ETS as a factor in asthma morbidity in an urban pediatric population

Abstract

Rationale To characterize families who agreed to be in a 12-month intervention study to reduce environmental tobacco smoke (ETS) exposure in their asthmatic children. Methods Participants were recruited from urban Denver health clinics and emergency departments. Children aged 2–13 years with asthma symptoms and exposure to ≥2 cigarettes/day in the home were eligible. A structured interview regarding smoking habits, psychosocial functioning, ETS exposure, and family asthma management (FAMSS) was conducted with the primary caregiver. Urine was collected from each child. Results Families (n=106) were low-income (53% <$12,000/year) with the mother as primary caregiver (85%). According to NHLBI guidelines, children's asthma was severe persistent—18% (n=19), moderate persistent—23% (n=24), mild persistent—17% (n=18), and mild intermittent—43% (n=45). Within three months of baseline, 93% (n=98) had used albuterol, 48% (n=51) controller medications, and 40% (n=42) prednisone. Caregivers reported smoking a mean of 10 cigarettes/day (range 1–30), and children had a median smoke exposure of 5 cigarettes/day (range 1–40). Urinary cotinine (geometric mean 11.00 ng/mg creatinine, sd=3.06) was significantly correlated with reported ETS exposure (r=0.29, p=0.007, n=85) and with FAMSS (r=-0.28, p<0.01, n=88). ETS exposure did not correlate with asthma morbidity; rather, asthma morbidity (hospital days) was significantly related to FAMSS (r=0.25, p<0.03). Similarly, caregiver mental health was significantly related to reported asthma severity (r=0.20, p=0.04), as was number of stressful life events (r=0.25, p=0.01). Conclusion ETS exposure in the home is one of many factors, including caregiver mental health and life stressors, which contribute to significant asthma morbidity in a low-income, urban population.