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

Increased Severity of Respiratory Syncytial Virus Airway Infection Due to Passive Smoke Exposure

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Free PMC article

Increased Severity of Respiratory Syncytial Virus Airway Infection Due to Passive Smoke Exposure

Clemens Maedel et al. Pediatr Pulmonol. .
Free PMC article

Abstract

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.

Figures

Figure 1
Figure 1
Flowchart of patient recruiting and reasons for exclusion
Figure 2
Figure 2
Boxplot: SpO2 (%) on admission for COT—(left box) and COT+ (right box)
Figure 3
Figure 3
CSSA for COT—(left box) and COT+ (right box)
Figure 4
Figure 4
Boxplot: SpO2 (%) on admission for SHS0, SHS1, SHS2, and COT+
Figure 5
Figure 5
Boxplot: CSSA for SHS0, SHS1, SHS2, and COT+ (concerning boxplots: circles indicating outliers, asterisks are indicating extreme outliers)

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