Reduction in asthma-related emergency department visits after implementation of a smoke-free law

Rayens, Mary Kay; Burkhart, Patricia V.; Zhang, Mei; Lee, Seongjik; Moser, Debra K.; Mannino, David M.; Hahn, Ellen J.

doi:10.1016/j.jaci.2008.06.029

Cited by 100 publications

(89 citation statements)

References 21 publications

(16 reference statements)

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“…6 After taking the secular trends into account, emergency department visits for asthma declined by 22% in Lexington-Fayette County, Kentucky, after the introduction partial smoking ban in public places. 7 The decline in asthma admissions identified in this and previous studies are likely due to reductions in SHS exposure among children in their homes associated with the introduction of smoke-free legislation. We had no data on changes in SHS exposure or cotinine levels in our sample, but health survey data from England suggest that the introduction of smoke-free legislation was associated with accelerated reductions in cotinine-validated SHS exposure in children 17 and an increase in the proportion of smoke-free homes and cars.…”

Section: Resultsmentioning

confidence: 62%

“…3,4 A small number of studies conducted in North America have found that making public places and workplaces smokefree reduces hospital admissions and emergency department visits for asthma. [5][6][7] A Scottish study also found that the introduction of comprehensive smoke-free legislation in March 2006 was associated with a reduction in hospital admissions for childhood asthma. 8 These findings are consistent with evidence that SHS exposure increases the incidence and severity of childhood asthma 9 and that smokefree legislation is associated with reductions in SHS exposure in the home.…”

Section: Resultsmentioning

confidence: 99%

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Hospital Admissions for Childhood Asthma After Smoke-Free Legislation in England

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: A small number of studies have found that the introduction of smoke-free legislation has been associated with a reduction in hospital admissions and emergency department visits for asthma. WHAT THIS STUDY ADDS:The implementation of smoke-free legislation in England was associated with an immediate 8.9% reduction in hospitalizations for asthma along with a decrease of 3.4% per year. abstract OBJECTIVE: To assess whether the implementation of English smokefree legislation in July 2007 was associated with a reduction in hospital admissions for childhood asthma. METHODS:Interrupted time series study using Hospital Episodes Statistics data from April 2002 to November 2010. Sample consisted of all children (aged #14 years) having an emergency hospital admission with a principle diagnosis of asthma. RESULTS:Before the implementation of the legislation, the admission rate for childhood asthma was increasing by 2.2% per year (adjusted rate ratio 1.02; 95% confidence interval [CI]: 1.02-1.03). After implementation of the legislation, there was a significant immediate change in the admission rate of 28.9% (adjusted rate ratio 0.91; 95% CI: 0.89-0.93) and change in time trend of 23.4% per year (adjusted rate ratio 0.97; 95% CI: 0.96-0.98). This change was equivalent to 6802 fewer hospital admissions in the first 3 years after implementation. There were similar reductions in asthma admission rates among children from different age, gender, and socioeconomic status groups and among those residing in urban and rural locations.CONCLUSIONS: These findings confirm those from a small number of previous studies suggesting that the well-documented population health benefits of comprehensive smoke-free legislation appear to extend to reducing hospital admissions for childhood asthma. Comprehensive smoke-free legislation covering all enclosed public places and workplaces was implemented in England on July 1, 2007. This legislation has resulted in substantial population health gain, including reductions in workplace exposure to secondhand smoke (SHS), 1 increased smoking quit rates, 2 and decreased hospital admissions for acute myocardial infarction. 3,4 A small number of studies conducted in North America have found that making public places and workplaces smokefree reduces hospital admissions and emergency department visits for asthma. 5-7 A Scottish study also found that the introduction of comprehensive smoke-free legislation in March 2006 was associated with a reduction in hospital admissions for childhood asthma. 8 These findings are consistent with evidence that SHS exposure increases the incidence and severity of childhood asthma 9 and that smokefree legislation is associated with reductions in SHS exposure in the home. 10,11 This study examines whether the implementation of smoke-free legislation in England on July 1, 2007, covering virtually all enclosed public places and workplaces, was associated with a change in hospital admissions for childhood asthma. Because some studies suggest that this l...

