Autopsias de pacientes con enfermedad respiratoria aguda / Autopsies of patients with acute respiratory disease

Introducción: La enfermedad respiratoria aguda es la entidad más frecuente en la vida del ser humano y las enfermedades respiratorias agudas se encuentran entre las causas de muerte. La autopsia es el mejor método del estudio del enfermo y su realización es una fortaleza del sistema de salud cubano. Objetivo: Determinar las características demográficas y morfológicas que se encontraron en las autopsias de fallecidos con enfermedad respiratoria aguda. Método: Se realizó un estudio descriptivo y de corte transversal, de los fallecidos a quienes se realizó autopsia, en el periodo de 1986 al 2019. Se estudiaron las variables edad, sexo, comorbilidades, causas de muerte y relación clínico - patológica. Resultados: La población quedó conformada por 390 autopsias que presentaban estas afecciones (2,5 por ciento). El grupo de edades entre 65 a 84 años fue el más afectado en ambos sexos. En las causas directas de muerte predominó la bronconeumonía bacteriana. Se destaca la elevada coincidencia en las causas directas de muerte y las discrepancias en las causas básicas. La línea de tendencia indica el incremento progresivo en el transcurso de los años estudiados. Conclusiones: Las características demográficas muestran que todos los grupos de edades están afectados, con predominio de 65 a 84 años, en ambos sexos. El pulmón fue el órgano más afectado en las causas directas de muerte, con predominio de la bronconeumonía, mientras que la mayoría presenta enfermedad respiratoria aguda como causa básica de muerte, con elevada discrepancia en su relación clínico patológica(AU)

Introduction: Acute respiratory disease is the most frequent entity in human life and acute respiratory diseases are among the causes of death. The autopsy is the best method of studying the patient and it is a strength of the Cuban health system. Objective: To determine the demographic and morphological characteristics found in the autopsies of the deceased with acute respiratory diseases. Method: A descriptive and cross-sectional study was carried out of the deceased who underwent autopsy, in the period from 1986 to 2019. The variables age, sex, comorbidities, causes of death and clinical-pathological relationship were studied. Results: The population was made up of 390 autopsies with these conditions (2.5 percent). The 65 to 84 age group was the most affected in both sexes. In direct causes of death, bacterial bronchopneumonia predominated. The high coincidence in the direct causes of death and the discrepancies in the basic causes stand out. The trend line indicates the progressive increase in the course of the years studied. Conclusions: The demographic characteristics show that all age groups are affected, with a predominance of 65 to 84 years, in both sexes. The lung was the most affected organ in direct causes of death, with a predominance of bronchopneumonia, while the majority had acute respiratory disease as the basic cause of death, with a high discrepancy in its clinical-pathological relationship(AU)

Effect of a single high-dose vitamin d3 on the length of hospital stay of severely 25-hydroxyvitamin d-deficient patients with COVID-19

OBJECTIVES: In this ancillary analysis of a multicenter, double-blinded, randomized, placebo-controlled trial, we investigated the effect of a single high dose of vitamin D3 on the length of hospital stay of patients with severe 25-hydroxyvitamin D deficiency and COVID-19. METHODS: The primary outcome was length of hospital stay, defined as the total number of days that patients remained hospitalized from the date of randomization until the date of hospital discharge. Secondary outcomes included serum levels of 25-hydroxyvitamin D, mortality during hospitalization, number of patients admitted to the intensive care unit, and number of patients who required mechanical ventilation. ClinicalTrials.gov: NCT04449718. RESULTS: Thirty-two patients were included in the study. The mean (SD) age was 58.5 (15.6) years, body mass index was 30.8 (8.6) kg/m2, and 25-hydroxyvitamin D level was 7.8 (1.6) ng/mL. No significant difference was observed in the median interquartile range of length of hospital stay between the vitamin D3 group (6.0 [4.0-18.0] days) versus placebo (9.5 [6.3-15.5] days) (log-rank p=0.74; hazard ratio, 1.13 [95% confidence interval (CI), 0.53-2.40]; p=0.76). Vitamin D3 significantly increased serum 25-hydroxyvitamin D levels in the vitamin D3 group compared with that in the placebo group (between-group difference, 23.9 ng/mL [95% CI, 17.7-30.1]; p<0.001). CONCLUSIONS: A dose of 200.000 IU of vitamin D3 did not significantly reduce the length of hospital stay of patients with severe 25-hydroxyvitamin D deficiency and COVID-19.

