COPD World News Week of February 19, 2012
Help smokers quit whether they ask or not
Birmingham, UK - Doctors should automatically offer smokers help with quitting, without waiting for signs that they're ready to kick the habit, researchers say. Right now, the general guidelines for doctors say that they should ask smokers about their willingness to quit. Then if the patient seems motivated, the doctor should offer help.
In a new research review, UK investigators found that offering quit help to all smokers seems more effective. Looking at 13 past clinical trials, the researchers found that some smokers at least attempted to quit after getting simple advice from their doctor - namely, that they should kick the habit for the sake of their health. But actual assistance in quitting - either counseling on behavior changes or nicotine replacement therapy - worked better.
Based on three studies, the researchers say, such help could prompt an additional 40 percent to 60 percent of smokers to at least try quitting, versus advice alone. And all three of the studies offered help to smokers without first checking their "willingness to quit." The findings are published in the journal Addiction.
Official guidelines in the U.S. and UK suggest that doctors first gauge patients' willingness to quit before offering them help. And that's probably based at least partly on "common sense," said Dr. Paul Aveyard, lead researcher on the new study. That is, why spend time discussing treatment with someone who doesn't want it? There's also the theory in psychology that people go through stages of thinking about change before they are actually ready to do it, noted Aveyard, a professor of behavioral medicine at the University of Birmingham. "I guess what we are saying is that people are sometimes ready to take action without having thought about it prior to that," Aveyard told Reuters Health in an email. "Make them a good offer and they'll act."
For more information:
http://www.nlm.nih.gov/medlineplus/news/fullstory_120712.html
COPD World News Week of February 12, 2012
Smoke-Activated Cells Ravage Lungs in Emphysema
Houston, TX - The destruction of lung tissue in emphysema was mediated by antigen-presenting cells (APCs) that were activated by the smoke, according to an experimental study.Four months of active smoke exposure in a chamber that mimicked smoking habits in humans significantly increased dendritic cells and neutrophils compared with controls. The exposed mice also showed significant increases in lung volume reported Farrah Kheradmand, MD, from the Baylor College of Medicine in Houston, and colleagues, in Science Translational Medicine.
Comparing lung-specific interleukin there was an increase in the number of lung inflammatory cells in the transgenic mice and a decrease in the null mice when compared to the wild type. The results showed increase in smoke-induced emphysema among the transgenic mice but attenuation in the null mice. The mice, 6 weeks to 8 weeks of age, were exposed to active cigarette smoke four times a day, for five days a week, over four months.
Air was forced intermittently through the burning cigarette to mimic puffing cycles of human smokers. With this study, the authors have "identified some of the crucial events that cause ... emphysema. They find that the antigen-presenting cells of the immune system are culpable; indeed, transfer of these cells from a mouse with emphysema into a healthy mouse induces disease," wrote the journal editors in an accompanying commentary.
Although smoking-related diseases have long been recognized as a leading cause of death, little is known about the underlying pathology. The researchers attempted to investigate the immune mechanisms that lead to emphysema. "These discoveries provide a foundation for developing diagnostic, prognostic, and therapeutic strategies that are critically needed for emphysema and other smoking-related diseases," the authors said.
For more information:
http://www.medpagetoday.com/Pulmonology/SmokingCOPD
COPD World News Week of February 5, 2012
Statins Tied to Lung Damage in Smokers
Among individuals with a history of at least 10 pack-years of smoking, statin use was associated with a 60% increase in the odds of having abnormalities on CT scans, according to Gary Hunninghake, MD, MPH, of Brigham and Women's Hospital in Boston, and colleagues. The findings were independent of a history of high cholesterol, coronary heart disease, or a number of other cardiovascular risk factors, the researchers reported online in the American Journal of Respiratory and Critical Care Medicine.
"Our findings suggest that statins may influence the susceptibility to, or progression of, interstitial lung disease," they wrote. But they advised caution before applying the findings to patient care because the possible risks of statins on interstitial lung abnormalities likely do not outweigh the benefits of statin therapy in patients with cardiovascular disease. "In addition, our findings do not rule out the possibility that statin use could benefit some patients with respiratory disease," they wrote. "Instead, we believe that clinicians should be aware that radiographic evidence of interstitial lung disease, much like myopathy, can occur in some patients on statins."
The researchers acknowledged some limitations of the current analysis, including the lack of data to correlate the experimental findings in mice to humans, the lack of biopsies in the human participants, the lack of information on the duration of statin use or dose for most patients, and the possibility that the findings apply only to current and former smokers.
Despite the potential negative association of statins with interstitial lung damage, recent studies have shown that statins might confer protective benefits for those hospitalized with the flu and for those who suffered a head trauma.
