Gerald LB, Gerald JK, Gibson L, Patel K, Zhang S, McClure LA. Chest. 2009;135(4):911–916
PURPOSE OF THE STUDY. Using data from a large randomized trial of supervised asthma therapy in urban elementary schools, the authors of this study sought to document the relationship between changes in environmental tobacco smoke (ETS) exposure and childhood asthma morbidity.
STUDY POPULATION. There were 290 children with physician-diagnosed persistent asthma that required daily controller medication who were enrolled in 1 of 36 participating schools.
METHODS. By using data from a randomized, clinical trial of supervised asthma therapy versus usual care, asthma morbidity and ETS exposure data were collected from caregivers via telephone interviews at baseline and at a 1-year follow-up time. No smoking cessation counseling or ETS exposure education was provided to caregivers; however, children were given 20 minutes of asthma education, with a discussion on avoidance of asthma triggers including ETS.
RESULTS. At baseline, 28% of the caregivers reported ETS exposure in the home, and 19% reported exposure outside the primary household only. At the follow-up time, caregivers were asked whether ETS exposure had increased, decreased, or stayed the same, with results as follows: 74% reported no change, 17% reported decreased exposure, and 9% reported increased exposure. Among children whose ETS exposure decreased, there were fewer hospitalizations (P = .034) and emergency department visits (P < .001) reported in the 12 months before the second interview, compared with the 12 months before the first interview. These children were also less likely to have an episode of poor asthma control, compared with the children with no change or increased exposure (odds ratio: 0.45 [95% confidence interval: 0.23–0.88]).
CONCLUSIONS. This study demonstrated associations between ETS exposure reduction and fewer episodes of poor asthma control and fewer respiratory-related emergency department visits and hospitalizations.
REVIEWER COMMENTS. Approximately 60% of US children 3 to 11 years of age are exposed to ETS. This study demonstrated that reduction in ETS exposure improved asthma outcomes. Limitations of this study are that it was questionnaire-based, relying on caregivers’ report and that it was based on recall over the prior 12 months. It is promising that a benefit was seen even without specific counseling on ETS exposure and tobacco cessation. With more-targeted education and counseling, a greater benefit may be seen. It is important for pediatricians to play an active role in inquiring about ETS exposure and offering parents guidance on smoking cessation; this is especially important for children with asthma.
- Copyright © 2009 by the American Academy of Pediatrics