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Respiratory Effects of a Smoking Ban in Public Places

Respiratory Effects of a Smoking Ban in Public Places. Arun Nair Asthma & Allergy Research Group. SMOKE INDEX. Background. Passive smoke is a major cause of ill-health worldwide Increased coronary artery disease, lung cancer and stroke Increased hospital admissions in asthmatics

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Respiratory Effects of a Smoking Ban in Public Places

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  1. Respiratory Effects of a Smoking Ban in Public Places Arun Nair Asthma & Allergy Research Group

  2. SMOKE INDEX

  3. Background • Passive smoke is a major cause of ill-health worldwide • Increased coronary artery disease, lung cancer and stroke • Increased hospital admissions in asthmatics • Impaired glucose tolerance

  4. Banning smoking • A number of countries have banned smoking in public • USA, Ireland • March 26th saw the introduction of similar legislation in Scotland

  5. Previous studies in bar-workers • Improvements in symptoms1,2 • Small improvement in lung function (VC)1 • No evaluation made of effects on inflammation (systemic or airway) • No specific evaluation of those with respiratory disorders 1. Allwright et al; BMJ 2005 2. Eisner et al; JAMA 1998

  6. ETS causes inflammation ATTICA, American Journal of Medicine 2004

  7. Current study • Exposure to smoke • Symptoms • Lung function • Inflammation (pulmonary and systemic) • Asthmatic and rhinitic workers

  8. Study design • Dundee and Perth • Prospectively gathered data from bar-workers • February to June 2006

  9. Inclusion Non-smokers Anticipated continuing employment for duration of study No significant respiratory disease Asthmatic sub-group Known physician diagnosed asthma Criteria

  10. Symptoms Spirometry (FEV1 and PEF) WCC and neutrophil count CRP Cotinine levels Self-reported exposure Exhaled nitric oxide Asthmatics Alveolar nitric oxide Juniper QOL questionnaire Methacholine challenge ICAM-1 Outcome measures

  11. Study visits • 1 month before ban then repeated 1 and 2 months after the ban • Took place in usual working hours • Investigator visited each person at work • In addition, asthmatics attended department 1 month before and 2 months afterward

  12. Statistical methods • Primary outcome –symptoms and MCh challenge for asthmatics • All others secondary • Needed 74 patients in total plus 14 in sub-group • McNemars χ2 for paired proportions • All data assessed for normality prior to analysis

  13. Conclusion • There has been a rapid and sustained improvement in the health of bar-workers following the introduction of a smoking ban • Improvements were noted in • Symptoms • Reported and measured smoke exposure • Spirometry • Systemic inflammation

  14. Pre-existing airway disease • Asthmatics and rhinitic patients also had • Improved airway inflammation • Better QOL scores

  15. Daniel Menzies * Pete Williamson† Martyn Barnes* Stuart Schembri† Mudher Al-Khairalla† Arun Nair* Tom Fardon† Lesley McFarlane* Gareth Magee* Brian Lipworth* Investigators • * Asthma & Allergy Research Group, University of Dundee • † Department of Respiratory Medicine, Ninewells Hospital • Thanks to all the respiratory technicians at AARG

  16. Thanks for listening Any questions?

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