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Asthma and Smoking: What’s the Deal?

When I turned 18, at the end of one of my doctor appointments, my asthma doctor started for the door, stopped, and turned around in Colombo-like fashion and said, “Oh! And one more thing.” He paused, perhaps for effect, then said. “If you should ever decide to smoke cigarettes, let me know and I’ll do you a favor and put you out of your misery.”

It was his way of reminding me that I best not smoke. His words were well received, even though I was already well aware that I should never smoke, considering I had had been dealing with severe asthma my entire life.

Ironically, smoking used to be recommended for asthma.

Tobacco smoke was sometimes a remedy for asthma, but more than likely it was asthma cigarettes, which contained belladonna and stramonium. I think it was Francis Rackeman (1877-1973) who once quipped that he could always tell which homes belonged to asthmatics by the sweet aroma of asthma cigarettes.

By the time I was born the dangers of smoking were well known. In fact, thanks to the evolution of better and safer asthma medicines, smoking is no longer recommended for asthma. This is despite evidence that smoking does produce a mild bronchodilator effect. However, most health experts would agree that the risks of smoking far outweigh any benefits.

Research on smoking and asthma

Back then, the mechanisms for how smoking made asthma worse were unknown, and that basically remains the case today. However, thanks to extensive research in this regard, researchers do know a little bit more than back then.

For instance, they understand that asthmatics have some degree of underlying airway inflammation that makes their airways hypersensitive (twitchy) when exposed to asthma triggers, causing asthma attacks. They also know that asthma attacks are completely reversible with either time or treatment.

The inflammation present in most asthmatics is eosinophilic inflammation, and this is very responsive to corticosteroids. This is why most asthmatics respond well to inhaled corticosteroids and are able to obtain ideal asthma control.

However, the chemicals in cigarette smoke may irritate asthmatic airways in such a way as to cause neutrophilic inflammation to exist alongside eosinophilic inflammation. Neutrophilic inflammation responds poorly or not at all to corticosteroids. So, smoking can make your lungs less responsive to traditional asthma medicine.1-2

Smoking leads to airway inflammation, which may not be treatable

Perhaps because it is not treatable, airway inflammation becomes severe, and this may cause scarring. Scarred tissue is thicker than normal, and this can lead to some degree of chronic (it’s always there) airway narrowing. This means that their asthma becomes only partially reversible with time or treatment, meaning some degree of shortness of breath is always present.

So, if you already have asthma, smoking cigarettes on a daily basis long-term can cause your asthma to get worse over time, and it can also cause airway changes that may cause COPD. The combination of both asthma and COPD is generally referred to as Asthma/ COPD Overlap Syndrome.

Asthma is completely reversible, and it is generally understood that asthmatics have the same life expectancy as non-asthmatics. COPD, on the other hand, is only partially reversible and progresses with age. However, aggressive treatment can slow the progression so you can live longer and better with it.

Now, it should be noted that you can develop COPD without smoking. You can develop it due to chronic (day after day) exposure to chemicals at your work. It can also be caused by a rare gene called alpha 1 antitrypsin. So, you don’t necessarily have to smoke to get it. However, it is also known that about 80% of people who develop COPD smoked at some point in their lifetimes.

And it’s also true that not everyone who smokes develops COPD. Most studies show that about 20-30% of smokers will eventually be diagnosed with it, although I have seen studies showing it’s as high as 50%. Studies show that children with persistent asthma have a 32% greater risk of developing COPD, and adults with asthma have a 12% greater risk of developing it.3-4

So, with an increased risk already, smoking with asthma can only elevate the risk.

Researchers are not sure why asthmatics have an elevated risk for developing COPD, although some studies seem to suggest that asthma genes may have something to do with it. Smoking may turn some of these asthma genes into COPD genes.1-2

I do know some people who have asthma who also smoke. One of my friends said she thought it was fine to do because she no longer has asthma. However, I humbly reminded her that it’s a myth that asthma goes away with age, and that, even though she displays no symptoms, she still has it. “So, be warned,” I said.

And I don’t judge people. That’s not the point here. It’s a free country, so I’m not an advocate of laws forcing people to not do something they choose to do. A am, however, of the belief that education is important. Plus, I think I’d feel guilty if my friend with asthma who smokes actually developed worsening asthma or COPD and I never said anything. So, I did. And I won’t say anything further.

Okay, so, it has been known for years now that smoking can make your asthma worse. My doctor warned me not to do it. So, here’s my humble reminder to all my fellow asthmatics not to smoke, and if you do smoke, and if you’re interested, here’s your incentive to quit. If you’re a former smoker, I commend you for quitting.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Spears, et al., “Smoking in Asthma Is Associated with Elevated Levels of Corticosteroid Resistant Sputum Cytokines—An Exploratory Study,” 2013, August 9,, accessed 3/8/17
  2. Stapleton, Megan, et al., “Smoking and Asthma,” Journal Of The American Board Of Family Medicine, 2011,, accessed May 21, 2017
  3. "New 20-Year Study Links COPD And Asthma," American College of Chest Physicians, July 12, 2004,, accessed 6/11/17
  4. "Links Between Asthma and COPD," American Lung Association,, accessed 6/13/17


  • illeanafernandes
    12 months ago

    Tobacco smoke is harmful to those who smoke or those who are exposed to environmental tobacco smoke. This increases the likelihood of developing asthma, and those who are already struggling with asthma may experience worsening of asthma symptoms. Smoking can weaken the lung function of an asthmatic. Such patients find daily control over asthma, a challenge. Medications for asthma are less effective in people who smoke. Smoking contributes to chest infections which cause your asthma symptoms to worsen. Aim to be smoke-free to avoid the negative impact that smoking can have on your existing asthma. Quitting smoking can reverse the effects of smoking on the lung function of people with asthma. Take your asthma medicine regularly to improve lung function and reduce the airway inflammation. Get medicine for asthma offered by at a very low price. A wide range of medications for asthma such as asthma inhalers and tablets are available on this website, and you can buy what your doctor has prescribed to you.

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