Respiratory effects in children from passive smoking of cigarettes and narghile: ISAAC Phase Three in Syria

The association between environmental tobacco smoke (ETS) and asthma symptoms is well documented, but a causal relationship is inconclusive. International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three was the first to report a dose-response relationship between current wheezing and exposure to parental cigarette smoke. As exposure of children to water pipe (narghile) smoke is of concern in Syria, in the ISAAC Phase Three Tartous Centre we also examined the role of parental smoking of the narghile.

Parents of children aged 6-7 years completed core written questionnaires about the prevalence of symptoms, and an environmental questionnaire for other risk factors, including parental cigarette smoking. We added questions about narghile to the questionnaire.

Among 2 734 pupils (49% females) surveyed, we found an association between exposure to ETS of the mother smoking cigarette or narghile and ever wheezing, nocturnal cough and severe wheeze; however, the strongest association was found when the mother smoked narghile. Mother smoking narghile was also associated with exercise wheeze. Father smoking narghile, but not cigarettes, was associated with nocturnal cough, severe wheeze and exercise wheeze. The association with current wheeze became significant when mother smoked both cigarettes and narghile; however, the effect was addititive and not synergic.

We recommend that international studies investigating ETS include questions on narghile smoking.