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Section: Resultsmentioning

confidence: 62%

Section: Resultsmentioning

confidence: 99%

Hospital Admissions for Childhood Asthma After Smoke-Free Legislation in England

et al. 2013

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“…After the implementation of a smoke-free law in Kentucky, the state once known to have the highest smoking rates in the United States, it was reported that emergency department visits because of asthma declined by 22%,suggesting a possible relationship between SHS exposure and asthma. 63 The prevalence of smoking and nicotine addiction was high among parents of children who are brought to the emergency department because of asthma or bronchiolitis in one study, 64 but, in another, SHS was found to have a weak association with acute asthma severity. 65 Counseling about the detrimental effects of SHS in the emergency department may have a positive impact on the smoking habits of caregivers when they are around their children by educating them about the possibility of smoking as a trigger to their child's asthma, but more investigations are needed to verify.…”

Section: Effects Of Shs Exposure Among Children With Asthmamentioning

confidence: 86%

Smoking and Asthma

Stapleton

Howard-Thompson²,

George³

et al. 2011

The Journal of the American Board of Family Medicine

141

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Background:The purpose of this review is to describe the current understanding of the prevalence and adverse effects of cigarette smoking and secondhand smoke (SHS) in asthmatics in terms of patient outcomes and response to inhaled corticosteroids.Methods: We searched the English biomedical literature via PubMed, Embase, and Scopus using the terms "smoking and asthma," "secondhand smoke and asthma," "environmental tobacco smoke and asthma," and "smoking/secondhand smoke and corticosteroids." We also reviewed reference lists of identified articles for relevant citations.Results: In asthmatic patients who smoke, disease control is poorer than in asthmatic nonsmokers. Of all forms of SHS, maternal exposure seems to have the largest impact on asthma by increasing the frequency and severity of the disease and decreasing lung function. Asthmatic children exposed to multiple household smokers face an increased risk for respiratory illness-related absences from school, and these effects persist during adolescence but weaken during adulthood. Airway mucosal permeability is increased in smokers, which could lead to increased clearance of inhaled corticosteroids from the airways. Smokers also have decreased histone deacetylase activity, which is necessary for corticosteroids to fully suppress cytokine production, and can lead to corticosteroid resistance.

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“…Accumulating evidence now demonstrates the public health benefits of smoke-free legislation, including effects on paediatric respiratory health [14]. Asthma hospitalisations decreased among children following smoke-free legislation in Scotland and England, UK [15,16], as did paediatric emergency department visits for asthma in Lexington-Fayette County in Kentucky, USA [17]. In a recent meta-analysis that included these studies, we demonstrated that implementation of smoke-free legislation was followed by a 10% (95% CI 5-15%, p=0.0001) drop in paediatric hospital attendance for asthma [14].…”

Section: Introductionmentioning

confidence: 99%

Smoke-free legislation and childhood hospitalisations for respiratory tract infections

et al. 2015

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Second-hand smoke exposure is a major risk factor for respiratory tract infections (RTIs). Although evidence suggests important early-life health benefits of smoke-free public environments, the impact on childhood RTIs is unclear. We investigated the association between England's smoke-free legislation and childhood RTI hospitalisations.We used the Hospital Episode Statistics database to obtain nationwide data on hospital admissions for acute RTIs among children (<15 years of age) from 2001 to 2012. Hospitalisation counts were disaggregated by month, age group, sex and small-area level, and linked to urbanisation, region, deprivation index and corresponding population estimates. Negative binomial regression analyses were adjusted for confounders, seasonal variation, temporal autocorrelation, population-size changes and underlying incidence trends. Models allowed for sudden and gradual changes following the smoke-free legislation. We performed sensitivity and subgroup analyses, and estimated number of events prevented.We analysed 1 651 675 hospital admissions. Introduction of smoke-free legislation was followed by an immediate reduction in RTI admissions (−3.5%, 95% CI −4.7-−2.3%), this mainly being attributable to a decrease in lower RTI admissions (−13.8%, 95% CI −15.6-−12.0%). The reductions in admissions for upper RTI were more incremental.The introduction of national smoke-free legislation in England was associated with ∼11 000 fewer hospital admissions per year for RTIs in children. @ERSpublications Smoke-free legislation in England was associated with a drop in paediatric respiratory infection admissions

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Reduction in asthma-related emergency department visits after implementation of a smoke-free law

Cited by 100 publications

References 21 publications

Hospital Admissions for Childhood Asthma After Smoke-Free Legislation in England

Hospital Admissions for Childhood Asthma After Smoke-Free Legislation in England

Smoking and Asthma

Smoke-free legislation and childhood hospitalisations for respiratory tract infections

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