PASSIVE SMOKE EXPOSURE IMPAIRS RECOVERY AFTER HOSPITALIZATION FOR ACUTE ASTHMA

Objective: To determine if children with chronic asthma hospitalized f or an acute exacerbation experienced prolonged clinical recovery after hospital discharge if they returned to a home environment in which th ey were exposed to environmental tobacco smoke. Design: A prospective longitudinal study. Setting: Children's Hospital and Medical Center, S eattle, Wash. Patients: Patients admitted to the emergency department of the Children's Hospital and Medical Center with the single diagnosi s 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 betwee n 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 immedi ate predischarge asthma status. Discharge medication use was similar i n 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%) i n the tobacco-smoking group. beta(2)-Agonist bronchodilator use declin ed significantly (P<.001) during follow-up in the nonsmoking group but not in the tobacco-smoking group, despite similar anti-inflammatory d rug therapy in both groups. Conclusions: Recovery by children after ho spitalization for acute asthma is impaired by environmental tobacco sm oke exposure when the period of recovery is characterized by persisten t respiratory symptoms and use of asthma medication for symptomatic re lief. These findings underscore the need to limit environmental tobacc o smoke exposure in children with asthma and argue for closer physicia n follow-up of those children returning to a home environment in which smokers are present.