COPD World News - 2024

Week of April 21, 2024

Higher abstinence rate with e-cigarettes vs. nicotine gum

Peking, China - Individuals using e-cigarettes for smoking cessation had a higher 6-month abstinence rate than nicotine replacement therapy users and a similar rate to varenicline users, according to results published in JAMA Internal Medicine. “[E-cigarettes] were as effective in helping smokers quit as varenicline and more effective than nicotine chewing gum when all three products were provided with minimal behavioral support,” Hao-Xiang Lin, DrPH, of the Institute for Global Health and Development at Peking University in China, and colleagues wrote. In a multicenter, randomized clinical trial in China, Lin and colleagues assessed 1,068 individuals (mean age, 33.9 years; 33.5% women) smoking a daily minimum of 10 cigarettes to determine how e-cigarette use for 12 weeks compares with 12-week nicotine replacement therapy (NRT) and varenicline (Chantix, Pfizer) in terms of sustained abstinence at 6 months. Of the total cohort, 409 (38.3%) individuals received a cartridge-based e-cigarette with a 30 mg/mL nicotine salt dose for the first 2 weeks and then a 50 mg/mL dose. The varenicline group also consisted of 409 individuals, and the dosing of this drug started as 0.5 mg once daily for 3 days, followed by 0.5 mg twice daily for 4 days and 1 mg twice daily for the remainder of the time. Fewer patients randomly received nicotine chewing gum (n = 250; 23.4%), and the dose of this therapy was based on level of smoking (2 mg ≤ 20 cigarettes/day, n = 197; 4 mg, > 20 cigarettes/day, n = 53). Researchers additionally noted that each smoker was invited to join a self-help internet forum regardless of their cessation method group. Around 80% of individuals from each group had 6-month follow-up data. Using an expired-air carbon monoxide reading (< 8 parts per million), individuals using e-cigarettes had the highest abstinence rate at 6 months (15.7%), followed closely by varenicline users (14.2%) and then nicotine gum users (8.8%). Between the e-cigarette group and the varenicline group, researchers found similar quit rates (absolute risk reduction, 1.47%; 95% CI, –1.41% to 4.34%). However, when compared with the nicotine gum group, e-cigarette users had a higher likelihood of quitting (OR = 1.92; 95% CI, 1.15-3.21). Researchers continued to see the above results after controlling for education level and Fagerstrom Test for Cigarette Dependence baseline scores, with similar quit rates between e-cigarette users and varenicline users (absolute risk reduction, 1.47%; 95% CI, –1.41% to 4.34%) and increased odds for quitting among e-cigarette users vs. nicotine gum users (adjusted OR = 1.89; 95% CI, 1.13-3.17). Similar to the relationship between e-cigarettes and nicotine gum, use of varenicline vs. nicotine gum was linked to elevated odds for abstinence (adjusted OR = 1.82; 95% CI, 1.07-3.08). Within the first 3 months of treatment, all three groups had comparable adherence rates. The varenicline and nicotine gum groups stopped using these delivery methods at 3 months. But 62.3% of individuals using e-cigarettes continued to use their assigned treatment at 6 months, including 67.2% of those who achieved 6-month sustained abstinence. Researchers did not find any serious adverse event reports in the total cohort but did find adverse reactions. Throat irritation and mouth irritation occurred frequently among individuals using e-cigarettes (7.8%; 6.9%) and individuals chewing nicotine gum (8%; 8.8%). In contrast, individuals using varenicline commonly reported nausea (8.8%). “As 63% of participants in the [e-cigarette] arm still used their products at 6 months, further studies are needed to assess whether such use is beneficial or harmful,” Lin and colleagues wrote. 

For more information: https://tinyurl.com/3vka8fww

Week of April 14, 2024

New study shows vaping may help people quit smoking cigarettes

Buffalo, NY - Combustible cigarette smokers are now more likely to quit if they start on e-cigarettes, a trend not seen a decade ago, according to longitudinal data from adults in the Population Assessment of Tobacco and Health (PATH) study. Between 2016-2017 and 2018-2019, 20.1% of adult smokers who used electronic nicotine delivery systems discontinued cigarette smoking at follow-up compared with 16.5% of those who did not use e-cigarettes (P<0.05), reported Karin Kasza, PhD, of Roswell Park Comprehensive Cancer Center in Buffalo, New York, and co-authors. This trend continued between 2018-2019 to 2021, with 30.9% of those who used e-cigarettes discontinuing cigarette smoking at follow-up compared with 20% of those who did not use e-cigarettes (P<0.001), they detailed in Nicotine & Tobacco Research. Of note, between 2013 and 2016, rates of discontinuing cigarette smoking among U.S. adults were almost identical between those who used e-cigarettes, at 15.5%, and those who did not, at 15.6%. "Our findings here suggest that the times have changed when it comes to vaping and smoking cessation for adults in the U.S.," said Kasza in a press release. "While our study doesn't give the answers as to why vaping is associated with cigarette quitting in the population today when it wasn't associated with quitting years ago, design changes leading to e-cigarettes that deliver nicotine more effectively should be investigated. This work underscores the importance of using the most recent data to inform public health decisions." The researchers explained that in the nearly 20 years since electronic nicotine delivery system products entered the market, there have been varied results regarding the role they play in quitting smoking. These findings follow a recent randomized trial that showed e-cigarettes helped people better stick to smoking cessation. "Our full study period spanned a time in the United States when the ENDS [electronic nicotine delivery systems] marketplace was expanding; salt-based nicotine formulations gained market share in 2016 and ENDS products became available with increased nicotine yields over time, prevalence of ENDS use and frequent ENDS use was increasing, and various tobacco control actions were taken at state and federal levels," the group wrote. "Inconsistent findings may be due in part to differences in the samples and measures considered, differences in analytic approaches used, and/or may be because of the rapidly changing product environment or differing policy contexts," they added.

