Allergic Rhinitis and its Impact on Asthma - ARIA

ALLERGIC RHINITIS AND ITS IMPACT ON ASTHMA GUIDELINES ● 2010 – V. 9/8/2010
judged suggestive <strong>and</strong> not sufficient to infer a causal relationship between ETS exposure <strong>and</strong> the
onset of childhood asthma. Authors of this report also found inadequate evidence to infer the
presence or absence of a causal relationship between parental smoking <strong>and</strong> the risk of allergy in
children. Irrespective of <strong>its</strong> effect on asthma <strong>and</strong> allergy, ETS has other detrimental respiratory <strong>and</strong>
developmental effects in children.
The authors of that report (68) found only one small study of a population intervention on parental
smoking <strong>and</strong> the symptoms of asthma in children. That study concluded by stating that exposure to
smoking be eliminated for the 37 asthmatic children in whom this was a problem. At 6-month to 2year
follow-up, 20 of the 35 families had complied, <strong>and</strong> improvement was obtained in 18 of these
children <strong>and</strong> in only 4 of the 15 who had failed to comply (73).
We did not find any other studies of interventions aimed on reduction of ETS exposure <strong>and</strong>
development of asthma or wheeze or on the symptoms in children that already had asthma.
Benef<strong>its</strong>
Exposure to ETS increases the risk of many chronic diseases in infants <strong>and</strong> children. Although there
is very limited evidence that stopping the exposure to ETS benef<strong>its</strong> infants <strong>and</strong> children, there is
little doubt that avoiding exposure would be beneficial in these populations <strong>and</strong> in pregnant women.
Harms
There are no important harms from smoking cessation <strong>and</strong> no known harms from reducing the
exposure to environmental tobacco smoke.
Conclusions <strong>and</strong> research needs
It appears that there is a net clinical benefit from not exposing pregnant women, infants <strong>and</strong>
children to environmental tobacco smoke. Given no important harms of smoking cessation or
reducing the exposure to second-h<strong>and</strong> smoke, clinical benefit from stopping the exposure is also
very likely, if pregnant women or children are already exposed.
Further well designed <strong>and</strong> rigorously executed r<strong>and</strong>omised trials of smoking cessation interventions
that measure <strong>and</strong> properly report (74, 75) patient-important outcomes are needed. If done, they are
likely to have an important impact on the quality of evidence supporting this recommendation.
Recommendation
In children <strong>and</strong> pregnant women, we recommend total avoidance of environmental tobacco smoke
(i.e. passive smoking) (strong recommendation | very low quality evidence).
Remarks: Smoking <strong>and</strong> exposure to second-h<strong>and</strong> smoke are common health problems around the
world causing a substantial burden of disease for children <strong>and</strong> adults. While it is very rare to make a
strong recommendation based on low or very low quality evidence, the ARIA guideline panel felt
that in the absence of important adverse effects associated with smoking cessation or reducing the
exposure to second-h<strong>and</strong> smoke, the balance between the desirable <strong>and</strong> undesirable effects is clear.
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