Teenagers with asthma who smoke cigarettes, vape, or use other nicotine products appear to face substantially worse day-to-day disease control than their peers, according to a retrospective study conducted at a pediatric allergy clinic in İzmir, Türkiye. The research, published in Frontiers in Pediatrics, found that adolescents who were active users of tobacco or nicotine products had markedly lower scores on a validated asthma-control questionnaire and roughly three times the odds of uncontrolled asthma compared with unexposed peers, even after accounting for age, sex, allergic comorbidities, family history of atopy, and treatment adherence.
The study drew on medical records from 238 adolescents aged 14 to 18 years with physician-diagnosed asthma who attended the Pediatric Allergy and Immunology Clinic of Bakırçay University Çiğli Training and Research Hospital between January 2023 and July 2026. Thirty were excluded because they attended only an initial visit or lacked baseline spirometry, leaving 208 adolescents in the final analysis. Participants were sorted into three groups based on their documented exposure status at the most recent follow-up visit: 50 active users of tobacco or nicotine products, 77 adolescents with passive-only exposure from parental smoking at home, and 81 who reported no exposure at all.
Among the active users, the pattern of product use was dominated by conventional cigarettes: 48 of the 50, or 96 percent, reported daily cigarette smoking, while 13 reported electronic cigarette or e-puff use, 12 used multiple products, and one used a waterpipe. Twenty-one of the active users also had passive smoke exposure at home and were retained in the active-use group for the primary analysis. Exposure information came from patient self-report recorded in routine clinical documentation; no standardized tobacco questionnaire or biochemical verification such as cotinine measurement was used, a limitation the authors flag repeatedly.
The central outcome was the Asthma Control Test, a validated five-item patient-reported measure whose Turkish version has demonstrated reliability and validity, with scores below 20 defining uncontrolled asthma. Active users had a median ACT score of 19, compared with 22 among those with passive-only exposure and 21 among the unexposed, a difference that was statistically significant overall. Uncontrolled asthma was present in 62 percent of active users, versus 29.9 percent of the passive-only group and 34.6 percent of the unexposed group.
In a prespecified multivariable logistic regression model with the unexposed group as the reference category, active use was independently associated with uncontrolled asthma, with an adjusted odds ratio of 3.15 and a 95 percent confidence interval of 1.45 to 6.81. Passive-only exposure, by contrast, showed no independent association with uncontrolled asthma, with an adjusted odds ratio of 0.82. When the researchers modeled ACT as a continuous outcome using multivariable linear regression with heteroskedasticity-robust standard errors, active use was associated with a 2.43-point lower ACT score, while passive-only exposure showed no significant association.
Respiratory symptoms told a similar story. Night cough and sputum production were both markedly more frequent among active users, with 74 percent reporting night cough and 66 percent reporting sputum production, compared with much lower rates in the other groups. At least one asthma attack requiring presentation to a healthcare facility during the preceding year was recorded in 64 percent of active users, 46.8 percent of the passive-only group, and 44.4 percent of the unexposed group, an unadjusted difference that did not reach statistical significance.
The attack outcome proved less reliable under scrutiny. In the primary adjusted model, active use was associated with at least one asthma attack, with an adjusted odds ratio of 2.20 and a confidence interval of 1.02 to 4.76. But when the 21 active users with concurrent passive exposure were excluded in a sensitivity analysis, the estimate for attacks weakened to an adjusted odds ratio of 1.69 with a confidence interval spanning 0.68 to 4.20, which the authors attribute at least partly to reduced statistical power in the smaller sample. The association with uncontrolled asthma, however, held up in that same sensitivity analysis, actually strengthening to an adjusted odds ratio of 4.08.
Lung function findings were more nuanced. Baseline spirometry was performed at the initial visit using standardized equipment and techniques, while exposure classification and ACT scores came from the most recent follow-up, a timing mismatch the authors emphasize carefully. The ratio of forced expiratory volume in one second to forced vital capacity, expressed as a percentage of predicted values, was lower in active users than in both other groups, but the authors explicitly caution that this baseline measurement should not be interpreted as a consequence of the exposure status observed later in follow-up. It may reflect earlier exposure, pre-existing airway characteristics, or other unmeasured differences. No significant group differences emerged for FEV1, FEF25-75, or bronchodilator reversibility, and FVC differences disappeared after correction for multiple comparisons.
The authors discuss several biological mechanisms that could plausibly connect active nicotine product use with poorer asthma control, while stressing that none were measured directly in this study. Combustible smoke delivers oxidants and reactive compounds that injure airway epithelium, weaken barrier function, promote mucus production, and impair mucociliary clearance. Electronic cigarette aerosols differ chemically but may contain ultrafine particles, carbonyl compounds, metals, and flavoring agents, with effects varying by device, liquid composition, and patterns of use. Smoke exposure may also promote neutrophilic airway inflammation and, through oxidative stress, reduce responsiveness to corticosteroid treatment, a possibility drawn largely from adult studies that cannot be transferred directly to adolescents.
The study’s limitations shape how its findings should be read. The retrospective, single-center design precludes causal inference, and the authors note that the direction of the association cannot be determined: adolescents with poorer asthma control may differ in psychosocial, behavioral, or environmental factors that also influence nicotine use. Self-reported exposure without biomarker verification leaves room for underreporting and misclassification, and adherence was assessed from clinical records rather than electronic monitoring. Product-specific estimates were not attempted because nearly all active users smoked cigarettes, making exclusive vapers and waterpipe users too few for reliable analysis. The authors conclude that documenting tobacco and nicotine exposure, including vaping and passive smoke, deserves careful attention during adolescent asthma follow-up, but they call for prospective multicenter studies with biomarker-verified, time-updated exposure assessment to clarify the temporal and product-specific relationships before any causal claims can be made.
Subject of Research: Associations between active and passive tobacco or nicotine exposure and asthma control in adolescents attending a pediatric allergy clinic
Article Title: Active and passive tobacco and nicotine product exposure and asthma control in adolescents: a retrospective study from a pediatric allergy clinic
Article References: Kangalli Boyacioglu, O., Soyoz, O., & Bahceci, S. (2026). Active and passive tobacco and nicotine product exposure and asthma control in adolescents: a retrospective study from a pediatric allergy clinic. Frontiers in Pediatrics, 14, Article 1952212. https://doi.org/10.3389/fped.2026.1952212
Image Credits: AI Generated
DOI: 10.3389/fped.2026.1952212
Keywords: asthma, adolescents, tobacco, vaping, e-cigarettes, passive smoking, asthma control test, spirometry, pediatric allergy, retrospective study, nicotine, lung function
News Source: Harold Sullivan. (October 28, 2026). Active Vaping and Smoking Tied to Poorer Asthma Control in Teens, Study Finds. Scienmag.