For more information: https://tinyurl.com/4a4trzuv

Week of April 7, 2024

Flu vaccine uptake tripled with simple promotion

San Francisco, CA - MedPage Today reported that a few simple interventions boosted flu vaccine uptake for patients waiting at the emergency department [ED], according to the cluster-randomized, controlled PROFLUVAXED trial. People in ED waiting areas who consented to view a 3-minute video with a scripted message, read a one-page flyer, and have a short discussion with an ED clinician about the flu vaccine had a 30-day follow-up vaccination rate of 41% versus 15% among patients that received no messaging about the vaccine. Even just asking people in the ED "Would you accept the influenza vaccine in the emergency department today if your doctor asked you to get it?" resulted in a 30-day vaccination rate of 32%, Robert Rodriguez, MD, of the University of California San Francisco, and colleagues reported in NEJM. "We fully expected the interventions to improve vaccine uptake but were surprised by how effective they were," Rodriguez stated. "The simple question intervention doubled vaccine uptake and the messaging intervention nearly tripled vaccine uptake." "There is a distinctly underserved population whose primary (and often only) healthcare access occurs in emergency departments," Rodriquez noted. "To decrease disparities, public health interventions, especially vaccine messaging and vaccine administration, can and should be delivered in emergency departments." To ensure the messages in the video and flyer reached medically underserved populations, researchers created five different versions with the same wording that featured African American, Latinx (English and Spanish versions), multiracial, or white physicians. The consequences of poor influenza vaccine uptake are particularly stark for members of racial and ethnic minority groups, Zanthia Wiley, MD, and Annelys Roque Gardner, MD, both of Emory University School of Medicine in Atlanta, wrote in an accompanying editorial. Black, Hispanic, and American Indian or Alaska Native adults have age-adjusted influenza hospitalization rates of 1.2 to 1.8 times the rate of non-Hispanic white adults, they noted. Moreover, it is common for people who lack health insurance and access to primary care to visit EDs for non-emergency care, they pointed out. "Exploring alternative methods of promoting vaccinations in racial and ethnic minority communities and for those individuals who have limited access to routine healthcare is essential for vaccine equity," Wiley and Gardner wrote. The study enrolled 767 participants from six emergency departments in San Francisco, Houston, Philadelphia, Seattle, and Durham, North Carolina from October 2022 to February 2023. No participant was critically ill, and the majority of ED visits were for conditions that would not preclude offering and administering vaccines.  

For more information: https://tinyurl.com/4ud32ymp

Week of March 31, 2024

Childhood cigarette smoking heightens COPD risk in adulthood

Hanover, NH - Childhood smoking was linked to an increased risk for COPD in adults aged 40 years or older. In adulthood, the risk for COPD rose with regular cigarette smoking starting before age 15 years, according to results published in American Journal of Respiratory and Critical Care Medicine. “In this sample, the developmental window for increased risk due to childhood smoking ended at about age 20 years, which coincides with the time [FEV1] reaches its peak during adolescence,” James D. Sargent, MD, Scott M. and Lisa G. Stuart Professor, as well as professor of pediatrics, professor of biomedical data science and professor of community and family medicine at Dartmouth Geisel School of Medicine, and colleagues wrote. Using data from the 2020 National Health Interview Survey, Sargent and colleagues assessed 22,374 adults (52.8% women; 75% white) aged 40 years or older to determine how COPD risk is linked to the age of smoking initiation (< 15 years old vs. ≥ 15 years old). Researchers used multivariable analysis that accounted for current smoking, cigarette pack-years and covariates to find this relationship. Over half of the total cohort never smoked (60%), and researchers observed more former smokers than current smokers (28% vs. 13%). Within the study population, 7.1% of adults self-reported a COPD diagnosis, and this diagnosis was reported more frequently in the cohort who started smoking regularly before age 15 years vs. the cohort who started smoking regularly at age 15 years or older and the cohort who never smoked (23.1% vs. 11.6% vs. 2.6%). Compared with the cohort of regular smokers at age 15 years or older, researchers found more median pack-years in the cohort of regular smokers before age 15 years (29 vs. 15). In terms of smoking intensity, the median number of cigarettes per day was 20 for those reporting early-onset/childhood smoking, whereas this number was smaller for those reporting later-onset smoking (10 cigarettes per day “Although it would be worthwhile to replicate the findings in other studies of COPD, this study gives child health providers and public health officials reason to be very concerned about future chronic disease among patients who begin smoking during early adolescence, both because of the increased risk of nicotine addiction and perhaps because of its impact on lung development,” Sargent and colleagues wrote. 

