Prevalence of urinary cotinine levels in children under 5 years of age during consultations for acute respiratory disease at the emergency department of the Universidad de la Sabana clinic

Abstract

Background: Several environmental factors favour the occurrence of acute respiratory disease, which is the main reason for paediatric consultations in our country (Colombia). Tobacco smoke is considered a significant environmental pollutant with a great impact on health. The objective of this study is to estimate the prevalence of cotinine levels measured in urine, in children between 1 to 60 months of age who attended an emergency department with acute respiratory disease. Methods: A cross-sectional study was conducted that included children between 1 and 60 months of age with acute respiratory disease who were admitted to the emergency department of the Universidad de La Sabana Clinic between April and July 2016. Results: We included 268 patients and 36% were female. Of the total population examined, 33.96% showed positive results for urinary cotinine, of whom 97.8% had values between 10 and 100 ng/ml, which is considered positive for exposure to second-hand smoke. The principal pathology was recurrent wheezing in 43.96% of these cases. Regarding the presence of smokers at home, it is important to mention that in 54.95% of the children with positive urinary cotinine test was no related with smokers at home. And in 45.05% of positive urinary cotinine was evidence of smokers at home, being associated with the positive result P < 0.001 and smoking within the house P = 0.018; smoking when children were present did not have significant P = 0.105. The activities performed after smoking such as hand washing, change of clothes, eating, brushing teeth, did not influence the test result P = 0.627. Conclusions: A high prevalence of urinary cotinine was observed, which is associated with the presence of a smoker at home, and this relationship was independent of the activities performed by the smoker after smoking. In addition, a positive test for urinary cotinine was presented in some children without documented exposure to cigarette smoke inside the home, which may be explained by the presence of environmental cotinine. Therefore, it is necessary to perform educational interventions aimed at parents and caregivers who smoke. © 2020 The Author(s).

Antecedentes: Diversos factores ambientales favorecen la aparición de la enfermedad respiratoria aguda, la cual constituye el principal motivo de consulta pediátrica en nuestro país (Colombia). El humo del tabaco se considera un importante contaminante ambiental con un gran impacto en la salud. El objetivo de este estudio es estimar la prevalencia de los niveles de cotinina medidos en orina, en niños de 1 a 60 meses de edad que acudieron a un servicio de urgencias por enfermedad respiratoria aguda. Métodos: Se realizó un estudio transversal que incluyó niños entre 1 y 60 meses de edad con enfermedad respiratoria aguda que ingresaron al servicio de urgencias de la Clínica Universidad de La Sabana entre abril y julio de 2016. Resultados: Se incluyeron 268 pacientes y El 36% eran mujeres. Del total de la población examinada, el 33,96% presentó resultados positivos para cotinina urinaria, de los cuales el 97,8% tuvo valores entre 10 y 100 ng/ml, lo que se considera positivo para exposición al humo de segunda mano. La patología principal fueron las sibilancias recurrentes en el 43,96% de estos casos. En cuanto a la presencia de fumadores en el hogar, es importante mencionar que en el 54,95% de los niños con cotinina urinaria positiva no hubo relación con fumadores en el hogar. Y en el 45,05% de los positivos a cotinina urinaria hubo evidencia de fumadores en el domicilio, asociándose con el resultado positivo P< 0,001 y fumar dentro de la casa P = 0,018; fumar cuando había niños presentes no tuvo una P = 0,105 significativa. Las actividades realizadas después de fumar como lavarse las manos, cambiarse de ropa, comer, lavarse los dientes, no influyeron en el resultado de la prueba P = 0,627. Conclusiones: Se observó una alta prevalencia de cotinina urinaria, la cual se asocia con la presencia de un fumador en el hogar, y esta relación fue independiente de las actividades realizadas por el fumador después de fumar.