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American Academy of Pediatrics
Research Articles

Is Secondhand Smoke Exposure Associated With Increased Exacerbation Severity Among Children Hospitalized for Asthma?

Annie L. Andrews, Nils Shirley, Elizabeth Ojukwu, Michelle Robinson, Michelle Torok and Karen M. Wilson
Hospital Pediatrics May 2015, 5 (5) 249-255; DOI: https://doi.org/10.1542/hpeds.2014-0128
Annie L. Andrews
aDepartment of Pediatrics, Medical University of South Carolina, Charleston, South Carolina;
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Nils Shirley
bMedical University of South Carolina College of Medicine, Charleston, South Carolina;
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Elizabeth Ojukwu
cUniversity of Massachusetts Medical School Worcester, Massachusetts; and
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Michelle Robinson
dDepartment of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
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Michelle Torok
dDepartment of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
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Karen M. Wilson
dDepartment of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
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Abstract

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.

  • asthma exacerbation
  • admission
  • Abbreviations:
    CHCO
    Children’s Hospital Colorado
    CI
    confidence interval
    CPAP
    continuous positive airway pressure
    ED
    emergency department
    IRR
    incidence rate ratio
    IV
    intravenous
    LOS
    length of stay
    MUSC
    Medical University of South Carolina
    OR
    odds ratio
    PNA
    pulmonary nodular amyloidosis
    RedCap
    Research Electronic Data Capture
    SHS
    secondhand smoke
    • Copyright © 2015 by the American Academy of Pediatrics
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    Hospital Pediatrics: 5 (5)
    Hospital Pediatrics
    Vol. 5, Issue 5
    1 May 2015
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    Is Secondhand Smoke Exposure Associated With Increased Exacerbation Severity Among Children Hospitalized for Asthma?
    Annie L. Andrews, Nils Shirley, Elizabeth Ojukwu, Michelle Robinson, Michelle Torok, Karen M. Wilson
    Hospital Pediatrics May 2015, 5 (5) 249-255; DOI: 10.1542/hpeds.2014-0128

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    Is Secondhand Smoke Exposure Associated With Increased Exacerbation Severity Among Children Hospitalized for Asthma?
    Annie L. Andrews, Nils Shirley, Elizabeth Ojukwu, Michelle Robinson, Michelle Torok, Karen M. Wilson
    Hospital Pediatrics May 2015, 5 (5) 249-255; DOI: 10.1542/hpeds.2014-0128
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