Passive smoke exposure impairs recovery after hospitalization for acute asthma

Objective: To determine if children with chronic asthma hospitalized for an acute exacerbation experienced prolonged clinical recovery after hospital discharge if they returned to a home environment in which they were exposed to environmental tobacco smoke. Design: A prospective longitudinal study. Setting: Children's Hospital and Medical Center, Seattle, Wash. Patients: Patients admitted to the emergency department of the Children's Hospital and Medical Center with the single diagnosis of asthma (International Classification of Diseases, Ninth Revision [ICD-9] code 493). Results: Twenty-two children with acute asthma were sequentially enrolled in the study and longitudinally observed between February and June 1994. The tobacco-smoking group (n=11) was defined as having at least 1 smoker in the home. The nonsmoking group (n=11) had no environmental tobacco smoke exposure at home. The 2 groups were similar in age, sex, preadmission chronic asthma severity, and immediate predischarge asthma status. Discharge medication use was similar in the 2 groups. During a 1 month follow-up period, the tobacco-smoking group had a significantly greater number of symptomatic days than the nonsmoking group (P<.05). Of the children in the nonsmoking group, 9 (82%) had less than I symptomatic day per week compared with 3 (27%) in the tobacco-smoking group. beta(2)-Agonist bronchodilator use declined significantly (P<.001) during follow-up in the nonsmoking group but not in the tobacco-smoking group, despite similar anti-inflammatory drug therapy in both groups. Conclusions: Recovery by children after hospitalization for acute asthma is impaired by environmental tobacco smoke exposure when the period of recovery is characterized by persistent respiratory symptoms and use of asthma medication for symptomatic relief. These findings underscore the need to limit environmental tobacco smoke exposure in children with asthma and argue for closer physician follow-up of those children returning to a home environment in which smokers are present.