Second-hand smoke tied to flu complications in kids

Children hospitalised with the flu are more likely to need intensive care and a longer stay if they've been exposed to second-hand smoke at home, a small new study finds.

Among more than 100 kids hospitalised with flu in New York state, those exposed to second-hand smoke were five times more likely to be admitted to the intensive care unit and required a 70% longer stay in the hospital, compared to the kids not exposed to smoke.

"People are being a bit complacent and thinking that because they don't see smoking as often that it's not a problem anymore," said Dr Karen Wilson, of Children's Hospital Colorado, in Aurora, who led the study. "But we still need to be vigilant about protecting kids from second-hand smoke."

Passive smoking and kids

According to the Centers for Disease Control and Prevention, passive smoking causes ear infection, breathing problems and lung infections in children, and leads to the hospitalisations of up to 15 000 children under the age of 18 months every year.

The new work is the first study to look at the effect of second-hand smoke on kids with influenza, however.

Dr Wilson and her team looked at hospital records for 117 kids admitted for influenza to a New York hospital between 2002 and 2009. Second-hand smoke exposure was reported on the charts of 40% of the kids - slightly lower than the 53% national exposure rate for kids under 11 estimated by the CDC in 2008.

The findings

Overall, 18% of the children required intensive care, and 6% were intubated. On average, kids stayed in the hospital for two days. When the researchers stratified them by exposure status, they found that 30% of smoke-exposed kids needed intensive care vs 10% of unexposed kids. Intubation was required for 13% of smoke-exposed kids, compared to 1% of those from smoke-free homes.

Hospital stays were up to 70% longer for smoke-exposed kids, with kids staying in for four days on average, compared with 2.4 days in non-exposed kids. If kids had a chronic illness as well as the flu, their length of stay increased to about 10 days, on average, if they had been breathing second-hand smoke, versus about three days in non-exposed sick kids.

"We've known that (second-hand smoke) is bad for children in a whole variety of ways," said Dr Susan Coffin, who has studied flu complications in children at the Children's Hospital of Philadelphia. "With this (study) we see that smoke exposure not only increases risk of hospitalizations but it specifically makes the course of illness worse."

The small study, published online in the Journal of Pediatrics, does have limitations. The authors note in their report, for instance, that children with severe illnesses may have been screened more frequently for smoke exposure, leading to an underestimate of how many kids were exposed to smoke.

Still, the findings do point to a need for better screening when kids with the flu are seen in the ER, researchers said.

"If you have a child who comes into the hospital and they are exposed to tobacco smoke, they have more risk of going on to develop more severe illness," Dr Wilson said. Knowing that kids are at increased risk could lead to better treatment decisions, she added.

But to her, it's critical that children don't end up in the ER in the first place. "This is a preventable cause of severe flu, and it's sad that children are in a position to be exposed even though these serious complications can occur," she said.

(Reuters Health, September 2012)

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