Passive Smoking and Lung Disease Clinical Presentation

Updated: Jun 07, 2016
  • Author: Timothy D Murphy, MD; Chief Editor: Girish D Sharma, MD, FCCP, FAAP  more...
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Presentation

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. [6, 10, 11, 7, 12] 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. [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.
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