Understanding the Risks of Smoking and Asthma: A Comprehensive Guide

Smoking is unhealthy for everyone, but it is especially harmful for people with asthma. In fact, smoking is one of the most common asthma triggers.

So it may be surprising that a sizable number of people with asthma smoke cigarettes. According to the U.S. Centers for Disease Control and Prevention (CDC), 21 percent of people with asthma smoke cigarettes.

Tobacco smoke introduces thousands of harmful chemicals into the lungs, many of which are irritants. For people with asthma, these substances worsen airway inflammation and increase mucus production. This can cause symptoms of coughing, wheezing and shortness of breath. It can trigger more frequent and severe asthma attacks. Smoking also weakens lung function over time, making it harder for people with asthma to manage their symptoms effectively.

A person with facial hair holds a lit cigarette close to their mouth, exhaling smoke against a dark background. The image focuses on the cigarette and the smoke.

Smoking kills more than 1,300 Americans per day. In addition to asthma symptom severity, it increases the risk of developing lung disease, heart disease and stroke. It can lead to the development of chronic obstructive pulmonary disease (COPD), lung cancer, and other types of cancer. These are life-threatening conditions.

Smoking is especially harmful for babies and children with still-developing lungs. It can affect lung growth. Exposure to secondhand smoke and thirdhand smoke can cause decreased lung function. It can also increase the risk of getting respiratory illnesses. Smoking is also considered a leading cause of adult-onset asthma.

Simply put, if you smoke, it is vital that you stop – especially if you have asthma. Quitting smoking not only improves your health but also the health of people around you.

Infographic titled "Asthma and Smoking" from the Allergy & Asthma Institute. Highlights asthma risks from smoking, secondhand smoke, and benefits of quitting smoking. Features statistics, icons, and illustrations related to health impacts.

How smoking affects the respiratory system

When inhaled, tobacco smoke can irritate and inflame the airways. It causes the lungs to produce mucus. Smoking weakens tiny hairs in the airways called cilia. Cilia sweep away mucus and other irritants. When cilia are weak, mucus and irritants settle in the airways. This can lead to asthma symptoms.

Respiratory symptoms caused from smoking and asthma can include:

  • Frequent coughing
  • Wheezing
  • Shortness of breath
  • Mucus production
  • Chest tightness
  • Airway inflammation
  • Airflow obstruction
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What are the effects of smoking with asthma?

The respiratory system is very sensitive. When you inhale cigarette smoke, it irritates and inflames the airways and causes mucus production. This can lead to asthma symptoms and more frequent and severe asthma attacks.

Smoke from cigarettes can also damage the lungs and cause changes in the structure of the respiratory system. Studies show this can make it harder for medicine such as inhaled corticosteroids to help control asthma. It can affect the body’s immune response, making it harder to fight viruses and infections. These can increase the risk of infections, including bronchitis and pneumonia.

Smoking is also linked to several other chronic diseases. Some smokers live with chronic bronchitis. Older smokers may develop COPD or asthma-COPD overlap. Smoking is also associated with heart disease, vascular disease, and lung cancer.

Smoking-induced asthma

Smoking-induced asthma refers to asthma symptoms that are caused or worsened by tobacco smoke. Smoking, whether active or passive (secondhand or thirdhand smoke), can inflame the airways and increase mucus, leading to asthma symptoms. It can lead to asthma attacks.

Numerous studies have found that people who smoke are more likely to have asthma. They are at higher risk of going to the emergency department or hospital due to asthma.

Cigarette smoking and COPD

COPD is a group of lung diseases that cause difficulty breathing. The most common types of COPD are emphysema and chronic bronchitis. Smoking is the leading cause of COPD. People with COPD often feel short of breath, cough a lot, and have trouble doing everyday activities.

Even if you’ve smoked for many years, quitting can help slow the progression of COPD and improve your health.

A woman holds a lit lighter to a cigarette in her mouth. In the background, a child sits at a table with a bowl and a glass of orange juice, appearing out of focus. The scene suggests an indoor setting.

Secondhand smoke and asthma

Secondhand smoke is the tobacco smoke you inhale when you aren’t the one smoking. It’s also known as environmental tobacco smoke (or ETS) or passive smoking. Secondhand smoke is a significant public health concern. It contains about 7,000 chemicals, of which hundreds are toxic and 70 can cause cancer.

