Exposure to secondhand smoke at home or in the car dramatically increases childrens odds of hospital readmission within a year of being admitted for asthma, according to a study.
The study, published Jan. 20 on the website of the journal Pediatrics, raises the possibility that measurement of tobacco exposure could be used in clinical practice to target smoking cessation efforts and reduce the likelihood of future hospitalizations.
To determine tobacco exposure, researchers at Cincinnati Childrens Hospital Medical Center, Penn State Milton S. Hershey Childrens Hospital and Boston Children’s Hospital measured serum and salivary cotinine in more than 600 children. Cotinine is a substance produced when the body breaks down nicotine and provides a scientific assessment of tobacco exposure.
The ability to measure serum and salivary cotinine levels presents the possibility of an objective measure that can be obtained when a child is seen in the emergency department or in the hospital and may be used to predict future hospitalizations, Robert Kahn, MD, MPH, associate director of general and community pediatrics at Cincinnati Childrens and senior author of the study, said in a news release.
Such a measure for exposure to tobacco smoke could be used to target specific interventions at caregivers of those children before discharge from the hospital. Several interventions, including parental counseling and contact with the primary care physician, could be adopted in clinical practice.
The study is part of the Greater Cincinnati Asthma Risks Study, which seeks to understand the causes of hospital readmission, particularly for low-income and minority children.
The researchers studied 619 children between the ages of 1 and 16 who were admitted to Cincinnati Childrens between August 2010 and October 2011. Serum and salivary cotinine levels were taken during their hospital stay, and their primary caregivers were asked about tobacco exposure. All children were followed for at least 12 months to see whether they were readmitted to the hospital.
The researchers found no correlation between caregiver report of tobacco exposure and readmission. But a more scientific analysis of actual secondhand exposure via measurement of cotinine in the blood and saliva demonstrated a readmission risk in children exposed to secondhand smoke more than twice that of children not exposed.
Odds of readmission were 59% higher for children with detectable serum cotinine, and more than twice as high for children with detectable salivary cotinine, according to the study data.
Of the 619 children in the study, 76% were covered by Medicaid, Judie Howrylak, MD, PhD, a physician at Hershey Childrens and lead author of the study, said in the news release. Certainly there could be a financial incentive for insurance companies to help caregivers quit smoking, rather than pay the downstream costs of a future asthma readmission.
Study abstract: http://pediatrics.aappublications.org/content/early/2014/01/15/peds.2013-2422.abstract