthma who continued to experience frequent symptoms, despite treatment with regular oral prednisolone. Five patients experienced a symptomatic improvement from CSIT, leading to a reduction in regular medication. Three patients did not experience any lasting benefit from CSIT. The most common side effects were related to the infusion site (bruising and local infection). CSIT may lead to an improvement in symptoms and a reduction in oral steroid dose in selected children with chronic severe asthma. These initial findings support the need for further controlled studies to evaluate the use of CSIT in severe childhood asthma.
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Affiliation(s)
- Donald N R Payne
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK.
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Simoni M, Carrozzi L, Baldacci S, Scognamiglio A, Di Pede F, Sapigni T, Viegi G. The Po River Delta (north Italy) indoor epidemiological study: effects of pollutant exposure on acute respiratory symptoms and respiratory function in adults. ARCHIVES OF ENVIRONMENTAL HEALTH 2002; 57:130-6. [PMID: 12194158 DOI: 10.1080/00039890209602928] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The authors studied the effects of relatively low doses of nitrogen dioxide and respirable suspended particulate matter (i.e., < 2.5 mu) on acute respiratory symptoms and on peak expiratory flow in 383 adults (15-72 yr of age) who lived in the Po River Delta area, located near Venice. During 2 wk-1 wk in winter and 1 wk in summer--the authors monitored each participant's house to measure nitrogen dioxide (in parts per billion) and respirable suspended particulate (microgram/m3) concentration. Information on sex, age, height, weight, daily activity patterns, active and passive smoking, chronic respiratory diseases, daily peak expiratory flow, and presence of acute respiratory symptoms during the weeks monitoring occurred were also collected. Peak expiratory flow variation was studied as mean amplitude percentage (i.e., amplitude/mean) and percentage of diurnal variation (maximum/minimum). The exposure indices to nitrogen dioxide (nitrogen dioxide--index of exposure) and to respirable suspended particulate matter (respirable suspended particulate matter-index of exposure) were computed as the product of pollutant concentration and time of exposure. The authors considered indices as "low" or "high" on the basis of the median value. The median nitrogen dioxide was 20 ppb in winter and 14 ppb in summer; the highest nitrogen dioxide levels occurred in the kitchen in the winter (33 ppb) and summer (20 ppb). The median respirable suspended particulate matter was 68 micrograms/m3 in winter and 45 micrograms/m3 in summer. Only in winter were there significant associations between bronchitic/asthmatic symptoms and "high" nitrogen dioxide and respirable suspended particulate matter indices. In subjects who did not smoke, a significant influence of the "high" respirable suspended particulate matter-index of exposure was also observed in summer. With respect to peak expiratory flow and its variability, respirable suspended particulate matter-index of exposure was associated with an increase of both amplitude/mean and maximum/mean; however, with respect to the nitrogen dioxide--index of exposure, the association was significant only in subjects with chronic respiratory diseases (i.e., asthma and bronchitis). These relationships were significant only in winter. In conclusion, the results of the current study indicate that there is an association between relatively low doses of pollutants and acute respiratory symptoms and peak expiratory flow in adults.
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Affiliation(s)
- Marzia Simoni
- Department of Diagnostic and Experimental Medicine, Section of General Pathology, University of Ferrara, CNR Institute of Clinical Physiology, Pisa, Italy
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Battleman DS, Callahan MA, Silber S, Muñoz CI, Santiago L, Abularrage J, Jabbar H. Dedicated asthma center improves the quality of care and resource utilization for pediatric asthma: a multicenter study. Acad Emerg Med 2001; 8:709-15. [PMID: 11435185 DOI: 10.1111/j.1553-2712.2001.tb00189.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the relative effectiveness of pediatric asthma care among patients treated by a dedicated asthma center (AC) vs children who use the emergency department (ED) as a site of primary asthma care. METHODS A retrospective case-control design was used. A random sample of AC cases was selected from a designated comprehensive AC over a 12-month period. Concurrent ED control patients were identified from all cases of pediatric asthma from five urban hospitals based on two or more ED visits. Cases and controls were matched (1:2) based on age and National Heart, Lung, and Blood Institute (NHLBI) asthma severity of illness classification. A telephone survey was administered to the caregivers of all enrolled patients in the study sample. RESULTS Four elements of pediatric asthma care were examined: quality, access, hospital utilization, and functional impact of disease. Demographic data were similar between the ED cases and the AC controls. In terms of quality of care, the AC patients were more likely to use maintenance antiinflammatory medications, 60.2% vs 22.5% (OR = 5.3; 95% CI = 2.9 to 9.7) and more likely to be taking medications at school, 71.4% vs 48.1% (OR = 2.7; 95% CI = 1.5 to 4.7). In terms of access to care, the AC families were more likely to have a physician to call to assist with outpatient management, 98.2% vs 65.0% (OR = 25.3; 95% CI = 9.0 to 76.9). Frequent ED utilization (> or = 1 visit/month) was less likely in the AC patients, 9.2% vs 22.0% (OR = 0.35; 95% CI = 0.16 to 0.79) and school absenteeism was lower as well (9.5 +/- 6.7 days vs 16.6 +/- 10.3, p < 0.001). Additionally, the caregivers of the AC patients missed fewer workdays (4.7 +/- 2.8 vs 7.4 +/- 4.1; p = 0.03). CONCLUSIONS Significant disparities in quality, access, resource utilization, and functional impact exist between AC and ED patients. Emergency physicians have a unique opportunity to improve the public health by directing ED patients toward pediatric AC treatment.
