Passive Smoking and Lung Disease Clinical Presentation

  • Author: Timothy D Murphy, MD; Chief Editor: Michael R Bye, MD   more...
 
Updated: Mar 5, 2012
 

History

The specific diagnosis of passive smoke exposure (ie, secondhand smoke) is made by 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 ETS exposure should prompt questions related to smoking.[5, 8, 9, 6, 10] A history of the following can suggest environmental tobacco smoke (ETS) exposure:
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Physical

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).
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Causes

The cause of ETS exposure is straightforward; smokers are in the child's environment.[8, 9, 6, 10]

  • Sometimes this is difficult to discern, particularly if a primary caregiver is unavailable to provide a history.
  • The reasons for a caregiver's smoking are myriad but may include a physiologic or psychologic predilection for addiction, the effects of aggressive advertising campaigns by the tobacco industry, and family exposure.
  • Tobacco use by a parent is a risk factor for initiation of smoking.
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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.

Specialty Editor Board

Girish D Sharma, MD  Professor of Pediatrics, Rush Medical College; Senior Attending, Department of Pediatrics, Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush University Medical 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.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Heidi Connolly, MD  Associate Professor of Pediatrics and Psychiatry, University of Rochester School of Medicine and Dentistry; 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.

Mary E Cataletto, MD  Director of Children's Sleep Services, Winthrop Sleep Disorders Center, Mineola, NY; Professor of Clinical Pediatrics, State University of New York at Stony Brook, Stony Brook, NY

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: Nothing to disclose.

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