Related Experiment Video
Updated: Aug 31, 2025
Noninvasive Sampling of Mucosal Lining Fluid for the Quantification of In Vivo Upper Airway Immune-mediator Levels
Published on: August 7, 2017
Interaction between serum cotinine and body mass index on asthma in the children: a cross-sectional study
Li He1, Xiaojing Xi2
1School of Medicine, Xinjiang University of Science & Technology, No.89, Beijing Road, Yingxia Township, 841000, Korla City, Xinjiang, People's Republic of China. lihexjmu@outlook.com.
Insights
Environmental tobacco smoke exposure, indicated by serum cotinine, and high body mass index (BMI) synergistically increase childhood asthma risk. Interventions targeting weight and smoke exposure are crucial for affected children.
Area of Science:
- Environmental Health
- Pediatric Pulmonology
- Epidemiology
Background:
- Childhood asthma is a significant public health concern.
- Environmental tobacco smoke exposure is a known risk factor for asthma development and exacerbation.
- Obesity is also increasingly recognized as a contributing factor to asthma prevalence and severity in children.
Purpose of the Study:
- To investigate the interaction between serum cotinine levels, a biomarker for environmental tobacco smoke exposure, and body mass index (BMI) on the risk of childhood asthma.
- To determine if a synergistic relationship exists between these two factors in the development of asthma.
Main Methods:
- Utilized a cross-sectional study design using data from the National Health and Nutrition Examination Survey (1999-2018).
- Included 11,504 American children aged 3-12 years.
- Employed multivariate logistic regression to analyze associations and interactions between serum cotinine, BMI z-score, and asthma, controlling for potential confounders. Serum cotinine was dichotomized, and interaction analyses were performed in subgroups.
Main Results:
- High serum cotinine levels were significantly associated with increased asthma risk (OR=1.190).
- Overweight (OR=1.275) and obesity (OR=1.636) were significantly associated with higher asthma risk compared to normal weight.
- A significant synergistic interaction was observed between serum cotinine levels and BMI on childhood asthma (Synergy Index=1.617), indicating a combined effect greater than the sum of individual effects. This interaction was consistent across age and ethnicity subgroups.
Conclusions:
- A significant synergistic interaction exists between environmental tobacco smoke exposure and overweight/obesity in contributing to childhood asthma.
- Interventions aimed at reducing both passive smoking exposure and excess weight in children are essential for asthma prevention and management.
- Public health strategies should address both environmental and lifestyle factors to mitigate the burden of childhood asthma.
Background:
The purpose of this study was to explore the interaction between serum cotinine (a marker of environmental tobacco smoke exposure) and body mass index (BMI) on asthma in children.
Methods:
This cross-sectional study relied on representative samples of American children included in the National Health and Nutrition Examination Survey in 1999-2018. Multivariate logistic regression analyses were to evaluate the association between serum cotinine level, BMI z-score and asthma. Serum cotinine was dichotomized at 0.0436 ng/mL. Interactions were examined by the estimated joint effect of BMI and serum cotinine levels. We also performed interaction analyses in age and ethnicity subgroups.
Results:
Among the 11,504 children aged 3 to 12 years included in the analysis, 15.86% (n = 1852) had childhood asthma, 15.68% (n = 1837) were overweight, and 17.31% (n = 2258) were obese. Compared to low serum cotinine, high serum cotinine was significantly associated with asthma [odds ratio (OR) = 1.190, 95% confidence interval (CI): 1.004-1.410]. Overweight (OR = 1.275, 95%CI: 1.079-1.506) and obesity (OR = 1.636, 95%CI: 1.354-1.977) were significantly associated with asthma compared with normal weight. The adjusted attributable proportion of interaction = 0.206 (95%CI: 0.075-0.337) and the adjusted synergy index = 1.617 (95%CI: 1.126-2.098) indicated that there was a significant synergistic effect of serum cotinine levels and BMI on asthma. In males, females, non-Hispanic White and other Hispanic, there were synergistic interactions between serum cotinine levels and BMI on asthma.
Conclusion:
A synergistic interaction between serum cotinine and overweight/obesity on childhood asthma was found. For children with asthma, both intensive weight interventions in overweight or obese children and intensive passive smoking interventions in children exposed to the environment may be important.
Related Concept Videos
01:29Asthma-I: Introduction
01:26Asthma-II: Pathophysiology and Classification
Additionally, environmental and genetic factors play crucial roles in determining an individual's susceptibility to asthma and the severity of their condition.
Critical processes in asthma pathophysiology include:
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:20Asthma: Pathogenesis and Management
Asthma is classified as allergic and non-allergic. Allergens such as dust mites, pollen, and pet dander trigger allergic asthma, while factors like cold air, intense emotions, or exercise can induce non-allergic asthma.
01:27Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies
Medical History
01:24Asthma-III: Symptoms and Complications
Classification of Asthma