Passive Smoke Exposure Increases the Incidence of Sinusitis in Children

Persons who smoke cigarettes demonstrate dramatic increases in their levels of nicotine and nicotine metabolites; however, it is now clear that others who are exposed to the exhaled smoke (so-called "passive smokers") can also demonstrate nicotine levels that may affect their health and well-being. This health risk is particularly important in children. Research to date indicates that children exposed to passive cigarette smoke have elevated rates of otitis media, bronchiolitis, and diminished pulmonary function, as well as more frequent exacerbations of asthma.

A direct correlation has been observed between the extent of exposure to passive smoke and urine cotinine values. Cotinine is a metabolic by-product of nicotine that is readily measured in the urine. Numerous investigators have concluded that there is a correlation between the frequency of symptoms and signs of respiratory illness, such as nasal symptoms and even asthma, and levels of cotinine in the urine.

To further define what effect passive cigarette smoke may have on the health of children, Steven Stryk and colleagues from the St. Louis University Health Sciences Center asked parents to complete a detailed questionnaire about their smoking habits. They also collected urine samples from children in these households and periodically analyzed the cotinine/creatinine ratio (CCR), which serves as a highly reliable measure of exposure to nicotine. They are now following these children prospectively under double-blind conditions to determine their rates of sinusitis.

Previous studies have indicated that a CCR of 30 mg/mL or higher reflected significant exposure to nicotine through passive smoke inhalation. For example, Dr. Stryk noted that in smokers, one cigarette can increase the urine cotinine levels by about 135 ng/mL, and some smokers have urine cotinine levels of up to 1,000 ng/mL. In the twenty children (aged 3--18 years) studied to date, Stryk and his team have identified five children with urine cotinine levels higher than 30 ng/mL. One 5-year-old had a urine cotinine level of 298 ng/mL! Among these twenty children, there have been eight cases of sinusitis. Key to these findings is that all of the infections have occurred in the five highly exposed children.

In addition, the investigators found that whether or not their mother was a smoker was very highly correlated with the children's urine cotinine levels. Such findings suggest that when a mother smokes, the child may absorb clinically important levels of nicotine, and that these levels in many cases can affect the respiratory health of these children. source:AAAAI