Coronavirus - COVID 19: Más allá de la enfermedad pulmonar, qué es y qué sabemos del vínculo con el sistema cardiovascular / COVID-19 coronavirus: More than just a lung disease: what it is and what we know about the link with the cardiovascular system

Resumen La infección por SARS-CoV2 es una pandemia. Se creía que el primer caso de esta enfermedad ocurrió el 8 de diciembre de 2019 en la provincia de Hubei en China, aunque posteriormente se indicó que el primer caso confirmado por laboratorio ocurrió el 1.( de diciembre de 2019 ante la presencia de un brote de neumonía en 59 pacientes sospechosos en un mercado local de mariscos en Wuhan. No solo produce patología respiratoria, con frecuencia compremete el sistema cardiovascular ya que produce lesión miocárdica, miocarditis, y, con cierta frecuencia, aumenta la descompensación de enfermedades cardiovasculares preestablecidas. En este artículo se trata de dilucidar el componente cardiovascular hasta ahora existente en la literatura y se sugieren algunos pasos a seguir en pacientes con estas enfermedades, acorde con la evidencia actual.

Abstract Infection due to SARS-CoV2 is a pandemic. It is believed that the first case occurred on 8 December 2019 in Hubei province in China, although it was later indicated that the first laboratory-confirmed case occurred on 1 December 2019 due to the presence of an outbreak of suspected pneumonia in 59 patients in a shellfish market in Wuhan. It not only caused a respiratory disease, it often compromised the cardiovascular system since it produces a myocardial lesion, myocarditis, and, less often, increased the decompensation of pre-established cardiovascular diseases. An attempt is made in this article to elucidate the cardiovascular component presented in the current literature, and to suggest some steps to follow in patients with these diseases in accordance with the current evidence.

Guidelines on Nutrition Support Therapy for Acute Respiratory Disease:A Systematic Review / 中国药学杂志

OBJECTIVE: To systematically review the related guidelines of nutrition support therapy (hereinafter referred to as nutrition support) in acute respiratory disease, and to provide evidence-based evidences for clinical nutrition in coronavirus disease 2019 (COVID-19). METHODS: Retrieved from PubMed, EMBase, CNKI, etc., websites of association in nutrition and global guideline databases. The guidelines in nutrition support for related diseases were collected. Recommendations were summarized after data extraction and quality evaluation. RESULTS: A total of 10 guidelines were enrolled, with development time ranging from 2006 to 2019. There were 6 guidelines with quality of level A, 3 with level B, and 1 with level C. “scope and purpose”, “clarity” and “independence” showed the higher scores in AGREE Ⅱ, and “applicability” showed generally low scores. There were differences among emphases of guidelines, however, supplements for each other, and the recommendations for the same questions showed substantial agreement. CONCLUSION: The recommendations, in high quality guidelines of critical illness, acute respiratory distress syndrome, pneumonia, etc., could be applied to nutrition support in COVID-19.

Tetramethylpyrazine inhibits LPS-inducedinflammation of human type Ⅱ alveolar epithelial cells / 基础医学与临床

Objective To study the protective effect of TMP(Tetramethylpyrazine) on LPS(Lipopolysaccharides)-induced inflammatory response of human type Ⅱ alveolar epithelial cells (HAECⅡ) and its corresponding mechanism.Methods HAECⅡ (A549 cells derived from human lung adenocarcinoma cells) were cultured in vitro.Inflammation model was established using A549 cells after LPS stimulation.TMP and FK866 (a specific inhibitor for pre-B cell colony-enhancing factor), were added to intervene respectively.Expression level of mRNA, inflammatory factors including tumor necrosis factor-α (TNF-α), interleukin-1β(IL-1β), interleukin-8 (IL-8) and PBEF(pre-B cell colony-enhancing factor) were detected by q-PCR and Western blot, respectively.The activation of NF-κB(Nuclear factor κB) was examined by Western blot to find the changes in phosphorylated P65 protein level in both nucleus and cytoplasm.Results Both the mRNA and protein level of TNF-α, IL-1β, IL-8 and PBEF in A549 cells were significantly higher after LPS stimulation than those in the control group(P<0.001).Meanwhile, the phosphorylation of P65 protein in the nucleus and cytoplas was higher(P<0.001).The expression of the aforementioned inflammatory factors and the phosphorylation of P65 protein were significantly lower after TMP inter-vention than those of LPS group(P<0.05).In comparison, after FK866 was added, the expression of TNF-α, IL-1β and IL-8 and the phosphorylation of P65 protein were also decreased(P<0.01).Conclusions TMP may be involved in the reduction of PBEF expression, which therefore inhibits NF-κB activation, antagonizes alveolar epithelial cell inflammatory response.

