Vaping Plus Smoking in the Home Might Be Worst for Kids’ Asthma

For kids with asthma, household exposure to e-cigarettes was associated with poorer respiratory health, and the risk was even higher when combined with tobacco use in the home, an observational study showed.

E-cigarette exposure alone was associated with a 30% elevated risk of asthma flares (adjusted OR 1.3, 95% CI 1.1-1.4) and a 40% greater likelihood of activity-related asthma symptoms (adjusted OR 1.4, 95% CI 1.2-1.5), Brian Jenssen, MD, MSHP, of Children’s Hospital of Philadelphia, reported at the American Academy of Pediatrics meeting in San Diego.

“There’s some evidence that e-cigarettes could be very helpful to help adult combustible users of tobacco quit smoking … but then what this draws attention to is we have to think about what harm is still there for children from exposure to these products,” Jenssen said. “Neither tobacco nor e-cigarette exposure is safe for children with asthma, or any child.”

“If the narrative is around harm reduction, helping people shift from combustible to e-cigarettes, a lot of those parents are still going to be using both. And what we’ve seen is that’s actually the worst concern in terms of asthma control in kids,” he said.

Children with asthma exposed to both tobacco and vaping had a statistically significant 20-40% higher risk of uncontrolled asthma, asthma flares, nighttime symptoms, symptoms with physical activity, need for albuterol, and hospital admissions in the prior year.

“And so when we ask about smoking in the home, we need to ask about vaping, too,” Jenssen said. “Screening parents for both products at routine visits and then connecting them to treatment — that’s a practical way to protect children who have asthma from any of the consequences of secondhand smoke or secondhand aerosol exposure.”

Just why dual exposure might be worse for kids’ asthma than either e-cigarettes or combustible tobacco alone isn’t yet clear. And that shouldn’t be surprising, Jenssen said. “It took a while to figure out this evidence about the harms of secondhand smoke and its impact on the lungs.”

Harms can show up in children sooner than adults because their smaller size means a faster respiratory rate and greater concentration in the body, he noted.

One possibility is an additive effect on the lungs from different aerosols produced by vaping versus smoking, Jenssen suggested.

“There seems to be something with the particle size when it comes to e-cigarettes that affects a different part of the lungs,” he told MedPage Today. “Maybe — assuming that there’s not a dramatic difference in amounts of use, which may not be a right assumption — secondhand smoke from cigarettes affects lungs in one way and then e-cigarettes affect the lungs in a different part, and that’s why you potentially have kind of worse outcomes in kids.”

The study couldn’t determine causality, and more research is needed, Jenssen emphasized.

The study was a cross-sectional analysis of electronic health record data from Children’s Hospital of Philadelphia’s primary care network from July 2023 through March 2026. It included 48,118 encounters with children 1 year of age or older (48% 6-12 years) who had an asthma diagnosis and whose parent completed both the center’s tobacco and e-cigarette assessment and the child asthma control assessment at the same visit. Of these, 2,500 families (5%) reported combined tobacco and e-cigarette use in the household, 4,238 (9%) reported tobacco-only use, and 1,427 (3%) reported e-cigarette use alone.

Findings were adjusted for child age, sex, insurance, and Child Opportunity Index as a socioeconomic indicator.

“We really need to follow the kids over time, add more objective measures of exposure and asthma outcomes,” Jenssen said. However, “I think we do have enough information to say none of these are safe around kids. … [Parents] certainly need to use outside and try to keep away from their kids as best they can. But the bigger story is trying to quit all tobacco, all nicotine products.”