COPD World News Week of June 24, 2012

Secondhand smoke tied to more health effects

New York, NY - People regularly exposed to secondhand smoke may have increased risks of dying from various causes, a long-term study from China suggests. Researchers found that compared with adults who lived and worked in smoke-free environs, those exposed to secondhand smoke were more likely to die of heart disease or lung cancer over 17 years. And they were also more likely to die of stroke or the lung disease emphysema -- two diseases that have had relatively weaker links to secondhand smoke. The findings, which appear in the medical journal Chest, cannot definitively prove that secondhand smoke is the culprit. But the researchers were able to account for some other key factors, like a person's age, education, job, and blood pressure and cholesterol levels. And the links between secondhand smoke and mortality remained, say the researchers, led by Dr. Yao He of Chinese PLA General Hospital in Beijing. "This is exactly the type of study design you want to see," said Joanna Cohen, director of the Institute for Global Tobacco Control at Johns Hopkins Bloomberg School of Public Health in Baltimore. Cohen, who was not involved in the research, pointed out that the study followed people over many years, and it found evidence of a "dose-response" relationship -- meaning people's risks climbed as their secondhand smoke exposure increased. Those things are considered key in building the case for a cause-and-effect relationship. A number of studies have found that non-smokers who regularly breathe in other people's tobacco smoke have an increased risk of developing heart disease or certain cancers, including lung tumors. In the U.S., the most recent Surgeon General's report said there was "suggestive" evidence that secondhand smoke might boost people's risk of stroke and emphysema, also known as chronic obstructive pulmonary disease or COPD. But the evidence was considered insufficient to say there was a "causal relationship," Cohen noted. "This type of study," she said, "is important for adding to evidence of a causal relationship." Cohen also said it was "huge" that the information was coming from China. "It's the country with the most number of smokers," she pointed out. And, she said, it is trailing other nations in anti-smoking education and tobacco control. The current findings are based on 910 adults who were followed over almost two decades. At the start, 44 percent said they lived with a smoker, while 53 percent said they inhaled secondhand smoke at work. Over the following years, 249 study participants died. And the risks of death from heart disease, stroke, lung cancer and emphysema were all two to three times higher among people exposed to secondhand smoke. Among men, for example, 11 percent of the 271 men exposed to secondhand smoke died of stroke. That compared with 6.5 percent of the 168 men who lived and worked in smoke-free surroundings. The numbers of people who died of each specific cause were fairly small, which is a limitation. "When numbers get small," Cohen said, "it makes it more difficult to get a precise estimate" of risks. But she said the results do support evidence that secondhand smoke may boost the risks of not only heart disease and certain cancers, but stroke and emphysema as well.

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COPD World News Week of June 17, 2012

Study Ties Secondhand Smoke to Bladder Irritation in Kids

Hamilton, NJ - Parents who smoke may put their children at greater risk for bladder irritation, according to a small new study. Young children between the ages of 4 and 10 were at particular risk from exposure to secondhand smoke. Bladder irritation involves the urge to urinate, urinating more frequently and incontinence. The study revealed that exposure to secondhand smoke is linked to more severe symptoms of bladder irritation: The more exposure the children had, the worse their symptoms became.  Led by Dr. Kelly Johnson, researchers from Robert Wood Johnson University Hospital and Rutgers University analyzed survey information on 45 children ranging in age from 4 to 17. All had symptoms of bladder irritation. The researchers divided the children into four groups based on the severity of their symptoms: very mild, mild, moderate or severe. Twenty-four of the children studied had moderate to severe symptoms of bladder irritation, while 21 had mild or very mild symptoms. The children with moderate or severe symptoms were more likely to have consistent exposure to secondhand smoke, the researchers noted. Of these kids, 23 percent had a mother who smoked and 50 percent of them were regularly exposed to secondhand smoke while riding in a car. On the other hand, the children whose mother didn't smoke and were not exposed to secondhand smoke in the car had only very mild or mild symptoms of bladder irritation. The study was expected to be presented Sunday at the annual meeting of the American Urological Association in Atlanta. The data and conclusions should be viewed as preliminary until published in a peer-reviewed journal. "Secondhand smoke is a leading cause of preventable death in the United States," Dr. Anthony Atala, a pediatric urologist at Wake Forest Baptist Medical Center and a spokesman for the AUA, said in an association news release. "Beyond conditions such as lung cancer, heart disease and asthma, we now know that smoking has a negative impact on urinary symptoms, particularly in young children. Data presented today should be added to the indisputable evidence that parents shouldn't smoke around their children." While the study uncovered a link between secondhand smoke and bladder problems, it did not prove a cause-and-effect.

