Passive Smoking and Lung Disease Clinical Presentation
- Author: Timothy D Murphy, MD; Chief Editor: Girish D Sharma, MD, FCCP, FAAP more...
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.[6, 10, 11, 7, 12] A history of the following can suggest environmental tobacco smoke (ETS) exposure:
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).
The cause of ETS exposure is straightforward; smokers are in the child's environment.[10, 11, 7, 12]
- 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.
Gajewska E, Malak R, Mojs E, Samborski W. [Cigarette smoking--threat from first days of life]. Przegl Lek. 2008. 65(10):709-11. [Medline].
Halterman JS, Borrelli B, Tremblay P, et al. Screening for environmental tobacco smoke exposure among inner-city children with asthma. Pediatrics. 2008 Dec. 122(6):1277-83. [Medline].
Perret JL, Walters H, Johns D, Gurrin L, Burgess J, Lowe A, et al. Mother's smoking and complex lung function of offspring in middle age: A cohort study from childhood. Respirology. 2016 Mar 11. [Medline].
Yu M, Zheng X, Peake J, Joad JP, Pinkerton KE. Perinatal environmental tobacco smoke exposure alters the immune response and airway innervation in infant primates. J Allergy Clin Immunol. 2008. 122:640-7. [Medline].
USDHHS. US Department of Health and Human Services. The health consequences of smoking: a report of the surgeon general. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2004.
Van Minh H, Giang KB, Xuan LT, Nga PT, Hai PT, Minh NT, et al. Exposure to second-hand smoke at home and its associated factors: findings from the Global Adult Tobacco Use survey in Vietnam, 2010. Cancer Causes Control. 2012 Feb 29. [Medline].
Yi O, Kwon HJ, Kim H, Ha M, Hong SJ, Hong YC, et al. Effect of environmental tobacco smoke on atopic dermatitis among children in Korea. Environ Res. 2012 Jan 20. [Medline].
Gill R, Krishnan S, Dozor AJ. Low-level environmental tobacco smoke exposure and inflammatory biomarkers in children with asthma. J Asthma. 2014 May. 51(4):355-9. [Medline].
Centers for Disease Control and Prevention. Disparities in Secondhand Smoke Exposure-United States, 1988-1994 and 1999-2004. MMWR Morb Mortal Wkly Rep. 2008. 57:744-7. [Medline].
Chen YT, Chung MC, Hsiao FH, Miao NF, Chen PL. Exploration of Parental Smokers' Experience, Perceptions, and Family's Influences on Their Smoking in the Presence of Children. ANS Adv Nurs Sci. 2012 Jan. 35(1):E1-E13. [Medline].
Johannessen A, Bakke PS, Hardie JA, Eagan TM. Association of exposure to environmental tobacco smoke in childhood with chronic obstructive pulmonary disease and respiratory symptoms in adults. Respirology. 2012 Jan 16. [Medline].
Kim CH, Lee YC, Hung RJ, McNallan SR, Cote ML, Lim WY, et al. Exposure to secondhand tobacco smoke and lung cancer by histological type: a pooled analysis of the International Lung Cancer Consortium (ILCCO). Int J Cancer. 2014 Oct 15. 135(8):1918-30. [Medline]. [Full Text].
Schwartz JL. Review and Evaluation of Smoking Cessation Methods: The United States and Canada, 1978-1985. US DHHS, National Cancer Institute, Division of Cancer Prevention. 1987.
US DHHS. The Health Benefits of Smoking Cessation: A Report of the Surgeon General. US DHHS Public Health Service, Office of the Surgeon General, Office on Smoking. 1990.
Fathallah N, Maurel-Donnarel E, Baumstarck-Barrau K, Lehucher-Michel MP. Three-year follow-up of attitudes and smoking behaviour among hospital nurses following enactment of France's national smoke-free workplace law. Int J Nurs Stud. 2012 Feb 18. [Medline].
Fujishiro K, Stukovsky KD, Roux AD, Landsbergis P, Burchfiel C. Occupational gradients in smoking behavior and exposure to workplace environmental tobacco smoke: the multi-ethnic study of atherosclerosis. J Occup Environ Med. 2012 Feb. 54(2):136-45. [Medline]. [Full Text].
