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Smoke-free legislation reduces asthma hospitalizations for children

Robin Wulffson MD's picture
pediatric asthma, cigarette smoke, anti-smoking legislation, asthma triggers

Although Western Europe has lagged behind the US in regard to anti-smoking legislation, they are catching up. In addition to other health hazard, cigarette smoke is a known trigger for pediatric asthma. Anti-smoking legislation was implemented in England in 2007; thus, enough time has passed to assess its health benefits. Researchers affiliated with Imperial College, London, United Kingdom and the University of California, San Francisco designed a study to assess whether the implementation of English smoke-free legislation was associated with a reduction in hospital admissions for childhood asthma. They published their findings online on January 21 in the journal Pediatrics.

The researchers accessed Hospital Episodes Statistics data from April 2002 to November 2010. The study group comprised all children aged 14 years or less who had an emergency hospital admission with a principle diagnosis of asthma.

The researchers found that before the implementation of the legislation, the admission rate for childhood asthma was increasing by 2.2% per year. After implementation of the legislation, there was a significant immediate change in the admission rate of −8.9% and change in time trend of −3.4% per year. They noted that this change was equivalent to 6,802 fewer hospital admissions in the first three years after implementation. There were similar reductions in asthma admission rates among children from different age, gender, and socioeconomic status groups and among those residing in urban and rural locations.

The investigators concluded that their findings confirm those from a small number of previous studies suggesting that the well-documented population health benefits of comprehensive smoke-free legislation appear to extend to reducing hospital admissions for childhood asthma.
Take home message:
The findings regarding cigarette smoke exposure are applicable to the US. Asthma is a leading cause of hospital admissions and school absences in children. When they encounter a substance that can cause problems (a trigger), an asthma attack (exacerbation) can occur. Common asthma triggers include:

  • Animals (hair or dander)
  • Aspirin and other medications
  • Changes in weather (most often cold weather)
  • Chemicals in the air or in food
  • Dust
  • Exercise
  • Mold
  • Pollen
  • Strong emotions
  • Tobacco smoke
  • Viral infections, such as the common cold

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Children’s airways are narrower than those of adults. This means that triggers that may cause only a slight problem in an adult can create more serious problems in children. In children, an asthma attack can appear suddenly with severe symptoms. For this reason, it is important that asthma be diagnosed and treated correctly. Some children may need to take medicine every day, even when they do not have symptoms.

The most important preventive measures for the prevention of asthma attacks is the elimination of triggers. You and your family can help control a child’s asthma by helping get rid of the indoor triggers that make symptoms worse. If possible, keep pets outdoors, or at least away from the child’s bedroom. No one should smoke in a house or around a child with asthma. Eliminating tobacco smoke from the home is the single most important thing a family can do to help a child with asthma. Smoking outside the house is not enough. Family members and visitors who smoke carry smoke residue in and on their clothes and hair: this can trigger asthma symptoms.

Keeping humidity levels low and fixing leaks can reduce growth of organisms such as mold. Keep the house clean and keep food in containers and out of bedrooms. This helps reduce the possibility of cockroaches, which can trigger asthma attacks. Bedding can be covered with “allergy proof” polyurethane-coated casings to reduce exposure to dust mites. Detergents and cleaning agents in the home should be unscented.

All of the aforementioned efforts can make a significant difference to the child with asthma, even though it may not be obvious right away.

Reference: Pediatrics