Home Smoke Exposure and Health-Related Quality of Life in Children with Acute Respiratory Illness
OBJECTIVE: This study aims to assess whether secondhand smoke (SHS) exposure has an impact on health-related quality of life (HRQOL) in children with acute respiratory illness (ARI).
METHODS: This study was nested within a multicenter, prospective cohort study of children (two weeks to 16 years) with ARI (emergency department visits for croup and hospitalizations for croup, asthma, bronchiolitis, and pneumonia) between July 1, 2014 and June 30, 2016. Subjects were surveyed upon enrollment for sociodemographics, healthcare utilization, home SHS exposure (0 or ≥1 smoker in the home), and child HRQOL (Pediatric Quality of Life Physical Functioning Scale) for both baseline health (preceding illness) and acute illness (on admission). Data on insurance status and medical complexity were collected from the Pediatric Hospital Information System database. Multivariable linear mixed regression models examined associations between SHS exposure and HRQOL.
RESULTS: Home SHS exposure was reported in 728 (32%) of the 2,309 included children. Compared with nonexposed children, SHS-exposed children had significantly lower HRQOL scores for baseline health (mean difference –3.04 [95% CI –4.34, –1.74]) and acute illness (–2.16 [–4.22, –0.10]). Associations were strongest among children living with two or more smokers. HRQOL scores were lower among SHS-exposed children for all four conditions but only significant at baseline for bronchiolitis (–2.94 [–5.0, –0.89]) and pneumonia (–4.13 [–6.82, –1.44]) and on admission for croup (–5.71 [–10.67, –0.75]).
CONCLUSIONS: Our study demonstrates an association between regular SHS exposure and decreased HRQOL with a dose-dependent response for children with ARI, providing further evidence of the negative impact of SHS. Journal of Hospital Medicine 2019;14:212-217. © 2019 Society of Hospital Medicine
© 2019 Society of Hospital Medicine
Acute respiratory illnesses (ARIs), including acute exacerbations of asthma, croup, pneumonia, and bronchiolitis, are among the most common illnesses in childhood.1 Although most ARIs can be managed in the outpatient setting,
Exposure to secondhand smoke (SHS) is a preventable risk factor for ARI in children, particularly when there is regular exposure in the home.2 Chronic exposure to SHS impacts systemic inflammation by suppressing serum interferon-gamma,3 which can lead to increased susceptibility to viral and bacterial infections,4 and increasing Th2 (atopic) cytokine expression, which is associated with asthma.5 SHS exposure in children has also been linked to diminished lung function.6 As a result, SHS exposure is associated with increased ARI susceptibility and severity in children.7-10
Much research has focused on the clinical impact of SHS exposure on respiratory health in children, but little is known about the impact on patient-reported outcomes, such as health-related quality of life (HRQOL). Patient-reported outcomes help provide a comprehensive evaluation of the effectiveness of healthcare delivery systems. These outcomes are increasingly used by health service researchers to better understand patient and caregiver perspectives.11 Given the known associations between SHS exposure and ARI morbidity, we postulated that regular SHS exposure would also impact HRQOL in children. In this study, we assessed the relationship between SHS exposure and HRQOL within a large, multicenter, prospective cohort of children presenting to the emergency department (ED) and/or hospital with ARI.