Priest N, Roseby R, Waters E, et al. Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke. [update of Cochrane Database Syst Rev. 2003; (3): CD001746; PMID: 12917911]. Cochrane Database of Systematic Reviews. 2008. 4:CD001746. [Medline].
Gruer L, Tursan d'Espaignet E, Haw S, Fernández E, Mackay J. Smoke-free legislation: Global reach, impact and remaining challenges. Public Health. 2012 Feb 14. [Medline].
US DHHS. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta, Ga: USDHH, Public Health Service, CDC, National Center for. Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 1994. [Full Text].
Ortega Cuelva G, Cabezas Peña C, Almeda Ortega J, Saez Zafra M, Ballvé Moreno JL, Pascual Esteban JA, et al. Effectiveness of a brief primary care intervention to reduce passive smoking in babies: a cluster randomised clinical trial. J Epidemiol Community Health. 2014 Nov 11. [Medline].
Al-Delaimy WK, Crane J, Woodward A. Questionnaire and hair measurement of exposure to tobacco smoke. J Expo Anal Environ Epidemiol. 2000 Jul-Aug. 10(4):378-84. [Medline].
American Academy of Pediatrics, Committee on Environmental Hazards. American Academy of Pediatrics. Involuntary smoking--a hazard to children. Committee on Environmental Hazards. Pediatrics. 1986 May. 77(5):755-7. [Medline].
Cloutier MM, Wakefield DB, Hall CB, Bailit HL. Childhood asthma in an urban community: prevalence, care system, and treatment. Chest. 2002 Nov. 122(5):1571-9. [Medline].
Fiore MC, Novotny TE, Pierce JP, et al. Trends in cigarette smoking in the United States. The changing influence of gender and race. JAMA. 1989 Jan 6. 261(1):49-55. [Medline].
Fuji Y, Shima M, Ando M, et al. Effect of air pollution and environmental tobacco smoke on serum hyaluronate concentrations in school children. Occup Environ Med. 2002 Feb. 59(2):124-8. [Medline].
Groner J, Wadwa P, Hoshaw-Woodard S, et al. Active and passive tobacco smoke exposure: a comparison of maternal and child hair cotinine levels. Nicotine Tob Res. 2004 Oct. 6(5):789-95. [Medline].
Host A. The role of passive smoking and indoor pollution. Pediatr Pulmonol. 2004 Feb. 37 Suppl 26:218-9. [Medline].
Jaakkola MS, Piipari R, Jaakkola N, Jaakkola JJ. Environmental tobacco smoke and adult-onset asthma: a population-based incident case-control study. Am J Public Health. 2003 Dec. 93(12):2055-60. [Medline].
Lee YL, Hsiue TR, Lee CH, et al. Home exposures, parental atopy, and occurrence of asthma symptoms in adulthood in southern Taiwan. Chest. 2006 Feb. 129(2):300-8. [Medline].
National Institutes of Health, National Cancer Institute. Changes in cigarette-related disease risks and their implication for prevention and control. Smoking and Tobacco. 1997.
National Research Council. Environmental Tobacco Smoke: Measuring Exposures and Assessing Health Effects. Washington, DC: National Academy Press; 1986.
Overpeck MD, Moss AJ. Children's exposure to environmental cigarette smoke before and after birth. Health of our nation's children, United States, 1988. Adv Data. 1991 Jun 18. 1-11. [Medline].
Rushton L, Courage C, Green E. Estimation of the impact on children's health of environmental tobacco smoke in England and Wales. J R Soc Health. 2003 Sep. 123(3):175-80. [Medline].
Shiva F, Nasiri M, Sadeghi B, Padyab M. Effects of passive smoking on common respiratory symptoms in young children. Acta Paediatr. 2003 Dec. 92(12):1394-7. [Medline].
St Helen G, Jacob P 3rd, Peng M, Dempsey DA, Hammond SK, Benowitz NL. Intake of Toxic and Carcinogenic Volatile Organic Compounds from Secondhand Smoke in Motor Vehicles. Cancer Epidemiol Biomarkers Prev. 2014 Nov 14. [Medline].
US DHHS. Major Local Tobacco Control Ordinances in the United States. 1993. 1993.
US DHHS. Respiratory Health Effects of Passive smoking: Lung Cancer and Other Disorders. The Report of the U.S. Environmental Protection Agency. US DHHS, Public Health Service, National Institutes of Health;. US Environmental Protection Agency. 1993.