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Doctors against smoking: six million deaths a year from smoking, 14,000 in Austria

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Image: MedUni Vienna/Kovic
from left: Marco Idzko, Christian Hengstenberg, Markus Müller, Manfred Neuberger

(Vienna, 19 March 2018) According to WHO, the number of smoking-related deaths worldwide will increase from the current 6 million to 8 million by 2030. The Medical University of Vienna therefore sees it as extremely important to make people aware of the harmful effects of smoking and to emphasise the urgent need to protect non-smokers – particularly in view of the current debate about the Smoke-Free Environments Act in Austria. This point was made today, Monday, by MedUni Vienna experts Rector Markus Müller, cardiologist Christian Hengstenberg, pulmonologist Marco Idzko and occupational and environmental health expert Manfred Neuberger.

The facts are clear, say the doctors: according to "Eurobarometer", Austria, where 33% of the population smoke, lies in fourth place among the 27 European countries and five percentage points above the European mean. Furthermore, the average daily consumption of 18 cigarettes is significantly higher than in other EU countries, where average consumption is 14 a day. According to an estimate from the Ministry of Health,14,000 people die in Austria each year as a result of smoking.

"We want to publicly acknowledge, here and now, our responsibility as a medical university for the health of Austrians in terms of the current debate about the Smoke-Free Environments Act and to stress the harmful effects of smoking, seen from the medical perspective, and the need to protect non-smokers," said MedUni Vienna Rector Markus Müller.

Ending passive smoking is having a positive effect
"Passive smoking considerably increases the risk of developing cardiovascular, respiratory and malignant diseases, which reduce life expectancy and lead to premature invalidity. We know that the general ban on smoking in catering establishments introduced in Australia, North America, Northern and Western Europe and Italy, which eliminated to passive smoking, has brought about a significant reduction in cases of heart attack, stroke, and respiratory diseases," say Christian Hengstenberg, Head of the Division of Cardiology, and Marco Idzko, Head of the Division of Pulmonology within MedUni Vienna's Department of Medicine II.

This shows that the rapid drop in the number of heart attacks following the introduction of the blanket smoking ban in the hospitality sector is primarily due to the elimination of passive smoking. The greatest reduction was found in younger non-smokers, who frequently visited bars and restaurants, explains the cardiologist. "Moreover, cigarette smoke releases fine dust particles, which are associated with the development of coronary calcification and also acute heart attack. The high burden of fine dust experienced during passive smoking immediately raises blood pressure, disrupts cardiac rhythm, inhibits automatic expansion of the coronary vessels to provide sufficient oxygen and increases blood clotting."

Children must be protected
"Breath by breath, inhaled cigarette smoke paralyses the ciliated epithelia, which play an important role in the immune response by evacuating inhaled particles such as allergens, viruses or bacteria," explains pulmonologist Marco Idzko. In addition to this, breathing in cigarette smoke causes acute inflammation of the airways, leading to serious lung damage in the long term (e.g. COPD or emphysema), and can even lead to lung cancer due to inhalation of carcinogenic substances. Says Idzko: "Passively exposing young children to smoke negatively affects their lung development and makes them more likely to suffer from lung problems, such as broncho-pulmonary infections or bronchial asthma, for example."

Therefore providing consistent protection for non-smokers in public buildings, restaurants and bars would improve the lung function of "healthy" passive smokers, lead to a reduction in acute attacks of bronchial asthma or exacerbation of COPD and would also bring about a significant reduction in cases of viral or bacterial lung inflammation. It was also found, explains Idzko, that the introduction of stricter laws to protect non-smokers dramatically reduces the proportion of adolescents who smoke.

COPD is an occupational disease among hospitality sector workers
Manfred Neuberger, a doctor of internal, occupational and environmental medicine, makes the point that non-smoking employees in the hospitality industry excrete up to 25 times more nicotine in their urine on work days than they do on their days off and up to 4.5 times more tobacco-related carcinogens. "The urine concentration of the most potent lung carcinogen in tobacco smoke increases by 6% per hour while waiters are at work. In this atmosphere, even non-smokers have an elevated risk of developing cancer or dying prematurely. COPD resulting from passive smoking in bars and restaurants is a recognised occupational disease, the risk of developing lung cancer doubles over 8 years for serving staff in smoking areas and can increase tenfold over 40 years," says Neuberger, also stressing that smoke also penetrates into non-smoking areas, causing a higher concentration of airborne particles than the traffic on a busy street. Even the carcinogen burden is higher, only being exceeded by that in the smoking area.

In the longer term, one can also expect to see a reduction in cancers, metabolic diseases such as type II diabetes, retinal damage with risk of blindness and other conditions caused by passive smoking (e.g. sinusitis). Says Neuberger: "The ban on smoking in bars and restaurants will alert parents to the danger, so that they will also refrain from smoking at home or in the car when children or pregnant women are present." According to Neuberger, it was found that the introduction of smoke-free bars and restaurants also led to a significant reduction in the number of premature births and hospital admissions for children suffering from asthma (10 – 18 percent) or lung inflammation (14 – 18%).

Stopping smoking quickly pays dividends
In countries that have introduced smoke-free bars and restaurants, the number of cases of illness and death due to passive smoking fell, both among the serving staff and also the public at large. There was also a decline in social acceptance of this form of air pollution and young people were less likely to be tempted to take up smoking. This regulatory measure made it easier for smokers to break their nicotine habit or to cut down their cigarette consumption. In all EU countries that have introduced a blanket ban on smoking in bars and restaurants, public approval ratings for the measure have increased.

MedUni Vienna's new anti-smoking website
The press conference in the Rectorate Hall of MedUni Vienna coincided with the launch of a website (www.meduniwien.ac.at/kontra_rauchen), featuring short statements by numerous MedUni Vienna doctors and researchers explaining why, from the point of view of their medical specialism, (passive) smoking is damaging to health.