Smoking and Asthma:
Two Things That Mix Worse Than Oil and Water
By Thomas J. Kallstrom, BS, RRT, AE-C, FAARC
 It would seem intuitive that a person with a chronic respiratory disease such as asthma would never use a tobacco product. The same thing goes for the parents of children with asthma. Unfortunately, people with asthma do smoke, and so do the parents of kids with asthma. When I was a practicing respiratory therapist in Ohio, I can remember countless numbers of children who arrived in our emergency department with family members who smelled of tobacco smoke or had a pack of cigarettes in their shirt pocket.
Why is smoking so bad for asthma? Cigarette smoke primes the airways of the person with asthma for an inflammatory reaction. Many studies have shown a sizable number of asthma patients who end up in the emergency department are smokers. In one report published in the medical journal CHEST, researchers found more than one third of adult asthma patients who came to the ED were current smokers and another 23% were former smokers. However, only 4% of those who were in respiratory distress stated that their smoking was responsible for their current flare up—even though they did admit that smoking sometimes worsens their asthma symptoms.
The denial factor
The denial factor goes beyond the patient. A study in France demonstrated how mothers of asthmatic children who themselves had a significant smoking history underreported their smoking habits when questioned.
A U.S. study looked at this denial factor more closely and noted that there was a tendency for a subset of smokers to deny that their child had been exposed to secondhand smoke in their home despite the fact that both they and their child were enrolled in a secondhand smoke study. The children of 17% of these smoking parents had a urinary cotinine/creatinine ratio—a hallmark of secondhand smoke exposure—that was more than two times higher than the mean for non-smoking households.
If you are a smoker
What is especially unexpected about the results of the CHEST study mentioned earlier (which noted that 35% of asthmatics who came to the ED smoke) is that, according to the U.S. Centers for Disease Control and Prevention, only 20.9% of adults in the United States smoke cigarettes. I would not necessarily take this to mean that there is a larger proportion of smokers who have asthma compared to the general public. Rather, there is a direct link between smoking and the potential for an asthma flare up requiring a trip to the ED.
If you are a smoker with asthma—or a smoking parent of a child who has asthma—quitting smoking could go a long way to improving your asthma symptoms or the symptoms of your child. The pay off for you (the smoker with asthma) would be fewer asthma flare ups and overall better health. For your child with asthma, it could mean an end to those trips to the emergency department—or at least, a lot fewer of them. It would also lead to a better quality of life for everyone in the family.
For more information on kicking the habit, visit the Stop Smoking pages of www.lunghealthonline.com.
Thomas Kallstrom is associate executive director and chief operating officer of the American Association for Respiratory Care (AARC) and a member of the National Asthma Education and Prevention Program Coordinating Committee.
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