For more information: https://tinyurl.com/bdh5cbkp

Week of March 24, 2024

Commonly Used Fingertip Pulse Oximeters Not Up to Snuff

San Francisco, CA - Commonly used types of fingertip pulse oximeters were not consistent in their performance, with more frequent issues when tested in participants with darker skin tones, and sometimes fell short of regulations and manufacturer claims, according to a study from the Open Oximetry Project. Among 11 fingertip pulse oximeters used during hypoxemia in healthy participants, five devices had a root mean square error (ARMS) >3%, which falls outside the acceptable FDA performance range, reported Isabella Auchus, MD, of the University of California San Francisco, and co-authors. In addition, nine devices had worse performance in participants in the darkest skin pigmentation category versus those in the lightest category, they noted in eBioMedicine.  The reference device and eight other devices met International Organization for Standardization (ISO) criteria for ARMS of ≤4%, while 10 devices plus the reference device demonstrated higher ARMS in participants who were categorized at the lowest third of individual typology angle (ITA) values (having dark skin tones), compared with the highest third of ITA values (light skin tones) when measured at the area between the joint and the fingernail. Seven devices and the reference device demonstrated a positive bias in participants who had darker pigmentation compared with those with lighter pigmentation. Most devices also demonstrated higher ARMS at lower arterial oxygen saturation (SaO2) levels, particularly among individuals with darker skin pigmentation. "Our data support several steps that could be taken now to update regulatory guidance and improve performance standards," Auchus and team wrote. "The commonplace reliance on subjective, non-standardized skin pigmentation assessment tools (e.g., pFP [perceived Fitzpatrick Scale]) is problematic and should be abandoned for several reasons, including the lack of standardized colors, inter-operator variability and bias, and the misappropriation of the initial purpose of the scales." These findings come just over a month after an FDA advisory committee provided largely positive feedback to the agency's effort to improve the accuracy of pulse oximeters when used in darker-skinned patients. The FDA Medical Device Advisory Committee Anesthesiology and Respiratory Therapy Devices Panel did, however, raise some concerns, including the need for larger trials.

For more information: https://tinyurl.com/52z6kntp

Week of March 17, 2024

New government repeals New Zealand's tobacco ban

Wellington, NZ - Despite its diminutive size and geographic isolation, New Zealand has an international reputation for pragmatic and sensible political action.  As part of the newly elected coalition government's rush to tick 48 actions off its 100-day list by March 8, it has repealed the Smokefree Environments and Regulated Products Amendment Act of 2022. This act, passed by the previous Labour government, would have banned selling tobacco products to those born on or after January 1, 2009, reduced the nicotine in tobacco products to non-addictive levels, and slashed the number of outlets allowed to sell tobacco by 90%, from 6,000 to 600. Overall tobacco use was predicted to drop from the current 8% to lower than 5% by 2025, and the act was expected to create a tobacco-free generation. Clinical trials and modeling studies showed Smokefree policies would have reduced mortality rates by 22% for women and 9% for men, saving up to 5,000 lives annually. Also, it would have saved New Zealand $1.3 billion in healthcare expenditures over the next 20 years, and New Zealanders would have enjoyed a cumulative gain of $29 billion in disposable (and taxable) income by 2050. This world-leading legislation would have shown that fighting the tobacco industry is possible, encouraging other countries to do the same and perhaps eventually saving some of the more than 8 million  people who die annually from tobacco-related causes. Why would New Zealand's new coalition government, an alliance of the conservative National Party along with the libertarian ACT and populist New Zealand First parties, repeal data-driven and life- and money-saving legislation? Without a shred of evidence, Prime Minister Christopher Luxon and his coalition partners have repeatedly claimed restricting tobacco and reducing nicotine levels  experimental (as though that were a bad thing), leading to and a proliferation of crime.  ACT's health spokesperson Todd Stephenson, for example, said that  the "radical prohibitionism" of creating a smoke-free generation would "push smokers into the arms of gang members." This rhetoric uncannily echoes the tobacco lobby. Public health experts at the University of Otago recently released a damning report  showing that the coalition government's arguments in favor of a repeal closely mirror the tobacco industry's own narratives on this subject. So suspicious are the similarities between the flimsy remarks of coalition partners and tobacco companies' talking points that the report's authors are calling on all members of parliament to declare any past associations with tobacco companies. 

