Air pollution, tobacco smoke and vaping — branching viva

Stem

You review a preschooler with recurrent wheeze. The parent smokes. Extended family use wood for cooking when they stay. A teenage relative vapes. [1]

Examiner: Is there a safe level of second-hand smoke for children? [3]

Strong answer: No. Prenatal and postnatal exposure associate with SIDS risk pathways, lower respiratory illness, otitis media, impaired lung growth and worse asthma control. Prevention means eliminating exposure. [3] [4]

Examiner: The parent only smokes on the balcony and in the car with windows down. How do you respond? [1]

Strong answer: Outdoor smoking reduces but does not abolish exposure. Doorway drift and third-hand residues on clothes, dust and car interiors still reach young children. Negotiate a fully smoke-free home and car and offer cessation support. [1] [3]

Examiner: Why are children more vulnerable to air pollution than adults? [3]

Strong answer: Higher minute ventilation per kilogram, more outdoor play near traffic, developing airways, and for infants mouthing of third-hand contaminated surfaces. Dose and developmental timing both matter. [3]

Examiner: What is the global child-health importance of household solid-fuel smoke? [9]

Strong answer: Indoor air pollution from solid fuels is linked to increased childhood pneumonia risk in low- and middle-income settings. Cleaner fuels, improved stoves and ventilation are preventive priorities alongside case management. [9]

Examiner: A 16-year-old says vaping is just flavoured steam. Counter that claim. [6]

Strong answer: E-cigarette aerosols can deliver high nicotine doses and other toxicants; they are associated with dependence and cardiopulmonary concerns. They are not risk-free for nicotine-naive youth. Ask about dual use with cigarettes. [6]

Examiner: Outline first steps for suspected EVALI. [8]

Strong answer: ABCDE support, oxygen as needed, exclude infection, involve respiratory specialists, stop the product, and avoid claiming a single universal drug recipe — care is supportive and individualised. [8]