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COPD World News Week of June 10, 2012

Self-Management Program Flops for COPD

Washington, DC - A clinical trial of self-management in patients with chronic obstructive pulmonary disease was stopped early because of excess deaths and without a hoped-for decrease in hospitalizations, researchers reported. The Department of Veterans Affairs multi-site randomized trial, conducted among more than 400 patients, recorded 28 deaths in the intervention group compared with 10 in the usual care group (HR 3.60, 95% CI 0.99 to 13.08), with COPD accounting for the largest proportion of the difference, Vincent S. Fan, MD, MPH, and colleagues reported in the May 14th issue of the Annals of Internal Medicine. "We cannot explain the unexpected increase in mortality in the intervention group," Fan and co-authors wrote. "Whatever the reason, our findings suggest that self-management or intensive management protocols may not be appropriate for all subsets of patients with COPD." The use of comprehensive care management programs is usually associated with improved patient satisfaction, adherence, and disease control in patients with chronic illnesses such as diabetes and arthritis, the authors noted in their introduction. However, trials of such programs in COPD patients "are few in number and highly variable in terms of patients, interventions, outcomes, duration of follow-up, and quality," they wrote. The investigators wanted to find out if COPD patients would be able to avoid hospitalization by taking part in an intense self-management and self-monitoring program. They undertook a trial that enrolled a total of 426 patients at 20 sites; 209 patients were chosen for the intervention and 217 were assigned to usual care (an informational booklet on COPD). Participants in the study were overwhelmingly male (97%), white (86-88%), with a median age of 66, and around 28% were current smokers. Eligibility requirements included age older than 40 years, current or past history of smoking (equivalent to 10 pack-years), hospitalization for COPD within in the previous 12 months or least one visit in the past year to either a primary care or pulmonary clinic at a Veterans Affairs medical center, and no disease exacerbations in the past 4 weeks. Eligible patients were also required to have a post-bronchodilator ratio of FEV1 to FVC below 0.70, with an FEV1 below 80% predicted. Exclusion criteria included a primary diagnosis of asthma or any medical condition that would impair patient ability to provide informed consent. The intervention consisted of 4 weeks of 90-minute education sessions, which included an action plan to identify and treat COPD exacerbations and scheduled telephone calls from a case manager. Patients in both groups were provided with a COPD information booklet and their physicians were given a copy of COPD guidelines and instructions to follow them.  Researchers were supposed to follow both groups to the time of first hospitalization. But the trial was stopped early because of excess mortality after enrolling only half of the hoped-for patients, Fan told MedPage Today in an interview. "We were surprised that the intervention was unsuccessful in changing behaviors and had no effect on hospitalizations," he said. Among the 209 patients enrolled in the intervention group, 28 deaths occurred from all causes versus 10 in the usual care group. Among those in the intervention group, COPD accounted for the largest proportion of the difference -- 10 deaths. There were no differences seen in the number of hospitalizations or the time to initiation of treatment for an acute exacerbation of COPD. The researchers could not determine the reason that intervention patients did not initiate treatment sooner. It's difficult to figure out why self-management didn't work, Stuart J. Pocock, PhD, of the London School of Hygiene & Tropical Medicine, wrote in an accompanying editorial. "Although one can argue post hoc about how the protocol of this current trial differs from the others, nothing convincing comes to light; therefore, the possibility of chance must be considered when interpreting these data," he wrote. "It may be best to think of this trial as having stopped for futility -- there was no hint of any beneficial effect on the primary outcome," Pocock continued. "On the other hand, the possibility that genuine harm was done by this behavioral intervention cannot be dismissed. Perhaps insufficient evidence was collected by the investigators about the detailed consequences of the educational package, thus denying us any causal insight into the excess mortality." Limitations of the study included the inability to determine a specific cause of death in a high proportion of cases, lack of generalizability to other populations, and inability to study the accuracy of the educational materials or the manner in which the intervention was delivered, Fan and colleagues noted. The authors also stressed that threats to internal validity, such as biased group assignments or outcome assessments did not appear to contribute to the findings.

