Smoke exposure puts infants with family history of asthma/allergies at higher risk for severe infection

More evidence has surfaced that supports the war on smoking, especially if smokers have an infant in their household. A study published today in the June issue of Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI), found that infants with a family history of allergic disease with lower respiratory tract infections, who are exposed to secondhand smoke are at risk for longer hospital stays.

An estimated 20 to 30 percent of otherwise healthy infants develop lower respiratory infections, such as bronchiolitis, annually. Of these, three percent are hospitalized.

"Respiratory infections in infants are common, but if the infant has a family history of respiratory issues such as asthma, they are at higher risk for infection and hospitalization," said allergist Meghan Lemke, MD, ACAAI member and lead study author. "Our research found that infants with a family history of allergic disease who are also exposed to secondhand smoke had a 23 percent longer hospital stay than those without secondhand smoke exposure."

Researchers examined 451 mothers and infants enrolled in a study focusing on childhood asthma and atopic disease outcomes associated with viral respiratory infections. In this group, 57 percent of infants were exposed to secondhand smoke. While 36 percent had a mother with atopic disease and an allergy, and 68 percent had an immediate relative with an allergic disease.

"Infants that are hospitalized for bronchiolitis have up to a 30 percent chance of developing persistent wheezing or asthma within the first decade of life," said allergist James Sublett, MD, chair of the ACAAI Indoor Environment Committee. "Secondhand smoke is extremely harmful to children with asthma and other respiratory illnesses, and has been shown to contribute to uncontrolled asthma."

According to the Centers for Disease Control and Prevention (CDC), secondhand smoke contains more than 7,000 chemicals, hundreds of which are toxic and 70 that can cause cancer.

"Secondhand smoke can trigger asthma attacks in small children, which can be life-threatening," said Dr. Sublett. "It is critical that parents and other family members never smoke around children, young or old, especially inside of the home and car where smoke can linger."

Seven million American children have asthma, a disease that is a leading cause of missed school days and 456,000 hospitalizations in the United States annually. Asthmatics under the care of a board-certified allergist have a 60 to 89 percent reduction in hospitalizations.

Secondhand smoke kills 900 infants a year; Black children disproportionately affected

Secondhand smoke is accountable for 42,000 deaths annually to nonsmokers in the United States, including nearly 900 infants, according to a new study.

Altogether, annual deaths from secondhand smoke represent nearly 600,000 years of potential life lost – an average of 14.2 years per person – and $6.6 billion in lost productivity, amounting to $158,000 per death, report the researchers.

The study, which involved the first use of a biomarker to gauge the physical and economic impacts of cigarette smoke, revealed that secondhand smoke exposure disproportionately affects African Americans, especially black infants.

Of the 42,000 total deaths resulting from secondhand smoke, 80 percent were white, 13 percent were black, and 4 percent were Hispanic. The vast majority of deaths were caused by ischemic heart disease. Black babies accounted for a startling high 24 percent to 36 percent of all infant deaths from secondhand smoke exposure, the researchers reported, although blacks represented only 13 percent of the total U.S. population in 2006.

The value of lost productivity per death was highest among blacks ($238,000) and Hispanics ($193,000).

“Black adults had significantly greater exposure rates than did whites in all age groups,” the authors wrote. “The highest secondhand smoke exposure was for black men aged 45 to 64 years, followed by black men age 20 to 44 years. Black women aged 20 to 44 years had a higher exposure rate (62.3 percent) than did any other women.”

“In general, fewer people are smoking and many have made lifestyle changes, but our research shows that the impacts of secondhand smoke are nonetheless very large,” said lead author Wendy Max, PhD, professor of health economics at the UCSF School of Nursing and co-director of the UCSF Institute for Health & Aging. “The availability of information on biomarker-measured exposure allows us to more accurately assess the impact of secondhand smoke exposure on health and productivity. The impact is particularly great for communities of color.”

Exposure to secondhand smoke is linked to a number of fatal illnesses including heart and lung disease, as well as conditions affecting newborns such as low birth weight and respiratory distress syndrome.
About a decade ago, the federal Centers for Disease Control and Prevention – using data from the California Environmental Protection Agency – reported that 49,400 adults died annually as a result of secondhand smoke exposure. Additionally, the CDC reported that 776 infants annually died as a result of maternal exposure in utero.

“Our study probably under-estimates the true economic impact of secondhand smoke on mortality,” said Max. “The toll is substantial, with communities of color having the greatest losses. Interventions need to be designed to reduce the health and economic burden of smoking on smokers and nonsmokers alike, and on particularly vulnerable groups.”

The study was published this month in the American Journal of Public Health.