Tobacco Smoke And Asthma

Tobacco smoke, whether you inhale from your own cigarette or breathe in secondhand smoke, is dangerous to your health. When you have asthma, it can be even worse.

What is Secondhand Smoke?
Secondhand smoke, also known as Environmental Tobacco Smoke (ETS), is a combination of the smoke from a burning cigarette, cigar or pipe and the smoke exhaled from a smoker's lungs. The Environment Protection Agency (EPA) states that over 4,000 different chemicals can be found in tobacco smoke. More than 50 of them are known or probable causes of cancer, and six are hazardous to growing children and unborn babies.

Secondhand Smoke Statistics

• Secondhand smoke is the second leading cause of deaths that could be prevented in Michigan.
• One nonsmoker dies of secondhand smoke for every eight smokers.
• People whose partners smoke are nearly five times more likely to develop asthma in adulthood than those who are not exposed to secondhand smoke.
• Nonsmokers who are regularly exposed to secondhand smoke at home or work have almost double the risk of heart disease. That translates to about 50,000 fatal heart attacks a year in nonsmokers.
• Smoke filled rooms can have up to six times the air pollution as a busy highway.

Health Effects of Secondhand Smoke
The exposure of secondhand smoke has been linked with many bad health effects, including many cancers, heart disease, sudden infant death syndrome, middle ear problems and respiratory conditions. Secondhand smoke is dangerous to everyone, although unborn babies, infants and children are at the most risk because their bodies are still growing.

Tobacco smoke is an irritant to the lungs. People with asthma who smoke or are exposed to secondhand smoke have a higher risk for asthma attacks because their airways are overly sensitive. Secondhand smoke is more harmful to nonsmokers because their bodies are not as used to smoke exposure, as smoker’s bodies are.

Secondhand smoke contains: formaldehyde (embalming fluid), cyanide (poison) arsenic (poison), carbon monoxide (car exhaust), methane (poison), benzene (poison in cleaning solvent), nitro amines (cancer-causing compounds), cadmium (toxic metal), benzopyrene (cancer -causing substance found in gasoline and tar), aniline (poison used in dye) and polonium (radioactive materials).

Listed below are the known health effects of secondhand smoke:

Adults

• Secondhand smoke exposure can cause lung cancer.
• Secondhand smoke exposure increases the risk of getting nasal sinus cancer.
• Secondhand smoke is well known as a risk factor for heart attack and stroke.
• Secondhand smoke irritates the lungs, leading to coughing, excess mucus, chest discomfort, and poorer lung function.
• Eye and nose irritation in adults can occur after being around secondhand smoke.

Children

• Children who breathe secondhand smoke can have more frequent and more severe asthma attacks.
• Secondhand smoke may cause children to develop asthma.
• Children who breathe secondhand smoke are more likely to get pneumonia, bronchitis, breathing problems that don’t get better, and poor lung function.
• Children who breathe secondhand smoke are more likely to have more middle ear infections.
• Infants who breathe secondhand smoke are at a higher risk for Sudden Infant Death Syndrome (SIDS), the main cause of death in babies between one month and one year of age.
• Secondhand smoke can result in infants with low birth weight or be small for gestational age.

Secondhand Smoke and Older Adults
Tobacco has been called a "childhood disease" because children are the targets of tobacco company ads, and childhood is when 90% of current smokers were addicted. However, tobacco/secondhand smoke is also a "senior disease" because that is when the disease and death caused by tobacco usually happens. Exposure to secondhand smoke has been found to start attacks of angina, irregular heart beats, and the symptoms of asthma. About 53,000 people in the U.S. die every year from secondhand smoke-related diseases. If you use the same percentages of smoking-related deaths to secondhand smoke deaths, then over 50,000 of these deaths are to people aged 50 and over; and over 37,000 of these people are to people aged 65 and over.

For more information about tobacco and seniors, go to The Center for Social Gerontology’s website, and the section "Tobacco & Elderly" at www.tcsg.org/tobacco.htm.

