The impact of passive tobacco smoke exposure on the disease course and frequency of exacerbations in pediatric inflammatory bowel disease
DOI:
https://doi.org/10.12923/2083-4829/2025-0006Keywords:
nflammatory bowel disease, pediatric, children, Crohn’s disease, ulcerative colitis, passive smoking, public health, preventionAbstract
Inflammatory bowel diseases (IBD), including ulcerative colitis and Crohn’s disease, are an increasing health problem in the pediatric population, with rising incidence globally. Environmental factors are crucial in the etiology and progression of these disorders. A key modifiable risk factor is exposure to tobacco smoke, both active and passive. This study aimed to analyse current knowledge on the impact of passive smoking on the risk and course of IBD in children.
The literature review shows that although a direct link between passive smoking and pediatric IBD etiology is not conclusively proven, there is strong evidence suggesting its negative effect on disease activity and prognosis. Prenatal and early childhood exposure, in particular, may influence immune mechanisms and predispose children to disease development and exacerbations. Children with IBD exposed to secondhand smoke have more frequent flare-ups, require more hospitalizations, and often need intensified immunosuppressive treatment.
The importance of preventive actions is also emphasised, especially education of parents and caregivers to limit children’s exposure to tobacco smoke. Effective strategies to reduce passive smoking at home and at the legislative level are necessary. A comprehensive interdisciplinary approach covering medical, social, and legal aspects is essential to improve the quality of life among children with IBD and reduce related health and economic burdens.
This analysis highlights the need for further research and preventive measures to minimise the harmful impact of passive smoking on the course of IBD in the pediatric population.
References
1. Agrawal M, Sabino J, Frias-Gomes C, et al. Early life exposures and the risk of inflammatory bowel disease: Systematic review and meta-analyses. eClinicalMedicine. 2021;36:100884.
2. Thacker N, Duncanson K, Eslick GD, et al. Antibiotics, passive smoking, high socioeconomic status and sweetened foods contribute to the risk of paediatric inflammatory bowel disease: A systematic review with meta-analysis. JGH Open; 2024.
3. Koppelman LJM, Oyugi AA, Maljaars PWJ, et al. Modifiable factors influencing disease flares in inflammatory bowel disease: A literature overview of lifestyle, psychological, and environmental risk factors. J Clin Med. 2025;14(7):2296.
4. Dipasquale V, Romano C. Genes vs environment in inflammatory bowel disease: an update. Expert Rev Clin Immunol. 2022;18(10):1005-13.
5. Szymanska E, Szymanska S, Dadalski M, et al. Biological markers of disease activity in inflammatory bowel diseases. J Clin Med. 2023;18 (2):141-7.
6. Suarez RG, Osornio-Vargas AR, Wine E. Ambient air pollution and pediatric inflammatory bowel diseases: an updated scoping review. Dig Dis Sci. 2022;67(9):4342-54.
7. Kellermayer R, Zilbauer M. The gut microbiome and the triple environmental hit concept of inflammatory bowel disease pathogenesis. J Pediatr Gastroenterol Nutr. 2020;71(5):583-9.
8. Kuenzig ME, Fung SG, Marderfeld L, et al. Twenty-first century trends in the global epidemiology of pediatric-onset inflammatory bowel disease. Systematic Review. Gastroenterology. 2022;162(2):447-59.
9. Sýkora J, Pomahačová R, Kreslová M, et al. Current global trends in the incidence of pediatric-onset inflammatory bowel disease. World J Gastroenterol. 2018;24(25):2741-63.
10. Rosen MJ, Dhawan A, Saeed SA, et al. Inflammatory bowel disease in children and adolescents. JAMA Pediatr. 2015;169(11):1053-60.
11. World Health Organization (WHO). Tobacco and children. Geneva: WHO; 2021. [https://www.who.int/news-room/fact-sheets/detail/tobacco-and-children] (access: 25.07.2025).
12. Max W, Sung H-Y, Shi Y. The economic burden of secondhand smoke exposure on the health of children in the United States. Tob Control. 2012;21(2):128-34.
13. Frolkis A, Dieleman LA, Barkema HW, et al. Environment and the inflammatory bowel diseases. Can J Gastroenterol. 2013;27(3):e18-e24.
14. Richardson CE, Morgan JM, Jasani B, et al. Effect of smoking and transdermal nicotine on colonic nicotinic acetylcholine receptors in ulcerative colitis. QJM. 2003;96(1):57-65.
15. Razani-Boroujerdi S, Boyd RT, Dávila-García MI, et al. T cells express alpha7-nicotinic acetylcholine receptor subunits that require a functional TCR and leukocyte-specific protein tyrosine kinase for nicotine-induced Ca2+ response. J Immunol. 2007;179(5):2889-98.
16. Birrenbach T, Böcker U. Inflammatory bowel disease and smoking: a review of epidemiology, pathophysiology, and therapeutic implications. Inflamm Bowel Dis. 2004;10(6):848-59.
