4.10 Effects of secondhand smoke on the respiratory system in adults

Secondhand smoke affects the respiratory system of non-smokers through mechanisms similar to those by which tobacco smoke affects the airways and lungs of active smokers. However, since the levels of exposure are lower, the effects of secondhand smoke tend to be less severe.1

Non-smokers exposed to secondhand smoke commonly experience eye, nasal and throat irritation.1 They also have an elevated nasal ciliary beat frequency (a defence mechanism that transports secretions, particles and other substances out of the nasal passages) comparable to smokers.2 An hour's exposure to high levels of secondhand smoke, such as that found in bars or restaurants with unrestricted smoking, can produce an acute decline in lung function and airflow restriction.3 A range of chronic and acute respiratory symptoms in non-smokers are also associated with exposure to secondhand smoke, such as cough, phlegm and sputum production, wheezing and shortness of breath, in both people with and without asthma.1 Secondhand smoke may also be responsible for causing the onset of asthma in adulthood, and for making the management of asthma more difficult.1 Evidence suggests that people with asthma have a small acute decline in lung function following exposure to secondhand smoke.1 Chronic exposure to secondhand smoke is associated with a small decrement in lung function in the general adult population, but more research is needed to determine if this effect actually reflects a larger decrement in susceptible sub-groups (such as those with asthma).1

Adults exposed to secondhand smoke have a higher likelihood of snoring,4 and are at greater risk of experiencing respiratory complications during surgery involving anaesthesia.5 Secondhand smoke exposure is a risk factor for chronic rhinosinusitis, and worsens the symptoms of blocked nose, nasal discharge, headaches and cough.6 7 Secondhand smoke may also exacerbate symptoms or progression of disease among adults with co-existing poor lung function,8 or lung disease such as asthma and cystic fibrosis.9

Research suggests that exposure to secondhand smoke may cause an elevated risk of developing of chronic obstructive pulmonary disease (COPD), which is marked by permanent and progressive damage to the airways and airway sacs of the lung.1 COPD results in reduced lung function that is largely irreversible.1 There is some evidence to suggest that impaired lung growth and development resulting from exposure to maternal smoking during pregnancy and exposure to secondhand smoke during childhood may persist into adulthood and possibly contribute to the development of COPD, but further research is needed.1

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1. US Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Atlanta, Georgia: US Deptartment of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2006/index.htm

2. Zhou H, Wang X, Brighton L, Hazucha M, Jaspers I and Carson J. Increased nasal epithelial ciliary beat frequency associated with lifestyle tobacco smoke exposure. Inhalation Toxicology 2009;21(10):875–81. Available from: http://www.informahealthcare.com/doi/full/10.1080/08958370802555898?cookieSet=1

3. Flouris A, Vardavas C, Metsios G, Tsatsakis A and Koutedakis Y. Biological evidence for the acute health effects of secondhand smoke exposure. American Journal of Physiology. Lung Cellular and Molecular Physiology 2009;298(1):L3–12. Available from: http://ajplung.physiology.org/cgi/reprint/00215.2009v1.pdf

4. Franklin K, Gí­slason T, Omenaas E, Jõgi R, Jensen E and Lindberg E. The influence of active and passive smoking on habitual snoring. American Journal of Critical Care Medicine 2004;170:799–803. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15242843

5. Moller A and Tonnesen H. Risk reduction: perioperative smoking intervention. Best Practice Research and Clinical Anaesthesiology 2006;20:237–48. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16850775

6. Reh D, Lin S, Clipp S, Irani L, Alberg A and Navas-Acien A. Secondhand tobacco smoke exposure and chronic rhinosinusitis: a population-based case-control study. American Journal of Rhinology & Allergy 2009;23(6):562–7. Available from: http://www.ingentaconnect.com/content/ocean/ajra/2009/00000023/00000006/art00016;jsessionid=2fp3n7eyhmic7.victoria

7. Tammemagi C, Davis R, MS B, Holm A and Krajenta R. Secondhand smoke as a potential cause of chronic rhinosinusitis: a case-control study. Archives of Otolaryngology--Head & Neck Surgery 2010;136(4):327–34. Available from: http://archotol.ama-assn.org/cgi/content/full/136/4/327

8. National Health and Medical Research Council. The health effects of passive smoking: a scientific information paper. Canberra: Australian Government Publishing Service, 1997.

9. Office of Environmental Health Hazard Assessment and California Air Resources Board. Health effects of exposure to environmental tobacco smoke: final report, approved at the Panel's June 24, 2005 meeting. Sacramento: California Environmental Protection Agency, 2005. Available from: http://www.oehha.ca.gov/air/environmental_tobacco/2005etsfinal.html

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