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Collectively, these results give solidconfirmation for the role of second-hand

cigarette smoke in the causation of COPD,as well as for the significant protective effectof vitamin D.

These results have significant implicationsfor medical and public health policy.

MEDICAL:

Due to severe and irreversible nature ofCOPD, and the subtlety of initial symptoms,doctors should be made aware of the

importance of screening patients forexposure to SHS. This especially true inpatients with whom COPD would be asignificant co-morbid factor, such as thosewith, or at risks for, bronchitis, asthma,pneumonia, sarcoidosis, lung cancer, heart

disease, and any disease involving systemicinflammation. This also applies to all elderlypatients, as well as to infants.

As COPD, even in its early stages, has been

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shown to be associated with emotionaldisturbances such as anxiety anddepression, these patients too should be

screened for exposure to SHS.

Even though COPD per se is irreversible, dueto the complexity of the disease and thefrequent occurrence of do-morbid conditionswhich are reversible, early identification of

COPD can lead to interventions such asexercise, respiratory training, and mind-body interventions such as Qigong, all ofwhich are known to be of benefit to heprogression and exacerbation of COPD, andwhich are of greater therapeutic efficacy

when implemented early in the course of thedisease.

By screening regularly for exposure to SHS,doctors will be able to detect subtlesymptoms of COPD earlier, and will be able

to treat the patient more effectively. Giventhe debilitating effects of this condition,early treatment will significantly reducepatient suffering and the load on societyfrom increased medical costs, lost work

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hours, and need for social services.

PUBliC HEALTH POLICY

These findings strongly reinforce thearguments for the continuing enforcement,and the extension, of laws, regulations andpolicies forbidding smoking in various

contexts.

All the points made above, about COPD andits co-morbidities and their impact onsociety, apply equally at the level of publicpolicy.

These findings should be brought to theattention of those responsible for 'nosmoking' laws and regulations. This includesa very wide range of people, includingofficials in Federal, State and local

government, managers of public spacessuch as restaurants, movie theaters, shops,malls, etc., as well as business owners andhomeowners.

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These findings should be brought clearly tothe public's attention.

If smokers realize they are not just harmingthemselves by smoking, but also thosearound them, this might bring morecompliance with 'no smoking' laws andregulations, and might be more of amotivation to change behavior than if they

believe they are harming only themselves.

If non-smokers exposed to SHS realize howmuch danger they are exposing themselvesto, they hopefully will be more likely to takesteps, either to remove themselves from the

situation or to request the smoker towithdraw or to stop smoking. With the solidfindings from this study, people willhopefully feel more empowered, motivated,and justified in taking action to protectthemselves and those they care for.

Vitamin D

These findings add to the already

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considerable body of evidence for thebeneficial and protective effects of vitaminD. This information should be made

available to doctors and to the generalpublic.

A more widespread appreciation by doctorsof these effects could lead to more medicalscreening for vitamin D deficiency, and the

prescription of appropriate levels ofsupplementation especially in cases where aperson is necessarily or involuntarilyexposed to SHS or other forms of lungirritant which might have similar modes ofaction; when a person is at risk for, or

chronically suffers from, an illness which canbe exacerbated by COPD (lung disease,heart disease, depression, anxiety,inflammatory conditions); and in populationsat risk for vitamin D deficiency such asAfrican-Americans, those living in northern

sections of the country, the house-bound,and the elderly.

If the public is made more aware of theseprotective effects of vitamin D, those at risk

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will be more likely to ask their doctors aboutthe advisability of supplementing their dietwith vitamin D or increasing their

consumption of foods containing it.