Clearing the Air: Researching the Effect of Smoke on Health

Mark Eisner, MD, MPH

Article from the UCSF Department of Medicine Newsletter

Fall, 2007 

In December 1997, Mark Eisner, MD, MPH and his colleagues went bar-hopping. This was no celebratory event, however. It was the month before San Francisco’s restaurants and bars went smoke-free, and they wanted to measure the health effects of the smoking ban on bartenders, who made a living in some of the city’s smokiest workplaces.

Eisner, an associate professor of Pulmonary and Critical Care and Occupational and Environmental Medicine, interviewed 53 bartenders and measured their lung function a month before the ban went took effect, then followed up two months later.

“Even a short period of time later, working in a smoke-free environment was related to lowering their respiratory symptoms,” Eisner says. “They had less coughing, wheezing and shortness of breath, and their lung function improved.” This proved true even for the 45% of bartenders who were smokers themselves.

The study was published in the Journal of the American Medical Association, received wide press coverage, including the New York Times, and was used as a model for similar studies worldwide, including before and after a recent smoking ban in Irish pubs.

“Dr. Eisner’s work had a terrific policy impact,” says Chief of the Division of Occupational and Environmental Medicine Paul Blanc, MD, MSPH. “It helped promote smoking bans in places across the United States and around the world… The unfortunate thing is that the marketplace is not a level playing field. The people that bear the costs of environmental and occupational disease are often not the same group that may have had economic gain from introducing the materials that cause the problems in the first place.”

Eisner agrees. “Part of the reason for studying this is to create an overwhelming preponderance of evidence that people are being hurt by secondhand smoke,” he says.

Smoking is also the number one risk factor for Chronic Obstructive Pulmonary Disease (COPD), another major area of Eisner’s research. COPD refers to chronic bronchitis and emphysema, which often occur together and interfere with normal breathing. According to the Centers for Disease Control, COPD is the fourth leading cause of death in the United States.

“I think of people with COPD as having a lot of the things that happen with normal aging, but it happens faster and earlier,” says Eisner. “People who smoke or were exposed to dusty workplaces lose lung function at a much more rapid rate. So instead of being 80 with a very low lung function, they’re 50.”

Many people with COPD also gradually lose the ability to walk, lift objects and perform other normal activities. Yet the relationship between COPD and becoming disabled is unclear. “Why would a disease that affects the lungs lead to weakness in the arms and legs?” he asks. “Also, you can have two people with the same lung function impairment: one person may be unable to stand up from a chair without assistance, and someone else may be working and walking two miles a day. Why is that?”

To help answer those questions, Eisner is currently studying more than 1,000 adults with COPD. Together with an interdisciplinary group of colleagues, he is investigating how socioeconomic status, exposure to secondhand smoke and air pollution, and psychological factors like depression and anxiety might contribute to development of COPD-related disability. His ultimate goal is to learn how to prevent disability in people with COPD, because currently there is no cure.

Eisner says that if funding were available, he would want to study COPD in the general population, since so many people go undiagnosed. “There really haven’t been studies to do that because it’s enormously expensive and difficult, and you may need to screen 10,000 people,” says Eisner. “But it would be worthwhile because we would learn a lot more about how the disease progresses in its earliest stages. So if we could figure out who these people are earlier, we might be more successful in preventing disability 10 or 20 years down the road.”