_Imagine a child who never smoked cigarettes, growing up and developing chronic obstructive pulmonary disease or COPD, simply because they live in a home where smoking occurs. This is a true medical tragedy. It is also avoidable. _
In an earlier sharepost, I discussed the Hygiene Hypothesis which explains how certain factors in an infant’s early upbringing can predict the likelihood of developing asthma later in life. Specifically, I discussed the benefit of exposure to certain childhood infections, and how that can influence optimal immune cell development and protect the child from developing asthma later-in-life.
There is new evidence supporting what experts like me have suspected. Children who are exposed to second hand smoke in their homes have a double risk for hospitalization for asthma. According to a recent research review at the Mayo Clinic Children Research Center, kids already diagnosed with asthma are more likely to have breathing problems (and symptoms) and be hospitalized when they live with someone who smokes. The review and analysis helped quantify the overall risk for asthmatic children.
This study reviewed 25 previous studies that looked at smoking exposure in the home. It involved more than 400,000 children with an average age of 7 years. The vast majority of the subjects were exposed to some level of second hand smoke at home. Kids exposed to secondhand smoke were:
- 66 percent more likely to seek emergency care
- 85 percent more likely to be hospitalized compared to peers not exposed to secondhand smoke
- Likely to have a triple risk of poor lung function
- 32 percent at higher odds of developing wheezing
There has been a prevailing awareness in our society regarding the dangers of second hand smoke, enough to mandate smoke free public zones and to somewhat influence the behavior of current smokers. There has been no effort to control home environments and smoking. Currently, smoking in the home is regulated by the smokers themselves. So when it comes to the overall safety of kids and exposure to cigarette smoke in the home, and especially when there’s an asthmatic child, it is the adult who will decide whether or not to modulate their in-home smoking behavior.
Childrens’ vulnerability and consequences of second hand smoke
Why are children more vulnerable to second hand smoke? Childhood is when there is crucial growth and development of all the body’s organs, including the lungs**.** The damage done to the architecture of the lungs is directly caused by the inflammation that the smoke exposure instigates. This can result in scarring in the lungs that will have long term, lasting effects. This scarring phenomenon is observed in children from third world countries who had severe pneumonias at an early age. They develop a condition known as bronchiectasis, characterized by permanent widening of the airways and frequent infections.
When it comes to asthma, the constant inflammation of the inner lining of the airways, and the resulting narrowing of the airways, will result in shortness of breath and ultimately limit the physical activities of a normal, active child. Health care providers have treated the inflammation, believing that this would limit the impact of the inflammatory process and preserve normal airways and normal lung function.
The problem with this treatment approach is twofold. First, we always try to avoid regular use of prescription medications in children because the side effects from these drugs may be more dramatic. For example, there is still no clear position on the immediate and long term effects of steroids (a first line treatment in asthma) on growth in children (even in the more local, inhaled form). Second, although we believe that asthma, when treated, is fully reversible with the preservation of patent and normal airways, there is new evidence that questions this assumption. Recurrent and persistent inflammation in the airways can result in permanent narrowing of the airways, a process known as remodeling.
The consequences of remodeling of the airways can be devastating. People with remodeling cannot empty all the air from their lungs when they breathe out. This leads to air trapping, a hallmark of emphysema.
Avoid at all costsWhen it comes to children, it is crucial to prevent disease. Smoking in the home and exposing a child to second hand smoke places them at a huge risk for dire health consequences. This is further compounded if they already have asthma. When we legislate for public safety, public spaces are not the only ones that deserve scrutiny.** When it comes to certain diseases and risks, health and safety begin in the home.**** See More on Kids and Respiratory Care:**
Eli Hendel, M.D., is a board-certified internist/pulmonary specialist with board certification in Sleep Medicine. An Assistant Clinical Professor of Medicine at Keck-University of Southern California School of Medicine, and Qualified Medical Examiner for the State of California Department of Industrial Relations, his areas include asthma, COPD, sleep disorders, obstructive sleep apnea, and occupational lung diseases. Favorite hobby? Playing jazz music. Find him on Twitter @Lung_doctor.