Smokefree legislation effects on respiratory and sensory disorders: A systematic review and meta-analysis.

Yolanda Rando-Matos,Vega Estíbaliz Benito-López,José Manuel Trujillo,Carlos Martin-Cantera,Mariona Pons-Vigués,José Luis Ballve-Moreno,Anna Guardia-Riera,María José López,Rodrigo Córdoba,Elisa Puigdomènech-Puig,Olga Lucía Arias-Agudelo,Mercè López-Grau

doi:10.1371/journal.pone.0181035

Abstract

AimsThe aim of this systematic review and meta-analysis is to synthesize the available evidence in scientific papers of smokefree legislation effects on respiratory diseases and sensory and respiratory symptoms (cough, phlegm, red eyes, runny nose) among all populations.Materials and methodsSystematic review and meta-analysis were carried out. A search between January 1995 and February 2015 was performed in PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, and Google Scholar databases. Inclusion criteria were: 1) original scientific studies about smokefree legislation, 2) Data before and after legislation were collected, and 3) Impact on respiratory and sensory outcomes were assessed. Paired reviewers independently carried out the screening of titles and abstracts, data extraction from full-text articles, and methodological quality assessment.ResultsA total number of 1606 papers were identified. 50 papers were selected, 26 were related to symptoms (23 concerned workers). Most outcomes presented significant decreases in the percentage of people suffering from them, especially in locations with comprehensive measures and during the immediate post-ban period (within the first six months). Four (50%) of the papers concerning pulmonary function reported some significant improvement in expiratory parameters. Significant decreases were described in 13 of the 17 papers evaluating asthma hospital admissions, and there were fewer significant reductions in chronic obstructive pulmonary disease admissions (range 1–36%) than for asthma (5–31%). Six studies regarding different respiratory diseases showed discrepant results, and four papers about mortality reported significant declines in subgroups. Low bias risk was present in 23 (46%) of the studies.ConclusionsSmokefree legislation appears to improve respiratory and sensory symptoms at short term in workers (the overall effect being greater in comprehensive smokefree legislation in sensory symptoms) and, to a lesser degree, rates of hospitalization for asthma.

Highlights

Passive exposure to tobacco smoke multiplies the risk of coronary disease and lung cancer in adults
Four (50%) of the papers concerning pulmonary function reported some significant improvement in expiratory parameters
Smokefree legislation appears to improve respiratory and sensory symptoms at short term in workers and, to a lesser degree, rates of hospitalization for asthma

Summary

Introduction

Passive exposure to tobacco smoke ( known as exposure to environmental tobacco smoke, second-hand smoke, and passive smoking) multiplies the risk of coronary disease and lung cancer in adults It exacerbates asthma and respiratory symptoms, and increases the risk of sudden infant death syndrome amongst other health effects[1]. Most systematic reviews have evaluated cardiovascular effects[15,16,17,18,19], tobacco consumption[8], exposure to second-hand smoke [7], and, in a more heterogeneous manner, respiratory diseases at population levels[8,21] This last issue is, to the best of our knowledge, the least studied field

Methods

Results

Conclusion