Asthma
Tobacco Smoke, Vaping, and Asthma
Cigarette smoking is the leading cause of preventable deaths in the United States. It can trigger asthma attacks or make asthma worse in people who have asthma.1 Tobacco can be bad for your health even if you are not the one smoking. Breathing in the smoke can lead to many health problems.
Vaping is also bad for you. E-cigarettes are often marketed as better than tobacco, but they have harmful chemicals and create air pollution too. Vaping emissions can have negative effects, especially in infants, children, pregnant people, and people with lung conditions such as asthma.
What Is in Tobacco Smoke and E-Cigarette Aerosol?
Tobacco smoke has more than 7,000 chemicals.1 This includes trace amounts of poisons, such as formaldehyde, arsenic, DDT, and cyanide. At least 70 of the substances in tobacco smoke can cause cancer.2 Many more irritate the lungs and airways.
E-cigarettes are sometimes called e-cigs, electronic nicotine delivery systems (ENDS), vape pens, or vapes. They work by heating liquid found in cartridges. This creates a mist or aerosol that is breathed into the lungs. The act of breathing e-cigarette aerosol in and out is known as vaping.
E-cigarette aerosol often contains nicotine and other toxic chemicals.3 This may cause serious health conditions, such as lung disease, heart disease, and cancer. The aerosols create air pollution that is a health risk to the users and non-users around them.
Harmful substances found in e-cigarettes include:3
- Nicotine
- Cancer-causing chemicals (carcinogens)
- Very fine particles that can be breathed into the lungs
- Volatile organic compounds (gases released into the air from products)
- Chemical flavoring that is linked to serious lung disease
- Heavy metals, such as nickel, tin, and lead
It is hard to know exactly what is in e-cigarettes. For instance, some products that claim not to have nicotine have been found to contain nicotine.
How Is Secondhand Smoke Linked to Asthma and Allergies?
Environmental tobacco smoke (ETS) is also called “secondhand smoke.” This refers to the smoke that is released into the air when a smoker breathes out. It also refers to the smoke released from a burning cigarette, cigar, or pipe.
Secondhand smoke is harmful. A person who is around someone who is smoking is also exposed to the same harmful chemicals in the smoke. Secondhand smoke can trigger asthma attacks or make asthma worse. It can cause heart disease, stroke, and lung cancer, too.
Children are at high risk of lung damage and illness from breathing in smoke. Studies have shown a clear link between secondhand smoke and asthma in children. But studies have not proven that secondhand smoke causes asthma in children.
Secondhand smoke can cause serious health problems in children.
- Secondhand smoke can trigger asthma attacks in children who have asthma. Children with asthma who are around secondhand smoke have worse and frequent asthma attacks.1
- Studies show that children whose parents smoke have a greater chance of getting sick more often. Their lungs may grow less than children who do not breathe secondhand smoke. They also have a higher risk of more bronchitis and pneumonia.1
- Wheezing and coughing are more common in children who breathe secondhand smoke.4
- Children whose parents smoke around them get more ear infections. They have fluid in their ears more often. They also have more operations for ear tubes for drainage.4
How Is Secondhand E-Cigarette Aerosol Linked to Asthma?
Studies have shown that secondhand e-cigarette aerosol can worsen existing asthma and cause asthma flare-ups, especially in young people.5 Exposure to secondhand e-cigarette aerosol can cause the following respiratory symptoms:
- Wheezing
- Shortness of breath
- Cough
- Increased or thickened mucus
Secondhand vape is e-cigarette aerosol inhaled by someone who doesn’t vape. Experts are still learning about secondhand vape. But they do know it is harmful. It can cause some of the same health problems as vaping.
What Is Thirdhand Smoke?
Thirdhand smoke is residue from tobacco smoke. When a cigarette is smoked, chemicals in the smoke stick to surfaces and dust for months after the smoke is gone. The chemicals in the residue then react to other pollutants in the air, like ozone, to create harmful particles you can easily breathe into your airways.6
Thirdhand smoke particles are extremely tiny, easily making their way into your lungs. These particles can stick to skin and clothing. Adults and children then breathe in the residue or absorb it through their skin or mouth.