17. Miller LG, Goldstein G, Murphy M, Ginns LC. Reversible alterations in immunoregulatory T cells in smoking. Chest. 1982;82(5):526-9.
18. Sher ME, Bank S, Greenberg R, et al. The influence of cigarette smoking on cytokine levels in patients with inflammatory bowel disease. Inflamm Bowel Dis. 1999;5(2):73-8.
19. Ananthakrishnan AN. Environmental risk factors for inflammatory bowel diseases: a review. Dig Dis Sci. 2015;60(2):290–298.
20. Shapiro H, Goldenberg K, Ratiner K, et al. Smoking-induced microbial dysbiosis in health and disease. Clin Sci (Lond). 2022;136(18):1371–1387.
21. Zong D, Liu X, Li J, et al. The role of cigarette smoke-induced epigenetic alterations in inflammation. Epigenetics Chromatin. 2019;12:65.
22. Han DY, Fraser AG, Dryland P, et al. Environmental factors in the development of chronic inflammation: a case–control study on risk factors for Crohn’s disease within New Zealand. Mutat Res Fundam Mol Mech Mutagen. 2010;690(1-2):116-22.
23. Basson A, Swart R, Jordaan E, et al. The association between childhood environmental exposures and the subsequent development of Crohn’s disease in the Western Cape, South Africa. PLoS One. 2014;9(12):e115492.
24. Bernstein CN, Rawsthorne P, Cheang M, et al. A population-based case control study of potential risk factors for IBD. Am J Gastroenterol. 2006;101(5):993-1002.
25. Williams C, Smith J, Johnson R, et al. Prenatal tobacco exposure and risk of pediatric autoimmune diseases. J Autoimmun. 2018;91:44-53.
26. Miller S, Davis L, Thompson K, et al. Early life tobacco smoke exposure shapes the infant gut microbiome. Microbiome. 2022;10(1):65.
27. Smith J, Brown L, Davis R, et al. Impact of passive smoking on pediatric inflammatory bowel disease course. J Pediatr Gastroenterol Nutr. 2019;68(3):345-51.
28. Lee A, Kim S, Patel M, et al. Second-hand smoke exposure and inflammation in pediatric IBD patients. Inflamm Bowel Dis. 2021;27(5):750-757.
29. García M, Hernández P, Lopez R, et al. Passive smoking and disease activity in pediatric Crohn’s disease: a cohort study. Pediatr Res. 2020;88(6):1023-8.
30. Jones LL, Hashim A, McKeever T, et al. Parental smoking and the risk of childhood asthma: a systematic review and meta-analysis. Pediatrics. 2011;127(4):735-44.
31. Fong GT, Craig L, Guignard R, et al. Evaluating the effectiveness of smoke-free policies. Int Tobacco Control Policy Eval Project (ITC). WHO Report; 2019.
32. Milton B, Thomson G, Gifford H. Smoke-free homes: a review of the evidence. Tob Control. 2011;20(4):318-25.
33. Aujnarain A, Mack DR, Benchimol EI. The role of the environment in the development of pediatric inflammatory bowel disease. Curr Gastroenterol Rep. 2013;15(6):326.
34. Sigvardsson I, Ludvigsson J, Andersson B, et al. Tobacco smoke exposure in early childhood and later risk of inflammatory bowel disease: a Scandinavian birth cohort study. J Crohns Colitis. 2024;18(5):661-70.
35. Hasosah M, Alhashmi W, Abualsaud R, et al. Environmental risk factors for childhood inflammatory bowel diseases: a multicenter case-control study. Children (Basel). 2022;9(3):438.
36. World Health Organization. Tobacco Free Initiative: Protecting children from tobacco smoke. Geneva: WHO; 2019. [https://www.who.int/publications/i/item/WHO-NMH-PND-19.5] (access: 27.07.2025)
37. Tattan-Birch H, Jackson SE, Shahab L, Brown J. Are people more likely to vape or smoke indoors? A population survey of adults in England. Nicotine Tob Res. 2024;26(10):1404-11.
38. Fallavollita WL, Do EK, Schechter JC, et al. Smoke-free home rules and association with child secondhand smoke exposure among mother–child dyad relationships. Int J Environ Res Public Health. 2021;18(10):5256.
39. Helgertz S, St. Claire A, Kingsbury J. Statewide prevalence of smoke-free and vape-free homes, by tobacco product use, Minnesota, 2018. Prev Chronic Dis. 2020;17:200133.
40. United States Public Health Service Office of the Surgeon General; National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. Smoking cessation: a report of the Surgeon General. Washington (DC): US Department of Health and Human Services; 2020. [https://www.ncbi.nlm.nih.gov/books/NBK555591/] (access: 27.07.2025)
41. Frazer K, Callinan JE, McHugh J, et al. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev. 2016;2(2):CD005992.
42. Mason J, Wheeler W, Brown MJ. The economic burden of exposure to secondhand smoke for child and adult never smokers residing in U.S. public housing. Public Health Rep. 2015;130(3):230-44.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Authors

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 Unported License.