eMedicine Specialties > Pediatrics: General Medicine > Pulmonology

Passive Smoking and Lung Disease: Differential Diagnoses & Workup

Author: Timothy D Murphy, MD, Assistant Professor, Department of Pediatrics, Division of Pulmonology, University of Pittsburgh; Consulting Staff, Division of Pulmonology, Children's Hospital of Pittsburgh
Contributor Information and Disclosures

Updated: Mar 3, 2009

Differential Diagnoses

Other Problems to Be Considered

Recurrent pneumonia

Workup

Laboratory Studies

  • The diagnosis of passive smoking exposure (secondhand smoke) is primarily obtained by history.
  • Urinary cotinine levels have limitations and widely vary between individuals. As many as 50% of nonsmokers may show urinary cotinine, demonstrating the ubiquity of the exposure.
    • Levels are generally low and are less than 1% of those found in smokers.
    • Cotinine is a biomarker of environmental tobacco smoke (ETS) exposure but may not be related to the adverse effect under study.
    • Cotinine may not be specific for ETS exposure because dietary nicotine (eg, eggplant, green pepper, tea, tomato) may elevate cotinine levels.
    • Salivary or serum levels may also be measured.
  • Outside of a clinical history, questionnaires are the most common method to attempt to quantitate ETS exposure, but these can be limited by a lack of understanding of the questionnaire, bias, faulty memory, or intentional alteration of answers.

Other Tests

  • Measuring hair cotinine levels in children exposed to ETS may prove a more sensitive biomarker of exposure.

More on Passive Smoking and Lung Disease

Overview: Passive Smoking and Lung Disease
Differential Diagnoses & Workup: Passive Smoking and Lung Disease
Treatment & Medication: Passive Smoking and Lung Disease
Follow-up: Passive Smoking and Lung Disease
References
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Further Reading

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Keywords

environmental tobacco smoke, ETS, second hand smoke, second hand smoking, smoke exposure, secondhand smoke, secondhand smoking, second-hand smoke, second-hand smoking, ETS-related lung disease, ETS-associated lung disease, recurrent pneumonia, asthma, bronchiolitis, upper respiratory infection, otitis media, bronchitis, sudden infant death syndrome, SIDS, lower respiratory tract infections, LRTIs, bronchiolitis, otitis media, sinusitis, upper respiratory tract infections, URTIs

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Contributor Information and Disclosures

Author

Timothy D Murphy, MD, Assistant Professor, Department of Pediatrics, Division of Pulmonology, University of Pittsburgh; Consulting Staff, Division of Pulmonology, Children's Hospital of Pittsburgh
Disclosure: Nothing to disclose.

Medical Editor

Girish D Sharma, MD, Associate Professor, Department of Pediatrics, Rush University Medical Center, Rush Children's Hospital; Director of Pediatric Pulmonary Section and Rush Cystic Fibrosis Center
Girish D Sharma, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Royal College of Physicians of Ireland
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Heidi Connolly, MD, Associate Professor of Pediatrics and Psychiatry, University of Rochester; Director, Pediatric Sleep Medicine Services, Strong Sleep Disorders Center
Heidi Connolly, MD is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

CME Editor

Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital
Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians
Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Michael R Bye, MD, Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center
Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society
Disclosure: Merck Honoraria Speaking and teaching

 
 
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