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Existing evidence on the effects of smoke-free policies on respiratory diseases is scarce and inconclusive. Spain enacted two consecutive smoke-free regulations: a partial ban in 2006 and a comprehensive ban in 2011. We estimated their impact on hospital admissions via emergency departments for chronic obstructive pulmonary disease COPD and asthma.


Data for COPD ICD-9 490–492, 494–496 came from 2003–2012 hospital admission records from the fourteen largest provinces of Spain and from five provinces for asthma ICD-9 493. We estimated changes in hospital admission rates within provinces using Poisson additive models adjusted for long-term linear trends and seasonality, day of the week, temperature, influenza, acute respiratory infections, and pollen counts asthma models. We estimated immediate and gradual effects through segmented-linear models. The coefficients within each province were combined through random-effects multivariate meta-analytic models.


The partial ban was associated with a strong significant pooled immediate decline in COPD-related admission rates 14.7%, 95%CI: 5.0, 23.4, sustained over time with a one-year decrease of 13.6% 95%CI: 2.9, 23.1. The association was consistent across age and sex groups but stronger in less economically developed Spanish provinces. Asthma-related admission rates decreased by 7.4% 95%CI: 0.2, 14.2 immediately after the comprehensive ban was implemented, although the one-year decrease was sustained only among men 9.9%, 95%CI: 3.9, 15.6.


The partial ban was associated with an immediate and sustained strong decline in COPD-related admissions, especially in less economically developed provinces. The comprehensive ban was related to an immediate decrease in asthma, sustained for the medium-term only among men.

Autor: Iñaki Galán , Lorena Simón, Elena Boldo, Cristina Ortiz, Rafael Fernández-Cuenca, Cristina Linares, María José Medrano, Rob



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