Children of heavy smokers may not be getting the treatment for asthma that they need, suggests research in Thorax.

Passive smoking is a major cause of respiratory illness among children. But the research showed that the more heavily parents smoked, the less likely were they to make an appointment for asthma for their children. Over 400 asthmatic children aged 2 to 12 with a parent who smoked were studied. Health service contacts for asthma, taken from GP case records in 73 practices, were assessed. The effects of passive smoking were measured by levels of a tobacco by-product, cotinine, in the children's spit. The results showed that when parents perceived their child's asthma to be severe, they were likely to make more visits. And the higher the reported levels of smoking at home, the fewer visits were made for asthma, with the highest rates dropping the visit frequency by over a third. Frequency also fell the more parents smoked, and this was particularly so if the mother smoked. This effect was not seen for other illnesses. Age of the child and the number of other children in the family all influenced the amount of visits made to the GP. The authors conclude that heavy smoking may simply reduce parental awareness of their children's asthma symptoms. Or it may be that heavy smokers do not want to be told to stop smoking by their GP. But they say, it means that asthmatic children whose parents smoke may not be being treated adequately.

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