Exposure to secondhand smoke may actually be worse than smoking. Secondhand smoke contains higher amounts of toxic chemicals compared to cigarette smoking because it is not filtered.

Exposure to secondhand smoke, even for short periods, can lead to asthma symptoms, asthma attacks, and other respiratory issues. Children, pregnant women and people with pre-existing respiratory conditions are at higher risk for health problems.

Secondhand smoke causes 7,300 lung cancer deaths among nonsmokers every year in the United States. It is attributed to more than 8,000 deaths from stroke each year.

Secondhand smoke is a major factor in indoor air pollution.

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The harmful chemicals can create a toxic indoor environment that can trigger asthma. The pollutants linger in enclosed spaces, degrading air quality. Good indoor air quality is essential for people with asthma.

A recent study looked at trends in children’s emergency department visits for asthma in states that passed indoor smoking bans in public places and workplaces. The study found a 17% decline in emergency department visits by children occurred over the first three years of the ban.

How to reduce exposure to secondhand smoke?

Exposure to secondhand smoke is hard to control. You could encounter it just by walking past someone who is smoking. Here are some ways you can try to reduce your exposure:

  • Don’t let anyone smoke in your home or car.
  • Don’t go to places where smoking is allowed indoors. Many states – but not all – have adopted “no smoking” bans in indoor environments such as restaurants.
  • Avoid places outside where people who smoke tend to gather.

These same strategies apply to secondhand e-cigarette smoking and vaping.

Is wildfire smoke the same as secondhand smoke?

No. Smoke from wildfires is not the same as secondhand smoke. Wildfire smoke is a form of outdoor air pollution arising from burning vegetation in wildfires. Secondhand smoke refers to the smoke inhaled from burning tobacco products like cigarettes. Both contain harmful particles and can result in asthma symptoms. But the mix of chemicals in wildfire smoke can differ depending on the type of vegetation burning.

Thirdhand smoke and asthma

Most people are aware of secondhand smoke and its impact on health. But have you heard of thirdhand smoke? Thirdhand smoke is the residue left behind from tobacco smoke, long after the cigarette, cigar or pipe is gone.

It’s usually present in indoor environments where smoking has occurred. The residue can get in the air, furniture, walls, dust, and throughout the environment, lingering for weeks and months. It can even be left behind in clothing and hair.

The residue includes harmful chemicals that can cause breathing problems and other health issues, especially to children. Even if you can’t see or smell thirdhand smoke, it can still affect you.

It can be hard to identify thirdhand smoke as an asthma trigger. Some signs may include a musky smell in a room or in clothes. There may be yellowish stains on surfaces like a wall, tiles or countertops. Consider getting a thirdhand smoke testing kit, available at home improvement stores.

How long does thirdhand smoke last? It can linger indoors for years. To avoid exposure, dispose of household items contaminated with thirdhand smoke residue, such as carpeting or furniture. Replace drywall and wash curtains. Open windows and use high-efficiency particulate air (HEPA) filters in your house can increase circulation of clean air.

A woman and two children sit on the floor in a sunlit living room, enjoying each other's company. The room boasts large windows and is filled with potted plants. As they play and smile together on the soft carpet near a sofa, they're blissfully unaware of concerns like thirdhand smoke.

How does thirdhand smoke affect people with asthma?

Particles left behind from thirdhand smoke can be inhaled into the lungs or even absorbed through the skin. This can cause episodes of coughing, wheezing, mucus production, and shortness of breath in people with asthma. It can lead to an asthma attack. Over time, it can reduce lung function.

Thirdhand smoke and children with asthma

Exposure to thirdhand smoke is especially harmful for young children with developing airways. Children are more vulnerable because they spend significant time indoors. They may engage in hand-to-mouth behaviors, increasing contact with contaminated surfaces.

Persistent exposure to thirdhand smoke can irritate a child’s airways and cause inflammation. This can hinder lung growth and cause respiratory symptoms. It can make asthma harder to manage. Children who inhale thirdhand smoke are more vulnerable to getting sick with ear infections, bronchitis and pneumonia.

Pregnant Black woman getting advice on asthma medications from her doctor.

Smoking when pregnant with asthma

If you’re a smoker and your pregnant, it is best to stop smoking right away, whether you have asthma or not. Smoking can lead to poor lung health for both mother and baby. Quitting smoking during pregnancy, especially in the first trimester, can reduce the risk of poor health outcomes.

