title: Salivary cotinine, doctor-diagnosed asthma and respiratory symptoms in primary schoolchildren.
abstract: Due to impaired airway function, children are at risk for adverse respiratory symptoms if exposed to environmental tobacco smoke (ETS). A community-based, cross-sectional study of 425 children (5-11 years) attending 15 primary schools in a low socio-economic area of Merseyside/UK was undertaken to investigate the association of adverse respiratory symptoms and ETS exposure using a parent-completed questionnaire and children's salivary cotinine measurements. Overall, 28.9% of children had doctor-diagnosed asthma (DDA) and 11.3% a history of hospital admission for respiratory illnesses. The symptom triad of cough, wheeze and breathlessness (C+W+B+) occurred in 12.6% of children. The geometric mean cotinine level was 0.37 ng/ml (95% CI, 0.33-0.42 ng/ml) and it was estimated that 45.6% of children were ETS exposed. A history of asthma in the family was reported for 9.2% of fathers and 7.2% of mothers. Salivary cotinine level was significantly increased in children with DDA compared to those without (P = 0.002). Cotinine-validated levels [adjusted odds ratio (AOR), 1.8; 95% CI, 1.4-2.5), low socio-economic (disadvantaged) status (AOR, 1.4; 1.1-2.9), child's male gender (AOR, 1.6; 1.1-2.5) and maternal smoking (AOR, 2.2; 1.4-3.1) were significantly associated with DDA. The cotinine-validated level (AOR, 1.4; 1.1-2.9) as well as maternal smoking (AOR, 1.8; 1.1-2.5), were also independently associated with C+W+B+. The use of salivary cotinine as an indicator of ETS exposure could be used to inform parents of exposure risk to their asthmatic children and may help re-enforce deterrent efforts to reduce childhood parental smoking exposure.
authors.affiliation: Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK. delpishe@liv.ac.uk
authors.forename: Ali
authors.initials: A
authors.lastname: Delpisheh
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Kelly
authors.forename: Shaheen
authors.initials: S
authors.lastname: Rizwan
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Brabin
mesh_terms: D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D003367:Cotinine / Q000032:analysis*; D003371:Cough / Q000209:etiology; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D011204:Poverty Areas; D012135:Respiratory Sounds / Q000209:etiology; D012463:Saliva / Q000737:chemistry*; D012574:Schools; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D012923:Social Class; D011795:Surveys and Questionnaires; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D014028:Tobacco Smoke Pollution; D003367:Cotinine