Impact of Environmental Tobacco Smoke on Children Admitted With Status Asthmaticus in the Pediatric Intensive Care Unit

Introduction: Environmental tobacco smoke (ETS) and allergens are risk factors in children with critical status asthmaticus. Genetic studies support that ETS-associated asthma is a special inflammatory entity, causing significant number of hospital admissions and relapses. Accordingly, the course and outcome of patients with ETS-induced status asthmaticus might also be different. Hypothesis: We hypothesized that the progression, course, and outcome of patients with ETS-induced status asthmaticus would be worse than those of patients without ETS exposure. Methods: Medical records of children who were admitted to the Pediatric Intensive Care Unit (PICU) with the diagnosis of asthma at the Children's Hospital of Winnipeg, Manitoba, over 10 years were audited after Institutional Review Board (IRB) approval. Two hundred thirty records were reviewed. We extracted data including demographics and analyzed the patient's deterioration defined as clinical asthma score (CAS) drift between the ED and PICU. We computed the treatment response, expressed as length of stay (LOS) in the PICU and in hospital. The risk factors were stratified as none, ETS exposure, allergies, and ETS with allergies. Results: There were 55 (25%) patients with no risk factors, 66 (30%) with ETS exposure only, 46 (21%) with allergies only, and 53 (24%) with both. There was a 25% decrease in CAS deterioration when patients were exposed to ETS (P < 0.05). For patients with or without allergies but with exposure to ETS, both the PICU and overall hospital LOS were similar to 15% longer (P < 0.05) than for those not exposed to ETS. Stratifying for gender and race in multivariate analysis did not alter the results. Conclusions: Patients with ETS-associated critical status asthmaticus deteriorate and recover slower than non-ETS-exposed patients. Pediatr Pulmonol. 2011; 46: 224-229. (C) 2010 Wiley-Liss, Inc.