Health Effects of Passive Smoking in Children

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Abstract
The harmful effects of passive smoke exposure were described in a series of meta-analyses published in 1999, the findings of which have largely been resoundingly confirmed subsequently. Despite the introduction of anti-smoking legislation, which is undoubtedly effective, millions of children worldwide are still exposed to tobacco smoke, leading to 170,000 premature deaths in children. Early life events critically impact long-term lung health, and there are multiple adverse effects of tobacco exposure. Maternal smoking in pregnancy causes preterm and small-for-date deliveries, and immunological and structural changes in the foetus (amongst other issues), leading to airway obstruction at birth, which never recovers. Childhood risk factors, of which tobacco smoke exposure is much the most important, are at least as important as heavy smoking in adult life in causing later chronic obstructive pulmonary disease. Other effects of passive smoke exposure in children include an increased risk of sudden infant death, an increased risk of upper airway disease, including the need for adenotonsillectomy, premature vascular aging, neurocognitive defects and the exacerbation of coincidental respiratory diseases, such as cystic fibrosis. The family and societal fiscal burden of passive smoke exposure is also huge. In summary, prevention of exposure of children to tobacco smoke is the single most important and achievable public health measure to ensure long-term lung health.

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