Cotinine excretion as a predictor of peak flow variability

Characteristics and predictors of readiness to quit among emergency medical patients presenting with respiratory symptoms

Purpose

To examine behavioral factors that lead patients to consider quitting smoking and features associated with readiness to quit among adults who are seeking treatment in the emergency department (ED) for respiratory symptoms.

Methods

A toal of 665 adult smokers seeking treatment in an ED for respiratory symptoms and respiratory illness answered survey questions during the ED visit.

Results

Patients self-reported "readiness to quit" was broadly distributed among this patient population. Patients with COPD, pneumonia or asthma perceived higher risks from smoking than other patients with respiratory complaints. Over half of all participants had scores indicative of depression. Regression analysis showed that prior efforts to quit, confidence, perceived importance of quitting and decisional balance were each significantly predictive of readiness to quit, accounting for 40% of the variance.

Conclusions

While many of these patients appear unaware of the connection between their symptoms and their smoking, patients with diagnosed chronic respiratory illness perceived higher risks from their smoking. In patients who do not perceive these risks, physician intervention may increase perceived risk from smoking and perceived importance of quitting. Interventions designed for the ED setting targeting this patient population should consider screening for depressive symptoms and, when appropriate, making referrals for further evaluation and/or treatment. Medications that can help alleviate depression and withdrawal symptoms while quitting smoking, such as bupropion, may be particularly useful for this subset of patients, as depression is a substantial barrier to quitting.

Relationship of endotoxin and tobacco smoke exposure to wheeze and diurnal peak expiratory flow variability in children and adolescents

BACKGROUND AND OBJECTIVE

The relationship between endotoxin exposure and asthma severity (wheeze and airways obstruction) is not well described. The effects of endotoxin and tobacco smoke exposure on self-reported wheeze and diurnal PEF variability (DV-PEF) were examined in children aged 6-18 years with asthma or wheeze.

METHODS

A cross-sectional study was performed in a rural area. From this study, children who reported wheeze in the previous 12 months or a physician diagnosis of asthma (n = 98) were selected for a case-control study. These subjects, who were the basis for the present analysis, completed: (i) a home environmental assessment, including dust collection to measure endotoxin levels: (ii) a clinic visit, including saliva collection to measure cotinine levels; and (iii) 2 week monitoring of twice daily symptom records, including wheeze, and PEF to calculate DV-PEF.

RESULTS

Among these children, 22.4% reported wheeze during the monitoring period. Greater DV-PEF was associated with higher endotoxin loads in play areas (P < 0.05). The association between salivary cotinine levels and high DV-PEF was modified by gender. In females, higher cotinine levels were associated with an increased risk of high DV-PEF compared with lower cotinine levels (P < 0.05), but this was not observed among males.

CONCLUSIONS

Higher endotoxin exposure was associated with greater DV-PEF among children with asthma or wheeze. While previous studies have suggested that endotoxin exposure protects against the development of asthma, individuals with the disease should avoid high exposure levels to limit exacerbations. The effect of tobacco smoke exposure on lung health may differ between male and female children.

Respiratory effects of tobacco smoking on infants and young children

Second-hand smoke (SHS) and tobacco smoke products (TSPs) are recognised global risks for human health. The present article reviews the causal role of SHS and TSPs for respiratory disorders in infants and young children. Several studies have shown an effect of TSPs exposure during pregnancy upon lung function in the newborn infant and of SHS on symptoms and lung function after birth. From 1997 to 1999 a set of systematic reviews concerning the relationship between second-hand exposure to tobacco smoke and respiratory health in children was published in Thorax by Cook and Strachan, covering hundreds of published papers. The evidence for a causal relationship between SHS exposure and asthmatic symptoms and reduced lung function is quite strong, whereas the evidence related to the development of allergy is much weaker. There is recent evidence relating to an interaction between TSP exposure and genetic ploymorphisms, demonstrating that certain individuals are more susceptible to the effect of TSP exposure on lung health. In the present review, an overview is given for the effects of TSP exposure and SHS upon lung health in children, with a focus on infants and young children. There is a need for intervention to reduce TSP exposure in young children, by educating parents and adolescents about the health effects of TSP exposure. Recent legislation in many European countries related to smoking in the workplace is of great importance for exposure during pregnancy. Studies are needed to identify possible critical periods for TSPs to induce harmful effects upon lung health in young children and on environment-gene interactions in order to prevent harm.

Parental smoking and childhood asthma: clinical implications

Environmental tobacco smoke and constituents are global risks for human health. Considerable evidence shows that environmental tobacco smoke exposure contributes to, and exacerbates, respiratory disorders. This review assesses the causal role of environmental tobacco smoke exposure for childhood respiratory disorders, and in particular asthma. Tobacco smoke and environmental tobacco smoke exposure during pregnancy have an effect upon lung function in newborn infants; exposure after birth also has an effect upon lung function. An effect upon bronchial responsiveness has been suggested but the evidence is not as strong as for lung function. From 1997 to 1999 a comprehensive set of systematic reviews concerning the relationship between exposure to environmental tobacco smoke and respiratory health in children summarized the results from hundreds of published papers. The evidence for a causal relationship between environmental tobacco smoke exposure and asthmatic symptoms on the one hand, and between environmental tobacco smoke exposure and reduction in lung function on the other hand, was quite strong, whereas the evidence between environmental tobacco smoke exposure and development of allergy was much weaker. Here we present an overview of the effects of environmental tobacco smoke exposure on lung health in children. A hypothesis has been put forward regarding upregulation of pulmonary neuroendocrine cells in relationship to mechanisms of tobacco smoke products (TSP)-induced pulmonary disease. It has also been reported that genetic variation makes part of the population especially vulnerable to environmental tobacco smoke exposure during pregnancy. Furthermore, there is a need for intervention to reduce environmental tobacco smoke exposure in young children, by educating parents and adolescents about the health effects of environmental tobacco smoke exposure. Studies are needed to identify possible critical periods when environmental tobacco smoke exposure is more likely to induce harmful effects on lung health in young children in order to implement effective preventive strategies.

Smoking and pediatric respiratory health

Many children are exposed to smoking both prenatally and postnatally. Prenatal exposure to mainstream smoke from the mother and even to environmental tobacco smoke (ETS) from the mother in utero has been shown to change fetal lung development and cause airflow obstruction and airway hyperresponsiveness. Children exposed to ETS postnatally have more symptoms of cough, wheeze, respiratory illnesses, decreases in lung function, and increases in airway responsiveness. Smoke exposure is associated with the early development of asthma, increased severity of asthma, and the development of allergy. Finally smoke exposure is associated with sudden infant death and airway obstruction. This article reviews the spectrum of effects of cigarette smoke exposure on the respiratory health of infants and children and highlights basic science research exploring the mechanisms of these effects.

The adverse health effects of tobacco and tobacco-related products

Tobacco use continues to occur in epidemic proportions and with it, significant morbidity and mortality. One third of smokers will die prematurely of a smoking-related disease. This article reviews the adverse health effects of tobacco use so that clinicians can be aware of the benefits patients will reap when they stop using this lethal substance.