History

The specific diagnosis of passive smoke exposure (ie, secondhand smoke) is made by the history.

Degree of exposure is best ascertained by questionnaire but can be elicited by simply asking the parents if they smoke or if anyone else smokes around the child. Determining whether other caregivers, such as grandparents or day care workers, smoke around the child is important.

A history of findings consistent with the different diagnoses associated with environmental tobacco smoke (ETS) exposure should prompt questions related to smoking.^{[11, 6, 7, 8, 9]}A history of the following can suggest ETS exposure:

Recurrent pneumonia
Asthma
Bronchiolitis
Upper respiratory tract infections (URTIs)
Otitis media
Bronchitis
Sinusitis

Physical Examination

The physical examination findings depend on the illness associated with ETS exposure.

Findings are consistent with the basic physiologic changes known to occur with smoke exposure, and these changes then predominate.

Increased signs of inflammation in the upper airways (asthma, bronchorrhea, rhinitis/rhinorrhea, bronchiolitis, increased mucus production and/or decreased mucus clearance) can suggest ETS exposure.

Specific findings are associated with specific illnesses (eg, wheezing associated with asthma).

Workup

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