Aggravation of asthma in children by inhalation of smoke from smokers

1993/12/01 Furundarena Salsamendi, Jose Ramon Iturria: Elhuyar aldizkaria

• Osasuna

Although it is previously known that the inhalation of smoke from smokers' cigarettes affected asthmatic children in one way or another — reducing lung function, increasing the reactivity of the airways and increasing the asthmatic crises — on this occasion a work is mentioned in the United States.

The degree of exposure of children is measured by two ways: the one declared by the parents and the amount of cotin in urine. Cotin is a metabolic derivative of nicotine that is expelled from urine after an average life of 24 hours. At the same time, lung functions were measured and the aggravation situations of asthma were taken into account.

Cotin measurements were performed in 199 asthmatic children and lung function was measured in 145 children. Reviewing the medical histories of each child, they learned the number of aggravations they suffered the previous year. The average level of cotin of the 116 children who had no relation to tobacco was 5.6 ng/ml, 13.1 ng/ml in 53 children with mother or another person of their family smoking and 55.8 ng/ml in children with mothers and other people of their family smoking.

Acute exacerbations of asthma were more frequent in exposed children, both in the case of recognized parents and in the case of cotin levels. Comparing the children with the lowest ones, they showed a relative risk of 1.8 taking into account what was said by the parents and 1.7 with the level of cotin.

The parameters studied to measure lung function were also affected in children who had contact with smokers.

The magazine “The New England Journal of Medicine”, which has published this work, comments in an editorial. In the research carried out so far, the exposure to smoking tobacco — the passive habit — was measured only with what their parents had said and, of course, this measurement was very subjective and changing. Now, measuring the level of cotin in the urine, we have an objective level of exposure and, in addition, asthmatic children with a high level of cotin have more in common the crises of exacerbation and changes in lung function.

The Environmental Protection Agency has recently published that 434,000 people die annually in the United States for tobacco (of which 120,000 die of lung cancer). It is also believed that 1,500 non-smoking women and 500 non-smokers die from passive smokers. Although some of the epidemiological instruments or pathways used to measure these data have been criticized, they have generally been accepted. In Japan, China and Eastern Europe there are more and more smokers and the incidence of lung diseases (including cancer) has been shown to increase. As women smokers are growing in the countries of our environment, the same problems are appearing in them with greater assiduity and that is known by the services of Pneumology.

Measuring “markers” such as cotin for long periods of time allows a better analysis of tobacco effect, both in smokers and passive smokers. Years are needed to carry out comprehensive epidemiological research, especially to measure the risks of people with low exposure. However, the need for strict measures is essential to see that tobacco kills so much and so much.