For more information:
http://www.medpagetoday.com
COPD World News Week of January 29, 2012
Millions of Smokers Don't Tell Docs that They Light Up
The findings mean that doctors and nurses are missing important health information on more than six million U.S. smokers, warned Cheryl G. Healton, DrPH, president of the organization. "Healthcare providers play a critical role in reaching smokers with appropriate messages and resources for quitting, especially now that insurance coverage has expanded to include some smoking cessation treatments," she said in a press release.
The nationally representative panel of 3,146 smokers and former smokers surveyed online in 2011 was conducted with support from Pfizer, maker of the smoking-cessation drug varenicline (Chantix).
Most of the 1,370 respondents who answered the survey question on whether they had ever kept their smoking status a secret from a healthcare provider said they felt comfortable discussing smoking (53.4%). Not surprisingly, of those who had kept their smoking status a secret, fewer were comfortable discussing it with clinicians (27.4% of 177).
"Many smokers know why they should quit, but often don't know how," the Legacy report noted. "Healthcare providers have an important role to play in helping smokers take that first step and helping smokers get on the path to quitting successfully."
For more information:
http://www.legacyforhealth.org/4973.aspx
COPD World News Week of January 22, 2012
Report says extra oxygen may harm emergency patients
In a review of earlier research, they found no support for routinely giving critically ill patients high-dose oxygen, a common practice among paramedics and emergency physicians. "There is not a single study that points to beneficial effects," said Dr. Yvo Smulders, a professor at VU University Medical Center in Amsterdam. "All of the evidence that we found points to detrimental effects."
Most doctors believe extra oxygen is life-saving and many guidelines recommend it, he and his colleagues write in the Archives of Internal Medicine. "What you would expect is that oxygen is healthy," Smulders told Reuters Health. "But it seems that God didn't introduce 20 percent oxygen in room air for nothing." Studies on animals dating to the 1960s and 70s have found that higher-than-normal oxygen levels could be dangerous.
Smulders' team gathered all the human research they could find on supplemental oxygen after heart attacks, strokes, cardiac arrest and acute attacks of chronic obstructive pulmonary disease, or COPD. The 18 studies they came up with all had the same grim message: supplemental oxygen doesn't work, and there is some weak evidence that it might be harmful. For instance, one trial from 1976 found nine out of 80 heart attack patients who got oxygen died, compared to just 3 out of 77 who got compressed air.
Although that difference could have been a statistical fluke, it was still bad news for oxygen. Another trial, this one in stroke patients, had to be stopped early because too many patients who got extra oxygen died. And for cardiac arrest, in which the heart stops beating, a study out last year found that people who had a lot of oxygen in their blood after they were revived died more often than people with normal levels. "It has potentially far-reaching implications, because supplemental oxygen is just ubiquitous in the care of critically ill patients," Dr. Stephen Trzeciak.
Too much oxygen in the blood can lead to the formation of molecules known as free radicals, he said, which can damage organs such as the heart and the brain. But this is still theory, Trzeciak warned, and so far there is no iron-clad proof that supplemental oxygen is harmful. What is clear is that too little oxygen can be lethal. "My concern is, if we just indiscriminately stop giving supplemental oxygen to post-arrest patients, they might end up having low oxygen, which is just as harmful or more harmful" than high oxygen, said Trzeciak, who studies resuscitation at Cooper University Hospital in Camden, New Jersey.
The American Heart Association currently recommends giving supplemental oxygen to people with cardiac arrest until the heart is restarted. At that point, the group urges doctors and paramedics to use measurements to ensure that oxygen levels in the blood don't get too high. The same goes for heart attacks.
But what often happens is that providers just leave the oxygen on full blast, according to Dr. Michael Sayre of the American Heart Association. "They don't realize they are giving too much oxygen," Sayre told Reuters Health. "It's just not something they are paying attention to." The Dutch researchers call for more studies. But until then, Smulders said, health providers should only give oxygen when blood levels are very low and they should make sure they never become too high. "I think it is about time that you step away from your intuitive approach and look at the evidence," he said.
For more information:
http://bit.ly/xuJqt6
COPD World News Week of January 15, 2012
Statins may be tied to lung damage in smokers
Boston, MA - Statin use appears to be associated with interstitial lung abnormalities among current and former smokers, researchers found.
Among individuals with a history of at least 10 pack-years of smoking, statin use was associated with a 60% increase in the odds of having abnormalities on CT scans, according to Gary Hunninghake, MD, MPH, of Brigham and Women's Hospital in Boston, and colleagues. The findings were independent of a history of high cholesterol, coronary heart disease, or a number of other cardiovascular risk factors, the researchers reported. online in the American Journal of Respiratory and Critical Care Medicine.
