Background:
SHS exposure causes several diseases. Most countries who have banned smoking in pubs still allow smoking in outside areas if the space meets certain requirements. There is no evidence that such exposure is harmless but there are no studies which document adverse health effects. SHS effects on health took many years to document.
Ireland, Spain and Czech Republic have comprehensive smokefree laws which have been in place for varying lengths of time.

Objectives:
To measure effects on breathing of spending at least I hour in an outside area of a pub where smoking is allowed.

Methods:
We monitored the effects on breathing rate (BR) in 60 patients with airway diseases from these three EU countries using personal monitors for continuous breath-by-breath recording and simultaneous particle exposure monitoring during a 24-hour period with a visit to an outside area in a pub of at least one hour’s duration.

Results:
Significant breathing rate changes were seen in 58 of 61 patients. Increases and decreases in breathing rates (Br) occurred. Increasing from Br 20 .83 (1.28 SD) in asthma (17) and Br 22.28 (1.94 SD) in COPD (11) at rest outside SHS area to Br 21.72 (1.65 SD), and Br 24.52 (2.15 SD) respectively at rest in SHS areas in 28 patients. (p =0.00). In 29 patients Br decreased from 21.23 (2.34 SD) in asthma patients at rest to 19.58 (2.38 sd) during SHS exposure and in COPD from 22.55 (2.40 sd) at rest outside the SHS area decreased to 21.03 (3.00 sd) during SHS exposure. (p =0.00).

Conclusions:
Exposure to SHS in areas outside pubs where smoking is allowed alters the breathing rates of patients with asthma and COPD. The change can be an increase or a decrease which may be moderated by the chemical drive to breathing and seems to be influenced by disease and gender.