Increased severity of respiratory syncytial virus airway infection due to passive smoke exposure

Pediatr Pulmonol. 2018 Sep;53(9):1299-1306. doi: 10.1002/ppul.24137. Epub 2018 Jul 30.


Objective: Aim of this study was to analyze whether children with objectively measured second-hand cigarette smoke (SHS) exposure suffer from a more severe course of disease when hospitalized with lower respiratory tract infection (LRTI) due to respiratory syncytial virus (RSV).

Methods: This prospective study was conducted at the Department of Pediatrics, Wilhelminen-Hospital, Vienna, Austria in children aged below 1 year without a history of preceding lung disease and with acute symptoms of LRTI and a positive nasopharyngeal swab for RSV. On admission, urinary cotinine was measured as a marker of recent SHS and clinical severity of LRTI was assessed by oxygen saturation SpO2 and the "admission clinical severity score" (CSSA). Parents/caregivers were asked to complete a customized questionnaire assessing risks for SHS and demographic characteristics.

Results: After inclusion of 217 patients, data of 185 patients with a mean (SD) age of 106 days (80) were analyzed. Twenty-five patients (13.5%) were "cotinine-positive" (COT+) defined as a urinary cotinine level of ≥7 μg/L. SpO2 on admission was significantly lower in children recently exposed to SHS defined objectively by COT+ (94.8% ±2.0) in urine on admission compared to children not recently exposed (COT-) (96.8% ±3.0; P < 0.01). Disease severity, assessed via mean clinical severity score on admission (CSSA) for COT+ and COT- was 2.56 and 1.71, respectively (P = 0.03).

Conclusions: Recent exposure to SHS was associated with lower O2 saturation and higher clinical severity score, measured by urine cotinine levels in children hospitalized for RSV infection under 1 year of age.

Keywords: RSV; bronchiolitis; cotinine; lower respiratory tract infection; nicotine; second-hand smoke.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Austria
  • Female
  • Hospitalization
  • Humans
  • Infant
  • Infant, Newborn
  • Lung Diseases / complications
  • Lung Diseases / diagnosis
  • Male
  • Nicotine
  • Oxygen
  • Parents
  • Prospective Studies
  • Respiratory Syncytial Virus Infections / complications*
  • Respiratory Syncytial Virus Infections / diagnosis
  • Respiratory Syncytial Virus, Human*
  • Respiratory Tract Infections / complications*
  • Respiratory Tract Infections / diagnosis
  • Respiratory Tract Infections / virology
  • Surveys and Questionnaires
  • Tobacco Smoke Pollution / adverse effects*


  • Tobacco Smoke Pollution
  • Nicotine
  • Oxygen