Systematic literature review assessing tobacco smoke exposure as a risk factor for serious respiratory syncytial virus disease among infants and young children

Abstract

BackgroundThe role of environmental tobacco smoke (ETS) exposure as a risk factor for serious respiratory syncytial virus (RSV) disease among infants and young children has not been clearly established. This systematic review was conducted to explore the association between ETS exposure and serious RSV disease in children younger than 5 years, including infants and young children with elevated risk for serious RSV disease.MethodsA systematic review of English-language studies using the PubMed and EMBASE databases (1990–2009) was performed to retrieve studies that evaluated ETS as a potential risk factor for serious RSV illness. Studies assessing risk factors associated with hospitalization, emergency department visit, or physician visit due to RSV (based on laboratory confirmation of RSV or clinical diagnosis of RSV) in children under the age of 5 years were included.ResultsThe literature search identified 30 relevant articles, categorized by laboratory confirmation of RSV infection (n = 14), clinical diagnosis of RSV disease (n = 8), and assessment of RSV disease severity (n = 8). Across these three categories of studies, at least 1 type of ETS exposure was associated with statistically significant increases in risk in multivariate or bivariate analysis, as follows: 12 of 14 studies on risk of hospitalization or ED visit for laboratory-confirmed RSV infection; 6 of 8 studies of RSV disease based on clinical diagnosis; and 5 of the 8 studies assessing severity of RSV as shown by hospitalization rates or degree of hypoxia. Also, 7 of the 30 studies focused on populations of premature infants, and the majority (5 studies) found a significant association between ETS exposure and RSV risk in the multivariate or bivariate analyses.ConclusionWe found ample evidence that ETS exposure places infants and young children at increased risk of hospitalization for RSV-attributable lower respiratory tract infection and increases the severity of illness among hospitalized children. Additional evidence is needed regarding the association of ETS exposure and outpatient RSV lower respiratory tract illness. Challenges and potential pitfalls of assessing ETS exposure in children are discussed.

The association between environmental tobacco smoke exposure and childhood respiratory disease: a review

“…ETS has been found to increase the risk of severe RSV disease as measured by hospitalization and hypoxia in both infants and children (adjusted OR 2.2–3.8) [46]. A recent systematic review and meta-analysis identifying risk factors for RSV-associated LRTI in children reported maternal smoking to be one of the most important risk factors (OR 1.36, 95% CI 1.24–1.50) [47] (Table 4).…”

Smoke-free legislation and childhood hospitalisations for respiratory tract infections

“…Associations between SHS exposure and bronchitis, bronchiolitis, middle ear infection, and RTIs in general are well established [6][7][8]. As a result, the vast majority of the estimated 166 000 deaths and 6.6 million disability-adjusted life-years resulting from SHS exposure among children each year are due to RTIs [9].…”

“…Given the strong association between SHS and childhood RTIs, and the potential importance of smoke-free legislation in achieving the internationally agreed Millennium Development Goal target [6][7][8][9], we investigated the association between the 2007 implementation of smoke-free public environments in England and rates of hospital admissions for RTIs among children.…”

A Randomized Clinical Trial of a Web-Based Tobacco Cessation Education Program

“…[1][2][3][4][5][6][7][8][9][10][11][12] Hospitalizations for respiratory-related visits represent a teachable moment when parental smokers can be motivated to quit smoking to reduce the impact of SHSe on their child. [19][20][21][22] Although national respiratory and nursing associations and others have long advocated for regular provision of tobacco cessation interventions by their members, [26][27][28][29][30][31][32][33] pediatric RTs and RNs still do not use their patients' visits to motivate parents to quit smoking.…”

“…[1][2][3][4] SHSe is particularly of concern in children because it places them at increased risk for allergies, eczema, bronchiolitis, asthma, respiratory tract infections, recurrent ear infections, and middle ear disease. [5][6][7][8][9][10][11] A recent investigation demonstrated that SHSe resulted in 10.9 million disability-adjusted life-years lost, with 61% of disability-adjusted life-years occurring in children worldwide. 12 The highest disease burden caused by SHSe is from lower respiratory tract infections in children ,5 years of age and asthma in children ,15 years of age.…”