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Many American children with asthma are exposed to secondhand smoke, and experience health problems as a result, according to a new study.

“National asthma guidelines have advised avoidance of environmental tobacco smoke for patients with asthma for decades, but it is unclear to what degree these recommendations are being followed and what the impact of exposure has been in an era of increased awareness of the effects of environmental tobacco smoke exposure,” study author Dr. Lara Akinbami of National Center for Health Statistics of the Centers for Disease Control and Prevention, said in a news release.

The study included data from 972 children ages 6 to 19, who had asthma, HealthDay reports. The researchers found that between 2005 and 2010, more than half—53 percent—of the children were exposed to secondhand smoke. This exposure was associated with an increased risk of having three or more visits to a physician or emergency room because of wheezing in the past year. It was also linked with having sleep disturbed by wheezing one or more nights a week, and activity limitations due to wheezing.

They did not find a significant association between exposure to secondhand smoke and missing school or work due to wheezing, or wheezing during exercise.

The study was presented this week at the Pediatric Academic Societies’ annual meeting in Boston.

“Although this advice is certainly not new, discussing avoidance of environmental tobacco smoke with asthma patients remains critical,” Dr. Akinbami said. “New tools are needed to help families achieve the goal of reducing exposure, both inside the home and in other environments.”

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