Chest
Volume 122, Issue 2, August 2002, Pages 409-415
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Clinical Investigations
SMOKING
Involuntary Smoking and Asthma Severity in Children: Data From the Third National Health and Nutrition Examination Survey

https://doi.org/10.1378/chest.122.2.409Get rights and content

Study objectives

We sought to determine the indicators of asthma severity among children in the United States with high and low levels of tobacco smoke exposure.

Design

Cross-sectional study.

Setting

Nationally representative survey of participants in the Third National Health and Nutrition Examination Survey (from 1988 to 1994).

Participants

Five hundred twenty-three children with physician-diagnosed asthma.

Measurements and results

We stratified the study participants into tertiles on the basis of serum levels of cotinine (a metabolite of nicotine that indicates tobacco smoke exposure). We used logistic and linear regression modeling, adjusting for known covariates, to determine the effect of high environmental tobacco smoke exposure on the following outcomes: asthma severity (determined using reported symptom and respiratory illness frequency); lung function; physician visits; and school absence. Among our study sample, 78.6% of children had mild asthma, 6.8% of children had moderate asthma, and 14.6% of children had severe asthma. Asthmatic children with high levels of smoke exposure, compared with those with low levels of exposure, were more likely to have moderate or severe asthma (odds ratio, 2.7 95% confidence interval [CI], 1.1 to 6.8) and decreased lung function, with a mean FEV1 decrement of 213 mL or 8.1% (95% CI, −14.7 to −3.5).

Conclusions

Involuntary smoke exposure is associated with increased asthma severity and worsened lung function in a nationally representative group of US children with asthma.

Section snippets

Study Population

The National Center for Health Statistics of the Centers for Disease Control and Prevention (Atlanta, GA) conducted NHANES III.13 NHANES III was approved by the Institutional Review Board of the National Center for Health Statistics, and the appropriate informed consent was obtained from survey participants. In this survey, a stratified, multistage, clustered probability design was used to select a representative sample of the civilian, noninstitutionalized US population. Survey participants

Results

Of the 13,944 children aged 2 months through 16 years who participated in NHANES III, 1,025 had physician-diagnosed asthma. Of this group, we excluded 308 who were < 4 years old, 36 who had not had a physical examination, 145 who had not had cotinine levels determined (typically because the blood sample was not enough for the cotinine analysis), and 13 who had cotinine levels of > 20 ng/mL, suggesting current smoking or spit tobacco use, resulting in 523 children in our analytic sample. Of

Discussion

Our primary findings are that children in whom asthma has been diagnosed by a physician have increased severity associated with tobacco smoke exposure. These children were significantly more likely to have more severe asthma, as indicated by increased symptoms of cough and wheeze, by an increased number of respiratory illnesses, and by lower levels of lung function. They were also more likely to have visited a physician more than once in the previous year, although this increase was not

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