For more information: https://tinyurl.com/mry53e2v

Week of March 10, 2024

Gaseous vs. polluting fuels for cooking, heating lower odds for COPD

Liverpool, UK - Use of gaseous household fuels vs. polluting fuels for cooking and heating lowered an individual’s odds for COPD, wheeze and severe respiratory illness/death, according to study results published in Lancet Respiratory Medicine. “This article demonstrates a significantly lower risk for key health outcomes when switching from polluting solid fuels or kerosene to gaseous fuels for cooking or heating, suggesting cleaner fuels could contribute to reducing the global disease burden from exposure to household air pollution,” Elisa Puzzolo, MSc, MPH, PhD, senior research fellow and in the department of public health, policy and systems at University of Liverpool and co-director of the university’s CLEAN-Air (Africa) Global Health Research Unit, and colleagues wrote. Using 10 databases, Puzzolo and colleagues reviewed and assessed 116 studies published between Dec. 16, 2020, and Feb. 6, 2021, to find out how gaseous fuels (natural gas, liquified petroleum gas and biogas) used for cooking and heating impact various health outcomes compared with polluting fuels (wood, charcoal, kerosene) or clean energy (electricity, solar energy). A majority of the included studies followed a cross-sectional design (78 studies), with fewer cohort studies (23 studies), case-control studies (13 studies) and randomized controlled trials (2 studies). The number of studies conducted in low-income and middle-income countries (LMICs) was similar to the number of studies conducted in high-income countries (60 studies vs. 54 studies). Two studies featured countries from both income levels. Further, 92 studies focused on fuels used in cooking, whereas only 17 studies focused on fuels used in heating. Seven studies evaluated both fuel usage areas. Researchers obtained 215 effect estimates from the total population. Between gaseous household fuels and polluting fuels, use of gaseous household fuels proved to be more beneficial to an individual’s health, with reduced odds for several health effects and symptoms, including: pulmonary function deficit (OR = 0.27; 95% CI, 0.17-0.44); severe respiratory illness or death (OR = 0.27; 95% CI, 0.11-0.63); COPD (OR = 0.37; 95% CI, 0.23-0.6); self-reported breathlessness (OR = 0.4; 95% CI, 0.21-0.76); wheeze (OR = 0.42; 95% CI, 0.3-0.59); self-reported cough (OR = 0.44; 95% CI, 0.32-0.62); acute lower respiratory infections or pneumonia (OR = 0.54; 95% CI, 0.38-0.77); bronchitis (OR = 0.6; 95% CI, 0.43-0.82); preterm birth (OR = 0.66; 95% CI, 0.45-0.97); and low birth weight (OR = 0.7; 95% CI, 0.53-0.93). Researchers also found significantly decreased odds for COPD, bronchitis, pulmonary function deficit and severe respiratory illness or death pooled together (OR = 0.36; 95% CI, 0.27-0.48) with gas fuel vs. polluting fuel.In this a according to researchers. In contrast, individuals who used gaseous household fuels vs. electricity faced a higher likelihood for acute lower respiratory infections or pneumonia (OR = 1.26; 95% CI, 1.03-1.53), as well as COPD (OR = 1.15; 95% CI, 1.06-1.25). Researchers noted that in higher-quality studies, determined using the Liverpool Quality Assessment Tool, the relationship between these health outcomes and gas vs. electricity usage was non-significant. Use of gaseous household fuels vs. electricity lowered an individual’s odds for bronchitis (OR = 0.87; 0.81-0.93). Similar to the above asthma findings, the likelihood for asthma in adults and children in relation to gas use vs. electricity was not significant. Researchers observed additional non-significance in this analysis when assessing the odds for wheeze, cough and breathlessness. “For LMICs reliant on polluting solid fuels and kerosene, transitions to gaseous fuels for cooking or heating can potentially produce substantial health benefits,” Puzzolo and colleagues wrote. “However, where transitions to clean energy such as electricity are a realistic option (ie, scalable and accessible in the short term) further protection of health is probable.” 

For more information: https://tinyurl.com/mv54v3wd

Week of March 3, 2024

A tobacco-free generation: the end goal of the endgame

London, UK - Last year The Lancet Respiratory Medicine published an editorial discussing how the tobacco endgame initiative could best establish a tobacco-free generation, in which less than 5% of the European population uses tobacco by 2040. A major goal to achieve this initiative will be to ensure that children and adolescents receive adequate help to avoid tobacco-related and nicotine-related products, in particular electronic nicotine delivery systems which are highly addictive. These tobacco control discussions have continued and in January this year, The Lancet Respiratory Medicine was invited to a panel discussion focused on policy changes in the UK that would best serve those already addicted to smoking, and how to implement cessation in the most at-risk groups. A key component of this UK policy is in the tobacco control manifesto proposed by the Prime Minister, which will make it an offence for anyone born on or after Jan 1, 2009, to be sold tobacco products. Other action points in the manifesto include establishing an Illicit Tobacco Taskforce, led by HMRC and Border Force, to oversee the future evolution of an illicit tobacco strategy, £70 million per year for local authority-led stop smoking services, and £10 million over 2 years for financial incentives to support pregnant smokers to quit. In addition, there are efforts to make vape products less attractive to children by introducing restrictions on flavours, promotion, packaging, and point-of-sale displays. The event served as a sobering reminder of how lethal this legal substance is. One quarter of all cancers are linked to smoking, and smoking-related cancer services costs the UK NHS £2·4 billion each year. Jeanelle de Gruchy, England's Deputy Chief Medical Officer, noted in the discussions that social disparities and the attributable mortality by economic deprivation—that smoking exacerbates—can be readdressed with the implementation of the manifesto. The momentum towards the tobacco endgame gained thus far is due to the wholly unique alignment of the efforts of public health officials, governmental parties, and medical communities. The proposed UK manifesto is a comprehensive package and experts agreed that it needs to be implemented before the next UK election to have immediate impact. A lasting message from the meeting was that for the tobacco endgame to succeed across the globe, each individual agenda needs a champion, no public health charity or non-governmental organisation can gain enough traction on their own to enact change. Various coalitions are already established and working effectively and should be aligned with campaigners who can relentlessly push forward agendas. The smoke-free generation legislation will move us closer to making smoking obsolete, which is not just the endgame, but the end goal.

