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Smoking Patterns Among Young People With Asthma

Posted on: Sunday, 21 November 2004, 03:00 CST

To the Editor.-

We read with great interest, and we congratulate the authors of, the article by Precht et al1 that describes the prevalence of smoking and the relationship between smoking and asthma among adolescents. In the conclusions, the authors state that asthmatic people smoke more and smoke more cigarettes per day than nonasthmatic subjects. In the introduction to their article, it is stated that the literature indicates that the smoking prevalence of adolescents with asthma is higher than or similar to that of adolescents without asthma. Moreover, they only found 1 study that asthmatic adolescents smoke less than nonasthmatics. We recently published an article2 with a similar objective. We studied 600 young people with asthma with a mean age of 20 years (20 3 years), a little higher than that of the group of adolescents with asthma in the Precht et al study.1 In our article, we found no difference in the smoking habits of our sample of asthmatics with respect to other young people,2,3 but the prevalence of smoking was lower than the average for healthy young people of the same age, and the smoking habits were mild. One problem of our sample could be that all of them were male, but we think that this does not change the final results. All of our male young people were diagnosed with asthma according to the National Heart, Lung, and Blood Institute/World Health Organization Global Initiative for Asthma, 1995, guidelines. All subjects had a positive bronchodilator test or a positive response to exercise or methacholine challenge. Thus, we were sure that they were asthmatics. In the Precht et al1 article, asthma diagnoses were physician-based (but they didn't ask all the physicians about that), and they based the article on a computerized questionnaire, without an objective diagnosis by asthma test. We think that this way of diagnosis can overestimate the level of asthma. So many physicians speak about asthma when the patient only has some respiratory symptoms and only for the patient that they think has asthma. The general population has a real confusion of what asthma really is. Another controversial point is that they have in their sample a great number of occasional smokers (21.2%), more than daily smokers (16.5%); when one adds both percentages, clearly the final results are overestimated.

On the other hand, in the Precht et al article,1 the smoking was self-reported, and we think that it is necessary to check the veracity of this verbal affirmation by measuring carbon monoxide in exhaled air.

We agree with them that adolescents with asthma should not be smoking, but we think that the problem is that young people with health problems should receive information about smoking during scheduled visits to their physicians. There is a need for medical counseling during the patient's first and later office visits, and a patient's smoking history should be included in the clinical history of all physicians regardless of whether they are primary care physicians or specialists.2,4,5

We discuss in our article2 that when we examined the motivation to stop smoking, we found that 54% of the smokers were willing to try to stop smoking in the next 6 months, and it was interesting that 59% of the smokers had already tried to stop smoking. This is no different than what was shown in the Precht et al1 article, with two thirds (64.3%) of daily smokers having tried to quit smoking, and more often for those with asthma than those without asthma. Is important to highlight this point, because we should offer help to stop smoking because asthmatics have several factors predictive of success.

In conclusion, we think that the important thing is that adolescents with asthma should not be smoking. We should become aware of this problem and start programs that focus on preventing smoking and motivating and supporting those who want to quit, which is necessary to reduce the prevalence of smoking among asthmatics.

REFERENCES

1. Precht DH, Keiding L, Madsen M. Smoking patterns among adolescents with asthma attending upper secondary schools: a community-based study. Pediatrics. 2003;111:562-568

2. Granda-Orive JI, Escobar JA, Gutirrez T, et al. Smoking- related attitudes, characteristics and opinions in a group of young men with asthma. Mil Med. 2001;166:959-965

3. Granda-Orive JI, Pea Miguel T, Reinares Ten C, et al. Attitudes to smoking and characteristics of the habit among a group of young asthmatics compared to a group of non-asthmatics [in Spanish]. Arch Bronconeumol. 2000;36:133-138

4. Granda-Orive JI, Pea Miguel T, Reinares Ten C, et al. [Reciben consejo mdico los asmticos jvenes]. Prev Tab. 2000;2:17-21

5. Tanski SE, Klein JD, Winickoff JP, Auinger P, Weitzman M. Tobacco counseling at well-child and tobacco-influenced illness visits: opportunities for improvement. Pediatrics. 2003;111(2). Available at: www.pediatrics.org/cgi/content/full/111/2/e162

doi:10.1542/peds.2004-0026

JOS IGNACIO DE GRANDA-ORIVE, MD, PHD

FRANCISCO ROIG VZQUEZ, MD

Department of Respiratory Disease

Defense Basic General Hospital

46930 Valencia, Spain

SEGISMUNDO SOLANO REINA, MD

Gregorio Maraon University Hospital

28009 Madrid, Spain

CARLOS A. JIMNEZ RUIZ, MD, PHD

Public Health Institute

28009 Madrid, Spain

Copyright American Academy of Pediatrics Nov 2004

Source: Pediatrics

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