Poorly Controlled Asthma in a School-Age Child, When Exposure History Is Not Enough

Beyond asthma, which pediatric conditions warrant active secondhand smoke screening at routine visits?

Actively screen for secondhand smoke exposure at all pediatric routine visits, and be especially deliberate when the child has recurrent ear disease, bronchiolitis/recurrent wheeze, chronic cough or frequent respiratory infections, sleep-disordered breathing, prematurity/BPD or other chronic lung disease, congenital he

How should I counsel families who believe outdoor or intermittent vaping is safe for children?

The safest advice is: there is no evidence-based “safe” level of children’s exposure to vape aerosol, and outdoor or intermittent use only reduces exposure—it does not eliminate it. E-cigarette aerosol can contain nicotine, ultrafine particles, and other potentially harmful chemicals, and children may also be exposed t

How do I weigh secondhand smoke against other modifiable drivers when asthma stays uncontrolled?

When asthma remains uncontrolled, secondhand smoke should be treated as a high-priority modifiable driver, not just a background issue, because guideline-based asthma assessment includes both symptom control and future risk, and tobacco smoke exposure is a recognized modifiable risk factor for poor control and exacerba

What practical advice reduces a child's exposure when a household member cannot stop smoking?

If a household member cannot yet quit, the most effective harm-reduction step is a strict smoke-free home and car rule: no smoking anywhere inside the house, near windows/doors, on balconies connected to living areas, or inside vehicles at any time. Moving smoking completely outdoors, away from children, and reducing s

Which respiratory symptoms in a child should prompt me to ask about household vaping?

- Chronic or recurrent cough, especially if worse indoors, at night, or around a specific caregiver/exposure. Secondhand e-cigarette aerosol is associated with respiratory symptoms and asthma morbidity in children/adolescents. - Wheeze or asthma-like episodes, including a child with new wheeze, frequent reliever use, o