Case links death to environmental tobacco smoke

February 08, 2008

A young asthmatic woman who collapsed and died shortly after arriving for her shift as a waitress at a bar may be the first reported death to be reported nationally from acute asthma associated with environmental tobacco smoke.

This case report by a Michigan State University physician, published in the February edition of the American Journal of Industrial Medicine, not only outlines circumstances under which the woman died, but also raises a number of issues regarding safety in the workplace.

The report states the woman arrived at the bar in Michigan and, according to co-workers, seemed happy and healthy. About 15 or 20 minutes later she collapsed and within a few minutes died.

"This is the first reported acute asthma death associated with work-related ETS," said Kenneth Rosenman, an MSU professor of medicine and chief of the Division of Occupational and Environmental Medicine. "Recent studies of air quality and asthma among bar and restaurant workers before and after smoking bans support this association."

In 2006, the surgeon general's report concluded that ETS causes coronary heart disease, lung cancer and premature death. But at that time there was little hard evidence linking ETS to the exacerbation of asthma in adults.

However, Rosenman and colleagues believe this case provides plenty of evidence to link secondhand smoke to this death.

"The autopsy clearly indicates she died from asthma," Rosenman said. "There was no other cause of death. Her death is consistent with what we know about exposures in bars like this. We know asthmatics are more susceptible to irritants and other particulates in the air.

"We know that particulate levels from secondhand cigarette smoke in bars like this reach sufficient levels to set off an asthma attack."

As an occupational and environmental health physician, Rosenman said he also is concerned about the long-term effects of ETS on all employees, not just those with pre-existing conditions like asthma.

"As a consumer, I don't have to go into that bar," he said. "But is it a safe environment for the employees? We have federal laws that say employers have to provide a safe and healthy workplace. This was clearly not a safe and healthy workplace for this employee.

"This death dramatizes the need to enact legal protections for workers in the hospitality industry from secondhand smoke."

In the United States, 23 states have already banned smoking in restaurants and bars. A number of other states, including Michigan, are considering it.

While many bar and restaurant owners say a smoking ban would hurt business, Rosenman argues that just the opposite is true.

"Consider that 75 percent of the population doesn't smoke," he said. "Banning smoking could actually serve to increase business. Studies of restaurants and bars in Boston, New York City, San Francisco and Washington D.C. all show business up since they banned smoking. Chicago went smoke free the beginning of this year.

"We're behind the times if we want to attract tourists and help businesses be more profitable."
-end-
Three public health disease-tracking systems in Michigan were used to gather information for this case report.

Other members of the research included Martha Stanbury, Michigan Department of Community Health; and Debra Chester and Elizabeth Hanna of MSU's Division of Occupational and Environmental Medicine.

The project was funded by grants from the Centers for Disease Control and Prevention.

Michigan State University

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