Respiratory pathogen distribution characteristics in children with acute respiratory disease / 国际检验医学杂志

Objective To investigate the respiratory pathogen distribution characteristics in children with acute respiratory disease(ARD).Methods Distribution of respiratory pathogen in 28 600 children with ARD,treated from January 2011 to December 2014 in this hospital,were analyzed.Results Among the 28 600 children,12 162 cases were pathogen positive,including 7 704 cases(63.34%) with single pathogen infection and 4 458 cases(36.66%) with more than two kinds of pathogens infection.Time,season,sex and age distribution of pathogen infection were with statistical difference(P<0.05).There was significant difference in infection rate of pathogens between different time(P<0.05).Infection rate of Mycoplasmal pneumonia(MP) was the highest,and the infection rate of MP and influenza B virus(IFB) increased year by year.Except Legionella pneumophila(LP),the season distribution of infection rate of MP,Coxiella burneti(COX),Chlamydia pneumoniae(CP),adenovirus(ADV),respiratory syncytial virus(RSV),influenza A virus(IFA),IFB and parainfluenza virus(PIVs) were with statistical difference(P<0.05).The infection rate of MP and IFB were higher in the whole year.Conclusion Distribution of respiratory pathogen in children with ARD might be related with the changes of gender,age and season.Detection of respiratory infection pathogen could be with guiding value for clinical diagnosis and drug selection.

Abordando las enfermedades respiratorias agudas en niños con un Enfoque Ecológico en la Comunidad / Addressing acute respiratory diseases in children with an ecological approach in the Community

Objetivos: Disminuir los episodios de enfermedad respiratoria aguda (ERA) en las familias, mediante un enfoque modificado del modelo ecológico de Morelatto para identificar y trabajar colectivamente determinantes que influyen en la salud respiratoria de niños y niñas. Materiales y Métodos: Durante el proceso se realizaron actividades encaminadas a prevenir las principales causas de ERA basadas en el modelo transteórico del comportamiento con el fin de generar cambios conductuales en las familias. Para ello se creó una escala de valoración del riesgo de ERA como instrumento de medición de la efectividad de las actividades realizadas, otorgándole a cada familia un puntaje antes y después de la intervención para determinar si hubo disminución del mismo. Resultados: Las actividades realizadas conducen a cambios evidenciados en las prácticas cotidianos de las madres y sus familias, reflejadas en la escala de valoración de riesgos a partir de la disminución de conductas que favorecen la enfermedad respiratoria aguda y sus complicaciones en la primera infancia afiliada a la FAR -Génesis. Conclusiones: Una menor exposición a eventos y complicaciones de la ERA en miembros de grupos familiares de la FAR -Génesis puede contribuir a mejorar la resiliencia y disminuir la vulnerabilidad socioeconómica de las familias afectadas regularmente por la ERA sus complicaciones.

Objectives: To reduce acute respiratory disease (ARD) in children under six years of age. An ecological model approach modified by Morelatto guided community actions to identify and improve respiratory health determinants. Materials and Methods: During this process activities were implemented to change behaviors at the family level, regarding respiratory health practices according to the trans theoretical model of behavior. A risk scoring scale was used as a tool to track change in respiratory health related practices. Results: Project activities lead to behavioral changes in daily practices related ot ARD in mothers and their families, traced through the risk scoring scale. This approach allowed a participatory intervention of determinants related to ARD at different levels to improve respiratory health of children under six years of age. Conclusions: Fewer episodes and complications of respiratory disease among households may improve resilience and reduce socioeconomic vulnerability of families previously exposed to frequent events and complications of acute respiratory disease.

