Respiratory illness in nonsmokers chronically exposed to tobacco smoke in the work place

Effect of a smoking ban on respiratory health in nonsmoking hospitality workers: a prospective cohort study

OBJECTIVE

The aim of this study was to examine the effect of a smoking ban on lung function, fractional exhaled nitric oxide, and respiratory symptoms in nonsmoking hospitality workers.

METHODS

Secondhand smoke exposure at the workplace, spirometry, and fractional exhaled nitric oxide were measured in 92 nonsmoking hospitality workers before as well as twice after a smoking ban.

RESULTS

At baseline, secondhand smoke-exposed hospitality workers had lung function values significantly below the population average. After the smoking ban, the covariate-adjusted odds ratio for cough was 0.59 (95% confidence interval, 0.36 to 0.93) and for chronic bronchitis 0.75 (95% confidence interval, 0.55 to 1.02) compared with the preban period.

CONCLUSIONS

The below-average lung function before the smoking ban indicates chronic damages from long-term exposure. Respiratory symptoms such as cough decreased within 12 months after the ban.

Cross-sectional and prospective associations between passive smoking and respiratory symptoms at the workplace

PURPOSE

The purpose of the study is to investigate the cross-sectional and prospective relation between workplace secondhand smoke (SHS) exposure and respiratory symptoms.

METHODS

Cross-sectional data for workplace SHS exposure and respiratory symptoms were collected by using random digit dialing from 7336 never-smoking Hong Kong workers 15 years or older in 1997 to 1998. In the 2000 to 2001 follow-up, 2213 workers who remained never smoking, had the same SHS exposure status, worked at the same job for at least 2 years, and were not exposed to SHS at home at follow-up were included for prospective analysis.

RESULTS

Cross-sectionally, SHS was associated significantly with frequent colds, cough and phlegm, throat problems, and the presence of any respiratory symptoms with adjusted odds ratios of 1.89 (95% confidence interval [CI], 1.66-2.15), 1.65 (95% CI, 1.35-2.02), 1.88 (95% CI, 1.63-2.15), and 1.96 (95% CI, 1.75-2.20) at baseline, each having significant linear associations with duration of exposure. SHS was not associated with rhinitis. Prospectively, consistent SHS exposure increased the risk for cough and phlegm and any respiratory symptoms by 48% (12% to 97%) and 54% (13% to 109%), respectively.

CONCLUSIONS

This first non-Western population-based prospective study shows that workplace SHS exposure is associated significantly with frequent respiratory symptoms, both cross-sectionally and prospectively, thus providing strong evidence that the association is causal.

Association between exposure to workplace secondhand smoke and reported respiratory and sensory symptoms: cross-sectional study

The purpose of this work was to assess the relation between exposure to secondhand smoke (SHS) at work and reported respiratory and sensory symptoms. A cross-sectional telephone survey of 382 nonsmoking indoor workers in Victoria, Australia was used. After controlling for potential confounders, exposure to SHS at work for part of the day was significantly associated with an increased risk of wheeze (OR = 4.26), frequent cough (OR = 2.26), sore eyes (OR = 3.77), and sore throat (OR = 2.70). Among workers who had not experienced a cold in the past 4 weeks, we found strong dose-response relationships between increasing levels of exposure to SHS at work and morning cough, frequent cough, sore eyes and sore throat, and a positive relationship for wheeze. These findings provide compelling evidence that nonsmoking indoor workers are adversely affected by exposure to SHS at work and underline the importance of workplace smoke-free policies in protecting the health of workers.

Passive smoking and its impact on employers and employees in Hong Kong

AIMS

To estimate the prevalence of passive smoking at work in the whole workforce in Hong Kong (population 6.8 million), the characteristics of the passive smokers, any extra use of health care among passive smokers, and who pays for that health care.

METHODS

A random sample of 14,325 households was contacted by telephone; 6,186 responding adults who worked full time were asked about their employment, their most recent use of health care and the cost of that care, their medical benefits, and their exposure to secondhand smoke in the workplace. After weighting the sample for sex, age, household size, and income, 4,739 subjects were included in the analysis.

RESULTS

Of 1,961 full time workers who did not smoke, 47.5% were exposed to secondhand smoke in the workplace compared with only 26% exposed at home. Exposure at work was associated with being younger, male, married, less educated, and having a lower income. Those exposed at work were 37% more likely to report having visited a doctor for a respiratory illness in the previous 14 days. Employers were paying 28% of the cost of these visits, the government paid 8%, and the individuals paid 63%. If extrapolated to the 3 million workers in the Hong Kong population, employers would pay just over US$9 million per year, while the affected workers would pay around US$20 million.

