A new study reveals that children who have asthma are much more likely to be readmitted to the hospital within 1 year if they are exposed to secondhand smoke at home or in the car.
Researchers from the study, which was published in the journal Pediatrics, say their findings could prompt insurance companies to give incentives to parents or guardians who quit smoking.
Guided by senior author Dr. Robert Kahn from Cincinnati Children’s Hospital Medical Center in Ohio, the research team – also from Penn State Milton S. Hershey Children’s Hospital in Pennsylvania – studied over 600 children between the ages of 1 and 16, who were admitted to the hospital for asthma or bronchodilator-responsive wheezing between August 2010 and October 2011.
By measuring cotinine – a substance produced when the body breaks down nicotine – in the blood and saliva of the children, the researchers were able to scientifically assess tobacco exposure, though they also asked primary caregivers about tobacco exposure.
The children were followed for at least 12 months to see if they were readmitted to the hospital in that time.
The researchers say their cotinine technique could be used in targeting smoking cessation efforts, as well as to reduce the chances of future hospitalizations for asthmatic children.
Dr. Kahn explains:
“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.”
This new finding could potentially help some of the 7.1 million children the Centers for Disease Control and Prevention (CDC) says have asthma in the US.
Of the children in the study, 17% were readmitted within 1 year, the researchers say.
Although tobacco exposure rates as reported by parents and caregivers totaled 35.1%, the researchers found that serum and saliva measures were actually 56.1% and 79.6%, respectively.
The overall findings state that there was no correlation between tobacco exposure reported by caregivers and hospital readmission.
However, secondhand smoke exposure as revealed by cotinine measurements in blood and saliva was linked to a readmission risk twice as high for children exposed to smoke, compared with those not exposed.
“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,” suggests Dr. Kahn.
“Several interventions, including parental counseling and contact with the primary care physician, could be adopted in clinical practice,” he adds.
Dr. Judie Howrylak, lead author of the study from Hershey Children’s Hospital, notes that 76% of the children from the study were assisted by Medicaid.
“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,” she says.
The team’s study is released at a time when the American Heart Association (AHA), in response to a new Surgeon General’s Report, calls for more action against tobacco.
The AHA’s CEO Nancy Brown writes that the report points to over 20 million Americans who “could have lived healthier and longer lives if they had never lit their first cigarette.”
She writes about the effects of secondhand smoke:
“The report also points to something that never occurred to Americans back in the 1960s – just being in the same room with a smoker can cause you irreparable harm. Two and a half million of those who died were non-smokers exposed to secondhand smoke.”
The study from Dr. Kahn and colleagues certainly lends credence to these latest statements. He and his team are also studying links between traffic-related air pollution and hospital readmission for asthmatics.