Babies and young children can ingest these toxic particles because they put their hands in their mouths often. They are more likely to touch a surface and then eat without washing hands. Also, children can absorb these chemicals through their skin. For example, if a child is put into a car seat wearing only a diaper and people smoke in the car – even when the child isn’t present – then the car seat may be coated in these chemicals.
Some experts believe thirdhand smoke may be worse for people with asthma than nicotine.
Smoking outdoors does not reduce the threat of thirdhand smoke because it can cling to a person’s clothing. Airing out rooms or cars doesn’t help. Open windows, fans, air filters or confining smoking to certain rooms or outside will not reduce thirdhand smoke either.
What Is Thirdhand E-Cigarette Aerosol?
Scientists are still learning about thirdhand e-cigarette aerosol. But they do know that the substances found in e-cigarette aerosol can stick to surfaces.6 This is known as thirdhand vape or thirdhand e-cigarette aerosol.
Some studies have shown that the nicotine found in e-cigarette aerosol can land on tables, walls, floors, and windows.6 It can then get into people’s bodies if they touch it, swallow it, or breathe it in. Infants and toddlers are most at risk of exposure to thirdhand vape. This is because many kids touch a lot of surfaces and put objects in their mouths. It can also be hard to remove nicotine from surfaces because it is very hard to clean with regular soap. It must be removed with an acidic cleanser.6
What Is the Link Between Smoke, E-Cigarette Aerosol, and Teens?
Teen smoking has always been a concern. Most people who smoke start smoking by age 18.7 Even though only 13 out of 100 of high school students say they currently smoke cigarettes (traditional or electronic), 28 out of 100 have tried a tobacco product.8
Vaping is becoming more popular among teens. The CDC’s 2023 Youth Data shows that almost 1 out of 20 middle schoolers and about 1 out of 10 high school students reported using e-cigarettes in the past 30 days.7 This means the number of students using e-cigarettes almost doubles between middle school and high school.
E-cigarettes could be popular among this age group because the liquid found in e-cigarette cartridges often comes in flavors that appeal to young people. The CDC’s 2023 Youth Data shows that almost all of high school students (90.3%) and middle school students (87.1%) who used e-cigarettes in the past 30 days said they used a flavored e-cigarette during this time.7
Flavored cartridges have been banned by the Food and Drug Administration (FDA). But these cartridges are still easy to buy because of an influx of imported flavors, making it harder to enforce the ban.
Many communities and local governments are trying to control tobacco advertising aimed at teens. The rise in vaping is concerning because e-cigarettes can have harmful substances that put teens at risk of illness. A recent study from Texas A&M University found that vaping is linked to smoking cigarettes, depression, behaviors related to substance (drug and alcohol) abuse, and increased risk of asthma in teens.8
Where Can I Get Help to Quit Smoking or Vaping?
People have different motivations to quit smoking or vaping. For some, they want to improve their health. For others, they want to protect loved ones around them from the effects of secondhand or thirdhand smoke. Some people have ethical concerns with how the materials used to create e-cigarettes/vapes are sourced. (Electronic items with lithium-ion batteries are tied to mining operations with rampant human rights abuses.) Disposable cartridges also contribute to plastic pollution.
It is important to have support to help you quit. Signs of a nicotine addiction can include:
- Craving nicotine
- Unable to stop smoking or vaping
- Developing a tolerance (needing to use more to feel the same effects)
There is free help and resources available by phone, online, or mail from the CDC. Call 1-800-QUIT-NOW (1-800-784-8669). Callers are routed to their state quit lines, which offer several types of information and services. These may include:
- Free support, advice, and counseling from experienced coaches
- A personalized quit plan
- Practical information on how to quit, including ways to cope with nicotine withdrawal
- The latest information about stop-smoking medicines
- Free or discounted medicines (available for some callers in most states)
- Referrals to other resources
- Mailed self-help materials
If you prefer online help, visit smokefree.gov. You will find online resources like:
- Live online chat
- Building a quit plan
- SmokefreeTXT
- QuitSTART app
- Links to Smokefree Espaňol, Smokefree Teen, Smokefree Women, SmokefreeVET, and Smokefree60+
How Can I Reduce My Family’s Exposure to Secondhand and Thirdhand Smoke and E-Cigarette Aerosol?
