Association between Exposure to Environmental Tobacco Smoke and Exacerbations of Asthma in Children

Chilmonczyk, Barbara A.; Salmun, Luis M.; Megathlin, Keith N.; Neveux, Louis M.; Palomaki, Glenn E.; Knight, George J.; Pulkkinen, Andrea J.; Haddow, James E.

doi:10.1056/nejm199306103282303

Cited by 477 publications

(218 citation statements)

References 23 publications

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“…Multiple studies have reported that children exposed to ETS are at risk for developing lower lung function, increased use of rescue medications, and more frequent hospitalizations (15,16,31). As reported in RESULTS, averaged albuterol usage and LTE 4 levels were higher on days with higher cotinine levels but the effect of subsequent ambient pollutant concentrations was attenuated.…”

Section: Discussionmentioning

confidence: 81%

“…Almost all such studies estimate ambient health effects without taking into account concurrent exposures that may impact asthma, such as environmental tobacco smoke (ETS). However, in the setting of urban asthma, where high ambient exposures are assumed, concurrent exposures to ETS are also prevalent (13)(14)(15)(16)(17)(18)(19)(20). There are limited data on the response to ambient or indoor exposures in the typical urban environment where these concurrent exposures often occur.…”

mentioning

confidence: 99%

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The Response of Children with Asthma to Ambient Particulate Is Modified by Tobacco Smoke Exposure

Rabinovitch¹,

Silveira

Gelfand³

et al. 2011

Am J Respir Crit Care Med

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Rationale: Ambient particulate matter concentrations have been positively associated with urinary leukotriene E 4 (LTE 4 ) levels and albuterol usage in children with asthma but interactions with environmental tobacco smoke (ETS) exposure have not been demonstrated despite obvious exposure to both pollutants in an urban setting. Objectives: To assess the health effects of concurrent ETS and ambient particulate matter exposure in children with asthma. Methods: Albuterol usage and LTE 4 levels were monitored in 82 urban schoolchildren with asthma over three consecutive fall to spring school periods. Concentrations of morning maximum ambient particulate matter ,2.5 mm in aerodynamic diameter (mmPM 2.5 ) and urine cotinine levels were also measured daily. Measurements and Main Results: Albuterol usage and LTE 4 were related to mmPM 2.5 concentrations on days when urine cotinine levels were low (,10 ng/ml/mg creatinine); on these days, mean albuterol usage and LTE 4 increased up to 5 or 6% per 10 mg/m 3 increase in mmPM 2.5 . In contrast, no significant relationship was observed when cotinine was high, although mean albuterol usage and LTE 4 levels were greater in this case. Model fits for LTE 4 levels as a function of mmPM 2.5 concentrations were improved when mmPM 2.5 concentrations were logged, suggesting a nonlinear dose-response relationship between particulate matter exposure concentrations and airway mediators of asthma, for which the relationship tends to flatten at higher concentrations. Conclusions: This study suggests that ETS modifies the acute effects of low-level ambient PM 2.5 exposure on childhood asthma. This negative interaction, the smaller effect of particulate matter exposure in children exposed to higher ETS, may be related to a nonlinear dose-response relationship between asthma mediators and particulate exposures.Keywords: air pollution; leukotriene E 4 ; asthma; interaction; environmental tobacco smoke A number of panel studies have demonstrated a relationship between levels of airborne particulate matter less than 10 or 2.5 mm in aerodynamic diameter (PM 10 or PM 2.5 ) and acute asthma severity indices including hospital admissions (1-3), declines in pulmonary function, and increases in medication use and symptoms (4)(5)(6)(7)(8)(9)(10)(11)(12). Almost all such studies estimate ambient health effects without taking into account concurrent exposures that may impact asthma, such as environmental tobacco smoke (ETS). However, in the setting of urban asthma, where high ambient exposures are assumed, concurrent exposures to ETS are also prevalent (13-20). There are limited data on the response to ambient or indoor exposures in the typical urban environment where these concurrent exposures often occur. As such, it is unclear whether acute exposures to both ETS and ambient air pollution produce additive or synergistic effects or whether adaptive responses occur, limiting cumulative health effects from concurrent exposures.In previous analyses involving a panel of Denver urban schoolchildren with as...

