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National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2012.

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Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General.

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Table 2.9Cross-sectional studies on the association of smoking with childhood cough, bronchitis symptoms, shortness of breath, wheeze, and asthma

508-Compliant Version

StudyPopulationPeriod of studyFindingsDefinitions/comments
Arday et al. 199526,504 high school seniors
United States
  • 10.7% smoked
  • Regular smoking since 9th grade associated with:

    Coughing spell in past 30 days: OR = 2.1; 95% CI, 1.90–2.33

    Shortness of breath when not exercising: OR = 2.67; 95% CI, 2.38–2.99

    Wheezing or gasping: OR = 2.58; 95% CI, 2.29–2.90

Dose-response relationship for most symptoms
Lewis et al. 199611,262 British children born in 1958, follow-up at age 16
United Kingdom

9,266 British children born in 1970, follow-up at age 16
United Kingdom
1974 and 1986
  • Child smoking associated with increased odds of asthma and/or wheezy bronchitis (OR = 1.44; 95% CI, 1.14–1.82 for ≥40 cigarettes/week)
  • Smoking did not explain 70% increase in wheezy illnesses between 1974 and 1986
Leung et al. 19974,665 schoolchildren
13–14 years of age
Hong Kong
  • Active smoking associated with:

    Current wheeze: OR = 2.72; 95% CI, 1.38–2.89

    Severe wheeze limiting speech: OR = 4.62; 95% CI, 2.43–8.75

ISAAC protocol
Lam et al. 19986,304 students
12–15 years of age
Hong Kong
  • Smoking >6 cigarettes/week associated with:

    Chronic cough: OR = 2.71; 95% CI, 1.95–4.69

    Chronic phlegm: OR = 3.91; 95% CI, 2.77–5.53

    Wheeze in the past 3 months: OR = 2.91; 95% CI, 1.99–4.26

    Use of asthma medicine in the past 2 days: OR = 3.07; 95% CI, 1.58–5.97

  • Ever asthma, allergic rhinitis, and eczema not associated significantly with smoking
Dose-response relationship for most symptoms
Manning et al. 20023,066 students
13–14 years of age
Republic of Ireland
  • More girls smoked than boys (23.3% vs. 17.6%)
  • Active smoking associated with increased bronchitis symptoms: OR = 3.02; 95% CI, 2.34–3.88
ISAAC protocol
Sotir et al. 2003; Yeatts et al. 2003; Sturm et al. 2004128,568 7th- and 8th-grade students primarily White, African
American, Native American, or Mexican American
North Carolina
  • Smoking 1–10 cigarettes/day in past 30 days associated with wheeze triggered by upper respiratory infection (prevalence OR = 1.26; 95% CI, 1.9–1.34)
Dose-response relationship
  • Smoking 2–10 cigarettes/day in past 30 days associated with:

    Active diagnosed asthma (OR = 1.24; 95% CI, 1.17–1.31)

    Wheezing in past 12 months (OR = 1.27; 95% CI, 1.21–1.32)

  • Current smoking associated with frequent wheezing not diagnosed as asthma (OR = 2.60; 95% CI, 2.43–2.79)
Dose-response relationship
Annesi-Maesano et al. 200414,578 adolescents
  • Active smoking >1 cigarette/day associated with increased odds of wheezing, current asthma, lifetime asthma, current rhinoconjunctivitis, lifetime hay fever, and current eczema after controlling for age, gender, geographic region, familial allergy, and passive smoking
ISAAC questionnaire
Zimlichman et al. 200438,047 young adult military conscripts
Mid-1980s to 1990s
  • Rates of smoking among asthmatic conscripts increased from 20–22% in the mid-1980s to an estimated 30% in the late 1990s
Cross-sectional study
Mallol et al. 20074,738 adolescents
Mean age = 13 years
  • Persistent smokers had higher rates of wheeze, wheeze with exercise, severe wheeze, and dry nocturnal cough
ISAAC protocol

Note: CI = confidence interval; ISAAC = International Study of Asthma and Allergies in Childhood; OR = odds ratio.


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