Second-hand vape smoke linked to more asthma symptoms in kids

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In a recent study published in the journal Children, researchers retrospectively investigated the impacts of second-hand e-cigarette smoke exposure on childhood asthma, especially in home environments. They carried out a pilot, monocenter, observational study of 54 young asthma patients, half of whom experienced second-hand exposure (SHE) to second-hand aerosols (SHAs).

Study: Association between Second-Hand Exposure to E-Cigarettes at Home and Exacerbations in Children with Asthma. Image Credit: Prostock-studio / ShutterstockStudy: Association between Second-Hand Exposure to E-Cigarettes at Home and Exacerbations in Children with Asthma. Image Credit: Prostock-studio / Shutterstock

Despite finding no statistically significant association between electronic nicotine delivery systems (ENDSs) and asthma exacerbations (no difference in the number of patients requiring clinical intervention step-up), this study suggests that asthmatic children exposed to elevated levels of second-hand e-cigarette smoke may experience increases in their number of asthma symptomatic days. This highlights the need for heightened awareness, both amongst adolescents and their parents, of the psychological harms of the 'safe' vape.

The ENDs pandemic and what this means for asthma patients

Extensive research and medical reports highlight tobacco smoking as the single most preventable cause of global mortality and morbidity, with the habit associated with significant increases in the risks of numerous cancers, cardiovascular diseases (CVDs), respiratory ailments, and psychiatric disorders. Long-term global efforts have resulted in substantial reductions in tobacco use prevalence amongst adults and adolescents, representing one of the most noteworthy accomplishments of modern public health.

Unfortunately, in recent years, tobacco smoking has been replaced by the use of electronic nicotine delivery systems (ENDSs). Commonly called 'vapes,' these devices are marketed as low- or no-risk alternatives to conventional smoking. While they are devoid of tar and a majority of the heavy metal components that make tobacco smoke harmful, recent research presents a growing body of evidence suggesting that ENDs are not as safe as we may think. Even non-smokers who take up vaping have been shown to develop adverse and often chronic respiratory symptoms, including bronchoconstriction and severe cough.

Asthma is a respiratory condition characterized by difficulty breathing, chest pain, cough, and wheezing, which in severe cases may lead to life-threatening suffocation. Caused by the inflammation or narrowing of a patient's airways or excessive mucus secretions along the respiratory tract, the condition is most common in young children. It presents the most common pediatric disease worldwide. Unfortunately, while a few studies have investigated the associations between e-cigarette exposure and asthma in adults and found that the former can exacerbate the latter, the impacts of second-hand exposure on pediatric asthma have hitherto remained unexplored.

"Establishing evidence of adverse health effects caused by second-hand nicotine vaping exposure could represent a valid motivation for minimizing household exposure and imposing restrictions on vaping in public spaces."

About the study

Aerosols produced by ENDs are known to contain volatile aldehydes and oxidant metals, some of which have been shown to produce adverse outcomes in adult patients' lungs, both asthmatic and non-asthmatic. Unfortunately, the effects of these volatile organic compounds (VOCs) on children's lungs remain unknown. The present study aims to fill this knowledge gap by retrospectively elucidating the associations between childhood ENDs exposure and asthma symptom progression.

The observational study was carried out between January and May 2023 at "Gaetano Martino" Hospital, University of Messina, Italy, and comprised children or adolescents aged five to 17 with medically confirmed asthma. Data collection included demographics (age, sex, gender, and race), clinical (comorbidities), parents' socioeconomic status, and the education levels of both parents and children. Additionally, ENDs exposure was recorded in terms of presence (yes/no) and frequency. All data was collected using a custom-designed questionnaire.

The Asthma Control Test (ACT) and the children-Asthma Control Test (c-ACT were administered at the time of initial study enrolment. Patients were assigned to asthma or no-asthma cohorts (n = 27 per cohort), with analyses stratified to account for age – two age cohorts (5-11 [n = 65%] and 12-17 [n = 35%]). Continuous data variables were analyzed using descriptive statistics (expressed as means and standard deviations [SDs]), while ordinary variables were expressed as percentages. Fisher's tests were used to compare cohorts qualitatively, while independent t-tests computed differences between continuous variables across cohorts.

Study findings and conclusions

The total sample size for the present study was 54, equally divided between children whose parents indulge in e-cigarette consumption at home and those whose parents do not. Of these, 39 were diagnosed with intermittent, nine with moderate, and six with severe asthma, respectively.

While the dataset was too small to provide statistically significant differences between asthma and non-asthma cohorts, descriptive statistics reveal that ENDs had more profound impacts on younger children (Group A – 5 to 11 years) compared to their older counterparts (Group B – 12 to 17 years) with the former group needing six times more rescue therapy and 15% more therapeutic step-up than the former. These results are in concordance with the conventional assumption that younger children are at higher risk of asthma contraction due to their undeveloped immune systems and narrower respiratory passages.

Despite not yielding statistically significant results, the proceeds of this study highlight the risk posed by household END usage to children. While not as harmful as conventional tobacco smoke, vaporization of e-liquids is known to release significant qualities of aldehydes, including formaldehyde, known for being respiratory irritants and carcinogens. Previous research comparing harmful aerosol concentrations in home environments raises cause for concern – ultrafine particulate matter produced by e-cigarettes matches. It sometimes exceeds that produced by an equivalent amount of tobacco smoke.

"…our data highlight the importance of the prevention of the vaping epidemic and passive exposure to e-cigarettes, even among children and adolescents. Implementing educational programs to increase awareness about the risks of vaping among children and emphasizing the potential impact on respiratory health, especially for those with asthma, should be a priority. Launching targeted campaigns to inform parents about the dangers of vaping and its specific implications for children with asthma should be strengthened."

Journal reference:
  • Costantino, S., Torre, A., Foti Randazzese, S., Mollica, S. A., Motta, F., Busceti, D., Ferrante, F., Caminiti, L., Crisafulli, G., & Manti, S. (2024). Association between Second-Hand Exposure to E-Cigarettes at Home and Exacerbations in Children with Asthma. Children, 11(3), 356, DOI – 10.3390/children11030356,
Hugo Francisco de Souza

Written by

Hugo Francisco de Souza

Hugo Francisco de Souza is a scientific writer based in Bangalore, Karnataka, India. His academic passions lie in biogeography, evolutionary biology, and herpetology. He is currently pursuing his Ph.D. from the Centre for Ecological Sciences, Indian Institute of Science, where he studies the origins, dispersal, and speciation of wetland-associated snakes. Hugo has received, amongst others, the DST-INSPIRE fellowship for his doctoral research and the Gold Medal from Pondicherry University for academic excellence during his Masters. His research has been published in high-impact peer-reviewed journals, including PLOS Neglected Tropical Diseases and Systematic Biology. When not working or writing, Hugo can be found consuming copious amounts of anime and manga, composing and making music with his bass guitar, shredding trails on his MTB, playing video games (he prefers the term ‘gaming’), or tinkering with all things tech.


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