Household e-cigarette exposure linked to poorer asthma control in children

Parent-reported household e-cigarette use, alone or combined with combustible tobacco, was associated with worse asthma control among children with asthma, according to research presented at the American Academy of Pediatrics (AAP) 2026 National Conference & Exhibition in San Diego, California.¹,² E-cigarette-only exposure showed associations with asthma symptoms comparable to combined exposure. The authors said this finding challenges assumptions of low risk from e-cigarettes.²

Combined exposure to tobacco and e-cigarettes had the broadest associations with poor asthma control, according to the study authors.¹,² The authors noted the effect of combined combustible tobacco and e-cigarette exposure on pediatric asthma control has needed further investigation.²

"There is no safe level of tobacco or e-cigarette exposure when it comes to children," Brian Jenssen, MD, MSHP, FAAP, associate professor of pediatrics at Children's Hospital of Philadelphia, said in a press release. "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."

Cross-sectional study links household tobacco and e-cigarette use with asthma symptoms

Investigators used electronic health record data from an urban primary care network from July 2023 to March 2026.² The analysis included visits where parents of children aged 1 year or older with asthma completed both a parent tobacco treatment platform (PTTP) and an asthma control tool (ACT).² The PTTP asked which family members used combustible tobacco, e-cigarettes, or both, and the ACT assessed symptoms, control, medication use, and health care utilization.²

Exposure was categorized as both tobacco and e-cigarettes, tobacco only, e-cigarettes only, or none, which served as the reference.² Multivariable logistic regression models adjusted for child age, sex, insurance, and Child Opportunity Index (COI).²

Among 48,118 encounters, 48% involved children aged 6 to 12 years, 42% involved female patients, and 43% involved Medicaid-insured patients.² Household use of both tobacco and e-cigarettes was reported in 5% of encounters (n = 2500), tobacco only in 9% (n = 4238), and e-cigarettes only in 3% (n = 1427).²

E-cigarette-only exposure associated with more asthma flares and activity symptoms

Combined exposure was associated with activity-related symptoms (adjusted odds ratio [aOR], 1.3; 95% CI, 1.2-1.4), nighttime symptoms (aOR, 1.3; 95% CI, 1.2-1.4), and albuterol use (aOR, 1.2; 95% CI, 1.1-1.3).² It was also associated with hospital admissions in the past year (aOR, 1.2; 95% CI, 1.1-1.3) and uncontrolled asthma status (aOR, 1.4; 95% CI, 1.2-1.6).² Associations extended to worse parent rating of asthma control (aOR, 1.3; 95% CI, 1.1-1.4) and lower parental comfort with asthma management (aOR, 1.3; 95% CI, 1.1-1.5).²

E-cigarette-only exposure was associated with more asthma flares (aOR, 1.3; 95% CI, 1.1-1.4) and activity-related symptoms (aOR, 1.4; 95% CI, 1.2-1.5).² Tobacco-only exposure showed more modest but significant associations across multiple domains.² Parent-reported emergency department or urgent care utilization and oral steroid use were not significantly associated with any exposure type after adjustment.²

Jenssen said the findings reinforce the need for pediatric care teams "to screen for all forms of household nicotine and tobacco use" and to offer cessation support for both as part of routine asthma care.¹ The authors concluded the results underscore the importance of comprehensive tobacco cessation counseling for families, covering both combustible and electronic products.²

Because the study was cross-sectional, the findings reflect associations rather than causation. Both exposure and asthma control outcomes were reported by parents.

References

1. American Academy of Pediatrics. E-cigarettes, tobacco in-home exposure linked to children's asthma flare-ups. Eurekalert. October 2, 2026. Accessed October 2, 2026. https://www.eurekalert.org/news-releases/1145252

2. Jenssen B, Ramachandran J, Jeritt T, et al. Parent-reported household tobacco and e-cigarette exposure and asthma control in children: a cross-sectional study. Abstract presented at: American Academy of Pediatrics 2026 National Conference & Exhibition; October 2-6, 2026; San Diego, CA.