Passivrauchen: Gesundheitliche Folgen, Effekte einer Expositionskarenz und Präventionsaspekte

Zusammenfassung

Passivrauchen stellt weltweit die drittwichtigste vermeidbare Todesursache dar. Eine Exposition gegenüber Passivrauch ist unter anderem mit einem erhöhten Risiko für die Entstehung akuter respiratorischer Erkrankungen, obstruktiver Atemwegserkrankungen, eines Lungenkarzinoms und kardiovaskulärer Erkrankungen assoziiert. Während die Dosis-Wirkungs-Beziehung hinsichtlich pulmonaler Erkrankungen vermutlich linear verläuft, besteht zwischen dem Ausmaß einer Passivrauch-Exposition und dem Risiko für akute Manifestationen der Atherosklerose ein nicht-linearer Zusammenhang. Auf diesem beruht die Beobachtung eines überproportional hohen Herzinfarkt-Risikos für Passivraucher im Vergleich zu nicht-exponierten Individuen. Die Passivrauch-Belastung in Deutschland ist zwar rückläufig, aber nach wie vor erheblich. Während die häusliche Exposition schwer beeinflussbar ist, zeigen aktuelle Studien, dass sich die Passivrauch-bedingte Morbidität und Mortalität durch öffentliche Rauchverbote deutlich reduzieren lassen. Entsprechende Maßnahmen sind auch präventiv zur Vermeidung von Expositionen am Arbeitsplatz notwendig und werden gut toleriert. In dieser Übersichtsarbeit wird die aktuelle Datenlage zu den Gefahren des Passivrauchens und den Auswirkungen öffentlicher Rauchverbote dargestellt.

Abstract

Passive smoking is the third leading but preventable cause of death worldwide. It is associated with an elevated risk of developing acute respiratory diseases, obstructive lung disorders, lung cancer, and cardiovascular disease. Whereas the dose-response relationship between second-hand smoke exposure and respiratory diseases is likely to be linear, a non-linear dose-response curve has been observed with respect to acute cardiovascular events. This explains the disproportionately high risk of myocardial infarction among passive smokers as compared to unexposed individuals. Over the last ten years, exposure to second-hand smoke has declined in Germany, but it is still substantial. With passive smoking in the home being a difficult target for preventive measures, public smoking bans have recently been shown to greatly reduce second-hand smoke-related morbidity and mortality. In addition, such measures are usually well tolerated and highly relevant regarding legal aspects related to workplace issues. This article summarises the current evidence on the health consequences of passive smoking and on the favourable effects of public smoking bans.

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