People with asthma who smoke during pregnancy are at increased risk of asthma attacks, endangering both mother and baby. They are also increasing the risk that the child will have respiratory problems. Children of people who smoked during pregnancy are 10 times more likely to develop asthma.

Smoking during pregnancy has been shown to increase the risk of…

  • preterm birth
  • birth defects in the child
  • low birthweight in the child
  • the child’s death, including from sudden infant death syndrome (SIDS)

To ensure a healthy pregnancy, it’s essential for pregnant people to quit smoking. Work closely with healthcare providers to manage asthma effectively. A smoke-free environment benefits both mother and child, reducing complications and promoting better long-term health.

What about exposure to secondhand during pregnancy? It can trigger asthma flare-ups and put the baby at risk for developing asthma. Secondhand smoke impacts an environment’s air quality, especially indoors. Good air quality is essential for both mother and baby during and after pregnancy. There is no amount of secondhand smoke that is safe during pregnancy. Even small amounts can trigger asthma symptoms for the mother and affect the lung growth of the baby.

Research is ongoing on the effects of thirdhand smoke during pregnancy. It’s believed that exposure to thirdhand smoke can impact the immune system of mother and baby, both in utero and early childhood. It can also increase the risk of postpartum depression.

A broken cigarette lies on a calendar page. Tobacco bits are scattered near the cigarette. The phrase "quit today" is printed near the bottom of the calendar, suggesting a focus on quitting smoking.

How to quit smoking?

If you smoke and have asthma, quitting smoking is the single best thing you can do to improve your condition. The health benefits for people with asthma are numerous and it can also help with chronic disease prevention. Quitting smoking can reduce the risk of developing asthma or having an asthma attack.

If you smoke and are ready to stop, look into smoking cessation interventions. Quitting can be difficult because nicotine is highly addictive. Talk with a healthcare professional and ask for strategies that can help you quit. Here are helpful steps to “START” quitting so you can adopt a smoke-free life:

S = Set a quit date.

This is not a day to cut back or think about quitting. This is the date you are going to become a nonsmoker. Setting a date is important. Too far into the future and you may rationalize and change your mind. Too soon and you will not have time to prepare emotionally and make a plan. Many choose a birthday or some other special day, but any day will do. Once you pick a day, write it down where you will prominently see it, as a reminder of your goal.

T = Tell your family, friends, and coworkers you are quitting and ask for their support.

This will give you a group of people who will support you. Plus, publicly declaring what you are going to do makes it harder to go back.

A = Anticipate problems and think about how you will handle them.

Consider the situations you think may pose the most trouble. Focus on situations that may have affected you during previous attempts to quit. Many smokers have problems when around alcohol or other smokers. Others struggle during activities associated with stress. Try to avoid these situations and make a plan to deal with them if they are unavoidable.

You will likely need to develop new ways to deal with stress. Try to plan something enjoyable every day like meeting a friend for coffee. Stay well hydrated and drink lots of water as a distraction technique to relieve cravings.

R = Remove all your cigarettes from your home, work, and car.

This includes anything related to smoking.

T = Talk with your doctor or other healthcare professional about quitting.

A healthcare professional can assess whether or not you need medication to help you quit. They can also provide you with their experience in helping other smokers “kick the habit.” Your doctor can provide support and resources such as individual, group, or telephone counseling, if needed.

Don’t be discouraged if you don’t quit on your first try. Tobacco cessation is not easy, but many people succeed each day. Some require multiple attempts to become tobacco free.

Can nicotine replacement therapy help me quit smoking?

Many people find it difficult to quit smoking. Nicotine can be highly addictive because of its fast uptake into the bloodstream and passage into the brain. Like many drugs, it can lead to dependence. The negative response your body feels when it does not receive nicotine can result in the need for increasing amounts of nicotine.

If you think you’re addicted to cigarettes, or you’re displaying signs of nicotine withdrawal, then nicotine replacement therapy can help. Nicotine gum, patches and other therapies are available over the counter and by prescription. These products work by decreasing cravings and withdrawal symptoms. And treatment can be tailored to when you think you would be most likely to relapse.

Talk with your doctor or healthcare professional about nicotine replacement therapy.

Many states offer nicotine replacement therapy and free counseling as part of settlement agreements between states and Big Tobacco. A free telephone quit line set up by CDC (1-800-QUIT-NOW) can provide support.

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What are signs of nicotine addiction?