Where Is the Smoke?
Exposure to secondhand smoke can come from many locations including homes, restaurants, worksites, public places, and vehicles. Currently, there is a strong movement to cut secondhand smoke exposure in public places and workplaces. By putting policies that limit smoking in place, this movement has been helpful in cutting exposure to secondhand smoke in public places.

The greatest exposure for children usually comes in the home. Almost 60% of U.S. children aged (3-11) years (or 22 million children) are exposed to secondhand smoke in the home (The Surgeon General Report, 2006). In Michigan, 21.7% of children live in a house where smoking is allowed in some or all areas of the house (2007 Michigan BRFS).

Children are not the same as adults because they are less able to control their environment on their own to limit their exposure to secondhand smoke. This is because infants and very young children are not able to protest, older children may not protest, or they may be ignored or scolded when they do.

What Can Be Done To Protect Children?

• If you smoke, choose to quit. The Michigan Department of Community Health has a free printable Tobacco Quit Kit.
• Choose not to smoke in your home and don’t allow others to do so.
• Teach your children how secondhand smoke affects their health and the health of others.
• Choose not to smoke around children.
• Choose to avoid smoke filled areas.
• Choose to not smoke in your car.
• Make sure your day care buildings are smoke-free.
• Choose to eat at smoke-free restaurants.
• Choose non-smoking hotel rooms.
• Take the Smoke-Free Home Pledge.
• Commit to make your home smoke-free and protect your children. Call the EPA's toll free Smoke-Free Home Pledge Hotline at 1-866-Smoke-Free or 1-866-766-5337.
• A Smoke-Free Home Kit will be mailed out to you, which includes: tips on keeping your home smoke-free, smoke-free home magnet and a smoke-free home certificate.

Secondhand Smoke and the Worksite
The most important location of secondhand smoke exposure for adults is in the work place. Experts believe that a large number of the estimated 30,000 to 60,000 secondhand smoke related deaths that occur each year in the U.S. are caused by workplace exposures.

Secondhand smoke is a class "A" carcinogen, something known to cause cancer in humans. There is no safe level of exposure to a cancer-causing agent. Simply dividing smokers from nonsmokers within the same airspace may cut down exposure to secondhand smoke, but cannot get rid of it.

Workers exposed to secondhand smoke on the job are 34 percent more likely to get lung cancer. Exposure to secondhand smoke can also result in worsened asthma symptoms, poor blood circulation, bronchitis, and pneumonia.

According to the 2007 Michigan BRFS, 57.7% of people responded that smoking is not allowed in any of their work areas and another 25.2% responded that smoking is restricted to designated areas within their worksite. Nationally, about 68.6% of all indoor workers said they were working under a smoke-free policy. People who work in hotels, motels, casinos, bars and restaurants are among the most exposed of all workers.
http://www.tobaccofreekids.org/research/factsheets/pdf/0072.pdf

Smoking in the workplace increases an employer's potential legal liability. Under the Americans With Disabilities Act (ADA), employees can sue for protection against tobacco smoke. Smoke limits access to the workplace for people with asthma and others legally classified as having disabilities who are sensitive to secondhand smoke.

The development and implementation of smoke-free policies in worksites and public places protect employees and the general public from the harmful effects of secondhand smoke. Smoke-free policies also prompt more smokers to try and quit, increase the number of successful quit attempts, reduce the number of cigarettes that continuing smokers consume, and discourage kids from ever starting to smoke.

Researchers found that the number of heart attack victims admitted to a regional hospital in Helena, Montana dropped 58% during the first six months that a smoke-free ordinance (all worksites were smoke-free) was in effect in Helena. The study's authors credited much of the decrease in heart attacks to the near elimination of the harmful effects of secondhand smoke in Helena's worksites. (Sargent, R.P.; Shepard, R.M.; Glantz, S.A., "Immediate Reduction in Acute Myocardial Infarctions After Implementation of a Comprehensive Smoke-Free Ordinance," Annual Scientific Sessions of the American College of Cardiology in Chicago, March 30-April 2)

For more information on smoke-free worksite policy, please call 517-335-8376.