For more information: http://tinyurl.com/uzzya9kf

Week of February 25, 2024

Even Moderate Exposure to Radon Tied to Increased Stroke Risk

Chapel Hill, NC - An analysis of radon exposures in more than 150,000 postmenopausal women in the Women's Health Initiative revealed a 14% higher stroke risk in those exposed to the highest concentrations compared with those exposed to the lowest concentrations. Even moderate concentrations of radon were associated with a 6% higher stroke risk. Radon is the second leading cause of lung cancer, but little was known about how exposure to the gas might affect stroke risk in women.  "Our research found an increased risk of stroke among participants exposed to radon above — and as many as 2 picocuries per liter (pCi/L) below — concentrations that usually trigger Environmental Protection Agency recommendations to install a home radon mitigation system," senior author Eric A. Whitsel, MD, MPH, professor of epidemiology and medicine, University of North Carolina, Chapel Hill, said in a news release. Radon is a naturally occurring odorless radioactive gas produced when uranium or radium break down in rocks and soil. Its presence is increasing as a result of climate change, and it is increasingly being found in people's homes. When inhaled, this air pollutant releases ionizing radiation in the lungs and is seen as second only to smoking as an established cause of lung cancer. The National Radon Action Plan of the US Environmental Protection Agency (EPA) lays out testing and mitigation guidelines based on the known role of radon in lung carcinogenesis. But radon testing and mitigation are less common than recommended, and the EPA's action plan doesn't cover diseases other than lung cancer. Compared with men, women have a higher rate of stroke and, in the US, typically spend about 11% more hours per day indoors at home, which investigators note highlights a "potential role of the residential environment among other risk factors specific to women." Researchers examined longitudinal associations between home radon exposure and incident stroke in 158,910 women at baseline (mean age 63.2 years; 83% White) over a mean follow-up of 13.4 years. During this time, participants experienced a total of 6979 strokes. Participants' home addresses were linked to radon concentration data drawn from the US Geological Survey and the EPA, which recommends that average indoor radon concentrations not exceed 4 pCi/L.  The highest radon exposure group resided in areas where average radon concentrations were < 4 pCi/L; the middle exposure group lived in regions with average concentrations of 2-4 pCi/L; and the lowest exposure group lived in areas with average concentrations < 2 pCi/L.  The researchers adjusted for demographic, social, behavioral, and clinical characteristics. The incidence rates of stroke per 100,000 women in the lowest, middle, and highest radon concentration areas were 333, 343, and 349, respectively. The study was funded by the National Institute of Environmental Health Sciences and National Heart, Lung, and Blood Institute. Whitsel and coauthors report no relevant financial relationships. 

For more information: http://tinyurl.com/3hh6f3tv

Week of February 18, 2024

Disposable vapes to be banned for children's health, government says

London, UK - Disposable vapes are set to be banned as part of plans to tackle the rising number of young people taking up vaping, the government says. Measures will also be introduced to prevent vapes being marketed at children and to target under-age sales. Prime Minister Rishi Sunak suggested adult smokers trying to quit would still have access to alternatives like vapes under the proposals. The ban is expected to be introduced across the UK, the government said. It is already illegal to sell any vape to anyone under 18, but disposable vapes - often sold in smaller, more colourful packaging than refillable ones - are a "key driver behind the alarming rise in youth vaping", according to the government. Figures from the Action on Smoking and Health (Ash) charity suggest 7.6% of 11 to 17-year-olds now vape regularly or occasionally, up from 4.1% in 2020. Announcing the plans on Monday, Mr Sunak said it was right that "strong action" was taken to stamp out vaping in children. "Children shouldn't be vaping, we don't want them to get addicted, we still don't understand the full long-term health impacts," he said. 'Maintain vapes for adult smokers' Mr Sunak suggested the proposals struck the right balance between restricting access for children and maintaining access for adult smokers trying to quit smoking. "It is important that we maintain vapes for adult smokers who want to stop," the Prime Minister continued, adding that he wanted to target "all the things that make sure children don't have access to vapes." Vaping is substantially less harmful than smoking, but it has not been around for long enough for its long-term risks to be known, according to the NHS. The vapour that is inhaled can still contain small amounts of  chemicals that are found in cigarettes, including nicotine - which is addictive but not seen by the health service as one of the most problematic ingredients in cigarettes. The proposals follow last year's announcement of a ban on the sale of cigarettes to anyone born on or after 1 January 2009 as part of an attempt to create a "smoke-free generation". Health Secretary Victoria Atkins told the BBC she was confident the new bill would pass Parliament by the time of the general election - expected to be this year - with it coming into force in early 2025. Once the timing is confirmed, retailers will be given six months to implement it. 