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COPD World News Week of June 3, 2012

Acupuncture may help some people with COPD

Southhampton, UK - Three months of acupuncture improved breathing problems in people with chronic lung disease, in a new study from Japan. According to one researcher, the benefits seen with the alternative treatment were on par with, or better than, what's been shown for conventional drugs and exercises used to treat the disease. But the study was small, he added, and more research will be needed to convince doctors and policymakers of acupuncture's usefulness. "We don't know if this is going to extend life, but the study suggests it improves quality of life," said Dr. George Lewith, from the University of Southampton in England. "If I had enough money and I was the patient, I would give acupuncture a try." Chronic obstructive pulmonary disease, or COPD, is irreversible impairment of lung function, including emphysema and chronic bronchitis, often caused by smoking. One large national health survey suggested 24 million Americans have the condition, according to the Centers for Disease Control and Prevention. Shortness of breath is one of the main symptoms of COPD. Typical treatment includes steroids and bronchodilators, as well as breathing exercises. Because of that, it's not totally surprising that an alternative therapy known to promote relaxation would help patients with breathing problems, according to Lewith. "What acupuncture does is it seems to relax all the muscles around the chest wall," said Lewith, who wrote a commentary published with the new study in the Archives of Internal Medicine. "It's absolutely consistent with what we're trying to do conventionally, which is help with their breathing exercises and their relaxation techniques." The new findings are based on 68 patients treated with real or fake acupuncture. More robust studies will be needed before health insurance companies and programs like Medicare, for example, start funding acupuncture for this group, Lewith said. For this study, researchers led by Masao Suzuki from Kyoto University in Japan randomly spilt patients with COPD and trouble breathing into two groups. Half of them had weekly acupuncture sessions, with needles placed at points on the arms, stomach, back, chest and legs that have been tied to asthma and other lung problems. Participants in the comparison group went through similar sessions but with sham acupuncture treatment -- when practitioners use needles that don't actually pierce the skin. All patients were allowed to stay on whatever medications they were already taking. Before starting treatment and at the end of the 12 weeks, patients did a standard six-minute walking test when researchers measured how far they got in that time and how much breathing trouble they had doing it. Breathlessness was assessed on a standard 10-point scale, with 10 representing the most difficulty breathing. In the real acupuncture group, shortness of breath was initially rated at 5.5 out of 10 after walking. After 12 weeks of treatment, that fell to 1.9. The average distance those patients were able to walk in six minutes also improved, from about 370 meters to 440 meters. In the comparison group, breathlessness scores held steady -- at 4.2 before treatment and 4.6 after -- and there was no improvement in patients' walk distance. "In a disease like COPD, we need to expand our thinking and come up with varying strategies to improve quality of life and relieve breathlessness," said Dr. Ravi Kalhan, head of Northwestern University Feinberg School of Medicine's asthma and COPD program in Chicago. Some patients respond better to conventional medications than others, he said -- and it's promising that people in the new study seemed to benefit from acupuncture over and above the effect of those drugs. Costs of acupuncture vary widely by location and practitioner, but a single session can run for about $100 and is often not covered by insurance. That may not be feasible for typical COPD patients, according to Lewith, who are often older and working class. But for people who can spare the cost, the researchers agreed there's nothing stopping them from trying out the alternative therapy. "For me, as long as the therapy is safe and someone wants to try it and it might help and won't hurt, I absolutely encourage it," Kalhan, who wasn't involved in the new study, told Reuters Health. "I don't think we have enough of a data base to recommend it and say: ‘This is going to help you,'" he said. "I would always prioritize traditional medicine over this right now."

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COPD World News Week of May 27, 2012

