Asthmatics are at double risk from smoking:

• Smoking increases asthmatic symptoms.
• Asthmatics are at greater risk of developing irreversible airway damage from smoking.

When smoking increases asthmatic symptoms, medication requirements increase. Smokers are then exposed to additional risks of medication that otherwise may not be needed. Even with the additional medication, control of asthma may be difficult to attain while smoking. Therefore, asthmatics should not smoke. If they do, they should not expect the degree of success from medical management attainable for nonsmokers, and they must personally accept the possible risks of medication that might otherwise be needed.

Second-hand or passive smoke refers to the smoke contaminating indoor air from the presence of smokers. This smoke is inhaled by smokers and nonsmokers alike and increases the asthmatic symptoms of many patients. Children with asthma in the homes of smoking parents have more asthmatic symptoms and more emergency care requirements for asthma than similar children in homes where there are no smokers. Smoking in the presence of an asthmatic child with a history of significant illness is therefore considered a form of child abuse.

In addition, parents who smoke set an example that teaches their children to smoke. If that child has asthma, then not only is the child's asthma likely to be worse from the passive smoking, but that child is also more likely to begin a lifelong habit of smoking during adolescence and be at substantial risk for developing irreversible lung-damage in midlife from smoking.

Asthma and allergies

Many people with asthma have allergy to inhalants as triggers to their asthma. The extent to which allergic factors bothers asthma varies widely among individuals. Assessment of allergic factors requires careful medical evaluation including a detailed history and a measure of the degree of allergic antibody. Determination of allergic antibody requires either allergy skin testing or specific types of laboratory tests on blood. Neither a history of symptoms or the skin testing alone can define the extent to which allergy contributes to problems. Medical assessment requires careful consideration of both the allergy testing and the history obtained by someone familiar with both asthma management and the aerobiology of inhalant allergens.

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