As a parent or caregiver, you can limit your family’s exposure to tobacco smoke and e-cigarette aerosol.
- If you smoke or vape, do your best to quit. Resources and groups above are available to help you.
- Talk with your children about the dangers of smoking and vaping and how it affects asthma.
- Ask other people not to smoke or vape in or near your home and car.
- Visit smoke-free and vape-free homes and businesses with a no-smoking/no-vaping policy.
- Choose child care that will not expose your child to second- and thirdhand smoke or vape. Even if a caregiver doesn’t smoke or vape around a child, they can still expose a child to thirdhand smoke and vape on their clothes or skin. Remember, children exposed to cigarette and e-cigarette aerosol and residue may get sick more often. Protecting them from exposure is good preventive medicine. Your child’s health depends on it.
Medical Review: May 2024 by Maureen George, PhD, RN, AEC, FAAN
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Drug Company Assistance Programs
The medicines covered by the programs below may change at any time. The following medicines are covered as of Jan. 24, 2025.
Company:
- AstraZeneca
Medicines offered:
- AIRSUPRA®
If you have commercial insurance: If you have employer-provided or individual private (commercial) insurance, you may be able to get AIRSUPRA for as low as $0 with the SUPRA Savings Card.
If you have government insurance: For people with Medicare Part D coverage, the average out-of-pocket cost is $89 per month. For people with Medicaid, the out-of-pocket costs range from $.99-$13 per month. Some states offer even lower copays or eliminate the copay altogether. If you have Medicare Part D and cannot afford AIRSUPRA, you may be eligible for the patient assistance program, AZ&Me.
If you have no insurance: If you do not have health insurance or your insurance does not cover AIRSUPRA, you will pay the amount determined by your pharmacy. You may also be eligible for the patient assistance program, AZ&Me.
Learn more on the Cost Assistance with AIRSUPRA website or call 866-480-0030.
Company:
- AstraZeneca
Medicines offered:
- BEVESPI AEROSPHERE®
- BREZTRI AEROSPHERE®
- SYMBICORT®
- FASENRA®
- TEZSPIRE®
If you have commercial insurance, government insurance, or no insurance:
AstraZeneca US Patient Support offers various savings for several of their medicines. They offer copay savings cards and patient assistance programs depending on what type of insurance you have.
For more information, visit AZPatientSupport or call 800-236-9933.
AstraZeneca has capped the cost of their inhalers to $35 if you have commercial or private insurance. Learn more about the price cap.
Company:
- AstraZeneca
Medicines offered:
- TEZSPIRE®
If you have commercial insurance: The TEZSPIRE Together Co-Pay Program can help may help you save regardless of income if you qualify. Get doses for as little as $0 and up to $100 off your in-office administration costs (pre-filled syringe only). Learn more on the TEZSPIRE Together Co-Pay Program website or call 888-987-7473.
If you have government insurance: The TEZSPIRE Together Program, you may be able receive TEZSPIRE at no cost if you qualify. This includes people who:
- Are uninsured
- Have Medicare Part B with no supplemental insurance
- Have a Medicare Advantage plan with an affordability gap
- Have insurance that does not cover TEZSPIRE
For more information, call 888-987-7473.
Company:
- Boehringer Ingelheim
Medicines offered:
- Atrovent® HFA
- Combivent® Respimat®
- Spiriva® Respimat®
- Stiolto® Respimat®
- Striverdi® Respimat®
If you have commercial insurance or don’t have insurance: If you qualify, your cost will automatically be discounted when you buy these inhalers at participating retail pharmacies. If your cost is more than $35, download and use a savings card. Learn more at: InhalerOffer.com
If you have government-funded insurance: If you use Medicare, Medicaid, CHIP, or TRICARE, visit the Boehinger Cares Patient Assistance Program webpage or call 800-556-8317 to apply for assistance.
