Abstract
Environmental air quality can affect asthma control and the development of overt asthmatic manifestations. In this population-based study, we investigated the effect of reinforcing a smoking ban in Taiwan through the enactment of the Tobacco Hazards and Prevention Act (THPA) on healthcare utilization rate by asthmatics. Analysis was performed based on data relevant to non-hospitalized asthmatic patients with insurance claims between 2005 and 2013 from the National Health Insurance Research Database of Taiwan, reported data on Asian dust storms, and penalty rates for violations of the tobacco ban. Poisson regression showed that the risk for outpatient visits for asthma was lower after enactment of the THPA (RR = 0.98, 95% CI = 0.98–0.99), with a yearly trend of a reduced risk (RR = 0.99, 95% CI = 0.99–1.00), also lower in geographic regions with medium (RR = 0.79, 95% CI = 0.79–0.80) and high (RR = 0.91, 95% CI = 0.91–0.92) penalty rates. Subgroup analysis showed that asthma visit rates were reduced in both male and female groups after the enactment of the THPA. The risk of an asthma ER visit was increased after the enactment of the amended THPA (RR = 1.07, 95% CI = 1.05–1.09), although the yearly trend was not significant (RR = 1.00, 95% CI = 1.00–1.00). The risk of emergency room visits for asthma was significantly reduced in regions with medium (RR = 0.68, 95% CI = 0.68–0.69) and high (RR = 0.75, 95% CI = 0.74–0.76) penalty rates. Subgroup analysis showed that the visit rates were similar in both male and female groups. The effectiveness of reinforcing the smoking ban warrants further policies aimed at further reducing passive smoking.
Highlights
The interplay between asthma burden and smoking control is an important issue
After controlling for Asian dust storms and demographic characteristics, we found that the postimplementation period had a reduced risk of outpatient asthmatic visits (RR = 0.98, 95% CI = 0.98–0.99), with a yearly trend of a reduced risk (RR = 0.99, 95% CI = 0.99–0.99)
THPA, Tobacco Hazards and Prevention Act; RR, relative risk; CI, confidence interval, *** p < 0.0001. In this population-based study, we found that reinforcement of the smoking ban in Taiwan through the enactment of the amended THPA in 2009 was associated with a reduced risk of outpatient visits due to asthma, but with an increased risk of emergency room (ER) visits due to asthma in the general population
Summary
The interplay between asthma burden and smoking control is an important issue. Smoking cessation may improve symptoms and lung function of asthmatic patients; the low rates of smoking cessation highlight the need for better strategies to manage this issue [3]. Tobacco smoke is a well-known risk factor for the development of fixed airflow limitation that cannot be controlled with standard asthma medications. People with asthma may have an accelerated decline in lung function and develop airflow limitation that is not fully reversible, which is often associated with more persistent dyspnea. Exposure to cigarette smoke has been reported to be an independent risk factor for fixed airflow limitation [4], and tobacco smoke has been reported to be a significant risk factor for
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