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A cross-sectional study of 48,118 pediatric asthma-related encounters found that children reported as exposed to both household tobacco smoking and vaping had higher rates of several asthma problems. The study shows associations, not proof that exposure caused the outcomes, and researchers say longer-term research is needed.
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 rates of several asthma problems, including flares and nighttime symptoms. The analysis, presented by Brian Jenssen of Children’s Hospital of Philadelphia at an American Academy of Pediatrics meeting, was observational and cannot establish that the exposures caused the children’s symptoms.
The study used electronic health record data from the hospital’s primary care network between July 2023 and March 2026. It included children aged 1 or older with an asthma diagnosis whose parent completed household tobacco and e-cigarette assessments and an asthma-control assessment during the same visit. Among the families, 5% reported both tobacco and e-cigarette use in the household, 9% reported tobacco use only, and 3% reported e-cigarette use only.
For children reported to be exposed to e-cigarettes alone, exposure was associated with a 30% higher likelihood of asthma flares (adjusted odds ratio 1.3, 95% confidence interval 1.1-1.4) and a 40% higher likelihood of activity-related asthma symptoms (adjusted odds ratio 1.4, 95% confidence interval 1.2-1.5). These figures are adjusted associations, not estimates of proven causal effects.
For children exposed to both products, the researchers reported statistically significant 20% to 40% higher risks across several measures of uncontrolled asthma compared with children without the reported household exposures. The measures included flares, nighttime and activity-related symptoms, albuterol use, and hospital admissions in the previous year. The analysis adjusted for age, sex, insurance and a socioeconomic indicator; it did not establish why the combined exposure was associated with poorer outcomes.
Household Exposure and Asthma Control
The findings point to a practical issue for families and clinicians: asking about cigarettes alone may miss another source of exposure in a child’s home. Jenssen said clinicians should ask about both smoking and vaping during routine visits and connect parents with treatment to stop using tobacco and nicotine products.
The results matter because the children already had asthma, a condition in which respiratory symptoms and flares can affect daily activity and lead to urgent care or hospital admission. The study does not quantify what would happen if a household stopped vaping or smoking, but it adds evidence that reported exposure to either product—and especially both—may accompany poorer asthma control. It supports attention to children’s exposure while avoiding the conclusion that the analysis proves causation.
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How the Study Measured Exposure
This was a cross-sectional analysis, meaning exposure reports and asthma assessments were collected at the same visit rather than tracking children prospectively to see how their health changed. The data came from one health system’s primary care network and included only visits with completed assessments, so the results may not represent all children with asthma.
Jenssen noted that research has taken time to establish the harms of secondhand tobacco smoke and said children may be more vulnerable because of their smaller size and faster respiratory rate. He suggested that smoke and e-cigarette aerosol could affect different parts of the lungs, potentially contributing to combined effects. That is a possible explanation, not a mechanism demonstrated by this study.
“Neither tobacco nor e-cigarette exposure is safe for children with asthma, or any child.”
— Brian Jenssen, MD, MSHP, Children’s Hospital of Philadelphia
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Causation and Exposure Levels Remain Unknown
The analysis cannot show whether household vaping or smoking caused asthma symptoms, or whether other factors contributed to the reported associations. Because exposure was assessed through parent reports, the study also does not establish the children’s precise exposure levels, how often products were used, or where in the home they were used.
The reason the combined exposure was associated with worse outcomes is not yet clear. Jenssen proposed that different particle sizes or effects on different lung areas could play a role, while acknowledging that the comparison may be affected by differences in how much each product was used. The study also did not follow children over time or use objective exposure measures, so it cannot establish how outcomes changed after exposure stopped.
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Longer Follow-Up Is Needed
Jenssen said future research should track children over time and use more objective measures of exposure and asthma outcomes. Such studies could better test whether exposure precedes worsening asthma, how risks differ by product and amount of use, and whether reducing household exposure changes children’s health.
In the meantime, Jenssen recommended that parents avoid exposing children to smoke or vaping aerosol and seek support to quit tobacco and nicotine products. He said using products outside and keeping away from children may reduce exposure, while emphasizing that the broader goal is to stop using them. The study itself did not test those steps or measure their effects.
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Key Questions
Does the study prove that vaping or smoking caused asthma symptoms?
No. It was a cross-sectional observational study, so it found associations but cannot establish that household exposure caused the asthma outcomes.
What did the study find about children exposed to both products?
Children reported as exposed to both tobacco smoke and e-cigarette aerosol had statistically significant 20% to 40% higher risks across measures including flares, nighttime symptoms, activity-related symptoms, albuterol use and hospital admissions in the previous year.
How many families reported vaping and smoking at home?
Five percent of families in the analysis reported both tobacco and e-cigarette use in the household. Nine percent reported tobacco use only, and 3% reported e-cigarette use alone.
What should parents and clinicians take from the findings?
Jenssen recommended asking about both smoking and vaping in the home and connecting parents with support to quit. The study did not test whether any specific exposure-reduction or quitting approach changed children’s asthma outcomes.
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