Chest
Volume 135, Issue 4, April 2009, Pages 911-916
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Original Research
Asthma
Changes in Environmental Tobacco Smoke Exposure and Asthma Morbidity Among Urban School Children

https://doi.org/10.1378/chest.08-1869Get rights and content

Background

Environmental tobacco smoke (ETS) exposure is associated with poor asthma outcomes in children. However, little is known about natural changes in ETS exposure over time in children with asthma and how these changes may affect health-care utilization. This article documents the relationship between changes in ETS exposure and childhood asthma morbidity among children enrolled in a clinical trial of supervised asthma therapy.

Methods

Data for this analysis come from a large randomized clinical trial of supervised asthma therapy in which 290 children with persistent asthma were randomized to receive either usual care or supervised asthma therapy. No smoking cessation counseling or ETS exposure education was provided to caregivers; however, children were given 20 min of asthma education, which incorporated discussion of the avoidance of asthma triggers, including ETS. Asthma morbidity and ETS exposure data were collected from caregivers via telephone interviews at baseline and at the 1-year follow-up.

Results

At baseline, 28% of caregivers reported ETS exposure in the home and 19% reported exposure outside of the primary household only. Among children whose ETS exposure decreased from baseline, fewer hospitalizations (p = 0.034) and emergency department (ED) visits (p ≤ 0.001) were reported in the 12 months prior to the second interview compared to the 12 months prior to the first interview. Additionally, these children were 48% less likely (p = 0.042) to experience an episode of poor asthma control (EPAC).

Conclusions

This is the first study to demonstrate an association between ETS exposure reduction and fewer EPACs, respiratory-related ED visits, and hospitalizations. These findings emphasize the importance of ETS exposure reduction as a mechanism to improve asthma control and morbidity. Potential policy implications include supporting ETS reductions and smoking cessation interventions for parents and caregivers of children with asthma. Research to identify the most cost-effective strategy is warranted.

Trial registration

Clinicaltrials.gov Identifier: NCT00110383

Section snippets

Materials and Methods

Data for this analysis come from a large randomized trial22, 23 of supervised asthma therapy that has been previously described in detail. Briefly, children were eligible if they met the following criteria: physician-diagnosed persistent asthma requiring daily controller medication, enrollment in 1 of 36 participating schools, and ability to use a dry-powder inhaler and a peak flowmeter. Children were recruited through local schools, physician offices, and health department clinics and

Results

Table 1 shows the demographic characteristics of the sample at baseline (n = 256). The mean age of children was 11 years (SD, 2.1 years). Fifty-eight percent of children (n = 149) were male, and 90% (n = 230) were black. Eighty percent of the children had moderate persistent asthma. At baseline, 28% of caregivers reported ETS exposure in the home and 19% reported exposure outside of the primary household only. There were no statistically significant differences at baseline among children in the

Discussion

This is the first study to demonstrate a statistically significant association between ETS exposure reduction and fewer episodes of poor asthma control, respiratory-related ED visits, and hospitalizations. Secondhand smoke exposure within this population of urban school children with asthma was 47%. Exposure in the primary home accounted for 60% of the exposure. Over time, ETS exposure decreased from 47 to 40% among the children enrolled in this clinical trial. Children who had any decrease in

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    This trial was sponsored by the National Institutes of Health, National Heart, Lung, and Blood Institute (R01HL075043). Blue Cross and Blue Shield of Alabama provided support for the Internet-based Asthma Agents monitoring system. Pulmicort Turbuhalers were provided by AstraZeneca Pharmaceuticals.

    The authors have no conflicts of interest to disclose.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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