Asthma affects 7% of children and 8% of adults in the United States. There is a paucity of studies examining the association between
passive smoking and an increased risk of
asthma exacerbations that led the authors to examine the association between various modes of smoking and rates of
asthma exacerbations. A retrospective cross-sectional/case-control study was conducted using the National Health and Nutrition Examination Survey dataset (2013-2018). Out of 312,979 respondents, 35,758 (11.43%) had a history of
asthma, 9083 (2.9%) had
asthma attacks in the past year, and 4731 (1.51%) had
asthma-related emergency room admissions in the past year. Prevalence of
asthma-related emergency admissions were higher among active cigarette smoking (46.25 vs 35.46%), e-cigarette smoking (26.63 vs 16.07%), and
passive smoking at home (37.53 vs 25.67%), workplace
passive smoking (14.35 vs 12.11%), in bar (32.38 vs 26.16%), and car (26.21 vs 14.44%) (p < 0.0001). In multivariate regression analysis, we found regular cigarette smoking (OR 1.13, 95% confidence interval (CI) 1.009-1.260, p = 0.0252), e-cigarette (OR 2.13, 95% CI 1.92-2.36, p = 0.0043), cigar use (OR 1.21, 95% CI 1.1-1.33, p < 0.001), ultra-long cigarette length (OR 4.85, 95% CI 3.33-7.06, p < 0.0001), and
passive smoking (OR 5.25, 95% CI 3.43-8.06, p < 0.0001) were associated with increased rates of
asthma exacerbations over last 12 months. The study shows increased odds of
asthma exacerbations among those using ultra-long cigarettes, e-cigarettes, and cigars. Consequently, passive inhalation from even a single smoker in the home, workplace, bars and cars is associated with worsening outcomes in
asthma patients.