Correspondence

Smoke-free Legislation and Acute Coronary Syndrome

N Engl J Med 2008; 359:2070November 6, 2008

Article

To the Editor:

Pell et al. (July 31 issue)1 report that smoke-free legislation in Scotland was strongly associated with a decreased risk of the acute coronary syndrome. Nested within their study is a critical and remarkable observation: smokers are also at substantial risk from exposure to secondhand smoke and benefit from its cessation. My group and others have also shown that smokers have adverse respiratory health effects from exposure to secondhand smoke.2,3 Bartenders, whether smokers or nonsmokers, have rapid improvement in their respiratory health after smoke-free–workplace legislation is instituted.4,5 This point is important, because most previous research on the health effects of secondhand smoke has excluded smokers on the basis of the assumption that passive smoking is inconsequential as compared with active smoking. We are now learning that secondhand smoke, like other air pollution, affects both smokers and nonsmokers. Research and public health efforts that address exposure to secondhand smoke need a broader focus, to include all persons, regardless of personal smoking status. It is time to clear the air, for smokers and nonsmokers alike.

Mark D. Eisner, M.D., M.P.H.
University of California, San Francisco, San Francisco, CA 94143
mark.eisner@ucsf.edu

5 References

1. 1

   Pell JP, Haw S, Cobbe S, et al. Smoke-free legislation and hospitalizations for acute coronary syndrome. N Engl J Med 2008;359:482-491
   Full Text | Web of Science | Medline

2. 2

   Osman LM, Douglas JG, Garden C, et al. Indoor air quality in homes of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2007;176:465-472
   CrossRef | Web of Science | Medline

3. 3

   Eisner MD, Smith AK, Blanc PD. Bartenders' respiratory health after establishment of smoke-free bars and taverns. JAMA 1998;280:1909-1914
   CrossRef | Web of Science | Medline

4. 4

   Menzies D, Nair A, Williamson PA, et al. Respiratory symptoms, pulmonary function, and markers of inflammation among bar workers before and after a legislative ban on smoking in public places. JAMA 2006;296:1742-1748
   CrossRef | Web of Science | Medline

5. 5

   Goodman P, Agnew M, McCaffrey M, Paul G, Clancy L. Effects of the Irish smoking ban on respiratory health of bar workers and air quality in Dublin pubs. Am J Respir Crit Care Med 2007;175:840-845
   CrossRef | Web of Science | Medline

Citing Articles (1)

Citing Articles

1. 1

   J. M. Martinez-Sanchez, E. Fernandez, M. Fu, M. Perez-Rios, M. J. Lopez, C. Ariza, J. A. Pascual, A. Schiaffino, R. Perez-Ortuno, E. Salto, M. Nebot. (2009) Impact of the Spanish smoking law in smoker hospitality workers. Nicotine & Tobacco Research 11:9, 1099-1106
   CrossRef