Does passive smoking increase the frequency of health service contacts in children with asthma?
I K Crombiea, A Wrighta, L Irvinea, R A Clarkb, P W Slanec
a Department of
Epidemiology and Public Health, University of Dundee, Ninewells
Hospital and Medical School, Dundee DD1 9SY, UK, b Department of Medicine, Stracathro Hospital,
Brechin, Angus DD9 7QA, UK, c Wallacetown Health Centre, West Lyon Street,
Dundee DD4 6PQ, UK
Correspondence to: Professor I K Crombie i.k.crombie{at}dundee.ac.uk
Received 14 April 2000; Returned to authors 7 June 2000; Revised version received 19 June 2000; Accepted for publication 3 July 2000
BACKGROUND
Passive
smoking is a major cause of respiratory morbidity in children. However,
few studies give accurate estimates of the health effects of passive
smoking in children with asthma using an objective measure of exposure.
The effects of passive smoking using salivary cotinine levels to
measure exposure were investigated.
METHODSA sample of
438 children aged 2-12 years with asthma who had a parent who smoked
were recruited in Tayside and Fife, Scotland. Health service contacts
for asthma, assessed from GP case records, were used as a proxy for morbidity.
RESULTSA weak
U-shaped relationship was found between the salivary cotinine level and
health service contacts for asthma: compared with low cotinine levels
those with moderate cotinine levels had a reduced contact rate
(relative rate (RR) = 0.91, 95% confidence interval (CI) 0.80 to
1.05), whereas high cotinine levels were associated with an increased
rate of contact (RR = 1.19, 95% CI 1.05 to 1.37). In contrast, a
strong association was seen with the amount the parent reported smoking
in front of the child: the higher the level the fewer visits were made
for asthma (RR for everyday exposure = 0.66, 95% CI 0.56 to 0.77).
This effect was not seen for non-respiratory visits. Demographic
factors, age of child, and number of children in the family all had a
powerful effect on the number of visits for asthma. The parents'
perception of asthma severity was associated with visit frequency
independent of actual severity (derived from drug treatment).
CONCLUSIONHigh levels
of parental smoking in the home are associated with a reduction in
health care contacts for asthma. This could be due to a lack of
awareness of asthma symptoms among heavy smokers or a reluctance to
visit the GP. Children with asthma who have parents who smoke heavily
may not be receiving adequate management.
Keywords: passive smoking; children; asthma; parental smoking; GP visits
© 2001 by Thorax
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