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Section: Discussionmentioning

confidence: 81%

mentioning

confidence: 99%

The Response of Children with Asthma to Ambient Particulate Is Modified by Tobacco Smoke Exposure

Rabinovitch¹,

Silveira

Gelfand³

et al. 2011

Am J Respir Crit Care Med

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“…The CCR levels ranged from 0 to 1014 ng/ mg with an arithmetic mean of 85.03 ng/mg. Considering a limit of detection of 10 ng cotinine/mg creatinine (see Chilmonczyk et al, 1993), 30 (26%) of the 115 children children had no cotinine (27 children had 0 ng/mg and three children had between 0.5 and 0.7 ng/mg), whereas cotinine was detected in the other 85 (74%).…”

Section: Resultsmentioning

confidence: 99%

Environmental tobacco smoke exposure in children: parental perception of smokiness at home and other factors associated with urinary cotinine in preschool children

Jurado

Muñoz

Luna

et al. 2004

J Expo Sci Environ Epidemiol

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Parental smoking behavior at home and sociodemographic variables may influence exposure to environmental tobacco smoke (ETS) in children. A sample of 115 preschool children aged 3-6 years was enrolled in this study. ETS exposure was evaluated through a questionnaire about parents' smoking behavior and determinations of urinary cotinine F a biomarker of exposure F in children. Bivariate and multiple regression analyses were used to evaluate the association between the smoking behavior of each parent at home, sociodemographic factors and cotinine levels in children. The parental perception of smokiness in the home was significantly associated with urinary cotinine in children (r-partial coefficient ¼ 0.324; Po0.002). The father's education, mother's smoking status, and day of the week when urine was sampled (Tuesday) were also independently associated with levels of cotinine. These four variables explained 26.4% of the variance in the cotinine levels of children. In designing educational programs to reduce passive smoking among children, it is necessary to take into account those factors related with cotinine levels in children. Our results support the influence of the mothers' smoking status, the fathers' educational level, and the day of the week of sampling on cotinine in children. The perception of parents (smokers and nonsmokers) about the smokiness in the home could also be a useful indicator of the cotinine in children exposed to environmental tobacco smoke in the household.

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“…A 25-item questionnaire was developed from existing instruments (Chilmoncyzk et al, 1993;American Institute of Research, 1991;Asher et al, 1995;New York City Health and Hospitals Corp., 1995;Beckett et al, 1996;Koren, 1997;Eskenazi et al, 1999;Joseph et al, 1999) and was designed to characterize symptoms, health practices, and environmental exposure factors that have been documented to be asthma triggers or suspected asthma triggers (Chilmoncyzk et al, 1993;Ingram et al, 1995;Stoddard and Miller, 1995;Beckett et al, 1996;Koren, 1997;Platts-Mills and Carter, 1997;Eskenazi et al, 1999). Parents were requested to complete the questions (in either Spanish or English) about their child's respiratory health (symptoms, diagnosis, and medications), family history of asthma, school absenteeism, potential environmental exposures in the home, insurance status, and race/ethnicity.…”

Section: Methodsmentioning

confidence: 99%

Household exposure factors, asthma, and school absenteeism in a predominantly Hispanic community

Freeman

Schneider

McGarvey

2003

J Expo Sci Environ Epidemiol

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The Passaic Asthma Reduction Effort (PARÉ ) used an asthma symptom and household exposure factor questionnaire to screen 4634 elementary school children over a 4-year period in Passaic, New Jersey. During the first year, an additional 240 preschool children were also screened. Overall, 16% of the school children were reported by their parents to have been diagnosed with asthma. In all, 30% of responding families claimed to have at least one family member diagnosed with asthma and this was five times more likely if the target child had asthma. Exposures consistently associated with childhood asthma diagnosis included environmental tobacco smoke (ETS), presence of dampness/mold, roaches, and furry pets in the home. Diagnosis of asthma was primarily associated with all six symptoms used in the PARÉ questionnaire, and secondarily with environmental factors. Puerto Rican and black children had the highest asthma prevalence (26% and 33%), while Mexican children had the lowest (7%). Use of medications and school absenteeism among asthmatic children were associated with wheeze and night cough, but not with any specific environmental exposure. Increased school absenteeism by children undiagnosed with asthma was associated with ETS and dampness/mold in the home. Differences in asthma diagnosis and absenteeism in response to environmental factors were found across ethnic subgroups. Getting asthmatic children on medical management protocols and providing families with education about environmental risk reduction should aid in reducing morbidity in this ethnically complex population. Such coordinated efforts offer the promise of reducing school absenteeism.

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Association between Exposure to Environmental Tobacco Smoke and Exacerbations of Asthma in Children

Cited by 477 publications

References 23 publications

The Response of Children with Asthma to Ambient Particulate Is Modified by Tobacco Smoke Exposure

The Response of Children with Asthma to Ambient Particulate Is Modified by Tobacco Smoke Exposure

Environmental tobacco smoke exposure in children: parental perception of smokiness at home and other factors associated with urinary cotinine in preschool children

Household exposure factors, asthma, and school absenteeism in a predominantly Hispanic community

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