Many Asthmatics Ignore Added Risk of Smoking
By Serena Gordon, HealthScoutNews Reporter
MONDAY, May 12 (HealthScoutNews) -- The last thing you'd expect to see someone with asthma do is light up a cigarette. But that's exactly what a sizable chunk of asthmatics do every day, new research says.
The study, published in the May issue of Chest, found that more than a third of asthmatics treated in the emergency room were smokers and nearly a quarter were former smokers. Less than 5 percent believed smoking had anything to do with the flare-up of their asthma symptoms.
"Smoking is all too common among individuals with chronic asthma, a disease that by itself causes breathing difficulty and can lead to hospitalization or even death," says study author Dr. Robert Silverman, an attending physician and director of research in the department of emergency medicine at Long Island Jewish Medical Center in New Hyde Park, N.Y.
"It was surprising and baffling to find so many -- more than one in three -- asthmatics were active smokers. Cigarette smoke is an irritant that inflames the lungs and causes wheezing and chest tightness, and one would have thought that asthmatics would be the least likely to smoke cigarettes," he adds.
Silverman and his colleagues interviewed 1,847 people with asthma from 64 different emergency departments in 21 U.S. states and four Canadian provinces. All of the study participants were being treated for acute asthma attacks. They were between the ages of 18 and 54 years.
Thirty-five percent reported being current smokers and 23 percent said they were former smokers. Only 23.4 percent of the U.S. population as a whole smokes, reports the U.S. Centers for Disease Control and Prevention.
The researchers found people in the study who were white, hadn't graduated from high school, had a lower income, had no private insurance and didn't regularly use inhaled steroids were more likely to be smokers.
Half of the smokers acknowledged that smoking made their asthma symptoms worse, yet only 4 percent believed smoking had anything to do with their current asthma attack.
Silverman says the current findings point to a need for doctors to ask about smoking and to educate smokers in the emergency room on the dangers of smoking, particularly for asthmatics.
"I would guess that many asthmatics are not asked whether they are active smokers because it seems counterintuitive that asthmatics would even consider smoking," Silverman says. "But based on the results of this study, a smoking history should be part of every emergency visit. For current smokers, the emergency department is a good place to start counseling patients, even if briefly."
Silverman explains that when people have an asthma attack they feel as if they are underwater and can't breathe in any air. He says this sensation is frightening, and might make smokers temporarily more receptive to messages about ways to improve their health.
"Every active smoker should be counseled on joining a smoking cessation program. For some individuals, a visit to the emergency department for a severe asthma attack can be the wake-up call needed to make this commitment," he explains.
Dr. Gailen Marshall, director of the division of allergy and clinical immunology at the University of Texas Medical School in Houston, wasn't surprised that so many people with asthma were smoking. He isn't so sure, however, that the emergency room is the right place for smoking cessation education, because there simply isn't enough time to properly address the subject.
"It's difficult to convince people with asthma that their asthma would get better if they stopped smoking," says Marshall, who believes primary-care and asthma-care physicians could better address smoking cessation with their asthma patients.
To learn more about the effects of smoking on asthma, visit the United Kingdom's Action on Smoking and Health or the Asthma Initiative of Michigan.
SOURCES: Robert Silverman, M.D., attending physician and director, research, Long Island Jewish Medical Center, New Hyde Park, N.Y.; Gailen Marshall, M.D., Ph.D., director, allergy and clinical immunology, University of Texas Medical School, Houston; May 2003 Chest
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