Vol. 17 •Issue 18 • Page 31
Michigan Study Shows Parents’ Smoking Triggers Asthma Attacks
Everyone knows that smoking near an asthmatic kid can trigger symptoms or even a life-threatening asthma attack, right? Wrong. Apparently some parents still haven’t gotten that message.
New research findings show children with asthma whose parents smoke at home are twice as likely to have asthma symptoms all year long compared to children of non-smokers, according to the study authors.
The results of a University of Michigan study were presented this spring at the Pediatric Academic Societies meeting in San Francisco.
Overall, in a nationwide sample of children with asthma, about 13 percent of parents of asthmatic children still smoke, even though second-hand smoke is known to trigger asthma attacks and symptoms in kids.
Those findings reinforce the importance of educating parents about how their own smoking can affect their children with asthma. The study is based on data from in-depth phone interviews with 896 parents of asthmatic children ages 2 to 12 years in 10 states. Those interviews were conducted as part of the Physician Asthma Care Education (PACE) project, which is designed to improve asthma education for physicians, and consequently the health of their young patients who have asthma.
The chronic condition affects one in every seven children.
The new analysis was conducted by Kathryn Slish, a researcher in the University of Michigan Department of Pediatrics, with assistant professor of pediatrics Michael Cabana, MD, MPH, MA.
The PACE project is led by the UM School of Public Health’s Dean Noreen Clark, PhD, and funded by the Robert Wood Johnson Foundation.
“We set out to look at children who have seasonal asthma symptoms but found that a substantial percentage have symptoms year-round,” explained Slish. In the course of the study, the researchers looked more closely and found a strong relationship between parents’ smoking status and the likelihood that their child would have problems all year long.
“It’s not rocket science,” Slish continued, “since it’s well known that second-hand smoke can trigger asthma in children. But it’s astounding that so many parents smoke around their asthmatic kids and don’t stop even though their children are having trouble breathing all year.”
The study echoes findings of previous research by the Centers for Disease Control and Prevention, which looked at whether children had severe asthma symptoms on more or less than 300 days per year, and found a strong correlation to parent smoking among those with more than 300 days.
Different Approach Used
The University of Michigan study used a different approach than the CDC and looked at 90-day blocks of time corresponding to a season. “The only other factor that was associated with year-round symptoms was Medicaid insurance coverage,” said Cabana.
These findings should provide even more reason for pediatricians, family physicians, therapists and nurses to broach the subject of smoking with the parents of any child diagnosed with asthma and to steer parents who smoke toward resources that can help them quit, noted the researchers.
“By addressing the issue directly and reminding parents how second-hand smoke can affect their children, perhaps we can cut down on the number of kids having symptoms throughout the year,” Cabana said.
“Even a very brief intervention with physicians encouraging patients to quit smoking has been shown to be successful,” added Clark.
Part of the PACE project centers on teaching physicians how to counsel asthmatic patients and their parents on avoiding common asthma triggers like dust, pollen, pet dander, stress, cockroach droppings, mold, air pollution, exercise, cold air and second-hand smoke.
Some triggers, like pollen, occur only during some times of the year, while others are present year-round and are mainly linked to indoor exposure.
Defining Some Terms
In the Michigan study, children who had symptoms on 27 or more days, or seven or more nights, in a 90-day season were considered to be in “peak” or persistent asthma symptoms during that time. That definition was laid out by the National Heart, Lung, and Blood Institute of the National Institutes of Health.
In the study, 84 percent of the children had peaks in none, one, two or three seasons of the past year. But 16 percent of the children had peaks in all four seasons, regardless of what seasonal triggers might be present.
Two-thirds of the children in the study were boys; 12 percent were African-American. The mean age was around 7; and 61 percent used some sort of daily medication to control their asthma. Parents were asked directly if they smoked, and 13 percent answered yes.
When researchers performed a statistical analysis to look at which factors were most associated with year-round symptoms, Medicaid status and parental smoking both were linked to a more-than-doubled likelihood.
Researchers hope to continue their evaluation of parental smoking behavior and conduct follow-up interviews with parents after the children’s doctors receive training in evidence-based asthma care and patient communication.