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Environmental exposure to tobacco smoke increases the risk of respiratory symptoms and disease in children

Respiratory diseases, including asthma, account for about one-third of the hospitalizations of children and adolescents less than 15 years of age in the United States. A recent review of the research literature by Peter J. Gergen, M.D., of the Agency for Healthcare Research and Quality, reveals that environmental tobacco smoke (ETS) increases the risk of respiratory disease in children, and that the most important source of this exposure is within the home. Not surprisingly, smoking by the mother is consistently associated with higher ETS exposure than smoking by the father, probably due to the greater time a child spends with the mother.

ETS exposure tends to decrease as the child grows older, perhaps due to less time spent around the mother or other household members when they are smoking. Exposure to ETS during the first year of life has been consistently found to have an impact on the respiratory system, either in symptoms such as wheeze or cough, specific diseases such as bronchitis/tracheitis or bronchiolitis, or health care use such as medical visits or hospitalizations. Several studies have shown the impact of ETS on respiratory symptoms to be strongest in a child's first 2 years.

Prenatal exposure to tobacco smoke clearly affects the unborn child's respiratory system. Pulmonary function tests done within 3 days of birth and within the first 6 months of life have found reduced pulmonary function in children exposed to ETS before birth. These abnormalities predispose the infant to an increased frequency of lower respiratory tract infections during the first year of life.

Between 40 and 50 percent of women continue to smoke after they learn that they are pregnant. This suggests that public health messages to avoid smoking during pregnancy are still not being communicated to women in ways that will cause them to change their behavior. In conclusion, Dr. Gergen notes that efforts should not be focused solely on the individual but must include the health care provider. During each patient's contact with the medical system, providers must inquire about ETS exposure and assist in reducing it.

See "Environmental tobacco smoke as a risk factor for respiratory disease in children," by Dr. Gergen, in Respiration Physiology 128, pp. 39-46, 2001.

Reprints (AHRQ Publication No. 02-R022) are available from the AHRQ Publications Clearinghouse.

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