Agarwal Dipti, Choudhary Richa, Narayan Shamrendra, Yadav Pradeep K, Singh Krishna K
Department of Pediatrics, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND.
Department of Forensic Medicine and Toxicology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND.
Cureus. 2025 Jul 23;17(7):e88583. doi: 10.7759/cureus.88583. eCollection 2025 Jul.
Introduction Passive smoking can exacerbate asthma symptoms in children. Although cotinine levels offer an accurate measure of passive smoking, their use in clinical, forensic, and medicolegal documentation remains limited. This study aimed to evaluate passive smoking in children with asthma by measuring urinary cotinine levels and to explore the forensic and medicolegal implications of documenting such exposure. The association of cotinine levels with asthma severity was examined alongside environmental and host-related factors. Cotinine levels were also correlated with demographic characteristics and parental smoking status. Methods Children newly diagnosed with asthma were enrolled in the study and underwent thorough clinical evaluation. To minimize confounding, children with recent respiratory infections, known environmental allergen exposure, or other chronic respiratory conditions were excluded. Parental smoking was assessed through a structured questionnaire. Urinary cotinine levels were measured using the high-performance liquid chromatography method to assess passive smoking. Host factors (age, sex, family history, and associated allergies) and environmental triggers (passive smoking, cold air, dust, seasonal variation, and residential setting) were also evaluated in relation to asthma severity. Results Among 92 children with asthma, 32 (34.8%) had cotinine levels within the passive smoking range. Children aged ≥6 years and those with a family history of asthma showed a significant association with asthma severity (p = 0.001 and p = 0.032, respectively). Cotinine levels within the passive smoking range were significantly correlated with disease severity (p = 0.043). Parental reporting identified only 30.3% of children exposed to passive smoking. In contrast, cotinine biomarker analysis provided objective evidence of environmental tobacco smoke exposure, underscoring the medicolegal importance of such documentation in clinical practice. Conclusions A considerable proportion of children with asthma demonstrated cotinine levels indicative of passive smoking. Passive smoking was significantly associated with increased asthma severity. Compared to parental reporting, urinary cotinine levels offer a more accurate assessment of passive smoke exposure. As a reliable biomarker, urinary cotinine links clinical findings with forensic documentation, reinforcing its role in medicolegal reporting. Integrating cotinine testing into clinical practice may support preventive strategies and strengthen legal advocacy for at-risk pediatric populations.
引言 被动吸烟会加重儿童哮喘症状。虽然可替宁水平能准确衡量被动吸烟情况，但在临床、法医及法医学文件中的应用仍然有限。本研究旨在通过测量尿可替宁水平评估哮喘儿童的被动吸烟情况，并探讨记录此类暴露的法医及法医学意义。同时研究了可替宁水平与哮喘严重程度的关联以及环境和宿主相关因素。还将可替宁水平与人口统计学特征及父母吸烟状况进行了关联分析。
方法 新诊断为哮喘的儿童纳入本研究并接受全面临床评估。为尽量减少混杂因素，排除近期有呼吸道感染、已知环境过敏原暴露或其他慢性呼吸道疾病的儿童。通过结构化问卷评估父母吸烟情况。采用高效液相色谱法测量尿可替宁水平以评估被动吸烟。还评估了宿主因素（年龄、性别、家族史和相关过敏）及环境触发因素（被动吸烟、冷空气、灰尘、季节变化和居住环境）与哮喘严重程度的关系。
结果 在92名哮喘儿童中，32名（34.8%）的可替宁水平处于被动吸烟范围内。年龄≥6岁的儿童以及有哮喘家族史的儿童与哮喘严重程度显著相关（分别为p = 0.001和p = 0.032）。处于被动吸烟范围内的可替宁水平与疾病严重程度显著相关（p = 0.043）。父母报告仅识别出30.3%暴露于被动吸烟的儿童。相比之下，可替宁生物标志物分析提供了环境烟草烟雾暴露的确切证据，凸显了此类记录在临床实践中的法医学重要性。
结论 相当一部分哮喘儿童的可替宁水平表明存在被动吸烟。被动吸烟与哮喘严重程度增加显著相关。与父母报告相比，尿可替宁水平能更准确地评估被动烟雾暴露情况。作为一种可靠的生物标志物，尿可替宁将临床发现与法医学文件联系起来，强化了其在法医学报告中的作用。将可替宁检测纳入临床实践可能有助于支持预防策略，并加强对高危儿科人群的法律宣传。
