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Column originally published Dec 29, 1999
Column last revised/updated on Nov 4, 2018

Parental Smoking Can Harm Children With Asthma

Question: My sister has three children with asthma. They are coughing all the time. When they get sick, their cough terrifies me. My sister has refused to give them any asthma medicine unless they are desperately ill. She said that she doesn’t believe in giving her children medicine. On top of this, she and her husband both smoke. Would this cause harm to these children when they grow up?


You are right to be concerned. What you sister is doing can definitely harm her children now and when they grow up. Let me explain in greater detail here.

Asthma is a chronic condition of the lungs where the bronchial tubes are too sensitive to triggers. The triggers for each person can be different, and it depends on where he/she lives. In southern United States, for example, many people are allergic to cockroaches and develop asthma. Except for a few very dry areas in North America, tiny little indoors insects called dust mites can be very troublesome for asthmatics. Mildew and animal dander, especially cats, are also important.

In many young children and adults, viruses and bacteria that infect the respiratory tract can trigger asthmatic attacks in those who are susceptible. The most serious of all, however, is smoking. People who have asthma and smoke will damage their lungs, leading to chronic bronchitis and emphysema.

Parents of children who have asthma and smoke are causing great harm to their children. Cigarette smoke has been known to irritate the airways of children with asthma, making their bronchial tubes swollen and twitchy even in between attacks. Doctors have known for a long time that these children have more severe asthma attacks, more visits to emergency room and hospital admission, and have worse lung function than children of non-smoking parents.

On top of these, second hand smoke has been proven to cause lung cancer. When these children enter secondary school, they will be faced with peer pressure to smoke. Those who have smoking parents are more likely to succumb to this pressure, and speed up damage to their already weakened lungs.

Your description of those children clearly suggests that they have the more severe form of asthma, with daily asthma symptoms like cough. It is quite likely that these children also have difficulty participating in sports activities. Many of them will choose a more sedentary life style instead of being active. When they get sick, these children can get very sick. If they do not have asthma medication at that time, their life can be in danger.

The first thing these parents have to do is to stop smoking in the house and in the car. Smoking in the bathroom, or blowing smoke out of windows, is ineffective. Smoking in the car when children are not around is not good enough, because cigarette smoke is soaked into the seats.

Ultimately, they should try to stop smoking altogether. Smokers often don’t realize this, cigarette smoke hang onto their clothes and their breath. As I mentioned earlier, role model is so important for these children. The worst thing that can happen is when they light up their first cigarette.

Of course, one cannot overlook other triggers in the house that I have mentioned. Removing these other triggers can often result in more healthy bronchial tubes and less need for medicine.

From your description of these children, they do need medicine to control their asthma. If they can use asthma medicine regularly, combined with removal of triggers in the environment, they can actually downgrade the severity of asthma so that the need for medicine can be much less in the future.

If these children are having a lot of cough and difficulty breathing, they will need bronchodilators that reduce muscle twitching around the bronchial tubes. It is important to remember that bronchodilators are useful as relief medicine, and can be stopped when coughing and wheezing are gone.

The more important medicines are those that can control the swelling of bronchial tubes and reduce mucus production. The most effective of these are steroids. When a child is very sick and needs hospitalization, steroids are often given by mouth or intravenously.

Oral steroids, generally, are not used for very long. They are very effective to bring severe asthma under control. Inhaled steroids, on the other hand, are very important to maintain control. Many children and adults with asthma require inhaled steroids daily, but this should be done under the supervision of physicians.

When asthma is finally under good control, which means that children have no daily symptoms and can participate in active sports without coughing, wheezing, and shortness of breath, the dose of inhaled steroids should be reduced to the minimum that will maintain control. These children also should not wake up coughing in the middle of the night.

There are other preventative medicines like Intal and Tilade. These are not steroids, and they have very little side effect, but they are not nearly as effective as steroids.

A new class of medicine was introduced in Canada in 1998. These are called leukotriene blockers. When scientists conduct research on the bronchial tubes of asthma patients, they found that many chemical reactions occur during an asthma attack. The most important chemicals belong to a group called leukotrienes. By designing blockers of these chemicals, researchers were able to reduce the severity of asthma.

Presently, Health Canada has approved two medicines in this group, Accolate and Singulair. Both of these are safe, although Accolate can have a few minor side effects. Most specialists are adding one of these leukotriene blockers to those who require higher doses of inhaled steroids to maintain control. After a while, the dose of inhaled steroids can often be reduced.

Leukotriene blockers can also be used alone for those with exercise induced asthma. Accolate has been approved for children 12 and over, while Singulair can be used for those as young as six.

Regardless, your sister needs to seriously consider the health of her children and stop smoking. If she can agree to give these children medicine regularly to get their asthma under control, she may end up using less medicine in the long run, and her children will be in better health.

Another measure that your sister can use is a peak flow meter to monitor asthma on a daily basis. Peak flow meters are inexpensive and fairly accurate gadgets that children and parents can use together to ensure asthma is under good control. Children as young as 5 or 6 can be trained to use it. Parents can often adjust medications according to peak flow meter readings and guidance from their physicians.

The question of long term damage to the bronchial tube is not totally clear as yet. Early research suggests that uncontrolled asthma will lead to scarring in the bronchial tubes, which can be permanent. Unfortunately, much of the damage cannot be detected by X-ray or lung function tests until many decades later. More studies are ongoing to answer this question.

I hope that I have given you some insight into the problem of severe asthma. It will not be easy for your sister and her husband to change their lifestyle overnight, or their preconception on asthma medicine. Please be patient with them and offer your support.

[Note to Readers: The content and message in this column are still current, after twenty years. Some medications like Intal and Tilade are not being used any more. Singulair is still an effective leukotriene antagonist that we recommend to children, although some may experience mood changes. Prevention is still the key: parents should stop smoking, reduce dust and mould in the house. Daily prevention medicine is useful for those with persistent asthma problem.]