"Our findings suggest that statins may influence the susceptibility to, or progression of, interstitial lung disease," they wrote. But they advised caution before applying the findings to patient care because the possible risks of statins on interstitial lung abnormalities likely do not outweigh the benefits of statin therapy in patients with cardiovascular disease. "In addition, our findings do not rule out the possibility that statin use could benefit some patients with respiratory disease," they wrote. "We believe that clinicians should be aware that radiographic evidence of interstitial lung disease, much like myopathy, can occur in some patients on statins."
The researchers acknowledged some limitations of the current analysis, including the lack of data to correlate the experimental findings in mice to humans, the lack of biopsies in the human participants, the lack of information on the duration of statin use or dose for most patients, and the possibility that the findings apply only to current and former smokers.
For more information:
COPD World News Week of January 8, 2012
Secondhand smoke way down, Brits find
Bath, UK - Levels of secondhand smoke exposure among nonsmoking English adults declined significantly after smoke-free laws went into effect, according to a new U.K. study.
Exposure to secondhand smoke, as measured by the percentage of the population with undetectable salivary cotinine, declined from 1998 to 2008. The percentage of the population who had undetectable cotinine was 2.9 times higher and the geometric mean cotinine declined by 80% over the term, Michelle Sims, PhD, from the UK Centre for Tobacco Control Studies at the University of Bath, and colleagues found.
After the implementation of the legislation, there was also a significant fall in exposure, they reported in Environmental Health Perspectives. The authors obtained and analyzed data from the annual Health Survey for England for the years 1998 to 2008. Data collection included interviews with all adults, 16 and over. In addition, up to two children were eligible.
On July 1, 2007, smoke-free legislation came into effect in the U.K., making almost every enclosed public or work place smoke free. The authors wanted to know if implementation had an impact on secondhand smoke exposure in nonsmokers. With outcomes defined as undetectable levels of cotinine, all predictors were significantly associated with secondhand smoke exposure, with the exception of ethnicity (black or Asian versus white). After controlling for other predictors, the odds of undetectable cotinine increased with age, at 1.6 times for ages 30 to 44, 1.8 times for ages 45 to 59, and 2.2 times for people age 60 and over. The odds decreased with declining socioeconomic status, being lowest in social class IV and V (29% lower than class I and II, 95% CI 21 to 35). Also, the odds decreased with educational level: 19% lower in those with no qualifications compared with those who qualified for higher education. The odds of having undetectable levels of cotinine were 8.1 times higher in adults where no one smoked in the household when compared with those households where there was at least one smoker (95% CI 6.6 to 10).
The study's main weakness was an absence of data on cotinine levels from 2004 to 2006. Another concern voiced by the authors was the timing of the saliva sample because there is evidence of lower levels in the morning than in the evening.
"Smoke-free legislation in England led to significant reductions in population exposure to secondhand smoke," the authors wrote. "These reductions were additional to already declining exposures which, in turn, likely reflect the success of tobacco control policies implemented over the period examined."
For more information:
http://www.medpagetoday.com/PrimaryCare/Smoking
COPD World News Week of January 1, 2012
How to make your quit-smoking resolution stick
Washington, DC - Quitting smoking is one of the most common New Year's resolutions, but it's easier said than done, with six of 10 smokers requiring multiple attempts before successfully kicking the habit, according to the American Lung Association. However, preparing a quit-smoking plan can greatly improve your chances of success.
"Quitting smoking is the single most important step smokers can take to improve their health," Dr. Norman Edelman, chief medical officer of the lung association said in an association news release. "The start of a fresh New Year is a great time for smokers to implement their plan to quit smoking and reap the health and financial benefits of a smoke-free lifestyle."
Here are some proven tips and resources that have helped thousands of people quit smoking, the lung association said. Various types of treatments and different over-the-counter and prescription medications are available to help people quit smoking. Talk to your doctor or pharmacist or visit the a lung association website. Pick your quit day a few weeks ahead of time and mark it on the calendar. Try to choose a quit day when you won't be under a great deal of stress.
As the day approaches, gather the medications and other quit aids you require and plan how you're going to deal with situations that make you want to smoke. Exercise every day. This will help improve your energy levels and mood, as well as help prevent weight gain. Walking is an ideal way to reduce the stress of quitting. You also need to eat a balanced diet, drink lots of water and get plenty of sleep.
And finally, ask for support from family, friends and co-workers and consider joining a stop-smoking program so that you don't have to quit alone.
For more information:
http://www.nlm.nih.gov/medlineplus/news/fullstory_120118.html