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Is secondhand smoke exposure associated with increased exacerbation severity among children hospitalized for asthma?
Annie L Andrews1, Nils Shirley2, Elizabeth Ojukwu3
1Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina; andrewsan@musc.edu.
Insights
Secondhand smoke exposure in children hospitalized for asthma was linked to longer hospital stays at one children's hospital. This exposure also increased the likelihood of receiving intravenous steroids, highlighting the need to reduce secondhand smoke exposure.
Area of Science:
- Pediatric Pulmonology
- Environmental Health
- Epidemiology
Background:
- Asthma exacerbations in children are a significant cause of hospitalization.
- Secondhand smoke (SHS) exposure is a known asthma trigger.
- The impact of SHS on hospitalization severity requires further elucidation.
Purpose of the Study:
- To investigate the association between SHS exposure and hospitalization outcomes in pediatric asthma patients.
- To determine if SHS exposure correlates with increased length of stay (LOS) and other severity indicators.
Main Methods:
- Retrospective chart review of 623 children (ages 2-18) hospitalized for asthma in 2012.
- Analysis of outcomes including LOS, PICU admission, magnesium, and intravenous (IV) steroid use.
- Utilized regression models to assess the independent association between SHS exposure and hospitalization severity.
Main Results:
- 41% of included patients reported SHS exposure.
- SHS-exposed children had a significantly longer mean LOS (50.0 hours) compared to non-exposed children (45.8 hours) (P = .02).
- SHS exposure was associated with a 20% increase in LOS at one institution and increased likelihood of IV steroid use (OR 1.6).
Conclusions:
- SHS exposure is associated with increased LOS in children hospitalized for asthma at certain institutions.
- IV steroid use was significantly associated with LOS in SHS-exposed children.
- Reducing SHS exposure is crucial for improving asthma management and reducing hospitalization severity in children.
Objective:
To determine the association between secondhand smoke (SHS) exposure and length of stay (LOS) and other exacerbation severity indicators in children hospitalized for asthma.
Methods:
We conducted a retrospective chart review at 2 children's hospitals. Patients aged 2 to 18 hospitalized for asthma in 2012 were included. Outcome variables included LOS, PICU, magnesium, and intravenous (IV) steroids. Bivariate analysis determined differences between SHS-exposed and non-SHS-exposed groups. Geometric means were used for LOS to account for skewed distribution. Logistic and zero-truncated negative binomial regression models were used to determine the independent association between SHS exposure and hospitalization severity indicators.
Results:
A total of 623 patients were included; 41% reported SHS exposure. Mean LOS was 47.5 hours. In the SHS-exposed group, LOS was 50.0 (95% confidence interval [CI] 46.7-54.0) and in the nonexposed group it was 45.8 (95% CI 43.4-48.4) (P = .02). In regression analysis, institution modified the effect of SHS exposure on LOS. At Children's Hospital Colorado, SHS exposure was associated with a 20% increase in LOS (incidence rate ratio 1.2, 95% CI 1.1-1.3). At the Medical University of South Carolina, there was no significant association. SHS-exposed patients were more likely to receive IV steroids (odds ratio 1.6, 95% CI 1.1-2.3) CONCLUSIONS: Among children hospitalized for asthma, we identified a significant association at 1 institution between SHS exposure and LOS and found that IV steroid use was significantly associated with LOS at both institutions. Eliminating SHS exposure among children with asthma is important.