Boehringer Ingelheim has capped the cost of their inhalers to $35 if you have commercial or private insurance. Learn more about the price cap.
Company:
- Sanofi and Regeneron Pharmaceuticals, Inc.
Medicines offered:
- DUPIXENT®
If you have commercial insurance: The Dupixent MyWay® Copay Card may help you lower the cost of your copay. Learn more on the Dupixent MyWay Copay Card website or call 844-DUPIXENT (844-387-4936), option 1.
If you don't have insurance or your insurance doesn’t cover Dupixent: You can apply for the DUPIXENT MyWay Patient Assistance Program. For more information or to sign up, call 844-DUPIXENT (844-387-4936), option 1.
If you have Medicare: At this time, there is not a savings program for Dupixent if you have Medicare. Call 844-DUPIXENT (844-387-4936), option 1 for more information.
If you have Medicaid: Your copay and coverage may vary depending on what state you live in. If you meet the criteria, you may also be able to get help from the DUPIXENT MyWay Patient Assistance Program. For more information or to sign up, call 844-DUPIXENT (844-387-4936), option 1.
Medicines covered:
- Epinephrine devices – all brands
Savings programs:
- See AAFA’s list of all available epinephrine devices and their patient assistance programs.
Company:
- Genentech
Medicines offered:
- Xolair®
If you have commercial insurance: Genentech offers a copay savings program for Xolair. You may also be able to get help from an independent copay assistance foundation. 
If you have government insurance or don’t have insurance: You may be able to get help from an independent copay assistance foundation. Find programs.
Company:
- GSK (GlaxoSmithKline)
Medicines offered:
- ARNUITY ELIPTA
- ANORO ELLIPTA
- BREO ELLIPTA
- INCRUSE ELLIPTA
- NUCALA®
- SEREVENT®
- TRELEGY®
If you have commercial insurance: You may be eligible for the GSK Copay Assistance Program.
If you have Medicare or no insurance: You may qualify for the GSK Patient Assistance Program. This program can help you receive certain GSK prescription medicines and vaccines at no cost.
For more information, visit GSK Patient Assistance Program & Savings Offers or call 888-825-5249.
GSK has capped the cost of their inhalers to $35 if you have commercial or private insurance. Learn more about the price cap.
Company:
- GSK (GlaxoSmithKline)
Medicines offered:
- NUCALA®
If you have commercial insurance: If you have a commercial medical or prescription insurance plan, you may be able to take part on the NUCALA Copay Program. If you are approved, the GSK Copay Program may help with your cost share for NUCALA and the your cost share for administration up to the total annual copay program maximums.
If you have government insurance or no insurance: You are not eligible for this program if you are covered by any federal or state prescription insurance program.
For more information, visit the NUCALA Copay Program website or call 800-691-1939.
Company:
- Organon
Medicines offered:
- ASMANEX® HFA
- ASMANEX® TWISTHALER®
- DULERA®
If you have commercial insurance: If you qualify, you may be able to save with an ASMANEX Multiuse Savings Coupon.
If you qualify, you may pay as little as $15 per Dulera prescription on each of up to 12 qualifying prescriptions. The maximum savings is $90 per prescription.
If you have government insurance or no insurance: At this time, there is no assistance program if you have Medicaid or Medicare.
Company:
- Teva
Medicines Covered:
- QVAR RediHaler®
- CINQAIR®
Teva Cares Patient Assistance Program provides certain Teva medicines at no cost if you live in the United States and meet specific insurance and income criteria. Learn more about program eligibility.
If you do not meet the eligibility requirements for the Teva Cares Foundation Patient Assistance Programs, you may be eligible for help from other programs they offer.
For more information, visit the Teva Cares Foundation website or call 888-838-2872.
