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Tobacco Smoke, E-cigarettes and Asthma

Tobacco smoke, whether you inhale from your own cigarette or breathe in secondhand smoke, is dangerous to your health. E-cigarettes may not be much better. When you have asthma, either type can be even worse.

What are E-cigarettes?

e-cigarette infographic

Electronic cigarettes (e-cigarettes) is the name given to a group of battery-operated tobacco products that allow users to inhale aerosolized liquid (e-juice) that has nicotine and other substances. The terms "e-cigarettes" and "e-cigs" are often used for electronic cigarettes, as well as for e-pens, e-pipes, e-hookah, and e-cigars. These products are also sometimes called "JUULs" (after a branded e-cigarette of the same name), "vapes," and "vape pens." Unlike real cigarettes, e-cigarettes are made up of a battery-operated heating part — a cartridge (unit) that typically holds nicotine and other chemicals that change into a chemical-filled aerosol when heated.

How E-Cigarettes Might Affect Allergies and Asthma

E-cigarettes may not be as dangerous for the person with allergies and asthma as real cigarettes. However, the dangers of e-cigarettes on allergies and asthma are not yet known so must be taken seriously. The e-juice in e-cigarettes is not pure, and could trigger an asthma attack or worsen nasal allergy symptoms, either by the person using the e-cigarettes or even from a person breathing the "second-hand" vapor that comes from the e-cigarette.e-cigarette infographic It is important for people to know that e-cigarettes are not a safe alternative to smoking real cigarettes.

How Smoking E-Cigarettes Affects Asthma

A 2016 study of Korean high school students found that using e-cigarettes was linked with increased asthma symptoms and caused school absences. Another study found that people with and without asthma had airway irritation after e-cigarette use, but the airway irritation in people with asthma was a lot worse, and they took twice as long to recover.

Learn more about e-cigarettes including why they are so popular with kids, laws, and additional health and safety concerns.

Two infographics from the MDHHS Asthma and Tobacco Programs:

What is Secondhand Smoke?

Secondhand smoke is a mixture of sidestream smoke given off by a smoldering cigarette and mainstream smoke exhaled by a smoker. The Environment Protection Agency (EPA) states that over 4,000 different chemicals can be found in tobacco smoke. More than 50 of them are known or probable causes of cancer, and six are hazardous to growing children and unborn babies.

Secondhand Smoke Statistics

  • Secondhand smoke is the second leading cause of deaths that could be prevented in Michigan.
  • One nonsmoker dies of secondhand smoke for every eight smokers.
  • People whose partners smoke are nearly five times more likely to develop asthma in adulthood than those who are not exposed to secondhand smoke.
  • Nonsmokers who are regularly exposed to secondhand smoke at home or work have almost double the risk of heart disease. That translates to about 50,000 fatal heart attacks a year in nonsmokers.
  • Smoke filled rooms can have up to six times the air pollution as a busy highway.

Health Effects of Secondhand Smoke

The exposure of secondhand smoke has been linked with many bad health effects, including many cancers, heart disease, sudden infant death syndrome, middle ear problems and respiratory conditions. Every year, nearly 54,000 people die of secondhand smoke exposure. Secondhand smoke is dangerous to everyone, although unborn babies, infants and children are at the most risk because their bodies are still growing.

Tobacco smoke is toxic to the lungs. People with asthma who smoke or are exposed to secondhand smoke have a higher risk for asthma attacks because their airways are overly sensitive. Secondhand smoke is more harmful to nonsmokers because their bodies are not as used to smoke exposure, as smoker's bodies are.

Secondhand smoke contains: formaldehyde (embalming fluid), cyanide (poison) arsenic (poison), carbon monoxide (car exhaust), methane (poison), benzene (poison in cleaning solvent), nitro amines (cancer-causing compounds), cadmium (toxic metal), benzopyrene (cancer -causing substance found in gasoline and tar), aniline (poison used in dye) and polonium (radioactive materials). About 54,000 people die of secondhand smoke exposure every year in the United States.

