Effect of environmental tobacco smoke on cough in children with a history of tonsillectomy or adenoidectomy

Abstract

We examined the possible impact of tonsillectomy or adenoidectomy (T/A) on the relationship between environmental tobacco smoke (ETS) exposure and respiratory outcomes. This study was conducted in Humboldt, Saskatchewan, in 1993. The target population included all residents aged 6-17 yrs. Of the 1,019 eligible subjects, 892 participated (88%). Estimates of ETS exposure were based on the reported smoking habits of the children's household members. We defined current cough as a positive response to the question: "Does this child usually have a cough?". Information also included morning cough, night cough and a history of T/A. For children with no history of T/A, the prevalence of current cough was 8.9%, 12.2% and 14.5% for those living in families with 0, 1, and 2+ smokers respectively. The corresponding prevalence was 7.0%, 30.2% and 36.8% for children with history of T/A. Similar effects of ETS exposure were observed on morning cough and night cough. The results did not change significantly when we used various ETS measures and controlled for confounding factors. Compared to children living in nonsmoking families and without history of T/A, the adjusted odds ratio for children with a history of T/A was 7.19 (p<0.001) if they were living in families smoking >20 cigarettes x day(-1) at home. The corresponding odds ratio was only 1.64 (p=0.11) for children without a history of T/A. We concluded that children living in smoking family were more likely to cough than those living in nonsmoking families and tonsillectomy or adenoidectomy increased the apparent influence of environmental tobacco exposure on cough.

The effect of parental smoking on lung function and development during infancy

“…Despite the difficulties of separating the detrimental effects of maternal smoking before and after birth, a number of studies strongly suggest that passive smoke exposure after birth is harmful to children's lungs. For example, independent effects of paternal smoking on the incidence of respiratory disease in children have been demonstrated in countries such as China, where smoking rates are much higher among fathers than mothers 36–38 . Although the potential impact of passive smoke exposure during pregnancy on foetal lung development must be borne in mind when interpreting these results, the likelihood that postnatal exposure contributes to observed associations between parental smoking and respiratory problems in childhood is supported by the observations of a dose–response relationship with exposure, and a protective effect of day care 39 .…”

Impact of environmental tobacco smoke exposure on anaesthetic and surgical outcomes in children: a systematic review and meta-analysis

“…The impact of ETS on this patient group was complicated by the confounding associated with ETS being a cause of delayed surgical recovery and a cause of primary disease or recurrence. In five studies, 29 31–33 38 ETS exposure was treated as a confounding variable, rather than the primary focus of the study.…”

“…ETS exposure was usually measured as a binary exposed/unexposed variable, although additional measures such as identifying which family members smoked, 17 20 levels of smoking 29 and biological markers 14 23 were also used. One study showed good correlation between parental questioning and urinary cotinine levels.…”

“…Three studies 32 38 39 showed no significant effects on outcomes, although two studies suggested some evidence that ETS exposure decreased the effectiveness or duration of tympanostomy (ventilation) tubes. 28 35 Other studies showed ETS exposure caused a potential deterioration of either subjective 29 34 36 or objective 30 31 33 40 outcomes.…”

“…Also, ETS exposure increases the incidence and prevalence of ENT conditions, and we were clear that an appropriate temporal relationship was required; the detail available in some studies meant a reverse relationship could not be excluded. This is illustrated by Chen's 29 conclusion that tonsillectomy increased the influence of ETS on cough, as opposed to ETS increasing the persistence of cough after tonsillectomy. Both are feasible interpretations which cannot be separated by this review.…”