Do Smoking Bans Help Prevent COPD?

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EVERYDAY HEALTH | DENISE MANN | MAY 14, 2015

Twenty-five years ago, the first U.S. smoking ban was enacted in California. Here’s how smoke-free laws across the country have affected COPD rates ever since.

For the more than 12 million Americans living with chronic obstructive pulmonary disease (COPD), every day can be a struggle. The progressive lung disease, often associated with a history of smoking, partially obstructs the airways, making it difficult to breathe. What’s more, the lung damage caused by COPD is irreversible, and the incurable disease is now the third leading cause of death in America, according to the American Lung Association.

To help lower rates of smoking-related diseases like COPD, states have been enacting public smoking bans over the past few decades. But not all states are on board with comprehensive smoke-free legislation yet — and the ones lagging behind may not be reaping the health benefits.

A Short History of the Smoking Ban

In 1990, San Luis Obispo, California, became the first city in the world to ban smoking in all public buildings. California was the first state to enact a statewide smoking ban, and other states have followed suit, passing bans in one manner or another.

As it stands, 28 states and the District of Columbia have passed comprehensive smoke-free laws, according to the American Lung Association. A comprehensive law bans smoking in virtually all public places, including bars, restaurants, and workplaces. Nine states have “strong” laws, which means that the bans have some loopholes.

Currently, about 80 percent of the U.S. population lives under a ban on smoking in “workplaces, and/or restaurants, and/or bars, by either a state, commonwealth, or local law,” according to the American Nonsmokers’ Rights Foundation. But less than half of all Americans live under a ban covering all workplaces, restaurants, and bars.

Do Smoking Bans Really Work?

There is a growing body of evidence showing that the number of people hospitalized for heart attacks, strokes, and lung diseases including COPD decreased after smoking bans were put in place.

In the largest study conducted yet, published in June 2014 in the American Journal of Public Health, researchers in Kentucky mined a statewide database to find all the COPD hospitalizations that occurred from 2003 to 2011. They then compared COPD hospitalization rates in 16 counties with strong smoke-free laws to rates in 104 counties with weak or no smoke-free laws. After ruling out other factors that might influence hospitalizations for COPD, such as availability of doctors, the researchers found a telling pattern in the data: Those who lived in counties with comprehensive smoke-free laws were 22 percent less likely to be hospitalized for COPD than those who lived in counties with weaker or no smoking restrictions.

Other research has also found a tie between smoking bans and healthier communities. A 2012 report published in the journal Circulation showed that the number of heart attack hospitalizations fell by 15 percent after communities passed laws banning smoking in restaurants, bars, and workplaces. Hospitalizations for stroke and lung disease also fell — by 16 percent and 24 percent, respectively.

Another study showed that after a five-year smoking ban in restaurants was expanded to all workplaces, including bars, in Minnesota’s Olmsted County, heart attack rates fell by 33 percent. The findings were published in 2012 in the journal Archives of Internal Medicine. And in another study, COPD-related hospital admissions of senior citizens receiving Medicare fell by 11 percent where workplace smoking bans were in place and by 15 percent where bar smoking bans were present.

How Smoke-Free Laws Help Fight COPD

As many as 90 percent of COPD deaths are caused by smoking, so it stands to reason that less smoking and secondhand smoke would result in decreased rates of COPD, says E. Neil Schachter, MD, medical director of respiratory care at the Mount Sinai Medical Center in New York City and author of several books, including Life and Breath: Preventing, Treating, and Reversing Chronic Obstructive Pulmonary Disease.

“Smoking bans are helpful because they change the perception about how legal it is to smoke,” says Dr. Schachter. A past president of the American Lung Association in New York, he lobbied extensively for tougher anti-smoking laws in New York City. “The more difficult you make it to smoke, the more COPD you will prevent,” he says.

However, it may be too early to draw any firm conclusions about how much the bans help, partly because there is a long lead time to a COPD diagnosis, says Thomas Gildea, MD, section head for bronchoscopy at the Cleveland Clinic Respiratory Institute. “We do know that people with COPD have fewer episodes and don’t get as sick as often if they are not exposed to secondhand smoke.”

Read the article online.