Listed below are the known health effects of secondhand smoke:


  • Secondhand smoke exposure can cause lung cancer.
  • Secondhand smoke exposure increases the risk of getting nasal sinus cancer.
  • Secondhand smoke is well known as a risk factor for heart attack and stroke.
  • Secondhand smoke irritates the lungs, leading to coughing, excess mucus, chest discomfort, and poorer lung function.
  • Eye and nose irritation in adults can occur after being around secondhand smoke.

Infants and Children

  • Children who breathe secondhand smoke can have more frequent and more severe asthma attacks.
  • Secondhand smoke may cause children to develop asthma.
  • Children who breathe secondhand smoke are more likely to get pneumonia, bronchitis, breathing problems that don't get better, and poor lung function.
  • Children who breathe secondhand smoke are more likely to have more middle ear infections.
  • Infants who breathe secondhand smoke are at a higher risk for Sudden Infant Death Syndrome (SIDS), the main cause of death in babies between one month and one year of age.
  • Secondhand smoke can result in infants with low birth weight or be small for gestational age.

Secondhand Smoke and Older Adults

Tobacco has been called a "childhood disease" because children are the targets of tobacco company ads, and childhood is when 90% of current smokers were addicted. However, tobacco/secondhand smoke is also a "senior disease" because that is when the disease and death caused by tobacco usually happens. Exposure to secondhand smoke has been found to start attacks of angina, irregular heart beats, and the symptoms of asthma. About 54,000 people in the U.S. die every year from secondhand smoke-related diseases. If you use the same percentages of smoking-related deaths to secondhand smoke deaths, then over 50,000 of these deaths are to people aged 50 and over; and over 37,000 of these people are to people aged 65 and over.

For more information about tobacco and seniors, go to The Center for Social Gerontology’s website, and the section "Tobacco & Elderly" at www.tcsg.org/tobacco.htm and click on Tobacco and Elderly.

Where Is the Smoke?

Exposure to secondhand smoke can come from many locations including homes, restaurants, worksites, public places, and vehicles. Currently, there is a strong movement to cut secondhand smoke exposure in public places and workplaces. By putting policies that limit smoking in place, this movement has been helpful in cutting exposure to secondhand smoke in public places.

The greatest exposure for children usually comes in the home. Almost 60% of U.S. children aged (3-11) years (or 22 million children) are exposed to secondhand smoke in the home (The Surgeon General Report, 2006). In Michigan, 21.7% of children live in a house where smoking is allowed in some or all areas of the house (2007 Michigan BRFS).

Children are not the same as adults because they are less able to control their environment on their own to limit their exposure to secondhand smoke. This is because infants and very young children are not able to protest, older children may not protest, or they may be ignored or scolded when they do.

Secondhand Smoke and the Worksite

Since 2010 Michigan residents and visitors are protected from exposure to secondhand tobacco smoke in all restaurants, bars and businesses (including hotels and motels), thanks to the Dr. Ron Davis Smoke Free Air Law. Click on www.michigan.gov/smokefreelaw for more information. For more information on smoke-free worksite policy, please call 517-335-8376.

Secondhand smoke is a class "A" carcinogen, something known to cause cancer in humans. There is no safe level of exposure to a cancer-causing agent. Simply dividing smokers from nonsmokers within the same airspace may cut down exposure to secondhand smoke, but cannot get rid of it.

Workers exposed to secondhand smoke on the job are 34 percent more likely to get lung cancer. Exposure to secondhand smoke can also result in worsened asthma symptoms, poor blood circulation, bronchitis, and pneumonia.