Pharmacy Drug Savings Programs
Program Name:
Contact Information:
- 844-265-6444
- moc.htlaehknilb@ofni
About the Program:
- Blink Health finds the lowest price for the medicines you need. Find discounted prescription prices on more than 15,000 medicines.
Program Name:
Contact Information:
- 844-926-2480
- moc.xrknilb@troppus
About the Program:
- BlinkRx is a digital pharmacy service that carries certain medicines. They can provide the lowest prescription price while providing free home delivery.
Program Name:
Contact Information:
- 855-268-2822
About the Program:
- GoodRx is a free resource that lets you compare medicine prices and find discounts.
Looking for savings on asthma inhalers? See the GoodRx Savings Guide for ways you may be able to save money on 25 asthma inhalers.
Program Name:
Contact Information:
- 833-317-2937
About the Program:
- The Kroger Health Savings Club is an annual membership program that entitles members to reduced prices on prescription drugs.
Program Name:
Contact Information:
About the Program:
- Mark Cuban CostPlus Drug Company offers access to affordable medicines at the lowest possible price. Learn about program eligibility.
Program Name:
Contact Information:
- 888-331-1002
About the Program:
- The SCBN Prescription Assistance program is for uninsured or underinsured people who cannot afford their prescribed medicines.
- The program requires a membership fee to participate.
Program Name:
Contact Information:
- Contact your local Walmart pharmacy
About the Program:
- The Walmart low-cost Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Prices for some drugs covered by the program may vary by state.
Program Name:
Contact Information:
- 877-296-4673
About the Program:
- Prescription Hope provides access to brand-name medicines for only $60 a month per medication through their medication access service. Learn about program eligibility.
Nonprofit Copay and Premium Assistance Programs
Organization:
Contact Information:
- 800-511-5144 (TTY 711)
- moc.htlaehairaca@eracremotsuc
About the Program:
- AcariaHealth provides specialty pharmacy services for people living with complex and chronic health conditions. Their Copay Assistance Support Team will research and apply to qualifying patient assistance programs on behalf of the patient. Learn about the program.
Organization:
Contact Information:
- 800-366-7741
About the Program:
- Accessia Health provides financial help to pay for copays, health insurance premiums, travel costs, and other medical expenses. Learn about program eligibility.
Organization:
Contact Information:
- 877-968-7233
About the Program:
- Good Days provides financial support for people who cannot afford the treatment they urgently need.
- Copay, travel, premium, and diagnostic testing assistance may be available.
- Learn about eligibility criteria.
Organization:
Contact Information:
- 980-859-3483
- gro.htaprobrah@ofni
About the Program:
- Harbor Path delivers lifesaving medicine for free to people who are uninsured. They currently serve 24 states. Use the eligibility calculator to see if you qualify.
Organization:
Contact Information:
- 800-675-8416
- gro.noitadnuofllewhtlaeh@stnarg
About the Program:
- HealthWell Foundation provide financial assistance to help with prescription copays, travel costs, behavioral health services, health insurance premiums, deductibles, and copays. Please note that diseases covered may change from time to time.
Organization:
Contact Information:
- 866-316-7263
About the Program:
- The PAN Foundation offers financial help for out-of-pocket medicine costs including copays, health insurance premiums, and transportation costs related to medical care. Learn about program eligibility. Please note that diseases covered may change from time to time.
Organization:
Contact Information:
- 866-512-3861
About the Program:
- PAF’s Co-Pay Relief (CPR) program provides direct financial help to qualified people with co-payments, co-insurance or cost-sharing associated with prescription drugs through funds for specific disease states. Learn about program eligibility. Please note that diseases covered may change from time to time.
Organization:
Contact Information:
- 800-769-3880
About the Program:
- Rx Outreach provides discounted medicines for eligible people. Learn about the program.
Organization:
Contact Information:
- 855-845-3663
About the Program:
- TAF helps people and families by providing them with financial help for their copays, coinsurance, premiums, deductibles, and other health-related expenses.
