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Previous Volume 328:1665-1669 June 10, 1993 Number 23 Next

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ABSTRACT

Background Exposure to environmental tobacco smoke, as reported by parents, has been linked to diminished pulmonary function and more frequent exacerbations of asthma in children with the disease. Further insight into this association might be gained by using urine cotinine levels to measure actual exposure.

Methods We measured urine cotinine levels in 199 children with asthma; 145 also underwent pulmonary-function studies. A parent answered questions about each child's exposure to environmental tobacco smoke. Acute exacerbations of asthma during the preceding year were documented through blinded review of medical records. Possible confounding factors were accounted for by the use of multivariate analysis and by comparisons of serum theophylline levels in exposed and unexposed children.

Results The median urine cotinine levels were 5.6 ng per milliliter in the 116 children reported not to have been exposed to tobacco smoke, 13.1 ng per milliliter in the 53 children exposed to cigarette smoking by the mother or other persons, and 55.8 ng per milliliter in the 30 children exposed to cigarette smoking by the mother and other persons. Acute exacerbations of asthma increased with exposure, whether such exposure was reported by a parent or identified on the basis of the cotinine level; the relative risks for the highest as compared with the lowest exposure category were 1.8 (95 percent confidence interval, 1.4 to 2.2) for reported exposure and 1.7 (95 percent confidence interval, 1.4 to 2.1) for exposure indicated by cotinine levels. The forced expiratory volume in one second (FEV₁), the forced expiratory flow between 25 and 75 percent of vital capacity, and the ratio of FEV₁ to forced vital capacity also decreased with increases in both measures of exposure.

Conclusions Measurement of urine cotinine levels provides further evidence of an association between exposure to environmental tobacco smoke and pulmonary morbidity in children with asthma. These data emphasize the need for systematic, persistent efforts to stop the exposure of children with asthma to environmental tobacco smoke.

Source Information

From the Foundation for Blood Research, Scarborough, Me. (B.A.C., L.M.N., G.E.P., G.J.K., A.J.P., J.E.H.); and the Maine Medical Center, Portland (B.A.C., L.M.S., K.N.M.).

Address reprint requests to Dr. Haddow at the Foundation for Blood Research, P.O. Box 190, Scarborough, ME 04070-0190.

Full Text of this Article

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• EISNER, M. D., YELIN, E. H., HENKE, J., SHIBOSKI, S. C., BLANC, P. D. (1998). Environmental Tobacco Smoke and Adult Asthma . The Impact of Changing Exposure Status on Health Outcomes. Am. J. Respir. Crit. Care Med. 158: 170-175 [Abstract] [Full Text]  
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• Schulaner, F. A., Jaen, C. R., Rosenstreich, D. L., The Environmental Subcommittee of the National Coo, (1997). Cockroach Allergen and Asthma. NEJM 337: 791-792 [Full Text]  
• Committee on Environmental Health, (1997). Environmental Tobacco Smoke: A Hazard to Children. Pediatrics 99: 639-642 [Abstract] [Full Text]  
• Abulhosn, R. S., Morray, B. H., Llewellyn, C. E., Redding, G. J. (1997). Passive Smoke Exposure Impairs Recovery After Hospitalization for Acute Asthma. Arch Pediatr Adolesc Med 151: 135-139 [Abstract]  
• Matsumoto, K., Aizawa, H., Inoue, H., Shigyo, M., Takata, S., Hara, N. (1996). Thromboxane causes airway hyperresponsiveness after cigarette smoke-induced neurogenic inflammation. J. Appl. Physiol. 81: 2358-2364 [Abstract] [Full Text]  
• Parmet, W. E., Daynard, R. A., Gottlieb, M. A. (1996). The Physician's Role in Helping Smoke-Sensitive Patients to Use the Americans With Disabilities Act to Secure Smoke-Free Workplaces and Public Spaces. JAMA 276: 909-913 [Abstract]  
• Council on Scientific Affairs, American Medical As, (1994). Environmental Tobacco Smoke: Health Effects and Prevention Policies. Arch Fam Med 3: 865-871 [Abstract]  
• Berwick, D. M. (1994). Eleven Worthy Aims for Clinical Leadership of Health System Reform. JAMA 272: 797-802 [Abstract]  
• Hisnanick, J. J., Coddington, D. A., Gergen, P. J. (1994). Trends in Asthma-Related Admissions Among American Indian and Alaskan Native Children From 1979 to 1989: Universal Health Care in the Face of Poverty. Arch Pediatr Adolesc Med 148: 357-363 [Abstract]  
• Richardson, R.S., Coggins, C., Haddow, J. E., Palomaki, G. E., Chilmonczyk, B. A., Boyle, P. (1993). The Hazards of Active and Passive Smoking. NEJM 329: 1580-1581 [Full Text]  
• (1993). PASSIVE SMOKING TRIGGERS CHILDHOOD ASTHMA. JWatch General 1993: 4-4 [Full Text]  
• Boyle, P. (1993). The Hazards of Passive -- And Active -- Smoking. NEJM 328: 1708-1709 [Full Text]