Smokefree Air Law Helps Those with Asthma

Recent research, published in Preventing Chronic Disease, "Racial Disparities in Asthma Hospitalizations Following Implementation of the Smoke-Free Air Law, Michigan, 2002–2012," studied statewide hospital discharge data from January 2002 through December 2012. After adjusting for age, sex, race, insurance type and month of year, there was an 8% reduction in the population-wide rate of asthma hospitalizations in the 12 months after the implementation of the Smoke Free Air Law (SFA). Whites were found to have a higher annual decrease in hospitalization rates (10.5% vs. 7.8% in blacks) after the implementation of the SFA Law. In the 32 months following implementation of the SFA law, researchers saw a reduction of 3,230 adult asthma hospitalizations, saving approximately $48.6 million in health care costs.

The Campaign for Tobacco-Free Kids is a national non-profit organization that works to bring awareness and advocacy to the issue of underage tobacco use. They provide up-to-date state-specific data about tobacco use and its toll on health and the economy.

Myths and Misconceptions About Smoking

Myth: If I smoke cigarettes in a separate room in the house, then my family is not being exposed.

Fact: Smoke will travel throughout the house no matter where the cigarette is being smoked. It is like putting chlorine in the shallow end of the pool and expecting the chlorine to not circulate to the deep end. Even ventilation systems in homes cannot filter and circulate air well enough to get rid of secondhand smoke. Going into another room to smoke, opening a window or smoking while children are gone may help reduce children's exposure but will not protect them from the dangers of secondhand smoke.

The Surgeon General Report in 2006 stated that even separately enclosed separately exhausted, negative-pressure smoking rooms cannot keep second hand smoke from spilling into adjacent areas. (The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, 2006)

In a July 2001 study in the Journal of American Medical Association, investigators found that brief exposure to small amounts of secondhand smoke can immediately affect the hearts of nonsmokers. The study showed that in as little as 30 minutes of exposure to secondhand smoke, the nonsmokers' blood flow dropped to the same level as people who had smoked a pack of cigarettes. After short amounts of exposure, secondhand smoke had caused damage to the cells that line the heart and blood vessels, causing them to narrow or constrict. This narrowing can lead to hardening or thickening of the arteries and heart disease.

Myth: Simply separating non-smokers within the same areas, such as a workplace or restaurant, will keep them from being exposed to secondhand smoke.

Fact: Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot eliminate secondhand smoke exposure. (The Surgeon General Report, 2006).

The American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), the Preeminent U.S. standard-setting body on ventilation issues, has concluded that ventilation systems cannot remove secondhand smoke from indoor environments. (Environmental Tobacco Smoke: Position Document. Atlanta, Georgia: 2005)

Quitting Tobacco Use

Nicotine addiction is the physical dependence of your body to the powerful chemical nicotine. If you use tobacco and you want to quit for your health and the health of others, help is available.

Once you have decided to quit it is important to incorporate these key elements:

A tobacco dependence treatment (or quit smoking) program is an important part of the quitting process. The following information can help you choose a tobacco cessation program.

Types of Cessation Programs

  • Group Programs
  • Telephone Cessation
  • One-on-one Counseling Programs
  • Twelve-step Programs
  • Self Help Programs
  • Inpatient Programs
  • Computer-based/Internet Programs

Guidelines for Choosing a Program to Help You Quit

Different programs work best for different people. When choosing a program, consider things like time, place and coaching methods.
  • Choose a research-based program.
  • Look around for tobacco cessation courses that may be offered at a local hospital, or through your health plan, the American Lung Association, or the American Cancer Society.
  • Ask your doctor, nurse or health plan for suggestions about programs with a good reputation.
  • When looking for a program, ask for details about the cost and length of the course.
  • Are the presenters trained cessation counselors, and do they have a background in health?
  • Will your health plan cover all or part of the cost for attending?
  • Look for programs that teach avoidance (staying away from tobacco), stress management, coping, interpersonal and refusal skills. It should also address diet, exercise and other health behaviors.
  • Will the program help you decide if you are ready to quit? Will it help you determine your motivation for quitting smoking? Will it help you pick a "quit date"?
  • The program should highlight the short and long-term costs of tobacco use.
  • Different types of instruction methods should be used. (video, group interaction, demonstrations).
  • The program should help you to understand how smoking fits into our society (most people don’t smoke).
  • The program should teach media awareness – an understanding of how your tobacco use is influenced by others.
  • The program will be better and more effective for you in a building where participants cannot have tobacco products, and where policy limits smoking.
  • You can improve your success at quitting by choosing a program with courses that have at least four to seven sessions, and are at least 45 minutes long.
  • Are refresher courses offered? Or can you drop in on another session if you have a slip or feel a need for some extra support?

