Abstract | OBJECTIVE: To explore the relationship between tobacco smoke exposure (reported versus biomarker) and rates of readmission for children hospitalized for asthma. METHODS: We enrolled a prospective cohort of 774 children aged 1 to 16 years admitted for asthma or bronchodilator-responsive wheezing. The primary outcome was at least 1 asthma- or wheeze-related readmission within 1 year. Caregivers reported any tobacco exposure at home, in a secondary residence, or in the car. We measured serum and saliva cotinine levels with mass spectrometry. We used logistic regression to evaluate associations between tobacco exposure and readmissions. RESULTS: A total of 619 children had complete tobacco exposure data; 57% were African American and 76% had Medicaid. Seventeen percent of children were readmitted within 1 year. Tobacco exposure rates were 35.1%, 56.1%, and 79.6% by report, serum, and saliva measures, respectively. Caregiver report of any tobacco exposure was not associated with readmission (adjusted odds ratio: 1.18; 95% confidence interval: 0.79-1.89), but having detectable serum or salivary cotinine was associated with increased odds of readmission (adjusted odds ratio [95% confidence interval]: 1.59 [1.02-2.48] and 2.35 [1.22-4.55], respectively). Among children whose caregivers reported no tobacco exposure, 39.1% had detectable serum cotinine and 69.9% had detectable salivary cotinine. Of the children with reported exposure, 87.6% had detectable serum cotinine and 97.7% had detectable salivary cotinine. CONCLUSIONS: Detectable serum and salivary cotinine levels were common among children admitted for asthma and were associated with readmission, whereas caregiver report of tobacco exposure was not.
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Authors | Judie A Howrylak, Adam J Spanier, Bin Huang, Roy W A Peake, Mark D Kellogg, Hadley Sauers, Robert S Kahn |
Journal | Pediatrics
(Pediatrics)
Vol. 133
Issue 2
Pg. e355-62
(Feb 2014)
ISSN: 1098-4275 [Electronic] United States |
PMID | 24446438
(Publication Type: Journal Article, Observational Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Chemical References |
- Tobacco Smoke Pollution
- Cotinine
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Topics |
- Adolescent
- Asthma
(blood, metabolism)
- Child
- Child, Preschool
- Cotinine
(analysis, blood)
- Female
- Humans
- Infant
- Male
- Patient Readmission
(statistics & numerical data)
- Prospective Studies
- Saliva
(chemistry)
- Tobacco Smoke Pollution
(adverse effects)
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