Association between CotonineLevel inUrine and Severity of Bronchial Asthma in Children Aged from 2 to 12 Years
Noha Zidan Mohamed;
Abstract
Exposure of children to environmental tobacco smoke at home has been linked to many complications including respiratory symptoms, airway inflammation and impaired lung ventilatory functions and bronchial asthma however, factors like housing conditions and genetic predisposition may influence the development of these complications. Exposure to SHS is associated with increased prevalence and severity of asthma and wheezing.
The best way to identify ETS exposure is unclear. Classifying smoking status by self-report alone may be unreliable because children may have ETS exposure outside their own homes or because caregivers may misreport household smoking.
Cotinine is a nicotine biomarker measurable in the blood, urine or saliva. Household smoking is associated with higher cotinine levels among asthmatic children. Many children considered non-exposed to tobacco smoke have elevated cotinine levels.
So, this study aimed to identify the relation between urinary cotinine level and severity of asthma in asthmatic children exposed to environmental tobacco smoke in patients attending the outpatient clinic in the chest department in Ain Shams University pediatric hospital and also to assess the relation between parental reports of the intensity of secondhand smoke contamination in the home, in terms of presence of household smokers and number of cigarettes smoked in the home daily, and urinary cotinine levels in the same population.
The study was conducted through interviewing 113 caregivers of children attending the outpatient clinic of chest department in pediatric hospital in Ain Shams University using an interview questionnaire. Clinical data were obtained from the medical records of the patients and urine samples were collected from the patients at the time of the interview. In this study patients with diagnosis rather than asthma were excluded.
Regarding the socio-demographic characteristics of the study population, most of the children are males (62.8%) and children who are attending school (61.1%). About two forties (42.5%) of children`s fathers are illiterate or have primary education while more than half (54%) of the mothers are so. Regarding fathers` occupation, most of them either have free business (31%) or manual work (39.8%). The majority of the mothers are housewives (87.6%).
The mean of crowding index was 2.33±0.73 and the mean home space is (86.66+24.516) m2. Regarding conditions in the child`s room, space ranges from 4 to 20 m2 and has a minimum of no windows to a maximum of 2. The median number of persons living in the child`s room was 3.
For those children who are exposed inside their homes only, urinary cotinine level is not significantly correlated with home environmental conditions, home space, crowding index, child room space, number of windows in the child`s room, and number of persons in the child`s room. For those children who are exposed inside their homes only, urinary cotinine level are significantly correlated with the number of smokers at home and the number of cigarettes and hours smoked daily, which indicate that smoking inside home is harmful to asthmatic patients and lead to high urinary cotinine level.
For those children who are exposed to ETS (n=82), the mean urinary cotinine level differs significantly among different levels of diagnosis of bronchial asthma (p=0.001), being lowest for mild disease (24 + 16.97) ng\mg creatinine, and highest for severe form (88.21 + 60.11) ng\mg creatinine. This indicates that, exposure to environmental tobacco smoke increases the severity of asthma. In addition, there was positive correlation between urinary cotinine level and number of asthmatic attacks during last year and last month which indicates that more severe cases had higher levels of urinary cotinine and assessment of ETS by urinary cotinine level was more reliable than self-reporting.
In this study, Urinary cotinine level was not significantly correlated to the number of hours the child was exposed to ETS in the last 24 hours as reported by their parents (p = 0.056)(table9b)which indicates that, reporting for exposure to ETS was not reliable for quantitative assessment of ETS exposure, which means that there was misreporting by caregivers about the exposure of their children.
The best way to identify ETS exposure is unclear. Classifying smoking status by self-report alone may be unreliable because children may have ETS exposure outside their own homes or because caregivers may misreport household smoking.
Cotinine is a nicotine biomarker measurable in the blood, urine or saliva. Household smoking is associated with higher cotinine levels among asthmatic children. Many children considered non-exposed to tobacco smoke have elevated cotinine levels.
So, this study aimed to identify the relation between urinary cotinine level and severity of asthma in asthmatic children exposed to environmental tobacco smoke in patients attending the outpatient clinic in the chest department in Ain Shams University pediatric hospital and also to assess the relation between parental reports of the intensity of secondhand smoke contamination in the home, in terms of presence of household smokers and number of cigarettes smoked in the home daily, and urinary cotinine levels in the same population.
The study was conducted through interviewing 113 caregivers of children attending the outpatient clinic of chest department in pediatric hospital in Ain Shams University using an interview questionnaire. Clinical data were obtained from the medical records of the patients and urine samples were collected from the patients at the time of the interview. In this study patients with diagnosis rather than asthma were excluded.
Regarding the socio-demographic characteristics of the study population, most of the children are males (62.8%) and children who are attending school (61.1%). About two forties (42.5%) of children`s fathers are illiterate or have primary education while more than half (54%) of the mothers are so. Regarding fathers` occupation, most of them either have free business (31%) or manual work (39.8%). The majority of the mothers are housewives (87.6%).
The mean of crowding index was 2.33±0.73 and the mean home space is (86.66+24.516) m2. Regarding conditions in the child`s room, space ranges from 4 to 20 m2 and has a minimum of no windows to a maximum of 2. The median number of persons living in the child`s room was 3.
For those children who are exposed inside their homes only, urinary cotinine level is not significantly correlated with home environmental conditions, home space, crowding index, child room space, number of windows in the child`s room, and number of persons in the child`s room. For those children who are exposed inside their homes only, urinary cotinine level are significantly correlated with the number of smokers at home and the number of cigarettes and hours smoked daily, which indicate that smoking inside home is harmful to asthmatic patients and lead to high urinary cotinine level.
For those children who are exposed to ETS (n=82), the mean urinary cotinine level differs significantly among different levels of diagnosis of bronchial asthma (p=0.001), being lowest for mild disease (24 + 16.97) ng\mg creatinine, and highest for severe form (88.21 + 60.11) ng\mg creatinine. This indicates that, exposure to environmental tobacco smoke increases the severity of asthma. In addition, there was positive correlation between urinary cotinine level and number of asthmatic attacks during last year and last month which indicates that more severe cases had higher levels of urinary cotinine and assessment of ETS by urinary cotinine level was more reliable than self-reporting.
In this study, Urinary cotinine level was not significantly correlated to the number of hours the child was exposed to ETS in the last 24 hours as reported by their parents (p = 0.056)(table9b)which indicates that, reporting for exposure to ETS was not reliable for quantitative assessment of ETS exposure, which means that there was misreporting by caregivers about the exposure of their children.
Other data
| Title | Association between CotonineLevel inUrine and Severity of Bronchial Asthma in Children Aged from 2 to 12 Years | Other Titles | الارتباط بين مستوى الكوتينين بالبول وشدة الربو لدى الأطفال | Authors | Noha Zidan Mohamed | Issue Date | 2016 |
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