For more information: http://tinyurl.com/4fe9sr54

Week of February 11, 2024

Omicron's surprise parting gift - evolution of the human immune system 

Seoul, South Korea - It has been four years since the start of the COVID-19 pandemic. SARS-CoV-2 has yet to be eradicated and new variants are continuously emerging. Despite the extensive immunization programs, breakthrough infections (infection after vaccination) by new variants are common. New research suggests that human immune responses are also changing in order to combat the never-ending emergence of new SARS-CoV-2 variants. Specifically, it has been discovered the immune system that encountered breakthrough infection by the omicron variant acquires enhanced immunity against future versions of the omicron. The study is published in Science Immunology. A team of South Korean scientists led by Professor Shin Eui-Cheol of the Korea Virus Research Institute Center for Viral Immunology within the Institute for Basic Science (IBS) announced that the memory T cells that form during the omicron breakthrough infection respond to subsequent strains of the virus. Emerging in late 2021, the SARS-CoV-2 omicron variant had drastically increased transmissibility in comparison to its predecessors, which quickly allowed it to become the dominant strain in 2022. New strains of omicron have kept emerging ever since then. Starting with BA.1 and BA2, BA.4/BA.5, BQ.1, XBB strains, and more recently JN.1 strains were among the new strains of the omicron variant. This has led to widespread breakthrough infection despite vaccination. After becoming infected or vaccinated, the body creates neutralizing antibodies and memory T cells against the virus. The neutralizing antibody serves to prevent host cells from being infected by the virus. While memory T cells cannot prevent the infection, they can quickly search and destroy infected cells, preventing the viral infection from progressing into a severe disease. The research team's goal was to find out the changes that occur in our body's immune system after suffering from post-vaccination breakthrough infection. In order to answer that question, they focused on the memory T cells that formed after the omicron infection. The previous studies on the omicron variant have mostly focused on vaccine efficacy or neutralizing antibodies, and the research related to memory T cells has been comparatively lacking. 

For more information: http://tinyurl.com/38xd4ym4

Week of February 4, 2024

Palliative telecare team improves quality of life in COPD

Aurora, CO - Receiving care from a palliative telecare team resulted in more improvements in quality of life than usual care among patients with COPD, interstitial lung disease or heart failure, according to study results published in JAMA. “This new approach can reduce the burden of illness for patients,” David B. Bekelman, MD, MPH, professor of medicine and psychiatry at the University of Colorado School of Medicine at the Anschutz Medical Campus, said. “Many patients with COPD, heart failure or interstitial lung disease suffer from persistent symptoms (shortness of breath, fatigue) and depression and anxiety despite disease-specific treatments,” Bekelman continued. “We found that a palliative telecare team of a nurse and social worker, who collaborate with physicians, improved multiple quality of life outcomes for patients with these illnesses.” In a single-blind, randomized trial of two Veterans Administration health care systems, Bekelman and colleagues assessed 306 outpatients (mean age, 68.9 years; 90.2% men; 80.1% white) with COPD, ILD or heart failure; self-reported poor quality of life; and a heightened risk for hospitalization or death to find out how palliative telecare from a nurse and social worker team (ADAPT intervention) impacts quality of life vs. usual care (educational handout). Within the team, the nurse helped patients with symptom management, whereas the social worker offered psychosocial care to each patient. The nurse and the social worker each called the patient six times and met with each other, a primary care physician and a palliative care physician once a week. A pulmonologist and cardiologist joined the discussion if needed, according to researchers. Researchers used Functional Assessment of Chronic Illness Therapy-General (FACT-G) questionnaire scores to assess how quality of life changed between baseline and 6 months in both groups. A score closer to 100 signaled better quality of life, whereas a score closer to zero signaled poor quality of life. The cohort was split into the ADAPT intervention group (n = 154) and the usual care group (n = 152); however, only 112 of those from the intervention group completed a minimal dose of the intervention, including “nursing calls that included all nursing topics, all social work topics and a close-out call,” according to researchers. “We were delighted to see that the improvement in quality-of-life lasted months after the intervention ended,” Bekelman said.