Effects of positive end-expiratory pressure on hemodynamics and intra-abdominal pressure in patients with acute respiratory distress syndrome with and without intra-abdominal hypertension / 中华急诊医学杂志

Objective To investigate the effects of positive end-expiratory pressure (PEEP) on hemodynamics and intra-abdominal pressure in patients with acute respiratory distress syndrome (ARDS) with normal intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) during mechanical ventilation under a incremental PEEP.Methods Eighteen ARDS patients with normal IAP or IAH treated in intensive care unit of Anhui Provincial Hospital were enrolled for study.At different PEEP levels (5,10,15,20 cmH2O),hemodynamic parameters including extravascular lung water index (EVLWI),intrathoracic blood volume index (ITBVI),stroke volume variation (SVV) and IAP were measured with PICCO technology.Results Compared with ARDS patients with normal IAP,the ARDS patients with IAH were characterized by:(1) EVLWI was decreasing under the increment of PEEP,but there was no significant difference between 15 cmH2O and 20 cmH2O (t =0.593,P =0.572).As PEEP was gradually escalated,EWLVI had no significant changes in patients with normal IAP.(2) SVV increased as PEEP was being titrated to higher level in both groups but in normal IAP group such effect was observed till PEEP above 10cmH2O (PEEP5 vs.PEEP10,t=0.326,P=0.752; PEEP,10 vs.PEEP 15,t=-20.032,P＜ 0.01).(3) There was no statistical difference in ITBVI between two groups at varied levels of PEEP.(4) PEEP could increase IAP levels and had much more profound effects on patients with IAH.Conclusions PEEP is a contributing factor changing IAP.It is necessary to take the level of PEEP into account as IAP variation is interpreted in patients under mechanical ventilation.Different PEEP levels can significantly affect the EVLWI in patients with IAH but not do not in ones with nomal IAP.

Contaminación vehicular en la conurbación pereira-dosquebradas / Vehicle fuel and sound contamination in the pereira-dosquebradas conubaation

Se realizó un estudio sobre la contaminación ambiental por ruido y emisiones de material particulado PM10 asociado a fuentes móviles en la conurbación Pereira-Dosquebradas. Objetivo: Analizar la relación salud con el ruido ambiental y el PM10 asociado al flujo vehicular. Metodología: Se realizaron mediciones de flujo vehicular y ruido ambiental en tres sitios de interés por congestión vehicular. Adicionalmente, se reunió información de estaciones de calidad del aire disponibles en la zona de estudio y población con enfermedad respiratoria aguda (ERA). A partir de estos datos, se desarrollaron modelos para estimar el ruido ambiental a partir de condiciones del flujo vehicular y se proponen dos modelos de simulación reuniendo características de la dinámica de crecimiento poblacional, flujo vehicular y posibles emisiones de material particulado, para estimar el efecto potencial sobre la salud y los costos inducidos asociados a la contaminación. Resultados: En los sitios estudiados, se encontró que el flujo vehicular y el ruido ambiental son estadísticamente mayores en horas pico de la tarde (5 pm a 7 pm). El mayor flujo vehicular se encontró en el sector de la avenida sur de Pereira con un promedio de 2693 veh-Eq/h. Adicionalmente, se pudo estimar que los costos ambientales asociados a la contaminación atmosférica (PM10) podrán llegar a ser del orden del 2% del presupuesto para el municipio de Pereira. Conclusión: El ruido ambiental está correlacionado con el flujo vehicular. El ruido ambiental generado principalmente por efecto del flujo vehicular puede llegar a superar los límites permitidos en la norma nacional para sitios cerca de hospitales. De acuerdo con los modelos de simulación desarrollados, si las condiciones de crecimiento del parque automotor circulante continúan a igual ritmo, en menos de ocho años los efectos de las concentraciones elevadas de material particulado causarán un efecto evidente sobre la morbilidad por enfermedad respiratoria aguda y en los costos ambientales estimados.

A study on noise contamination and particle pollution of PM10 associated with mobile sources in the Pereira-Dosquebradas conurbation was carried out. Objective: To analyze the relationship between health, environmental noise and PM10 due to vehicular flow. Methodology: Measurements of environmental noise and vehicular flow in three sites of interest by traffic congestion were carried out. Additionally, information from air quality stations available in the study area and population with acute respiratory disease (ARD) was collected. From these data, models to estimate the environmental noise from traffic flow conditions were developed and two simulation models using dynamic characteristics of population growth, traffic flow and potential emissions of particulate matter are proposed in order to estimate the potential effect on health and associated induced costs associated with pollution. Results: In the sites studied, it was found that the flow of traffic and environmental noise are statistically higher in the afternoon peak hour (5 pm to 7 pm). The higher traffic flow was found in the sector of Avenida Sur in Pereira with an average of 2,693 veh-Eq/h. Furthermore, from the simulation models, it was found that the environmental costs associated with air pollution (PM10) may become around 2% of the budget for the municipality of Pereira. Conclusion: Environmental noise is correlated with traffic flow. Environmental noise is generated mainly by the effect of traffic flow and it may exceed the limits established in the national standard for sites near hospitals. According to the simulation models developed, if the growth conditions of the vehicle fleet continue in the same tendency, in less than eight years the effects of high concentrations of particulate matter will cause a significant effect on morbidity due to acute respiratory disease and a higher estimated environmental cost.

