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A cross-sectional study of 48,118 pediatric asthma encounters found that reported exposure to both household tobacco smoke and e-cigarette aerosol was associated with higher risks across several asthma outcomes. The study cannot establish that exposure caused those outcomes, and researchers said the reasons for the association need further study.
A study of 48,118 encounters involving children with asthma found that reported household exposure to both tobacco smoke and e-cigarette aerosol was associated with higher risks of uncontrolled asthma and related problems. The findings, presented by Brian Jenssen of Children’s Hospital of Philadelphia at an American Academy of Pediatrics meeting, raise concern about children breathing both kinds of emissions, but the observational study cannot show that the exposure caused the outcomes.
Children whose families reported both tobacco and e-cigarette use in the home had statistically significant 20% to 40% higher risks across several outcomes than children without that combined exposure, according to the report. Those outcomes included uncontrolled asthma, flares, nighttime symptoms, symptoms during physical activity, use of albuterol and hospital admissions in the prior year. The source did not provide a separate effect estimate for each outcome.
For e-cigarette exposure alone, the analysis found an association with a 30% elevated risk of asthma flares (adjusted odds ratio 1.3; 95% confidence interval 1.1-1.4) and a 40% greater likelihood of activity-related symptoms (adjusted odds ratio 1.4; 95% confidence interval 1.2-1.5). These are adjusted associations, not proof that vaping exposure produced the symptoms.
The records covered children aged 1 or older whose parent completed tobacco and e-cigarette exposure assessments and the child’s asthma control assessment at the same visit. Families reported combined household use in 2,500 encounters (5%), tobacco use alone in 4,238 (9%), and e-cigarette use alone in 1,427 (3%). Researchers adjusted findings for age, sex, insurance and a socioeconomic indicator.
Household Exposure and Asthma Control
The findings point to a practical issue for pediatric care: asking families about cigarette smoking alone may miss another reported source of indoor exposure. Jenssen said clinicians should screen parents for both tobacco and e-cigarette use and connect them with treatment. For families, the results add to concern that keeping both products in use around a child with asthma may coincide with more difficulty controlling symptoms.
The analysis does not show that switching from cigarettes to e-cigarettes worsens a child’s asthma, or that either product caused the reported outcomes. It does, however, identify combined household use as an exposure pattern associated with several measures of poorer asthma control in this group. That pattern may help shape questions asked during routine visits while researchers seek stronger evidence.
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How the Children Were Assessed
The study was a cross-sectional analysis of electronic health records from the Children’s Hospital of Philadelphia primary care network. It included encounters from July 2023 through March 2026, rather than following the same children over time. Nearly half of the encounters involved children aged 6 to 12.
Because exposure and asthma assessments were recorded at the same visit, the study could identify associations but not determine which came first or whether other factors explain the relationship. The analysis used parent-reported exposure and adjusted for selected demographic and socioeconomic factors; it did not establish exposure through objective measurements.
Jenssen noted that children may experience effects from airborne exposures sooner than adults because they are smaller and breathe faster. He also suggested that particles from smoking and vaping might affect different parts of the lungs, potentially contributing to a combined effect. Those explanations remain possibilities, not findings demonstrated by this study.
“Neither tobacco nor e-cigarette exposure is safe for children with asthma, or any child.”
— Brian Jenssen, MD, MSHP, of Children’s Hospital of Philadelphia
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Cause and Combined Effects Remain Unclear
The study cannot determine whether household smoke or e-cigarette aerosol caused asthma flares, symptoms or hospital admissions. Since the analysis relied on assessments completed at the same encounter, it also cannot establish the timing of exposure relative to changes in a child’s asthma. Parent reports and the selected adjustments may leave other relevant differences between households unaccounted for.
Researchers do not yet know why combined exposure was associated with higher risks than either exposure alone. The idea that the two types of particles affect different parts of the lungs is a proposed explanation, and the report says the study did not measure exposure or lung effects objectively. The results also do not quantify how the risks vary with frequency or amount of household use.
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Longer Follow-Up Needed
Jenssen called for studies that follow children over time and use more objective measures of both exposure and asthma outcomes. Those studies could help establish timing and clarify whether combined exposure contributes to changes in control. For now, the reported findings support asking families about both smoking and vaping during asthma care, while keeping the limits of this observational evidence in view.
Jenssen said parents should use these products outside and try to keep away from children, while describing quitting tobacco and nicotine products as the broader goal. The report does not provide a timeline for additional research or a next study milestone.
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Key Questions
What did the study find about children exposed to both smoking and vaping at home?
Combined household exposure was associated with 20% to 40% higher risks across several measures, including asthma flares, nighttime and activity-related symptoms, albuterol use and hospital admissions in the prior year. The study did not establish that the exposure caused these outcomes.
Did the study prove that vaping or smoking caused asthma problems?
No. It was a cross-sectional analysis, so it identified associations in health records but could not establish cause and effect or the order in which exposure and symptoms occurred.
How many encounters involved reported household exposure?
Families reported both tobacco and e-cigarette use in 2,500 encounters (5%). Tobacco-only use was reported in 4,238 encounters (9%), and e-cigarette-only use in 1,427 (3%).
What did the researchers say families and clinicians can do?
Jenssen said clinicians should ask about vaping as well as smoking and connect parents with treatment. He also said parents should use these products outside and try to keep away from children; the study itself did not test those steps.
Source: rss
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