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“A burning cigarette is like a little toxic waste dumpon fire,” says Karen Kacirk, assistant director of theUniversity of California, San Francisco, Center forTobacco Control Research and Education. “It puts morethan 4,800 chemicals into the air, including at least 69solvents and irritants. We now know that secondhandsmoke causes the same diseases in non-smokers as smok-ers [are at risk for]: heart attacks, asthma attacks andother breathing problems (particularly in children), lungand other cancers.”

by Gretchen W. Cook

Clearing the Air

About Secondhand SmokeA Bigger Health Risk Than You May Think

When Kirk Day had a heart attack in April2005, addressing the heart problems—inhis case, blocked valves—was the easypart. His complications were respiratory.He remained in the intensive care unit,unconscious and unable to breathe with-out the aid of a ventilator. His health careteam was baffled. “He’s a smoker, right?”the nurses asked repeatedly. No, he wasnot a smoker, his family insisted. Finallysomeone mentioned, “But our mothersmoked for 49 years.” “I’d say that makeshim a smoker,” said the nurse. Shescrawled “Smoker’s Lungs” on his file.

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Secondhand smoke is dangerous for everyone who isexposed to it; however, it is children who are exposedto the smoke of parents and other adults in their liveswho may be at the greatest risk. “[Children’s] bodiesare still developing rapidly and, [given] their smallersize, they take more breaths than adults,” says Kacirk.“Probably because of these facts, the first evidence thatsecondhand smoke was dangerous for people appearedover 30 years ago when physicians and medical scien-tists found that children exposed to secondhand smokewere more likely to have asthma, respiratory problems,and ear infections.”

It is not just children who are affected by second-hand smoke. Adults face it in homes, restaurants, barsand, for many decades (although less so now), theworkplace. A “non-smoker” who is frequently exposedto cigarette smoke is basically a secondhand smoker. Infact, recent research indicates secondhand smoke, orpassive smoke, is a far greater health risk than was pre-viously understood.

Routine exposure to someone else’s cigarette smoke, or“secondhand smoking,” can increase your risk of heartdisease by 30%. It also elevates your risk of cancer andlung disease. According to Kacirk, “Each year at least53,000 American non-smokers die from heart disease,

cancer, and lung disease caused by their exposure to sec-ondhand smoke—more than die in auto accidents.”

How Dangerous Is SecondhandSmoke?Cardiovascular Effects

When a smoker inhales, the concentration of harmfulchemicals found in the cigarette is very high. With sec-ondhand or passive smoke, the chemicals are diluted—in some cases as much as 100 times less than their con-centrations in the smoke inhaled directly from a ciga-rette. So that means the risk would be about 100 timesless, right?

The answer is absolutely not. In fact, colleaguesJoaquin Barnoya, MD, MPH, and Stanton A. Glantz,PhD, of the Center for Tobacco Control Research andEducation maintain that the cardiovascular effects ofsecondhand smoke are nearly equal to those faced bysmoking itself (Circulation 2005;111:2684-98).

Increasingly, we are learning that the cardiovascularsystem is extremely sensitive to the toxins in secondhandsmoke. According to one study, in as little as 30 minutesof exposure to cigarette smoke—the level you mightexpect to find at a bar—measurable changes take placein your coronary arteries (JAMA 2001;286:436-41).

Secondhand smoking also accelerates the develop-ment of atherosclerosis (stiffening of the aortic arteries).It also contributes to the accumulation of bad forms ofcholesterol (LDL) in the body and reductions in thegood forms of cholesterol (HDL).

Overall, secondhand or passive smoking has a muchgreater effect on the cardiovascular system than isexpected from a comparison of the doses of toxins deliv-ered to active and passive smokers.

Some may wonder, “It's just a few hours in a bar.What difference will it make?” Quite a bit. “For everyfive or six active smokers felled by heart disease, a non-smoker exposed to their secondhand smoke also diesfrom the exposure,” says Kacirk. “That is something tothink about along the bar rail.”

Respiratory Effects“There is no safe level of secondhand smoke,” says

Kacirk. “The chemicals in secondhand smoke areresponsible for wheezing and asthma attacks for manyindividuals.” For people with asthma, and those forwhom cigarette smoke is a known trigger, even a visit toa local restaurant can put them in danger of having anasthma flare.

A large number of studies done over the years havelooked at the many ways secondhand smoke effects lunghealth. The evidence is particularly plentiful in lookingat its effects on children. Children who are exposed tosecondhand smoke, both directly and while in their

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mother’s womb, have a higher likelihood of developingasthma (Am J Respir Crit Care Med 2005;172:61-6).Children exposed to secondhand smoke in their homesin the first year of life may have higher rates of respira-tory illness, which in itself can be a significant trigger ofasthma (Pediatrics 1985;75:594-7). Children who haveasthma and whose mothers smoke may have more fre-quent asthma episodes and more severe symptoms (JAllergy Clin Immunol 1986;77:575-81).

The effects of secondhand smoke can be quite dan-gerous for adults as well. Adults whose partners smokeare nearly five times more likely to develop asthma inadulthood than those who are not exposed to passivesmoke (findings presented by Maritta Jaakkola at the11th European Congress on Lung Disease, Berlin, 2001).

Adults who are regularly exposed to secondhandsmoke in the workplace may experience more chesttightness, nighttime breathlessness, breathlessness afterphysical activity, and general bronchial responsivenessthan people not exposed to secondhand smoke (Lancet2001;358:2103-9). In addition, daily exposure to sec-ondhand smoke at home or in the workplace may causea significant increase in the risk of chronic bronchitis,asthma, and wheezing (Chest 2002;122:1086-90).

Going Smoke FreeExposure to secondhand smoke can be difficult to

avoid. Because of its very nature, smoke drifts. It can

make even a non-smoking section of an indoor facilitythe “secondhand smoking” section. Many people hesi-tate when faced with unwanted secondhand smoke.They don’t want to make a scene or draw attention tothemselves. Current information on the many healthrisks bolsters one’s stance when it comes to secondhandsmoke. Ask to be removed from the situation, or leave.

Until legislation passes to create more smoke-freepublic spaces and work places, it will be difficult tocompletely avoid secondhand smoke in group or publicenvironments. However, it is possible to control theenvironment of your home. “It is important for chil-dren, grown-ups, and families to understand [the risksof secondhand smoke] and the importance of makinghomes and cars smoke-free,” says Kacirk.

Secondhand smoking is not just a minor annoyanceto be tolerated. Its effects are far greater than the linger-ing scent on clothes and in hair. Studies show thatexposure to secondhand smoke is a health risk for every-one. For individuals with asthma, it is even moreimportant to avoid what is not only a known asthmatrigger, but a recognized toxic substance.

Gretchen W. Cook is a freelance writer in Jackson,Mississippi, who specializes in family and health topics. She was diagnosed with asthma at age 6.

Reprint requests: Elsevier Inc., 11830 Westline Industrial Dr., St.Louis, MO 63146-3318; phone 314-453-4350.doi:10.1016/j.asthmamag.2005.09.001

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