Asthma is one of the most common reasons for children's consultations with the general Background -Children with parents who smoke are often exposed to high levels of practitioner, 10 admissions to hospital, 11 and issuing of prescriptions. 6 It is estimated that environmental tobacco smoke, and children with asthma are particularly susceptible to approximately 50% of children under 10 years in this country have at least one parent who the detrimental effects of passive smoking. Data were collected from parents who smokes.2 In addition, one paediatric respiratory outpatient clinic recently reported that 42% of smoke and from their asthmatic children. The families are currently taking part in a children attending were regularly exposed to parental tobacco smoke in their own homes randomised controlled trial to test an intervention designed to reduce passive smoking (Clark RA et al, unpublished data, 1996).Families that include a child with asthma in children with asthma. This paper reports on the baseline data. Questionnaire data and at least one parent who smokes are currently taking part in a randomised clinical trial and cotinine levels were compared in an attempt to assess exposure and to identify to test an intervention designed to reduce exposure of children with asthma to tobacco factors which influence exposure of the children. The aim of the study was to identify smoke. This paper reports on the extent of passive smoking, assessed by salivary cotinine the scope for a reduction in passive smoking by these children. levels, of the children at baseline and identifies factors that influence exposure. Factors inMethods -A sample of 501 families with an asthmatic child aged 2-12 years was vestigated relate to the child, the index parent, other smokers in contact with the child, and obtained. Factors influencing passive smoking were assessed by interviewing the socioeconomic environment. The aim is to determine the scope for a possible reduction parents. Cotinine levels were measured from saliva samples using gas liquid in passive smoking by the children. chromatography with nitrogen phosphorous detection. Results -Cotinine levels in children were Methods strongly associated with the age of the   Criteria for admission were a documented diaConclusions -Many children are exposed gnosis of asthma in the GP case records and at at home. Families were identified by GP pracCentre, Lyon Street, (Thorax 1997;52:766-769) tice staff. The index child was the youngest Dundee DD4 6RB, UK family member with asthma. Where both par-P W Slane

Objective To investigate whether parents of asthmatic children would stop smoking or alter their smoking habits to protect their children from environmental tobacco smoke. Design Randomised controlled trial. Setting Tayside and Fife, Scotland. Participants 501 families with an asthmatic child aged 2-12 years living with a parent who smoked. Intervention Parents were told about the impact of passive smoking on asthma and were advised to stop smoking or change their smoking habits to protect their child's health. Main outcome measures Salivary cotinine concentrations in children, and changes in reported smoking habits of the parents 1 year after the intervention. Results At the second visit, about 1 year after the baseline visit, a small decrease in salivary cotinine concentrations was found in both groups of children: the mean decrease in the intervention group (0.70 ng/ml) was slightly smaller than that of the control group (0.88 ng/ml), but the net difference of 0.19 ng/ml had a wide 95% confidence interval ( − 0

Abstractagement -in attacks of all degrees of severity. There has been a concerted effort by proBackground -The management of asthma attacks by general practitioners in 1992/93 fessional bodies to address the problem of suboptimal asthma management. The publicawas compared with 1991/92 in relation to recommended guidelines.tion of revised UK asthma guidelines in 1993 presented the opportunity to repeat a national Methods -The findings from a postal survey of 299 UK general practitioners who audit of asthma attacks in general practice and to assess whether general practitioners had inmanaged 2332 patients with an asthma attack in 1992/93 were compared with those stituted changes in the management of acute attacks in line with the guidelines. from 218 practitioners who managed 1805 attacks in 1991/92. Management by a subThis paper compares the findings from the 1992/93 audit of asthma attacks in UK general group of practitioners from a special interest group was analysed separately.practice with the 1991/92 audit and assesses whether or not favourable changes in manResults -In 1992/93 2031 (87%) of attacks were managed entirely by general prac-agement have occurred. titioners, 251 (11%) were referred for admission to hospital, and 50 (2%) were managed by an accident and emergency Methods department. There was no change in the  pattern of management relative to 1991/92. In 1991/92 218 general practitioners supplied Compared with recommended guidelines details of 1805 patients of all ages who had there was underuse of systemic steroids recently experienced an acute asthma attack. and nebulised bronchodilators. Between One hundred and three participating prac-1991/92 and 1992/93 use of systemic steroids titioners were members of the special interest in acute attacks increased from 56% to group General Practitioners in Asthma Group 71%, nebulised bronchodilators from 31% (GPIAG) and the remainder were respondents to 32%, and an increase in prophylactic to a mailing invitation to a random sample of medication after an acute attack from 41% UK practitioners. to 49%. Contrary to guidelines, antibioticTo recruit a target of 2000 patients with use increased from 32% to 40% of attacks. asthma attacks in 1992/93 it was estimated that Practitioners from a special interest at least 200 general practitioners would need asthma group gave more of their patients to participate. A medical mailing agency was systemic steroids and nebulised broncho-commissioned to invite a random sample of dilators both in 1991/92 and 1992/93. 5000 of the 33 000 general practitioners in the Conclusions -Some aspects of the man-UK, stratified by region, to participate in an agement of asthma attacks by general audit exercise. In addition, those practitioners practitioners has changed in line with who participated in 1991/92 were offered the guidelines, but there is still a large gap chance to participate in 1992/93. between actual and recommended man-The 1991/92 study thus comprised a sample agement.of practitioners, approximately half of w...

Background-Passive smoking is a major cause of respiratory morbidity in children. However, few studies give accurate estimates of the health eVects of passive smoking in children with asthma using an objective measure of exposure. The eVects of passive smoking using salivary cotinine levels to measure exposure were investigated. Methods-A sample of 438 children aged 2-12 years with asthma who had a parent who smoked were recruited in Tayside and Fife, Scotland. Health service contacts for asthma, assessed from GP case records, were used as a proxy for morbidity. Results-A weak U-shaped relationship was found between the salivary cotinine level and health service contacts for asthma: compared with low cotinine levels those with moderate cotinine levels had a reduced contact rate (relative rate (RR) = 0.91, 95% confidence interval (CI) 0.80 to 1.05), whereas high cotinine levels were associated with an increased rate of contact (RR = 1.19, 95% CI 1.05 to 1.37). In contrast, a strong association was seen with the amount the parent reported smoking in front of the child: the higher the level the fewer visits were made for asthma (RR for everyday exposure = 0.66, 95% CI 0.56 to 0.77). This eVect was not seen for non-respiratory visits. Demographic factors, age of child, and number of children in the family all had a powerful eVect on the number of visits for asthma. The parents' perception of asthma severity was associated with visit frequency independent of actual severity (derived from drug treatment). Conclusion-High levels of parental smoking in the home are associated with a reduction in health care contacts for asthma. This could be due to a lack of awareness of asthma symptoms among heavy smokers or a reluctance to visit the GP. Children with asthma who have parents who smoke heavily may not be receiving adequate management. (Thorax 2001;56:9-12)