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Affiliation(s)
- D S Battleman
- Office of Outcomes Research, Department of Public Health, New York Presbyterian Healthcare System, Weill Medical College of Cornell University, New York, NY 10021, USA.
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Payne DN, Wilson NM, James A, Hablas H, Agrafioti C, Bush A. Evidence for different subgroups of difficult asthma in children. Thorax 2001; 56:345-50. [PMID: 11312401 PMCID: PMC1746042 DOI: 10.1136/thorax.56.5.345] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Children with difficult asthma experience frequent symptoms despite treatment with high dose inhaled steroids. Persistent symptoms may result from persistent airway inflammation which can be monitored by measuring exhaled nitric oxide (NO). This study aimed to assess the role of airway inflammation, using NO as a surrogate, in children with difficult asthma and to investigate the response to oral prednisolone. METHODS NO was measured in 23 children (mean age 11.7 years) with difficult asthma, before and after 2 weeks of treatment with oral prednisolone. The clinical response was assessed by spirometric tests, peak flow, bronchodilator use, and symptoms. Adherence to treatment was assessed by measuring serum prednisolone and cortisol concentrations. NO was measured in 55 healthy children to establish a normal range. RESULTS NO concentrations were higher in asthmatic patients than in controls (geometric mean 11.2 v 5.3 ppb, p<0.01). Using grouped data, the concentration of NO fell following prednisolone (11.2 v 7.5 ppb, p<0.01) accompanied by an improvement in morning peak flow (p<0.05). The baseline NO concentration was raised (>12.5 ppb) in nine asthmatic patients and remained high after prednisolone in five. Thirteen had normal levels of NO (<12.5 ppb) before and after prednisolone. Thirteen asthmatic patients remained symptomatic following prednisolone; NO levels were raised on both occasions in five of these and were normal in seven. CONCLUSIONS As a group, the asthmatic subjects demonstrated evidence of airway inflammation which responded to prednisolone. At least two subgroups of patients were identified: one with persistently raised NO levels despite treatment with oral prednisolone indicating ongoing steroid insensitive inflammation, and another with normal levels of NO. Both subgroups included patients with persistent symptoms, which suggests that different patterns of difficult asthma in children exist.
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Affiliation(s)
- D N Payne
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
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Effects of maternal and early tobacco exposure on the development of asthma and airway hyperreactivity. Curr Opin Allergy Clin Immunol 2001. [DOI: 10.1097/00130832-200104000-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Involuntary smoking is the third leading preventable cause of death, and among children it causes lower respiratory infections, middle ear disease, sudden infant death syndrome, and asthma. Half the world's children may be exposed to environmental tobacco smoke (ETS), exacerbating symptoms in 20% of children with asthma. Recent studies have reinforced previous conclusions that ETS exposure causes onset of childhood asthma and exacerbation of symptoms throughout life. The exact mechanisms by which this is accomplished are still unclear, as are the relative contributions of prenatal versus postnatal exposure. However, favorable health outcomes can be attained with reduced exposure. Among the few studies of ETS exposure reduction interventions, low-intensity advice methods appeared ineffective, and counseling parent smokers appeared successful. Direct counseling of school-aged children to avoid ETS has yet to be tested. Community norms may need to shift further in favor of protecting children and others from ETS before minimal interventions can be successful. This will require combined and ongoing efforts of the medical and public health establishments, in concert with legislation mandating tobacco-free public places and with ETS-related media campaigns.
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Affiliation(s)
- D R Wahlgren
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, CA, USA
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