Original ARTICLEDo household tobacco smoking habits influence asthma, rhinitis and eczema among 13–14 year-old adolescents?
Introduction
Environmental tobacco smoke (ETS), as the most common indoor air pollutant, has been postulated as one of the risk factors for respiratory diseases, especially asthma.
Much of the current evidence from cross-sectional and longitudinal observation studies suggests an increased risk of new-onset asthma as a consequence of ETS exposure in pregnancy and early childhood and increased respiratory symptoms such as cough, wheeze, phlegm, respiratory infections of later ETS exposure, the effect of which appears to diminish with the increasing age of the child.1 However, there is still debate as to whether ETS exposure beyond infancy can initiate asthma or simply acts as a trigger of exacerbations in established asthma.1, 2, 3 In a recently published meta-analysis,4 it was concluded that ETS in developing asthma is not limited to younger children, certain high-risk populations, or prevalent cases. Moreover, a recently published review article5 pointed out the increased risk of asthma in adults exposed to ETS. Maternal smoking has been reported to have a stronger effect than other household members’ smoking in the induction of asthma in children.3
Given current evidence, parental smoking either before or after birth is unlikely to increase the risk of allergic sensitisation in children.5, 6, 7 There have been several studies with conflicting results performed on associations of ETS exposure with rhinitis and eczema symptoms. Some studies have reported a positive association of ETS with rhinitis symptoms8, 9 or eczema symptoms and ever-diagnosed eczema,10, 11 while other studies6, 12 have reported no association between them.
Compared to asthma, rhinitis, and eczema prevalence rates worldwide,13, 14, 15 the Republic of Macedonia appears to have a moderately low prevalence of current asthma and low prevalence rates of current rhinoconjunctivitis and eczema symptoms.16 Despite the smoking cessation campaign worldwide, the prevalence of ETS at home in early adolescence in Macedonia has been demonstrated to be very high.17, 18 On the other hand, dietary antioxidants intake has been documented to be high,18 which may be explained by the geographical area in which our country is situated and its climate.
This study aims to contribute to the inconsistent reports in the literature about the association of ETS exposure with asthma, rhinitis and eczema in children, especially at older ages, investigating 13/14 year-old children in Skopje, the Republic of Macedonia, where ETS exposure is still very high and the prevalence rates of asthma, rhinitis, and eczema are low.
Section snippets
Subjects and methods
This study was conducted in Skopje, the capital of the Republic of Macedonia, as part of the Macedonian arm of the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three, and in accordance with its methodology.19, 20
Self-reported data obtained through the standardised ISAAC Phase Three written questionnaires on asthma, rhinitis, eczema and environmental risk factors by 3026 children aged 13/14 years from 17 randomly selected schools was used in the analysis. According to
Results
The established prevalence of ever-diagnosed asthma (1.7%) was much lower than the prevalence rates of current wheeze (8.8%) and current night dry cough apart from chest infection (16.5%) (p=0.000 for both) and was more similar to the prevalence of current speech-limiting wheeze as a parameter of asthma severity (1.2%). The prevalence of night dry cough was also much higher compared to the prevalence of current wheeze (p=0.000). In contrast, the prevalence of ever-diagnosed hay fever (6.7%) was
Discussion
The much lower prevalence of ever-diagnosed asthma in contrast to the prevalence rates of current wheeze and dry night cough apart from chest infection suggests under-diagnosis of asthma and/or underreporting of the diagnosis by the young adolescents in our country, which can be noted in other less affluent countries worldwide.13 In contrast, hay fever and eczema seem to be over-diagnosed and/or over-reported.
The results of the present study demonstrated an increased risk of current night dry
Acknowledgments
The authors would like to thank children for their participation, and the principals, psychologists, and teachers for their collaboration in the survey. The Ministry of Education and Science of The Republic of Macedonia provided financial support for the study.
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