Tobacco Use Quitline

Telephone-based cessation counseling provides tobacco-product users with support in counseling. A Free call to the Michigan Department of Health & Human Service's I Can Quit helpline 1-800-QUIT NOW (784-8669) can help you stop smoking. It provides up to seven sessions with a personal health coach who will call and work with you in the comfort of your home or office to develop your personal plan to successfully quit smoking.

Prescription and Over-the-Counter Tobacco Cessation Medications

The Food and Drug Administration has approved six medications to assist smokers in quitting:

  • Five are nicotine replacement therapies that relieve withdrawl symptoms. They include nicotine gum, patch, nasal spray, inhaler, and lozenge.
  • The sixth medication, bupropion SR (sustained release), is a non-nicotine medication that is thought to decrease the urge to smoke by affecting the same chemical messengers in the brain that are affected by nicotine.
Prescription and Over-the-Counter Tobacco Cessation Medications*
Type Form Common Brand Name(s) Availability
Nicotine Replacement Therapy Gum Nicorette® Over-the-counter (OTC)
Patch Nicoderm®, Habitrol®, Prostep®, Nicotrol® OTC and prescription
Inhaler Nicotrol® Prescription
Nasal Spray Nicotrol® Prescription
Lozenge Commit®** OTC
Bupropion Pill Zyban®, Wellbutrin® Prescription

* Approved by the Food and Drug Administration (FDA) and addressed in the 2000 PHS Guidelines.
** Received FDA approval on October 31, 2002, therefore not addressed in the 2000 PHS Guidelines.

Helpful Cessation Web Site Addresses

Other helpful resources are cessation web sites. Here are some websites that offer information about quitting:

American Lung Association (Freedom from Smoking)

American Lung Association's cessation program, which can be done online for free.

Mayo Clinic

Contains facts, information and research about quitting.

Other Important Tobacco Links

Smoke Free Environments Law Project

The Smoke-Free Environments Law Project (SFELP) is a statewide project, funded by the Tobacco Section of the Michigan Department of Health & Human Services. SFELP provides help for businesses, local units of government, and persons on policies and practices to protect employees and the general public from the harmful effects of secondhand smoke.

This web site provides information about secondhand smoke and the legal and liability issues related to secondhand smoke. While SFELP is a law project serving just Michigan, most of the information on this site is relevant to all states. The materials provided on this site are for informational purposes only and are not intended to be, and should not be taken as, legal advice.

Services for Michigan Employers and Residents

American Lung Association

The Stop Smoking Section includes quitting smoking information, smoking and women and smoking and teens. This site also contains information on their Not On Tobacco (NOT) ten-session tobacco cessation program for teens.

Environmental Protection Agency

Gives information and links to resources about secondhand smoke, gives information on lists of publications about secondhand smoke, and gives basic information about secondhand smoke and how it affects asthma.

American Cancer Society

Information about Quitting Smoking

Information about Smoking and Cancer

Campaign for Tobacco-Free Kids

Offers current tobacco news, youth action, research and facts, information about your state, links to other useful sites and much more. and facts, information about your state, links to other useful sites and much more.

Center for Disease Control and Prevention

CDC's Tobacco Information and Prevention Sources (TIPS) offers up-to-date information on major events, such as the Tips from Former Smokers media campaign, a Spotlight category and Tools and Resources category.