For more information: http://tinyurl.com/snbjzsjw

Week of January 28, 2024

Global tobacco use tumbles despite industry lobbying

Geneva, Switzerland - Global tobacco use has tumbled in a generation with one in five people smoking versus one in three in 2000, the World Health Organization said on Tuesday. The drop comes despite what the U.N. global health agency said were ongoing efforts by Big Tobacco to seek to influence global health policies to its own advantage. "Good progress has been made in tobacco control in recent years, but there is no time for complacency," said Dr Ruediger Krech, Director of WHO Department of Health Promotion. "I'm astounded at the depths the tobacco industry will go to pursue profits at the expense of countless lives." The global report said 1.25 billion people aged 15 or over used tobacco in 2022 versus 1.36 billion in 2000. Tobacco use is set to fall further by 2030 to around 1.2 billion people even as the world's population grows, the study said. One example of tobacco companies' efforts to win influence cited by the WHO was their offers of technical and financial support to countries ahead of a major WHO meeting on tobacco control in Panama in February. The regions with the biggest portion of smokers are Southeast Asia and Europe, the WHO said, with roughly a quarter of the population. In a handful of countries, tobacco use is still rising, including in Egypt, Jordan and Indonesia, according to the study. The report published every two years gave some preliminary data on the prevalence of vaping on which the WHO is urging governments to apply tobacco-style control measures. It said there were at least 362 million adult users of smokeless tobacco products globally but admitted this might be an underestimate due to missing data. 

For more information: http://tinyurl.com/266njetc

Week of January 21, 2024

Inhaled corticosteroids increasingly used for COPD outside recommended indications

Seattle, WA - From 2010 to 2018, a rising number of veterans with COPD received inhaled corticosteroid prescriptions as first-line therapy outside recommended indications, according to results published in Annals of the American Thoracic Society. “Our study has the greatest implications for health systems that are trying to improve value-based prescribing,” Kevin I. Duan, MD, MS, acting instructor in the division of pulmonary, critical care and sleep medicine at University of Washington, reported Healio. “However, for the everyday clinician, the study is a reminder that updating our inhaler prescribing norms to better align with the latest evidence and recommendations is needed. Currently, our study suggests that just under half of patients with COPD starting inhalers are getting a therapy that is not the recommended first-line therapy.” In a cross-sectional study, Duan and colleagues analyzed 131,009 veterans with COPD and new use of inhaler therapy in the U.S. Department of Veterans Affairs between January 2010 and December 2018, to determine national trends in low-value inhaled corticosteroid prescriptions during this timeframe using multivariable logistic regression models. Researchers defined an inhaled corticosteroid prescription as “low value” if it was given to a patient without asthma, with a low risk for future exacerbations or with a serum eosinophil count of less than 300 cells/L. Of the total cohort, nearly 45% (n = 57,472) of veterans had low-value inhaled corticosteroids as their first therapy, and this prescription appeared frequently across states (range, 32%-56%). Researchers found that the chances for a low-value inhaled corticosteroid prescription grew as the years progressed, which can be seen through a 0.42 percentage-point rise (95% CI, 0.31-0.53) per year in the probability for this outcome following adjustment for several covariates. Researchers also divided the cohort according to rural (n = 54,151; mean age, 68 years; 2% women; 88% white) vs. urban (n = 76,297; mean age, 68 years; 3% women; 77% white) residence and conducted fixed effects logistic regression to see if low-value inhaled corticosteroid prescribing differed by location. Results showed the probability for low-value inhaled corticosteroids heightened by 2.5 percentage points (95% CI, 1.9-3.1) for veterans living in rural vs. urban areas after adjustment. Using the complexity level of the VA medical center where each patient was treated, researchers observed increased probabilities for low-value inhaled corticosteroid prescriptions among rural residents treated in the most complex (2.5 percentage points; 95% CI, 1.8-3.2) and moderately complex (1.6 percentage points; 95% CI, 0.01-3.2) facilities vs. urban residents. Compared with urban residents treated in a least complex facility, rural residents in the same facilities did not have a higher probability for the assessed prescription, according to researchers. “For patients with COPD, the differences in disease burden and clinical outcomes between rural and urban areas is well documented, which was part of the motivation to conduct our rural-urban analysis,” Duan told Healio. “While we did detect a small difference, I was surprised that there wasn’t a more pronounced difference. The more important finding is that the issue of low-value prescribing is widespread and persistent over time, in both rural and urban areas alike.” Further, researchers observed similar results during sensitivity analyses that used the GOLD 2017 recommendations for classifying low-value inhaled corticosteroids, which do not factor in serum eosinophil counts. A sensitivity analysis that used the 6-point National Center for Health Statistics Urban-Rural Classification scheme also showed that more rurality meant higher chances for receiving low-value inhaled corticosteroids, according to researchers. After accounting for spirometric confounders, an analysis of 12,531 veterans with spirometry results revealed a 2.2% (95% CI, 0.1%-4.3%) heightened probability for receiving low-value inhaled corticosteroids among those living in rural vs. urban areas. “Additional work is needed to evaluate whether similar prescribing patterns are occurring outside of the VA system,” Duan told Healio. 