Secondhand Smoke May Harm Heart Function

San Francisco, CA - For non-smokers, exposure to low levels of secondhand smoke for just 30 minutes can cause significant damage to the lining of their blood vessels, the results of a new study indicate. The findings could have major public health implications because this type of damage has been associated with atherosclerosis (hardening of the arteries), which can lead to heart attack or stroke. "Breathing in very low levels of secondhand smoke -- the same amount many people and children would encounter out and about in the community -- appears to impair one's vascular function after just 30 minutes of exposure," the study's lead investigator, Dr. Paul Frey, of the division of cardiology at San Francisco General Hospital, said in a news release from the American College of Cardiology. "These findings have significant public health implications," Frey added. "We saw a steep decline in vascular function even after a very short exposure to low levels of secondhand smoke, and that's very concerning." The researchers used a smoking machine to produce specific particulate concentrations and measured its effects on 33 healthy non-smokers ranging in age from 18 to 40 years old. The non-smokers were divided into three groups and exposed to one of three levels of secondhand smoke: clean air; lower levels of lingering smoke found in smokers' homes or a restaurant; and high levels found in a smoky bar or casino. "We were able to faithfully characterize the concentration of secondhand smoke people were exposed to and produce very low levels that have not often been studied," Frey explained. The study, published in the May 22 issue of the Journal of the American College of Cardiology, revealed that a major blood vessel found in the upper arm, called the brachial artery, did not dilate properly in the people exposed to lingering secondhand smoke. This happened, the authors explained, because the inner lining of the blood vessels was not working properly. The investigators noted that the effect on the participants' cardiovascular function may have been greater if the study repeated short exposure rather than measure a one-time interval. Repeated exposure would also more closely resemble everyday life, they pointed out in the news release. The researchers concluded that more comprehensive policies are needed to ban public smoking. They also suggested that doctors should talk to their patients about whether or not they live with a smoker or are occasionally around or near people who smoke. "Smoking remains one of the most preventable risk factors for cardiovascular disease," Frey said. "We hope this study will reinforce to smokers the danger their habit has -- not only on their own heart health, but also to other people -- even if they move to the next room or smoke for short durations." Although the study uncovered an association between secondhand smoke and blood vessel damage, it did not prove a cause-and-effect relationship.

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COPD World News Week of May 20, 2012

Many Women Still Smoke During Pregnancy

Rockville, MD - Too many American women still smoke during their pregnancies, a new report finds, and rates of such smoking vary widely depending on race. Researchers found that almost 22 percent of pregnant white women aged 15 to 44 smoked cigarettes within the previous 30 days, compared with just over 14 percent of pregnant black women and 6.5 percent of Hispanic women in the same age range. The rate of illicit drug use during pregnancy, however, was higher among black women (7.7 percent) than among white women (4.4 percent) or Hispanic women (about 3 percent), according to the Substance Abuse and Mental Health Services Administration study, released Wednesday. Rates of alcohol use during pregnancy were about the same for black and white women (12.8 percent and 12.2 percent, respectively), and much higher than among Hispanic women (7.4 percent), according to the study. The findings are based on an analysis of data from the administration's 2002 to 2010 national surveys on drug use and health. "When pregnant women use alcohol, tobacco or illicit substances they are risking health problems for themselves and poor birth outcomes for their babies," Pamela Hyde, administrator at the Substance Abuse and Mental Health Services Administration, said in a government news release. "Pregnant women of different races and ethnicities may have diverse patterns of substance abuse," Hyde said. "It is essential that we use the findings from this report to develop better ways of getting this key message out to every segment of our community so that no woman or child is endangered by substance use and abuse."

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COPD World News Week of May 13, 2012

Prenatal Smoking Linked to High-Functioning Autism in Kids

Milwaukee, WI - If a woman smokes during pregnancy, it may increase her child's risk of high-functioning autism, a new study suggests. But the raised risk was slight, experts said. And researchers found no association between maternal smoking and more severe forms of autism. What the findings suggest is that although autism spectrum disorders share many of the same symptoms, subtypes of the disorder likely have many different genetic and environmental causes that vary from person to person and by type of autism, explained study author Amy Kalkbrenner, an assistant professor in the University of Wisconsin-Milwaukee Zilber School of Public Health. "We know 'autism spectrum disorders' is an umbrella term. What we're showing is the response to a environmental toxin may differ by the subtype of autism a child has," Kalkbrenner said. The study was published online in the journal Environmental Health Perspectives. Kalkbrenner and her colleagues examined data on maternal smoking from birth certificates of nearly 634,000 U.S. children born in 11 states in 1992, 1994, 1996 and 1998. That data was compared with information on 3,315 children aged 8 and under diagnosed with an autism spectrum disorder from the U.S. Centers for Disease Control and Prevention's Autism and Developmental Disabilities Monitoring Network. About 13 percent of the mothers smoked during pregnancy, and 11 percent of the mothers of kids with an autism spectrum disorder smoked during pregnancy, the investigators found. According to the study, kids born to moms who smoked during pregnancy had about a 25 percent increased risk of having high-functioning autism, such as Asperger's syndrome. However, the results did not reach statistical significance. Nor was smoking a clear risk factor for autistic disorder (a more severe form of autism). The researchers noted that the data used in the study may underestimate the true prevalence of autism spectrum disorders among mothers who smoke because lower-income kids are less likely to be identified as having autism, and lower-income mothers are also more likely to smoke during pregnancy. When researchers did another statistical analysis that took into account a suspected undercounting of kids with autism, the analysis did suggest a statistically significant association between smoking and high-functioning autism in offspring. Alycia Halladay, director for environmental research for Autism Speaks, said the research is consistent with prior studies that have found either no association or only a mild association between smoking during pregnancy and autism in children. What's interesting about this paper is that it included data on large numbers of kids, she added, and it hinted at differences in the contributing factors for various types of autism spectrum disorders. "It really supports the idea that there are multiple causes of autism, both genetic and environmental. When we talk about autism being one group or disorder, we really need to ensure we have these groups as well-defined as possible," Halladay said. "This is a very heterogeneous disorder." There are multiple reasons why tobacco might raise the risk of autism, Kalkbrenner noted. Tobacco can restrict oxygen flow to the baby, while the nicotine is known to interact with the nervous system and cross the placenta into the developing fetus. "There are many potential biological pathways for which tobacco can harm the developing baby," she said. Autism is a neurodevelopmental disorder that's characterized by problems with social interaction, verbal and nonverbal communication and restricted interests and behaviors. An estimated one in 88 U.S. children has the disorder, according to the CDC.

