title: Effect of Uruguay's National 100% Smokefree Law on Emergency Visits for Bronchospasm.
abstract: BACKGROUND
  Implementation of smokefree laws is followed by drops in hospital admissions for cardiovascular diseases and asthma. The impact of smokefree laws on use of non-hospital medical services has not been assessed. The purpose of this study is to evaluate the impact of Uruguay's national 100% smokefree legislation on non-hospital emergency care visits, hospitalizations for bronchospasm, and bronchodilator use.
  
  
  METHODS
  The monthly number of non-hospital emergency care visits and hospitalizations for bronchospasm, as well as monthly puffs of bronchodilators (total and per person), from 3 years prior to the adoption of the 100% smokefree policy on March 1, 2006, through 5 years after the policy were assessed using interrupted time series negative binomial regression. Data analysis was conducted in 2014.
  
  
  RESULTS
  The incidence of non-hospital emergency visits for bronchospasm decreased by 15% (incidence rate ratio [IRR]=0.85, 95% CI=0.76, 0.94) following implementation of the law. Hospitalizations for bronchospasm did not change significantly (IRR=0.89, 95% CI=0.66, 1.21). Total monthly puffs of salbutamol and ipratropium administered in the non-hospital emergency setting decreased by 224 (95% CI=-372, -76) and 179 (95% CI=-340, -18.6), respectively, from means of 1,222 and 1,007 before the law.
  
  
  CONCLUSIONS
  Uruguay's 100% smokefree law was followed by fewer emergency visits for bronchospasm and less need for treatment, supporting adoption of such policies in low- and middle-income countries to reduce the disease burden and healthcare costs associated with smoking.
authors.affiliation: Department of Medicine, Cardiovascular Research Institute, University of California San Francisco, San Francisco, California.
authors.forename: Sara
authors.initials: S
authors.lastname: Kalkhoran
authors.affiliation: Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Ernesto M
authors.initials: EM
authors.lastname: Sebrié
authors.affiliation: CIET, Centro para la Investigación de la Epidemia de Tabaquismo, Montevideo; CLAEH Medical School, Maldonado, Uruguay.
authors.forename: Edgardo
authors.initials: E
authors.lastname: Sandoya
authors.affiliation: Department of Medicine, Cardiovascular Research Institute, University of California San Francisco, San Francisco, California; Center for Tobacco Control Research and Education, Cardiovascular Research Institute, University of California San Francisco, San Francisco, California. Electronic address: glantz@medicine.ucsf.edu.
authors.forename: Stanton A
authors.initials: SA
authors.lastname: Glantz
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001986:Bronchial Spasm / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D004630:Emergencies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D008297:Male; D061845:Smoke-Free Policy / Q000331:legislation & jurisprudence*; D014583:Uruguay
chemical_list: D001993:Bronchodilator Agents