Respiratory Effects of a Smoking Ban in Public Places

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Respiratory Effects of a Smoking Ban in Public
Places

• Arun Nair
• Asthma Allergy Research Group

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SMOKE INDEX
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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

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Banning smoking

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

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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

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ETS causes inflammation
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Current study

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

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Study design

• Dundee and Perth
• Prospectively gathered data from bar-workers
• February to June 2006

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Criteria

• Inclusion
• Non-smokers
• Anticipated continuing employment for duration of
  study
• No significant respiratory disease

• Asthmatic sub-group
• Known physician diagnosed asthma

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Outcome measures

• 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

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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

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Statistical methods

• Primary outcome symptoms and MCh challenge for
  asthmatics
• All others secondary
• Needed 74 patients in total plus 14 in sub-group
• McNemars ?2 for paired proportions
• All data assessed for normality prior to analysis

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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

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Pre-existing airway disease

• Asthmatics and rhinitic patients also had
• Improved airway inflammation
• Better QOL scores

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Investigators

• Daniel Menzies
• Pete Williamson
• Martyn Barnes
• Stuart Schembri
• Mudher Al-Khairalla

• Arun Nair
• Tom Fardon
• Lesley McFarlane
• Gareth Magee
• Brian Lipworth

• Asthma Allergy Research Group, University of
  Dundee
• Department of Respiratory Medicine, Ninewells
  Hospital
• Thanks to all the respiratory technicians at AARG

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Thanks for listening

• Any questions?