Do you wonder if you’re addicted to nicotine? See if you identify with any of the following scenarios:

  • I smoke first thing in the morning.
  • It’s difficult to go to places where I cannot light up.
  • When I am out of cigarettes it is unbearable until I can smoke.
  • I crave a cigarette when I am somewhere I cannot smoke or I’ve gone an extended period without smoking.

If you answer yes to any of these questions, talk with a healthcare professional about quitting smoking.

What are the signs of nicotine withdrawal

Do you feel worse when you try to stop smoking? This is nicotine withdrawal. Symptoms include:

  • Anxiety or depression
  • Cravings
  • Difficulty concentrating
  • Increased appetite
  • Mood swings and irritability
  • Poor sleep
  • Restlessness or fidgetiness
  • Weight gain

Many patients also describe a significant emotional loss, similar to ending a relationship, when trying to quit smoking. Symptoms tend to peak during the first several days of quitting and gradually decrease after a few weeks.

Questions and Answers (Q&A) on Smoking and Asthma

Here are some common questions and answers about smoking and asthma. Do you have other questions or topics that you would like to see addressed here? Please email our editor.

Many people with asthma smoke marijuana (also called cannabis). This can be harmful to their lungs and cause asthma symptoms. The Allergy & Asthma Network Pain, Exercise and Cannabis Experience (PEACE) survey in 2021 found that approximately 8% of people with asthma smoke marijuana. About half of the marijuana smokers with asthma had uncontrolled asthma.

People with asthma who smoke marijuana should quit. Smoking marijuana can cause increased cough, wheezing and shortness of breath. It can increase risk of an asthma attack. In the PEACE survey, nearly one-third of those who smoked cannabis reported a frequent cough.

Some people with asthma cite potential benefits from cannabis when taking it in other ways than smoking. These benefits may include relaxed breathing, improved sleep, and decreased anxiety. Alternative ways to take cannabis include:

  • edibles
  • oils or tinctures
  • capsules
  • topical products

These routes of administration may be safer since they do not affect the lungs.

E-cigarettes and vape solutions contain many similar harmful chemicals as regular cigarettes. Research shows that vaping can:

  • increase inflammation in the airways
  • worsen lung function
  • harm or weaken your immune system
  • put you at risk for other lung diseases

If you have asthma and you vape, it is recommended that you stop. If you continue to vape, you put yourself at higher risk of asthma symptoms and an asthma attack.

Environmental tobacco smoke, or ETS, is more commonly known as secondhand smoke. It is inhalation of tobacco smoke in the air, not through the inhalation of a tobacco product.

People with asthma should not smoke tobacco products. Smoking can cause an increased risk of asthma attacks, poor asthma control and reduced lung function.

Yes, smoking when you have asthma can trigger symptoms or worsen your disease. People with asthma who smoke have more frequent asthma attacks. Over time it leads to poor asthma control and reduced lung function.

Yes, smoking can trigger an asthma attack. It can also increase the frequency and severity of asthma attacks.

Smoking is considered a cause of adult-onset asthma. But asthma can also be caused by genetics and environmental exposures. It’s best to seek a complete diagnosis from a doctor and discuss whether smoking has caused your asthma.

Yes, smoking tobacco with asthma can cause a life-threatening asthma attack. It can also increase the risk of developing life-threatening lung diseases (such as lung cancer), heart disease and stroke. Smoking kills more than 1,300 Americans per day.

Yes. Long-term smoking can damage both the structure and function of your lungs. When the lungs become damaged, it becomes harder for them to expand. This makes breathing more difficult.

When you quit smoking, you may not see an immediate decrease in your asthma symptoms. Some may feel their symptoms are worse. The bottom line is that it takes a while for your lungs to recover.

In the days and weeks after you quit smoking, the cilia in your lungs start to regrow. As they regrow, they may remove mucus and debris in your lungs. As the cilia does this, it may inflame your airways, which leads to a temporary worsening of symptoms.

In addition, some people may experience nicotine withdrawal when quitting smoking. These withdrawal symptoms can mimic asthma symptoms.

You also might become more aware of other asthma triggers, such as dust, pollen, or air pollution. These may have been previously overshadowed by the effects of smoking.


Reviewed by:
Bradley Chipps, MD, FACAAI, is a board-certified allergist and pediatric pulmonologist with Capital Allergy and Respiratory Disease Center in Sacramento, California. He earned his medical degree from University of Texas Medical Branch in Galveston in 1972. He is Past President of the American College of Allergy, Asthma and Immunology (ACAAI).