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There is a firm scientific evidence that smoking and second-hand smoke in patients with asthma can lead to worsening of the symptoms and increased mortality. Asthma usually starts during childhood, but there is also the late-onset asthma.

Smoking (in adults) and second-hand smoke (in both adults and children) are well-known risk factors for asthma, though the exact cause of the disease remains unknown. It is estimated that 25 to 35 per cent of people with asthma are smokers. Many studies have been conducted during the past few decades, with the aim to investigate all aspects of the relationship between smoking and human health.

Here are some of the most important facts regarding the correlation between asthma and smoking.

The rich history of asthma and smoking

Most of the facts from the above paragraph are well-known to people today, but that wasn’t always the case. Since the eighteenth century, people have actually used smoking as a therapy for asthma. Many plant extracts were used to prepare cigarettes for asthma, and that trend became very popular. The anti-asthma cigarettes were heavily commercialized. That was the common practice until the mid-nineteenth century, when scientists begun to understand the inflammatory nature of asthma, and that is when the use of anti-asthma smoking remedies started to decline.

What is the risk of asthma in smokers?

When we talk about adult onset asthma, smoking has been proven as one of the important risk factors. Namely, persons who smoke or have been smoking are at higher risk of asthma development than persons who have never smoked. One study found an interesting point that women are more prone to develop asthma due to smoking than men. In figures, people who smoke are about five times more likely to develop asthma in adulthood than those who don’t smoke. This is, of course, an average risk. Smoking has a cumulative effect, and therefore, the length of smoking and the number of cigarettes per day are other factors that greatly influence this estimation.

Does second-hand smoke affect children with asthma?

Second-hand smoke in children is strongly related not only to the development of asthma, but also to the development of other respiratory diseases, such as chronic obstructive pulmonary disease (COPD), emphysema, and respiratory tract infections.

It has been noticed that children have increased risk of asthma if parents are smokers. Furthermore, children with existing asthma have more pronounced symptoms if their parents are smokers. This applies even for less than 10 cigarettes per day. Children of mothers who smoke during the first year of their lives have a higher incidence of pneumonia and wheezing. On the other hand, one study has shown that in over 80 percent of children with asthma exposed to second-hand smoke, the father was the smoker. Similar to primary smoking, there is also a correlation between the amount of received second-hand smoke and the severity of asthma symptoms.

Second-hand smoke and adults with asthma

Besides children, adults with asthma are also affected by second-hand smoke. There is an interesting study conducted on flight attendants who never smoked, but have been exposed to second-hand smoke at a time when smoking was not forbidden during flights. These individuals had a significantly greater incidence of asthma, as well as other respiratory disorders than persons who were not exposed to second-hand smoke. Asthma was diagnosed in 14 per cent of the exposed flight attendants. Therefore, second-hand smoke definitely affects adults and produces respiratory disorders, one of which is asthma.

Asthma management in smokers

There are many difficulties when it comes to treatment of asthma in persons who smoke. The components of cigarette smoke can cause irritation of the airways and worsen the symptoms of asthma. Also, various studies have found that poor control of asthma is more common in smokers than in non-smokers.

Inhaled corticosteroids are among the most important drugs for the treatment of asthma attacks, as well as for long-term asthma treatment. Scientists have found that some smokers with asthma develop resistance to inhaled corticosteroids. They speculate that the mechanism might be reduced permeability of the airways’ mucous membrane in asthma patients who smoke. In patients with existing asthma, the treatment needs to be adjusted if they become smokers or start smoking more than they used to, as smoking negatively affects asthma symptoms.

Treatment challenge in asthma patients also lies in the adherence to the prescribed therapy. This is not a rule, neither it can be generalized, but it has been found that smokers are statistically less likely to stick to some treatment plans.

What about e-cigarettes or vaping?

Electronic cigarettes are less harmful to human health than regular cigarettes, and that is why there is a growing trend in switching to this alternative. While this is true for most diseases, airways are still affected by the smoke. Asthma patients often report that the smoke from e-cigarettes triggers their attacks. This is reasonable, because any kind of inhaled irritant can affect the sensitive and chronically inflamed airways of asthma patients. Therefore, while vaping is definitely less harmful than smoking, it cannot be considered as a safe alternative to asthma patients. More research is required in order to assess and make firm conclusions regarding the effects of e-cigarettes on human health.

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