Propuesta de intervención domiciliaria a la familia del niño con parálisis cerebral portador de infecciones respiratorias / Proposal of intervention at home for the family of the child with cerebral palsy and respiratory infections

Cada año un grupo importante de niños ven limitadas su capacidad funcional e integración social como consecuencia de una Parálisis Cerebral Infantil. Esta además constituye potencialmente una limitación para su expectativa de vida. Con el objetivo de diseñar una propuesta de intervención para facilitar el manejo de los padres de niños con Parálisis Cerebral Infantil portadores de enfermedades respiratorias agudas, se realizó un estudio descriptivo retrospectivo de pacientes portadores de esta afección, nacidos en el periodo 1986-2005 en la provincia de Camagüey, pertenecientes al área de salud del policlínico Rodolfo Ramírez Esquivel del municipio Camagüey. Al evaluar el expediente clínico de cada caso se constató en 10 por ciento, de la muestra 11, de un universo de 18 niños, de los cuales habían ingresado entre 1 y 5 veces al año como consecuencia de infecciones respiratorias. Las mayores cifras fueron en menores de 5 años, 7 (63,63 por ciento) que se corresponde con encamamiento prolongado por lo que favorece el factor predisponente a las infecciones respiratorias. Hubo un predominio de variables de edad, sexo, frecuencia de ingresos y factores asociados a las Infecciones Respiratorias Agudas. Se destaca la importancia de educar a la familia a través de una propuesta de intervención domiciliaria acerca del manejo, tratamiento postural y fisioterapia respiratoria como vía para prevenir infecciones respiratorias agudas en el Paralítico Cerebral, afección que compromete la expectativa de vida de estos casos

Every year, a significant group of children are affected in their functional capacity and social integration as a result of infantile cerebral palsy. This disease is a potential limitation for their life expectancy. With the objective of designing an intervention proposal to facilitate the management of parents of children with infant cerebral palsy and acute respiratory diseases, a retrospective and descriptive study of patients carrying this illness, born in 1986 to 2005 period in Camaguey province and living in the health area of Rodolfo Ramirez Esquivel polyclinics was made. On evaluating the clinical records of each case, it was found in 10 percent of the sample, that is, 11 of a universe of 18 children, who had been hospitalized one to five times from respiratory infections. The highest figures corresponded to children under 5 years of age, 7 (63.63 percent), which agreed with the prolonged bedding that favors the predisposing factor for respiratory diseases. Age, sex, frequency of admissions to hospital and acute respiratory infection-related factors were predominant. The study underlined the importance of educating the family through a proposal of intervention at home about management, posture treatment and respiratory physiotherapy to prevent acute respiratory diseases in the cerebral palsy patients, an illness that compromises their life expectancies

Molecular characterization of adenoviruses from children presenting with acute respiratory disease in Uberlândia, Minas Gerais, Brazil, and detection of an isolate genetically related to feline adenovirus

Human adenoviruses (HAdV) are a major cause of acute respiratory diseases (ARD), gastroenteritis, conjunctivitis and urinary infections. Between November 2000-April 2007, a total of 468 nasopharyngeal aspirate samples were collected from children with ARD at the Clinics Hospital of Uberlândia. These samples were tested by immunofluorescence assay (IFA) and 3 percent (14/468) tested positive for the presence of HAdV. By performing polymerase chain reaction (PCR) to detect HAdV DNA in samples that tested negative or inconclusive for all viruses identifiable by IFA (respiratory syncytial virus, parainfluenza viruses 1, 2 and 3, influenza viruses A and B and HAdV), as well as negative for rhinoviruses by reverse transcription-PCR, additional 19 cases were detected, for a total of 33 (7.1 percent) HAdV-positive samples. Nucleotide sequences of 13 HAdV samples were analyzed, revealing that they belonged to species B, C and E. Further analyses showed that species C (HAdV-2) was the most prevalent among the sequenced samples. To our knowledge, this is the first report describing the presence of HAdV-4 in Brazil. We also detected an isolate that was 100 percent identical to a part of the feline adenovirus hexon gene sequence.

