Prevalence of urinary cotinine levels in children under 5 years of age during consultations for acute respiratory disease at the emergency department of the Universidad de La Sabana clinic

Abstract

Background Several environmental factors favour the occurrence of acute respiratory disease, which is the main reason for paediatric consultations in our country (Colombia). Tobacco smoke is considered a significant environmental pollutant with a great impact on health. The objective of this study is to estimate the prevalence of cotinine levels measured in urine, in children between 1 to 60 months of age who attended an emergency department with acute respiratory disease. Methods A cross-sectional study was conducted that included children between 1 and 60 months of age with acute respiratory disease who were admitted to the emergency department of the Universidad de La Sabana Clinic between April and July 2016. Results We included 268 patients and 36% were female. Of the total population examined, 33.96% showed positive results for urinary cotinine, of whom 97.8% had values between 10 and 100 ng/ml, which is considered positive for exposure to second-hand smoke. The principal pathology was recurrent wheezing in 43.96% of these cases. Regarding the presence of smokers at home, it is important to mention that in 54.95% of the children with positive urinary cotinine test was no related with smokers at home. And in 45.05% of positive urinary cotinine was evidence of smokers at home, being associated with the positive result P < 0.001 and smoking within the house P = 0.018; smoking when children were present did not have significant P = 0.105. The activities performed after smoking such as hand washing, change of clothes, eating, brushing teeth, did not influence the test result P = 0.627. Conclusions A high prevalence of urinary cotinine was observed, which is associated with the presence of a smoker at home, and this relationship was independent of the activities performed by the smoker after smoking. In addition, a positive test for urinary cotinine was presented in some children without documented exposure to cigarette smoke inside the home, which may be explained by the presence of environmental cotinine. Therefore, it is necessary to perform educational interventions aimed at parents and caregivers who smoke.

Use of urinary cotinine and cotinine/creatinine ratio as a biomarker of environmental tobacco exposure

“…Despite this, indoor environments remain a very important source of exposure to environmental tobacco smoke during childhood 4 . The metabolite of nicotine taken into the body by smoking is cotinine and is excreted in the urine 9,20 . The most commonly used method to evaluate active or passive smoking is the determination of the nicotine metabolite cotinine in serum urine or saliva 23,24 .…”

“…Tovar et al reported that 33.96% of children aged 1 to 60 months who attended the emergency department with acute respiratory tract infection showed a positive result for the amount of urinary cotinine that was considered positive for exposure to secondhand smoke 9 .…”

“…When the literature is reviewed, many studies have reported that exposure to cigarette smoke has adverse effects on the health and development of fetuses and children 9 .…”

Factors Associated With the Differences Between Self-Report Smoking and Urinary Cotinine Criteria

“…6 Therefore, it can be used to measure recent exposure to nicotine, even low doses; a high concentration is usually observed 4 to 8 hours after exposure. 7 In addition, measurement of urinary cotinine (UC) is relatively inexpensive and easy and has high sensitivity and precision. 8 Trends of underreporting have been found in pregnant women, teenagers, African Americans, and East Asian women who self-report as nonsmokers through the use of biological indicators such as UC.…”

“…6 Therefore, it can be used to measure recent exposure to nicotine, even low doses; a high concentration is usually observed 4 to 8 hours after exposure. 7 In addition, measurement of urinary cotinine (UC) is relatively inexpensive and easy and has high sensitivity and precision. 8…”