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COPD World News Week of May 6, 2012

Cardiologists Urged to Lead in Smoking Cessation

Dublin, Ireland - Cardiologists as a group have largely ignored tobacco as a modifiable risk factor, concentrating instead on hypertension and dyslipidemia, a pattern Ottawa cardiologist Andrew Pipe, MD, calls "substandard care." Pipe is one of the moving forces behind the "Ottawa Model for Smoking Cessation," a cardiac-based program that boasts a "35% to 50% absolute cessation rate" and "over 450 bed-days saved at the University of Ottawa Heart Institute in 2009 with a $200,000 investment." Ian Graham, MD, of Trinity College in Dublin, called the Ottawa program a blueprint for success and thus far unequaled. Graham co-chaired the program committee at the EuroPRevent meeting where Pipe described his program. A key to its success, Pipe said, was the buy-in from cardiologists, who previously gave only passing recognition to smoking. When a patient with hypertension or hypercholesterolemia came to the emergency department it would "set off alarms and lights" and galvanize staff into action, but when a smoker was admitted, the cardiologist would usually wag a finger at the patient and remind him or her of the need to stop smoking. "Meanwhile, every year we admitted 2,000 smokers upstairs," Pipe said in describing the "ah-ha" moment that led to the Ottawa Model. But even as he recognized the need for action, he said that many colleagues said that an admission for STEMI or other acute event was "not the time to address smoking cessation, too stressful." Pipe counters that the hospital is the ideal place to initiate smoking cessation for several key reasons: There are large numbers of smokers admitted to the hospital, and smoking is a relevant factor in those admissions. A heart attack can provide a potent motivation to quit. Hospitals have available staff to work with the smoker, and the variety of staff makes the hospital an ideal incubator for a systemic approach to smoking cessation. Pharmacotherapy for both withdrawal and cessation is available in hospitals. Treating cardiologists can arrange follow-up Follow-up, Pipe said, needs to be at least 6 months, and in the Ottawa model it starts with a phone call. "A call that is delivered at a time that is convenient for the patient, in a voice and a language that are understandable for the patient," he said. The initial call consists of carefully constructed questions that can be answered with a simple "Yes" or "No." Those answers are then color-coded: red suggesting a patient at high risk of relapse or one who has already relapsed, yellow signaling a patient who has significant problems with cessation. Using the color-coded responses, a team of nurses follows up with the patients. The goal of the program, Pipe said, is to get the patients to a point where they are comfortable without cigarettes and are no longer craving nicotine -- a tough goal since most patients will have several relapses. But Pipe said that multiple relapses should not be considered failure by either the patient or the physician because "every smoker who has successfully stopped smoking has a history of multiple failed attempts. Each attempt increases the likelihood of eventual success." 