Aplicación del programa de atención integral a las enfermedades prevalentes en la infancia (AIEPI) del Ministerio de Salud Pública, en niños menores de 4 años. Cantón Ventanas: Provincia Los Ríos. Enero-Junio 2003 / The Application of an integral attention program with diseases that prevail in childhood of the Department of Public Health, in children less the 4 years of age. Ventanas Canton: Los Rios Province. January-June 2003

En nuestro país de manera general, y en el Cantón Ventanas en particular, se agudiza periódicamente el alto riesgo de enfermar y en algunos casos, morir, de los menores de 4 años por enfermedades prevenibles, tal como enfermedades infecciosas y parasitarias, infecciones respiratorias agudas, diarreas y desnutrición, asociadas con otras enfermedades infecciosas como malaria, tuberculosis, dengue, chagas, meningitis, las cuales tratadas con terapéutica accesible a la población, producirá resultados positivos, que permitirán mejorar el crecimiento y desarrollo del niño y por ende el nivel de vida de la familia (1, 13).Objetivos: Determinar las 10 principales patologías en menores de 4 años en el cantón Ventanas, durante el primer semestre, año 2003. Determinar la incidencia de las 2 principales patologías. Realizar un estudio comparativo retrospectivo de las referidas patologías.Resultados: De los 2722 niños, 893 presentaron enfermedad respiratoria aguda, 632 enfermedad diarreica aguda y 601 con diagnóstico de paludismo.La incidencia de la enfermedad respiratoria aguda y paludismo fue mayor en el mes de marzo, mientras que la enfermedad diarreica aguda tuvo su mayor incidencia en el mes de febrero.Conclusión: Las tres patologías señaladas, son las principales causas de morbilidad de los niños menores de 4 años; la incidencia de estas enfermedades está en relación con las características geográficas y de infraestructura de salud en el cantón Ventanas.

In our country in the general population and in Ventanas canton in particular it has become a seriously periodically problem the high risk that exists for children less than 4 years old to become sick or in many cases die of preventable diseases like infectious diseases, parasitosis, acute respiratory infections, diarrhea and malnutrition. They are associated with other diseases such as malaria, tuberculosis, dengue, chagas and meningitis. If the diseases are treated with accessible therapeutic measures it would have a positive result in the population. This would allow for child to have a better development and lead to a better life for the family.Objectives:„XTo determine the 10 main pathologies that will affect a child less than 4 years of age in Ventanas Canton during the first semester of year 2003.„XTo determine the incidence of the 2 main pathologies.„XTo have a retrospective comparative study of the pathologies referred to in this article.Results: Of the 2722 children studied, 893 had acute respiratory diseases, 632 acute diarrhea disease and 601 were diagnoses with malaria.The incidence of acute respiratory disease and malaria was higher during the month of March while acute diarrhea disease had a higher incidence during the month of February.Conclusion: The three pathologies that were pointed out in this study are the main cause of morbidity in children less then 4 years of age. The incidence of this diseases are in relation to the geographic characteristics and of the health infrastructure in Ventanas Canton.

Effects of Family Smoking on Acute Respiratory Disease in Children

A household interview survey of 3,651 children aged 0-14 years was performed February-June 1985 to assess the relationship between family smoking and acute respiratory disease (cough) in children. Family smoking (risk variable) was measured by using six variables which were: number of smokers in the family, parental smoking, number of smokers in the same room, number of cigarettes consumed daily by all family members, number of cigarettes consumed daily by parents and number of cigarettes consumed daily by the same room members. Then six logistic models were estimated with each of the six risk variables and selected confounding variables. The range of estimated relative odds of six risk variables was between 126 and 3.00. However, three risk variables showed a significant negative interaction with coughers in the family. So, if there were coughers in the family, the relative odds of these three risk variables were reduced to around 1. This study does not offer the conclusion that family smoking directly contributes to the develpment of acute respiratory disease in children but does suggest the possibility of direct or indirect causal relationship between them.