How Does Smoking & Secondhand Smoke Impact People with Cystic Fibrosis?

Reviewed by: HU Medical Review Board | Last reviewed: September 2019

Smoking and secondhand smoke are particularly harmful to people with cystic fibrosis (CF). It does not matter if that smoke is generated by a cigarette, cigar, e-cigarette, pipe, hookah, or inhaled marijuana.

The reason? In healthy people, smoking damages lung tissue and reduces lung function. In people with CF, smoking adds to the respiratory damage caused by the disease. The combination of smoking, or exposure to smoke, creates a double-whammy for a respiratory system that’s already vulnerable to infections and tissue damage.

Side effects of smoke and secondhand smoke

People with CF who smoke, or who are exposed regularly to secondhand smoke, experience several side effects, including:

How smoking mimics cystic fibrosis

One study documented that smoking cigarettes impacts the lungs by limiting activity of the CFTR protein. In fact, people exposed to cigarette smoke showed a 60% decrease in CFTR activity compared to people exposed to clean air. This effect lasted for at least two-and-a-half hours after cells were exposed to cigarette smoke.

In another sign that cigarette smoking mimics CF’s effect on the lungs, hypertonic saline (used in nebulizers) moved saline levels to more normal levels and increased mucus clearance.2

Additional reasons not to smoke

Smoking can cause wide-ranging physical and emotional health issues for people with CF, including:

  • Smoking can disqualify you for a lung transplant3
  • Smoking worsens osteoporosis (bone disease) by lowering bone density4
  • Smoking is expensive and can decrease financial well-being5
  • The active ingredient in marijuana can affect how CFTR modulators work5

Avoiding secondhand smoke

Secondhand smoke can contain more than 4,000 chemicals, dozens of which are known carcinogens (cancer-causing), making it particularly dangerous for people with CF. Secondhand smoke is extra harmful for children with CF because children breathe faster than adults. This means they breathe in even more poisons that damage their lungs.

Some tips to avoid secondhand smoke include:

  • Avoid homes, restaurants, bars, and other places where people smoke.
  • Make sure anyone caring for your child with CF does not smoke, even in their own home or car. Smoke lingers on clothing, carpets, and furniture is called thirdhand smoke.
  • Never ride in a car with someone who smokes.1

Resources to help someone quit smoking

If you smoke, consider asking your medical team for help in quitting. You probably are not the first person they’ve helped quit and may have programs to recommend and tips that have helped other patients. If you are not comfortable talking to your care team, many services exist to support people who are trying to quit smoking.

Resources and programs to help with smoking cessation

  • Text “IQUIT” (47848) to get special quit smoking advice by text message. The service will send up to 5 messages a day targeted to your age, gender and how much you currently smoke.
  • Visit for tips to help you quit, manage cravings and cope with stress without smoking.
  • Call the Substance Abuse and Mental Health Services Administration (SAMHSA) national helpline at 800-662-HELP (800-662-4357) for referrals to local services.
  • The Centers for Disease Control and Prevention offers information on best practices, insurance coverage and helplines in all 50 states.

Managing the stress and anxiety of a chronic illness like cystic fibrosis can be difficult at times. The good news is that smoking is a habit that can be exchanged for a healthier method of coping, and secondhand smoke can be avoided.

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