Myths and Misconceptions About Smoking
Myth: If I smoke cigarettes in a separate room in the house, then my family is not being exposed.

Fact: Smoke will travel throughout the house no matter where the cigarette is being smoked. It is like putting chlorine in the shallow end of the pool and expecting the chlorine to not circulate to the deep end. Even ventilation systems in homes cannot filter and circulate air well enough to get rid of secondhand smoke. Going into another room to smoke, opening a window or smoking while children are gone may help reduce children's exposure but will not protect them from the dangers of secondhand smoke.

The Surgeon General Report in 2006 stated that even separately enclosed separately exhausted, negative-pressure smoking rooms cannot keep second hand smoke from spilling into adjacent areas. (The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, 2006)

Myth: A little bit of smoke isn’t going to hurt anybody.

Fact: The scientific studies show that there is no risk-free level of exposure to second hand smoke. Even low levels of exposure can harm non smokers' health. (The Surgeon General Report, 2006)

In a July 2001 study in the Journal of American Medical Association, investigators found that brief exposure to small amounts of secondhand smoke can immediately affect the hearts of nonsmokers. The study showed that in as little as 30 minutes of exposure to secondhand smoke, the nonsmokers' blood flow dropped to the same level as people who had smoked a pack of cigarettes. After short amounts of exposure, secondhand smoke had caused damage to the cells that line the heart and blood vessels, causing them to narrow or constrict. This narrowing can lead to hardening or thickening of the arteries and heart disease.

Myth: Simply separating non-smokers within the same areas, such as a workplace or restaurant, will keep them from being exposed to secondhand smoke.

Fact: Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot eliminate secondhand smoke exposure. (The Surgeon General Report, 2006)

The American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), the Preeminent U.S. standard-setting body on ventilation issues, has concluded that ventilation systems cannot remove secondhand smoke from indoor environments. (Environmental Tobacco Smoke: Position Document. Atlanta, Georgia: 2005)

Quitting Tobacco Use
Nicotine addiction is the physical dependence of your body to the powerful chemical nicotine. If you use tobacco and you want to quit for your health and the health of others, help is available. Once you have decided to quit it is important to incorporate these key elements:

• self help information
• cessation treatments to help individuals understand and change their behaviors;
• pharmacologic (medication) therapy to help ease the discomfort of withdrawal from nicotine.

A cessation (or quit smoking) program is an important part of the quitting process. The following information can help you choose a tobacco cessation program.

Types of Cessation Programs

• Group Programs
• Telephone Cessation
• One-on-one Counseling Programs
• Twelve-step Programs
• Self Help Programs
• Inpatient Programs
• Computer-based/Internet Programs

Guidelines for choosing a tobacco cessation program
Different programs work best for different people. When choosing a program, consider practical matters like time, cost, location and instructor methods.

• Choose a research-based program.
• Look around for tobacco cessation courses that may be offered at a local hospital, or through your health plan, the American Lung Association, or the American Cancer Society.
• Ask your doctor, nurse or health plan for suggestions about programs with a good reputation.
• When looking for a program, ask for details about the cost and length of the course.
• Are the presenters trained cessation counselors, and do they have a background in health?
• Will your health plan cover all or part of the cost for attending
• Look for programs that teach avoidance (staying away from tobacco), stress management, coping, interpersonal and refusal skills. It should also address diet, exercise and other health behaviors.
• Will the program help you decide if you are ready to quit? Will it help you determine your motivation for quitting smoking? Will it help you pick a "quit date"?
• The program should highlight the short and long-term costs of tobacco use.
• Different types of instruction methods should be used. (video, group interaction, demonstrations).
• The program should help you to understand how smoking fits into our society (most people don’t smoke).
• The program should teach media awareness – an understanding of how your tobacco use is influenced by others.
• The program will be better and more effective for you in a building where participants cannot have tobacco products, and where policy limits smoking.
• You can improve your success at quitting by choosing a program with courses that have at least four to seven sessions, and are at least 45 minutes long.
• Are refresher courses offered? Or can you drop in on another session if you have a slip or feel a need for some extra support?