For more information: http://tinyurl.com/4wsr6duv

Week of January 14, 2024

Daily nitrate-rich beetroot juice decreases blood pressure in COPD

London, UK - Consuming nitrate-rich beetroot juice daily for 12 weeks resulted in decreased blood pressure and better 6-minute walk distance in patients with COPD compared with placebo, according to data published in European Respiratory Journal. “At the end of the study, we found that the blood pressure of people taking the nitrate-rich beetroot juice drink was lower and their blood vessels became less stiff,” Nicholas S. Hopkinson, PhD, professor of respiratory medicine at Imperial College London, said in a press release from the European Respiratory Society. “The juice also increased how far people with COPD could walk in 6 minutes compared to placebo.” Consuming nitrate-rich beetroot juice daily for 12 weeks resulted in decreased blood pressure and better 6-minute walk distance in patients with COPD compared with placebo, according to data published in European Respiratory Journal. In a randomized, double-blind, placebo-controlled parallel trial, Hopkinson and colleagues assessed 81 patients with COPD and a home systolic blood pressure of 130 mmHg or higher to determine if 70 mL of nitrate-rich beetroot juice (n = 40) per day for 12 weeks positively changed blood pressure vs. nitrate-depleted placebo juice (n = 41). Researchers also evaluated 6-minute walk distance, measures of endothelial function, plasma nitrate and platelet function between the two groups. Baseline characteristics of each group were similar. Within the total cohort, none of the patients experienced a serious adverse event; however, three patients (active treatment, n = 1; placebo, n = 2) withdrew because the juice was “unpalatable,” according to researchers. By week 12, patients drinking nitrate-rich beetroot juice had greater reductions in systolic blood pressure vs. patients drinking nitrate-depleted placebo juice (Hodges-Lehmann estimator treatment effect, –4.5 mmHg; 95% CI, –3 to –5.9). Researchers also observed more improvement in 6-minute walk distance among individuals in the nitrate-rich juice group (+30.04 m; 95% CI, 15.7-44.2). Notably, this measurement was only collected from 24 patients in the nitrate-rich juice group and 20 patients in the placebo group. To assess endothelial function, researchers used an EndoPAT device (Itamar Medical) and found improvements in reactive hyperemia index (+0.34; 95% CI, 0.03-0.63) and augmentation index corrected for heart rate 75% (–7.61%; 95% CI, –14.3% to –0.95%) among those drinking the nitrate-rich juice vs. the nitrate-depleted placebo juice. Patients consuming the nitrate-rich juice also had a “substantial increase” in plasma nitrate at the end of the study compared with baseline, according to researchers. Between the two groups, researchers did not find any changes in platelet aggregation. “This is one of the longest-duration studies in this area so far,” Hopkinson said in the release. “The results are very promising, but will need to be confirmed in larger, longer-term studies.” 

For more information: http://tinyurl.com/by7cvjnk

Week of January 7, 2024

Tobacco smoking attributed to more than 1 million cancer deaths in seven countries

Lyon, France - A total of 1.9 million cancer deaths were attributable to alcohol, tobacco smoking, excess body weight and HPV infections. Smoking tobacco resulted in 20.8 million years of life lost among patients with cancer. Among four preventable risk factors for cancer mortality, smoking tobacco resulted in the most deaths and years of life lost in seven countries, according to data published in eClinical Medicine. “We concluded that smoking, alcohol, overweight/obesity and HPV infections are the drivers of almost 2 million deaths from cancer across seven countries every year,” Harriet Rumgay, PhD, postdoctoral scientist of cancer surveillance at the WHO International Agency for Research on Cancer, said. “These findings highlight the key role of primary prevention to reduce cancer mortality by saving millions of lives from preventable cancers.” In a population-based study, Rumgay and colleagues assessed the estimated number of deaths and years of life lost (YLLs) to cancer in 2020 caused by alcohol consumption, tobacco smoking, overweight/obesity and HPV infections in Brazil, Russia, India, China, South Africa, the U.K. and the U.S. to evaluate the impact of these factors in patients with cancer across the world. Researchers determined the number and age-standardized YLL rates (ASYR) through life tables. When evaluating each risk factor in all seven countries, tobacco smoking contributed to the most cancer deaths (1.3 million) in 2020, followed by alcohol consumption (326,300 deaths), excess body weight (208,000 deaths) and HPV infection (190,400 deaths) for a total of 1.9 million deaths. Researchers further found that tobacco smoking was linked to the highest estimated YLLs out of the four factors, at 20.8 million. The second highest estimate of premature deaths was due to alcohol consumption (5.9 million), followed by HPV infection (4 million) and excess body weight (3.1 million). “We wanted to stress the continued impact of tobacco smoking on the burden of cancer, as we found that of the 2 million deaths from cancer due to the four risk factors in the seven countries, smoking was the driver of 1.3 million,” Rumgay told Healio. “Of the 30 million years of life lost from cancer due to the four risk factors, tobacco smoking had the biggest impact by far, leading to 20.8 million years of life lost. Our findings show that tobacco control should still be a priority even in countries where smoking rates have fallen, like the U.S. and U.K., as huge numbers of deaths from cancer due to tobacco are still emerging today.” 

For more information: https://tinyurl.com/3cm8sted