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August 4th, 2017

Secondhand Smoke

Dangers of Secondhand Smoke



Scope of Problem

Smokers in the US consume over 500 billion cigarettes annually. Secondhand smoke, known technically as environmental tobacco smoke (ETS) is increasingly recognized as a health hazard to children and adults.


Danger to Children

9-12 million US children younger than 5 years of age may be exposed to secondhand smoke in the home. Secondhand smoke is estimated to cause an annual increase of 150,000-300,000 cases of lower respiratory tract infections in children younger than 18 months of age. It also increases the incidence of fluid in the middle ear, known as serous otitis media. Two-week old children of mothers who smoke have been observed to have diminished lung elasticity.


The Centers for Disease Control (CDC) estimates that maternal smoking is responsible for 700 annual cases of sudden infant death syndrome (SDS).  Further, secondhand smoke is a risk factor for the development asthma in children and increases the severity of asthma in children already afflicted with the problem.


Danger to Adults

Chronic obstructive pulmonary disease (COPD) in middle-aged adults seems to be correlated with their mothers’ smoking during the years of raising them. Further, an additional 3,000 cases annually of lung cancer in adults are associated with exposure to secondhand smoke. This association is strongest with small-cell lung cancer.


Smoke Avoidance

Smoke avoidance in public places is easier now that laws prohibit or restrict smoking in many public places. Consequently, the greatest danger of exposure to secondhand smoke occurs in the home and in personal vehicles.


There is little ambiguity about what constitutes exposure to smoke in a personal vehicle. However, what constitutes exposure to smoke in the home is sometimes misunderstood.


It is imperative that no smoking should take place in the home, whether or not the child is present at the time. Smoking cannot simply be restricted to a portion of the home. Neither can an air filtration system in the home be relied upon to eliminate exposure to secondhand smoke.



Since smoke, once present, is difficult to contain, the best solution is liberation from smoking.


This is easier said than done, and there are good reasons. Nicotine acts on at least two areas of the brain. First, it stimulates the cerebral cortex causing a sense of increased alertness. Second, it stimulates the limbic system activating the reward center. Finally, it differs from other substances with these effects in that it does not excessively stimulate the peripheral nervous system. While other such substances cause tremors and anxiety, nicotine seems not to present these problems.


Nevertheless, there is help in dealing with this addiction.


Non-medical Aids

While most former smokers have quit independently, this does not work for everyone. Fortunately, there are many programs available. These include group support, hypnosis and self-hypnosis, behavioral aversive therapy, and gradual withdrawal.


One of the most underrated aids to tobacco liberation is repeated effort.

Few endeavors in life meet with unqualified success on the first attempt. Consequently, an attempt at smoking liberation that is followed by a return to smoking should not be viewed as a failure, but as a temporary success laying the groundwork for future endeavors.


Medical Aids

The addition of medical aids doubles the success rate in liberation from smoking. Of course, discussion with your doctor is always recommended as medical aids can have side effects as well as desired effects. The most important medical aids for liberation from smoking are nicotine patch, nicotine gum or lozenge, bupropion, and varenicline.


Nicotine patches slowly liberate nicotine to ameliorate withdrawal symptoms. Some of these are worn during daytime hours only in order to reduce the potential for sleep disturbance. Other patch systems are worn 24 hours a day and work for people who awaken craving a cigarette. Nicotine patches are slow onset and slow offset, requiring about 4 hours for blood levels of nicotine to rise or fall following application or removal.


Nicotine gums and lozenges, along with sprays and inhalers, are used intermittently and increase blood levels of nicotine within about 15 minutes of administration.


Bupropion is an antidepressant that is of some help in liberation from smoking. It may take 6-7 days to reach steady-state blood levels; consequently, it may be started before discontinuing smoking.


Varenicline attaches to the same sites of action as nicotine. Consequently, it both provides some stimulation to those sites and reduces the action of nicotine at those sites. It is considered by some to be the most effective of the medical aids.



Many aids, both non-medical and medical, are available to achieve liberation from smoking. These aids, in addition to effective smoke avoidance can sharply reduce the harmful effects of smoke upon the smoker as well as upon the adults and children in proximity.



Pharmacological interventions for smoking cessation/ an overview and network meta-analysis - Cahill 

Nicotine receptor partial agonists for smoking cessation - Cahill - 2016 - The Cochrane Library - Wi

Passive Smoking and Lung Disease.  WebMD.  Author: Timothy D Murphy, MD; Chief Editor: Girish D Sharma, MD, FCCP, FAAP 


Thomas Falasca, DO

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