Tobacco Use Quitline
Telephone-based cessation counseling provides tobacco-product users with support in counseling. A Free call to the Michigan Department of Community Health's I Can Quit helpline 1-800-480-QUIT (7848) can help you stop smoking. ; It provides up to seven sessions with a personal health coach who will call and work with you in the comfort of your home or office to develop your personal plan to successfully quit smoking.

Prescription and Over-the-Counter Tobacco Cessation Medications The Food and Drug Administration has approved six medications to assist smokers in quitting:

• Five are nicotine replacement therapies that relieve withdrawl symptoms. They include nicotine gum, patch, nasal spray, inhaler, and lozenge.
• The sixth medication, bupropion SR (sustained release), is a non-nicotine medication that is thought to decrease the urge to smoke by affecting the same chemical messengers in the brain that are affected by nicotine.

Prescription and Over-the-Counter Tobacco Cessation Medications

Source: Coverage For Tobacco Use Cessation Treatments, Department of Health and Human Services, Center for Disease Control and Prevention

Helpful Cessation Web Site Addresses
Other helpful resources are cessation web sites. Here is a list of web sites that offer information about quitting, and two that offer computer-based cessation programs.

American Lung Association (Freedom from Smoking): www.ffsonline.org
American Lung Association's cessation program, which can be done online for free.

Massachusetts Dept. of Health: www.trytostop.org
Massachusetts Department of Health’s online cessation program called Quit Wizard. It is completely private and free.

Mayo Clinic: http://www.mayoclinic.org/nicotine-rst/
Contains facts, information and research about quitting

Other Important Tobacco Links

This web site provides information about secondhand smoke and the legal and liability issues related to secondhand smoke. While SFELP is a law project serving just Michigan, most of the information on this site is relevant to all states. The materials provided on this site are for informational purposes only and are not intended to be, and should not be taken as, legal advice.

The SFELP web site is divided into the following main sections:

• Home
• Recent ETS News
• ETS & Health Effects
• ETS & the Law
• Economic Impacts
• Public Opinion
• ETS & Apartments & Condominiums
• Smoke-Free Regulations
• PowerPoint on Smoke-Free Issues
• Clean Indoor Air Regulation Tool Kit
• TCSG Tobacco Site
• Links
• State Tobacco Control Legal Centers
• Services for Michigan Employers & Residents

Services for Michigan Employers and Residents

American Lung Association
www.lungusa.org/stop-smoking/

The Stop Smoking Section includes quitting smoking information, smoking and women and smoking and teens. This site also contains information on their Not On Tobacco (NOT) ten-session tobacco cessation program for teens.

Environmental Protection Agency
www.epa.gov/smokefree/

Gives information and links to resources about secondhand smoke, gives information on lists of publications about secondhand smoke, and gives basic information about secondhand smoke and how it affects asthma.

American Cancer Society
www.cancer.org/docroot/PED/ped_10_1.asp?sitearea=PED

Tobacco Control section is divided into four categories, Health Issues, Quitting Tips, Public Issues and Smoking Related Cancers.

Campaign for Tobacco-Free Kids
www.tobaccofreekids.org

Offers today’s tobacco news, youth action, research and facts, information about your state, links to other useful sites and much more.

Center for Disease Control and Prevention
www.cdc.gov/tobacco/

CDC’s Tobacco Information and Prevention Sources (TIPS) offers an up- to-the-minute count of the young people who have started smoking so far this year. This site also includes the Surgeon General’s reports, quit tips, research and data, tips for kids, tips for teens, educational materials and publications.

Dining Smoke-Free in Michigan
www.smokefreemichigan.org/restaurants.htm

This booklet is for people who wish to avoid secondhand smoke. It states the locations of over 3,000 restaurants that are smoke-free in Michigan.

Compiled by tobacco staff at the Michigan Department of Community Health and the American Lung Association of Michigan, 2004.