Vaping at home tied to worse asthma control in kids

Clinical takeaway: Ask about all household nicotine exposure, including e-cigarettes, when caring for children with asthma. These findings suggest that vaping in the home may be no safer than combustible tobacco when it comes to asthma control.

Secondhand tobacco smoke is a well-established asthma trigger, but many families perceive e-cigarettes as a lower-risk alternative. Data on how household vaping affects children with asthma have been limited, particularly when e-cigarettes are used without traditional cigarettes.

Children with asthma who lived in homes where both combustible tobacco and e-cigarettes were used had the broadest pattern of poor asthma control in a large cross-sectional analysis of 48,118 clinic encounters from an urban pediatric primary care network. The study included children aged 1 year and older whose parents completed questionnaires on household tobacco use and asthma control between July 2023 and March 2026.

Household exposure to both tobacco and e-cigarettes was reported in 5% of encounters, while tobacco-only exposure was reported in 9% and e-cigarette-only exposure in 3%. After adjustment for demographic and socioeconomic factors, combined exposure was associated with roughly 20% to 40% higher odds of activity-related symptoms, nighttime symptoms, rescue albuterol use, poorer parent-rated asthma control, lower caregiver confidence in asthma management, hospital admissions, and uncontrolled asthma.

Notably, e-cigarette-only exposure was independently linked to worse outcomes. Children exposed only to household vaping had about 30% more asthma flare-ups and about 40% more activity-related symptoms than children with no reported exposure. Tobacco-only exposure was also associated with poorer asthma control, although the effects were generally smaller and less consistent. Exposure status was not significantly associated with emergency department visits or oral corticosteroid use after adjustment.

The findings, presented at the AAP 2026 National Conference & Exhibition and not yet peer reviewed, challenge the notion that secondhand e-cigarette exposure is a safer option for children with asthma.

“Many parents believe e-cigarettes are a safer alternative to cigarettes, both for themselves and for their children's health,” said lead author Brian Jenssen, MD. “Our findings suggest that assumption doesn't fully hold up for kids with asthma.”

Source: Jenssen B. AAP 2026 National Conference & Exhibition, October 2026. Parent-Reported Household Tobacco and E-cigarette Exposure and Asthma Control in Children: A Cross-Sectional Study