Smoking Parents Put Children At Risk For Empyema Thoracis

Prof Dr Dayang Anita Abdul Aziz says smoking parents increase the risk of empyema thoracis in children, and warns that nicotine poses gender-specific risks, such as serious birth defects, menstrual cycle changes, and fertility issues in women.

BANGI, April 27 – An expert has found a significant number of empyema thoracis cases in young children where at least one parent smokes.

Empyema thoracis is a condition in which pus or infected fluid accumulates in the pleural space, the area between the chest wall and the lungs, and is associated with high mortality. 

Prof Dr Dayang Anita Abdul Aziz, a paediatric laparoscopy and surgery specialist, revealed that in her 16 years of service at Universiti Kebangsaan Malaysia (UKM), the majority of empyema thoracis cases she has seen in children are not caused by the bacteria streptococcus pneumoniae or haemophilus influenzae – both reside in the upper respiratory tract and are the leading causes of childhood pneumonia and meningitis.

In cases where the usual bacteria that cause empyema thoracis are absent, Dr Dayang found that the majority of affected children have smoking parents. 

While there is currently no conclusive evidence to link smoking with empyema thoracis, Dr Dayang said the connection between smoking or vaping and empyema thoracis cannot be ruled out, especially in light of the presence of e-cigarette or vaping use-associated lung injury (EVALI) in adults.

“When I did surgery on children for the empyema thoracis disease where those that come are two, three, four, five years old with their lungs full of pus, historically, it is caused by the streptococcus pneumoniae bacteria. They (the patient) contract pneumoniae or haemophilus influenzae. And maybe their body is not too good, or [they] have a low immune system, they experience exaggeration of lung infection, they get empyema thoracis. 

“So, my job is to clean the lungs and throw out all the impurities and pus. And the latest method is through keyhole surgery — that is my niche area — so that it is not too painful compared to performing major surgery. 

“I found during my 16 years with UKM, before this 12 years I was with KKM (Ministry of Health), 16 years with UKM, most of the empyema thoracis is not caused by streptococcus pneumoniae only or haemophilus influenzae. 

“There are many cases where there is no bacteria detected, but when we ask [further], we tend to find that one or both parents smoke.

“We cannot pinpoint because the cases aren’t enough. We cannot pinpoint but we know that if EVALI can occur in adults, it is not surprising that it can occur in younger age groups,” said Dr Dayang during a roundtable discussion on the Control of Smoking Product for Public Health Bill 2023 and Implementation of the Generation End Game (GEG) on April 17.

Dr Dayang, who is chair of the health committee of the National Council of Women’s Organisations (NCWO), said that NCWO is backing a smoking hazard awareness programme that runs during the school period. 

“We support the smoking and vaping hazard awareness programme [that runs] continuously throughout the school period. So, the compulsory school period in our country is only three to 15 years old. We ask that it be extended to 18 years old. 

“We need to have smoking hazard awareness programmes – on access to cigarettes and vapes, prohibition of sales, including online sales, and awareness of the dangers of cigarettes and vape – and we hope [to have these programmes] not only in schools or in the community, but are also given specifically to newlywed couples via marriage programmes.

“This is the initiative that we hope will get the support of religious departments in states and ministers,” Dr Dayang said.

In addition to supporting educational programmes, Dr Dayang proposed a bold idea of prioritising non-smokers when filling job positions in industries that involve working with children.

“This last suggestion, the third in this slide, might be rather extreme, but if we give priority to individuals who do not smoke or vape work opportunities in sectors involving children there is a little importance to not smoke in circles of individuals who are applying for work opportunities,” Dr Dayang said.

Dr Dayang also endorsed incentive programmes aimed at encouraging people to quit smoking. She said the NCWO is collaborating with the government to promote the care industry this year.

“The care industry has the potential to generate more income for the government than tax on nicotine, actually. Women are inherently good at caring, but there is currently no mechanism in place to recognise them as professional caregivers. Therefore, the industry should begin with education, nursery care, and so on.

“Let me give you an example: Kiddocare online. It’s a platform where you can hire a fully-vetted nanny who is good with children. We can order their services online. To ensure that this industry is profitable, we cannot have a generation that is burdened with health issues. We need a physically and mentally healthy generation.”

Apart from its harmful effects on children, nicotine also has gender-specific effects on women. Dr Dayang shared some insights on the gender-specific repercussions of nicotine, stating that nicotine increases the risk of serious birth defects, shorter menstrual cycles, more painful periods, physical changes that can affect fertility, and cause damage to ovarian follicles. 

“We have found that smoking during pregnancy leads to a higher risk of serious birth defects, such as cleft lip, cleft palate, and a lower chance of a healthy birth weight. Many babies are born premature and small for their gestational age, and they are less likely to have normal brain development before birth and in early childhood, and more likely to die from sudden infant death syndrome.

“Cigarette smoking can also shorten the menstrual cycle, causing it to be shorter than the usual seven to ten days. Women who smoke are also more likely to experience painful periods. Unfortunately, these facts are rarely shared in advocacy programmes, except when the advocate is a woman.

“Ultimately, nicotine causes physical changes such as metabolic, inflammatory, pulmonary, and neurological changes that can affect fertility. Toxins in cigarettes can damage ovarian follicles, which means that the egg in the ovary is not as healthy for women who smoke, or for those who only quit during pregnancy. 

“Even before pregnancy, the egg and ovaries are affected by smoking,” Dr Dayang said.

She added that e-cigarettes, including those without nicotine, have been found to contain numerous harmful substances, including endocrine disruptors. These chemicals, both natural and man-made, can mimic or interfere with the body’s endocrine system and have been linked to developmental, reproductive, brain, immune, and other problems.

According to Dr Dayang, frequent smoking of nicotine can lead to an anti-estrogen effect due to these endocrine disruptors. As a result, women who smoke may experience changes in their voice as they age, as well as a decrease in oestrogen sensitivity.

“Even nicotine-free e-cigarettes contain harmful substances, including endocrine disruptors that can impact reproductive organs and morphology. Nicotine also has anti-estrogen effects in women. When women frequently smoke nicotine, when she ages, her voice becomes scratchy, her oestrogen sensitivity decreases, and on the ratio of androgen to oestrogen, androgen is higher,” Dr Dayang said. 

Androgens and oestrogens are hormones. Oestrogens are produced by the body in greater amounts in females, while androgens are produced by the body in greater amounts in males.

Correction: Prof Dr Dayang Anita Abdul Aziz’s designation at NCWO was corrected to state that she is chair of the health committee of NCWO.

You may also like