The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

THE IMPACT OF MATERNAL AND ENVIRONMENTAL TOBACCO SMOKE EXPOSURE ON INPATIENTS WITH BRONCHIOLITIS.

Julie Ballard BS RRT and Kim Bennion BS RRT, Primary Children’s Medical Center, Salt Lake City, Utah.

Introduction:
Studies suggest an association in children < 2 years of age between environmental smoke exposure (ESE), maternal smoking exposure (MSE) during pregnancy and the development of lower respiratory tract infections. We sought to test the hypothesis that clinical outcomes are worse for children with ESE &/or MSE who were admitted with bronchiolitis (a lower respiratory tract infection).

Methods:
Children hospitalized with bronchiolitis during the 2002-2003 & 2003-2004 respiratory seasons ( Nov. 1-April 30) were included in the retrospective analysis. Data were extracted from hospital databases. Pts were studied if they met the following criteria: (1) < 2 years of age, (2) any diagnosis of bronchiolitis, (3) a complete history, (4) an assigned severity of illness score (SOI) where scores are 1-4 with 1 being the least and 4 being the most severe. SOI scores were based on procedural & co-morbidity coding by medical records staff after pt discharge. Pt records were analyzed to determine the utilization of inhaled medication treatments (tx) including albuterol, epinephrine &/or xopenex, antibiotic & steroid utilization & length of stay (LOS). Statistical analysis included ANOVA with multiple comparison post-hoc analysis for continuous data and Chi square analysis for nominal data.

Results:
1583 pts met the first criteria with 547 being excluded for incomplete histories. This left us 1036 pts to study. Outcomes for all pts are reported in Table One.

Table One: Tobacco Smoke Exposure Outcomes No Smoke Exposure MSE ESE P-value
Mean # Inhaled Medication Txs 2.2 4.2 4.2 < 0.01
Initial O2 Need (L/min) 0.57 0.76 0.71 < 0.01
Steroid Utilization # (%) 111 (15) 24 (35) 44 (21) < 0.01
Antibiotic Utilization # (%) 279 (37) 25 (37) 78 (36) 0.98
Severity of Illness (SOI) Score # (%) Level 1 225 (30) 20 (29) 64 (30) 0.08
Level 2 405 (54) 32 (47) 104 (48)
Level 3 85 (11) 15 (22) 36 (17)
Level 4 38 (5) 1 (2) 11 (5)
LOS (hours) 94 108 118 < 0.02
All Patients # (%) 753 (77) 68 (7) 215 (22) ---

Discussion: Five pts initially required continuous positive airway pressure (CPAP), but there was no significance in their exposure to smoke. Given the results of our findings, pts with no smoke exposure presented with better outcomes when compared to those pts exposed to smoke either in utero or in the environment. Initial O2 requirement, inhaled medication txs, steroid utilization & LOS were all decreased in the no exposure group. Further study is needed on the effects of prenatal & postnatal smoke exposure on hospital outcomes in pt with bronchiolitis.

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