E-cigarette exposure in homes linked to worse asthma control in children

A study presented at the American Academy of Pediatrics conference in San Diego this fall challenges a widespread assumption: that e-cigarettes pose less risk to children than traditional cigarettes. Researchers analyzing data from more than 48,000 pediatric clinic visits found that children with asthma who lived in homes where e-cigarettes were used experienced measurable harm—more asthma flare-ups, more symptoms triggered by physical activity, more nighttime breathing problems, and greater reliance on rescue inhalers.

The work, led by Brian Jenssen of Children's Hospital of Philadelphia, examined electronic health records from an urban primary care network between July 2023 and March 2026. Parents of children aged one and older with an asthma diagnosis answered two standardized questionnaires during clinic visits: one about household tobacco and e-cigarette use, and another assessing their child's asthma control. The exposure patterns were clear. In 5 percent of visits, parents reported both combustible tobacco and e-cigarettes in the home. Another 9 percent involved tobacco alone, and 3 percent involved e-cigarettes alone. The remaining 83 percent of families reported no household nicotine or tobacco use.

What the data revealed was striking. Children exposed to both tobacco and e-cigarettes showed the broadest range of problems: they had more asthma flares, more nighttime symptoms, more activity-related breathing difficulties, more frequent use of albuterol rescue inhalers, and higher rates of hospital admission in the past year. But the finding that most directly challenged the "safer alternative" narrative was this: e-cigarette exposure alone, without any combustible tobacco in the home, was independently linked to increased asthma flares and activity-related symptoms—effects comparable to or sometimes exceeding those seen in homes with both products. Tobacco-only exposure showed more modest but still significant associations across multiple measures.

The study adjusted for several factors known to influence asthma outcomes: the child's age and sex, insurance status, and neighborhood opportunity index—a measure of socioeconomic resources. Even after accounting for these variables, the associations between household nicotine exposure and worse asthma control persisted. Children in homes with combined tobacco and e-cigarette use were 1.3 times more likely to experience activity-related symptoms and nighttime symptoms, 1.2 times more likely to need rescue inhalers, and 1.4 times more likely to have uncontrolled asthma. Those exposed to e-cigarettes alone were 1.3 times more likely to have asthma flares and 1.4 times more likely to experience activity-related symptoms.

Jenssen emphasized the clinical implications. "There is no safe level of tobacco or e-cigarette exposure when it comes to children," he said. "Parents and caregivers who use any tobacco or nicotine products should make every effort to quit, using evidence-based options like varenicline, nicotine replacement therapy, and counseling." He called for pediatric care teams to screen routinely for all forms of household nicotine and tobacco use—not just cigarettes—and to offer cessation support for both as part of standard asthma care.

The perception that e-cigarettes are safer for children's health appears to be widespread among parents. Jenssen noted that many believe the devices pose less risk both to themselves and to their children. The research suggests that belief does not hold up for kids with asthma. The study population was diverse: 48 percent of the clinic visits involved children aged 6 to 12 years, 42 percent were girls, 34 percent were Non-Hispanic Black, 43 percent had Medicaid insurance, and 30 percent lived in neighborhoods with very low opportunity indices. The findings were funded by the National Institutes of Health and presented as part of the Section on Nicotine and Tobacco Prevention and Treatment at the conference.