Passive smoking and the health of children.

Couriel, Jon

doi:10.1136/thx.49.8.731

Cited by 48 publications

(23 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Smoking and passive exposure to cigarette smoke in the home is more common among people in lower income groups [13,48], and may increase the morbidity among asthmatics [49]. Although parental smoking has not been shown to increase the risk of hospital admissions for acute asthma in children [50,51], it is possible that smoking may contribute to the relationship found in this study. There may be greater levels of atmospheric pollution in the more urban areas, which tend to be more deprived.…”

Section: Discussioncontrasting

confidence: 38%

The relationship between asthma admission rates, routes of admission, and socioeconomic deprivation

Watson¹,

Cowen²,

Lewis³

1996

Eur Respir J

View full text Add to dashboard Cite

T Th he e r re el la at ti io on ns sh hi ip p b be et tw we ee en n a as st th hm ma a a ad dm mi is ss si io on n r ra at te es s, , r ro ou ut te es s o of f a ad dm mi is ss si io on n, , a an nd d s so oc ci io oe ec co on no om mi ic c d de ep pr ri iv va at ti io on n ABSTRACT: This study aimed to explore the relationship between hospital admissions for asthma and socioeconomic deprivation. A retrospective study examined one year of hospital admissions for asthma in the West Midlands region of England (n=10,044), and in one of the region's wealthier districts, Worcester (n=251). Age standardized admission ratios (SARs) for asthma, and the routes of hospital admission, were compared with the Townsend Deprivation Index for the place of residence.Asthma SAR was strongly associated with deprivation as measured by the Townsend Index for the district of residence (Spearman rank correlation coefficient ρ=0.65; p=0.004). Asthma admission rates for all age groups, except those aged over 65 yrs, were higher in poorer districts. A significantly greater proportion of emergency admissions in poorer districts came via Accident and Emergency departments, rather than general practitioner referrals (ρ=0.76; p<0.001). Within Worcester District, SAR was associated with Townsend Index for the ward of residence (ρ=0.39; p<0.001). This remained significant after excluding repeat admissions (ρ=0.45; p<0.001).We conclude that asthma admissions are strongly associated with deprivation in the community. Differences in the health care received during acute exacerbations by asthma patients from different economic backgrounds is likely to be an important factor in this relationship.

show abstract

Section: Discussioncontrasting

confidence: 38%

The relationship between asthma admission rates, routes of admission, and socioeconomic deprivation

Watson¹,

Cowen²,

Lewis³

1996

Eur Respir J

View full text Add to dashboard Cite

show abstract

“…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%

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

View full text Add to dashboard Cite

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...

show abstract

“…[35][36][37][38] Smoking was present in more than half of the homes in which these study patients reside. A reduction in home exposure of children Ͻ6 years of age to Յ20% is a stated goal of the US Public Health Service in its Healthy People 2000 report.…”

Section: Discussionmentioning

confidence: 99%

School-age Follow-up of Prophylactic Versus Rescue Surfactant Trial: Pulmonary, Neurodevelopmental, and Educational Outcomes

et al. 1998

View full text Add to dashboard Cite

ABSTRACT. Background. Exogenous surfactant replacement has improved survival and reduced pulmonary complications of prematurity. Improved early outcomes for infants of <30 weeks' gestation treated with a strategy of prophylactic versus rescue surfactant, if needed, were demonstrated in a multicenter, randomized trial conducted between 1985 and 1988. We reevaluated a subset of survivors from this trial to determine the pulmonary and neurodevelopmental outcomes at school age.Methods. At 4.5 to 8 years of age, all survivors from one of the three centers were located, and 96% were evaluated. The original randomization included stratification by center and followed an intention-to-treat methodology in assessing the efficacy of prophylactic versus rescue treatment with surfactant. The follow-up test battery included a health-assessment questionnaire, spirometry, 88% saturation test, neurologic examination, and the McCarthy Scales of Children's Abilities (MSCA) and the Conners' Parent Rating Scale-48. Educational achievement was determined by school class placement and teachers' reports of achievement.Results. Of the 192 children originally enrolled, 154 survived. Evaluations were performed on 148 of these infants. An abnormal pulmonary history was found in 45 (30%) of the children: 16 (22%) in the prophylactic group and 29 (39%) in the rescue group. Formal pulmonary function was evaluated in 81 children; 29 (78%) in the prophylactic group and 33 (75%) in the rescue group were considered abnormal. No significant differences were found between the two groups on either cognitive or motor subscales of the MSCA, the Conners' Parent Rating Scale-48, the neurologic examination, the education services received in school, or the teacher ratings of below-average academic performance. Intelligence scores measured on the MSCA were low-normal for both groups. Some level of educational assistance was being provided to 72 (49%) of the cohort studied, and both groups had below average educational performance and increased needs for educational assistance.Conclusions. Prophylactic surfactant administration to infants of <30 weeks' gestation was associated with fewer long-term clinical pulmonary complications than assignment to rescue administration. Formal pulmonary testing at school age did not reveal significant differences between treatment groups in those infants who could be tested. There also were no group differences found on neurologic, cognitive, behavioral, or educational assessments at school age. E xogenous surfactant has become accepted therapy for the prevention and treatment of respiratory distress syndrome (RDS) in small premature infants. [1][2][3][4][5] Multiple studies have demonstrated short-term safety, improved survival, and decreased early morbidity with use of surfactant. 1,7,8 However, important issues concerning surfactant therapy remain unanswered including the optimum timing of its administration and the long-term (school-age) pulmonary, neurodevelopmental, and educational outcome of treated children.Prophy...

show abstract

Passive smoking and the health of children.

Cited by 48 publications

References 43 publications

The relationship between asthma admission rates, routes of admission, and socioeconomic deprivation

The relationship between asthma admission rates, routes of admission, and socioeconomic deprivation

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

School-age Follow-up of Prophylactic Versus Rescue Surfactant Trial: Pulmonary, Neurodevelopmental, and Educational Outcomes

Contact Info

Product

Resources

About