Impact of Combustible and Emerging Tobacco Products on Asthma Control, Lung Function, and Exacerbation Risk

Asthma is among the most prevalent chronic respiratory diseases worldwide, affecting more than 300 million individuals across all age groups. Tobacco exposure whether through active combustible cigarette smoking, secondhand smoke (SHS), electronic cigarettes (e-cigarettes), or heated tobacco products (HTPs) has been widely implicated in worsening asthma-related outcomes. This mini literature review synthesizes evidence from five peer-reviewed studies published between 2012 and 2025, identified through searches of PubMed, Wiley Online Library, and BMC databases, to examine the associations between tobacco product use and asthma outcomes in adult populations. The included studies consistently demonstrated that tobacco exposure is associated with poorer asthma symptom control, reduced lung function, and an elevated risk of severe exacerbations and emergency department (ED) visits. Notably, smoking cessation was associated with an 80% reduction in chest tightness and a 76% reduction in nocturnal symptoms within 12 months of quitting. Additionally, HTP use among never-smokers was associated with a 3.25-fold increased odds of worsening asthma symptoms, challenging the perception that HTPs constitute a safer alternative. Studies that failed to exclude comorbid chronic obstructive pulmonary disease (COPD) or to adjust for cumulative smoke exposure yielded spurious associations between tobacco use and asthma incidence, underscoring the necessity of rigorous methodological design. In conclusion, all forms of tobacco exposure adversely affect asthma outcomes. Clinicians should prioritize evidence-based smoking cessation strategies combining pharmacotherapy with behavioral counseling as a core component of asthma management.