Patient Assistance Tools and Databases
Tool:
- BenefitsCheckUp® – National Council on Aging
Contact Information:
- 800-794-6559
More Information:
- BenefitsCheckUp® is a free service of the National Council on Aging (NCOA). It is an online tool to connect older adults and people with disabilities to benefit programs such as health care, medicine, food, utilities, and more.
Tool:
Contact Information:
- 615-736-5075
- gro.epohfoyrasnepsid@ofni
About the Program:
- Dispensary of Hope provides medicine to communities, free of cost. They are a charitable medication distributor dedicated to providing pharmacies and clinics with reliable access to medication that was generously donated by pharmaceutical manufacturers. Find a dispensing site near you, here.
Tool:
Contact Information:
- 800-503-6897
- gro.sdemydeen@ofni
More Information:
- A national nonprofit that connects people to programs that may help them afford their medicines and other health care costs.
Tool:
- PhRMA’s Medicine Assistance Tool (MAT) – Partnership for Prescription Assistance
Contact Information:
- 571-350-8643
More Information:
- PhRMA’s Medicine Assistance Tool (MAT) is a search engine for many patient assistance resources offered by drug makers.
Tool:
Contact Information:
More Information:
- RxAssist offers a comprehensive database of patient assistance programs. Learn about the eligibility requirements.
Tool:
Contact Information:
- 844-234-3057
- moc.eracelgnis@troppus
More Information:
- SingleCare works with pharmacies on discounts on prescriptions. Look up prescriptions to find the lowest prices in your area.
Tool:
Contact Information:
- 800-719-5147
- moc.esnesxr@rednifsgnivasxr
About the Program:
- Walgreens Rx Savings Finder can help you find prescription discount cards that can help you find the lowest price on a medicine at Walgreens.
State Drug Assistance Programs
Organization:
- Extra Help – Social Security Administration
Contact Information:
- 800-772-1213
- (TTY 800-325-0778)
More Information:
- The Extra Help program helps people with limited income and resources lower or cut Medicare Part D costs.
Organization:
- State Health Insurance Assistance Programs (SHIPs) – National Technical Assistance Center
Contact Information:
- 877-839-2675
- gro.htlaehpihs@ofni
More Information:
- Free insurance counseling and help to Medicare-eligible people, their families, and caregivers.
Organization:
Contact Information:
- Contact your local county office.
More Information:
- CalAIM offers people on Medi-Cal access to services that address physical, behavioral, developmental, dental, and long-term care needs.
Organization:
- State Pharmaceutical Assistance Program – Medicare.gov
More Information:
- Find out if your state has a state pharmaceutical assistance program.
Organization:
- Pharmaceutical Assistance Program – Medicare.gov
More Information:
- Learn more about pharmaceutical companies that offer programs to help pay for prescriptions for people with a Medicare Drug Plan (Part D).
Community Resources
American Sleep Apnea Association: Assists people with sleep apnea who cannot afford their CPAP mask supplies through the CPAP Assistance Program.
Friends of Man: Receives applications for mobility equipment, prosthetics, home modifications, medical equipment, hearing aids, basic needs and much more. The referral must be made by a professional. This includes caseworkers, case managers, health care workers, social workers, school counselors, teachers, and clergy.
FoodFinder: A map of food pantries across the United States. Search your ZIP code to learn about free food assistance programs near you.
FundFinder: Helps you find financial assistance from charitable foundations.
Inspira Financial: Funds in a health savings account (HSA) or a health care flexible spending account (FSA) can be used for eligible medical expenses.
Society of St. Vincent de Paul: A national non-profit that provides local assistance and services.
United Way 211: The most comprehensive source of information about local resources and services in the country.
AAFA Regional Chapters
The AAFA New England Chapter has more information on drug assistance for Massachusetts residents.
The AAFA Michigan Chapter has more information on drug assistance for Michigan residents, including the Jared Williams Medication Fund (JWMF).
Asthma Capitals
Where you live can have an impact on your asthma. AAFA’s Asthma Capitals™ report looks at the top 100 most challenging cities in the continental United States to live with asthma.