CONCLUSION

As well as the costs of active smoking, the cost of extra health care utilisation associated with passive smoking is an additional cost being paid by those employers who have not established smoke free workplaces and by their employees.

Mortality from occupational exposure to environmental tobacco smoke in Finland

This article aimed to estimate the mortality from exposure to passive smoking at work in Finland. The estimation used statistics on causes of death, exposure prevalences, and risk ratios from epidemiologic studies. The attributable fractions of cause-specific mortality from passive smoking at work were 2.8% for lung cancer, 1.1% for chronic obstructive pulmonary disease, 4.5% for asthma, 3.4% for ischemic heart disease, and 9.4% for cerebrovascular stroke. Altogether, about 250 fatalities were estimated to have occurred in 1996. This is approximately 0.9% of the total mortality in the Finnish population in the relevant disease and age categories. The magnitude of mortality related to past occupational exposure to passive smoking is considerable. Preventive measures to reduce environmental tobacco smoke in the workplace will be a powerful means of reducing the high burden of respiratory and cardiovascular diseases.

Epidemiologic basis for an occupational and environmental policy on environmental tobacco smoke

ETS contains numerous toxins. Robust epidemiologic evidence implicates ETS as a cause of lung cancer and as a primary cause and source of exacerbation of excess respiratory disease. There is also increasing evidence that ETS may be associated with other outcomes, including heart disease. There is currently little doubt that ETS is an important and avoidable health hazard. Unfortunately, ETS is frequently encountered in the workplace--where it is no safer than in other environments and where it presents hazards to exposed workers and to others. A unique aspect of workplace ETS is that exposure is rarely an outcome of essential manufacturing, extraction, or service delivery processes. Moreover, ETS exposure, with its growing list of known hazards, is preventable by engineering or policy means. Implementation of policies to prevent workplace ETS can be highly effective while entailing low costs and yielding primary and secondary benefits to employers and employees. ACOEM strongly supports an increase in the scope and effectiveness of policies and efforts that protect against exposure to ETS in the workplace and elsewhere. To that end, ACOEM supports voluntary, regulatory, and legislative initiatives to eliminate ETS from the workplace, including public spaces such as bars, casinos, restaurants, schools, day-care centers, and public transportation. ACOEM also encourages employers to provide employee training concerning the health hazards of ETS and voluntary personal smoking-cessation programs.

Course and prognosis of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) continues to increase in incidence as the population of developed countries ages. Much time has been devoted to studying the natural course of this disorder and to searching for risk factors for a decline in respiratory function. The major risk factor for a decline in 1-second forced expiratory volume (FEV1) is cigarette smoking, and smoking cessation is a major part of its prevention. Other risk factors for development of COPD include passive exposure to cigarette smoke, age, and genetic factors including airway hyperreactivity, eosinophilia, and a history of atopy. This discussion presents a review of the current literature regarding the natural course and prognosis of COPD. The approach to patients with end-stage disease and the use of advance directives is considered.

The association between cigarette smoking and ocular diseases

Tobacco smoke is composed of as many as 4,000 active compounds, most of them toxic on either acute or long-term exposure. Many of them are also poisonous to ocular tissues, affecting the eye mainly through ischemic or oxidative mechanisms. The list of ophthalmologic disorders associated with cigarette smoking continues to grow. Most chronic ocular diseases, with the possible exception of diabetic retinopathy and primary open-angle glaucoma, appear to be associated with smoking. Both cataract development and age-related macular degeneration, the leading causes of severe visual impairment and blindness, are directly accelerated by smoking. Other common ocular disorders, such as retinal ischemia, anterior ischemic optic neuropathy, and Graves ophthalmopathy, are also significantly linked to this harmful habit. Tobacco smoking is the direct cause of tobacco-alcohol amblyopia, a once common but now rare disease characterized by severe visual loss, which is probably a result of toxic optic nerve damage. Cigarette smoking is highly irritating to the conjunctival mucosa, also affecting the eyes of nonsmokers by passive exposure (secondhand smoking). The dangerous effects of smoking are transmitted through the placenta, and offspring of smoking mothers are prone to develop strabismus. Efforts should be directed toward augmenting the campaign against tobacco smoking by adding the increased risk of blindness to the better-known arguments against smoking. We should urge our patients to quit smoking, and we must make them keenly aware of the afflictions that can develop when smoke gets in our eyes.