Sadreameli, SC, (2016) American Journal of Hematology, (Link to Abstract)
This is a retrospective and prospective cohort study evaluating the association between cigarette smoke exposure, quantified by measuring the salivary cotinine levels, and incidence of hospital admissions in children with sickle cell disease. Fifty children and young adults with sickle cell disease were enrolled in the study. Questionnaires were administered to determine self-reported/parent-reported smoke exposure and saliva samples were obtained from study subjects to determine cotinine, the major nicotine metabolite, levels. A cotinine level > 0.5 ng/mL was considered to be indicative of smoke exposure, with a level > 10 ng/mL indicative of a primary smoker.
The incidence risk ratio (IRR) for children with any smoke exposure (increased cotinine levels) for hospital admission was 3.7, with those exposed to second hand smoke with an IRR of 4.3. Risks of acute chest crisis and pain crises were also significantly increased in those children found to have any smoke exposure. One limitation of this study was that there was a significant age difference between patients being cotinine positive and negative, which might impact the findings.
* Both primary and secondary exposure to tobacco smoke increases the risk of hospitalizations in children with sickle cell disease, so it is vital that we regularly screen this population for tobacco smoke exposure and educate families about the associated risks.