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Asthma

Asthma and smoking (odor on clothes)

03/21/2008

Question:

I have a 5 year old and a 2 year old, both with asthma. My 5 year old does fine with his Flovent and only needs Albuterol a few time per year. My 2 year old however, has had a terrible time with his asthma. Finally, now that he has been on Pulmicort (through a nebulizer) for about 10 months, has not taken Albuterol every month. He does have flare-ups often, mostly lots of coughing which makes him whiny like he doesn`t feel well. My husband is a smoker. He does not smoke in our home, anywhere, but does go outside to smoke and also smokes regularly in his vehicle when the boys are not with him. He comes in from outside and I can smell how strong he is from the other room so I know that my 2 year old can smell him. And our boys ride in his vehicle nearly 100% of the time, so I think that the odor would be on his seats and on their car seats. Can you please tell me, can the odor on his clothes be causing my 2 year olds flare ups so often, even though my 5 year old doesn`t seem to have the often flare ups, but they both have asthma? I am not trying to `single him out` but it is important to me to figure out what is best for my children, and these flare ups are not what is best. Thank you so much for your help!

Answer:

Tobacco smoke and other airborne particulates are common triggers of asthma. In the studies looking at the association of parental smoking and childhood asthma the exposure was to tobacco smoke which functions as an irritant, leading to inflammation in the respiratory tract. Allergy to tobacco components is not common, though there have been rare reports of patients that have been proven to be allergic to tobacco extracts.

The issue you present is whether the tobacco residue can be acting as an allergen. This kind of sensitivity is rare and not the most likely cause of your son’s asthma severity. However, this can be tested using skin testing or serum testing that could be performed by your pediatric allergist. It is much more likely that your son is allergic to a number of more common allergens, such as house dust mite or mold. The difference between the asthma in your two-year-old and his older sibling could be a matter of differences in allergic sensitivities or responses to other asthma triggers such as upper respiratory infection.

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Response by:

Charity C Fox, MD Charity C Fox, MD
Clinical Associate Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University