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COPD World News Week of April 29, 2012

Secondhand Smoke Permeates Many Apartment Buildings: Study

Denver, CO - A new survey of American apartment dwellers reveals that upwards of a third of nonsmoking residents sniff the stench of secondhand smoke in their building's public spaces, while almost half smell it within their own homes. "As a pediatrician, I have had a lot of feedback from parents who have been telling me that this is really a significant issue for them," said study author Dr. Karen Wilson. "But I do think for many people this is a relatively new concept to think about, in terms of looking at the situation and the potential impact, and then being able to do something about it." Wilson is the section head of pediatric hospital medicine at Children's Hospital Colorado, and an assistant professor of pediatrics at the University of Colorado School of Medicine. The researchers surveyed apartment residents whose own homes had been smoke-free for a minimum of three months. All the participants were drawn from a larger 2011 Social Climate Survey. They were asked about their building's smoking restrictions; family composition; where they smelled secondhand smoke and how often. Among those who reported smelling secondhand smoke, 38 percent said it happened weekly and 12 percent said they noticed the smell daily. Nonsmoking residents were more likely to indicate that the smell of secondhand smoke was an issue in common areas if they had children. Building regulations only seemed to have an appreciable impact on secondhand smoke if they involved total bans, the survey found. Smoke-free buildings had lower rates of common-area smoking incursion than those with no restrictions. By contrast, secondhand smoke smells in public spaces was as much of a problem in buildings featuring common-area-only bans as they were in buildings featuring no restrictions whatsoever. "We clearly saw that a total ban is much more effective than a partial ban," Wilson noted. "And with that I would say that while I absolutely support moves to ban smoking in the workplace, at the very least adults have some choice in the matter in terms of their being able to leave a job or go somewhere else if they come into a work environment where smoking is still allowed. Children in the home, however, do not have that choice." "Parents need to advocate and speak up, and say 'I don't want my children to be exposed while they're sleeping, doing their homework or playing at home,'" she added. "And they should ask their landlord about smoking regulations in any apartment building they're considering before they move in." "We certainly think that residents have an absolutely legitimate right to at least know whether they are going to be exposed to this kind of health risk when they are considering moving into an apartment," said Marie Cocco, a spokeswoman for the Campaign for Tobacco-Free Kids. "Because we know that secondhand smoke is a deadly substance that contains more than 7,000 chemicals, 69 of which, at least, cause cancer." Cocco said her organization has publicly endorsed measures, such as the one recently unveiled by New York Mayor Michael Bloomberg, which would require multi-dwelling apartment buildings to fully disclose their smoking policy to all prospective renters and buyers. Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

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COPD World News Week of April 22, 2012

Early Exposure to Smoking May Predict COPD

Bergen, Norway - Exposure to tobacco smoke may predispose girls to developing chronic obstructive pulmonary disease as adults, a Norwegian study showed. Women who said they were exposed to environmental tobacco smoke as children were nearly twice as likely to have COPD as those who were not exposed, according to Ane Johannessen, PhD, of Haukeland University Hospital in Bergen, Norway, and colleagues.The relationship did not reach statistical significance among men, although early-life exposure to smoke was associated with greater odds of certain COPD-related symptoms, including morning cough, cough with phlegm, and chronic cough. "Although active smoking is still the most important risk factor for COPD, reduction of childhood environmental tobacco smoke exposure could contribute to the prevention of COPD and respiratory symptoms," they concluded. Johannessen and colleagues looked at data from 433 patients with COPD and 325 controls ages 40 to 79. All underwent spirometry and completed questionnaires about respiratory symptoms and risk factors for COPD. The patients with COPD had a smoking history of more than 10 pack-years. Overall, 61% of the patients and controls reported being exposed to environmental tobacco smoke for at least one year of their childhood. After adjustment for several variables, including age, smoking status, and pack-years smoked, smoke exposure in childhood was associated with a higher likelihood of having COPD among women, but not men. Other predictors of COPD among the women included occupational dust or gas exposure, a family history of COPD, and lower educational achievement). In addition, family history was associated with all of the respiratory symptoms, current exposure to tobacco smoke in the home was associated with morning cough, and lower educational achievement was associated with dyspnea. Among the men, the risk factors for COPD included occupational dust or gas exposure, family history and level of education. Dyspnea was predicted by occupational dust or gas exposure and family.

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COPD World News Week of April 15, 2012

Could Menthol Cigarettes Pose Even Higher Stroke Risk?

Toronto, ON - Menthol cigarettes may pose an even greater risk for stroke than other types of cigarettes, especially for women and non-black smokers, says a new, large study. In the latest look at the hazards of menthols vs. regular cigarettes, Canadian researchers found the stroke risk for those who smoked menthols was more than twice that for regular-cigarette smokers. And for women and non-blacks, the risk was more than three times higher. But no elevated risk was seen between mentholated cigarette smoking and high blood pressure, heart attack, heart failure and the lung disease chronic obstructive pulmonary disease (COPD), the researchers said. Exactly how, or if, smoking menthol cigarettes raises risk of stroke more than other cigarettes types is not fully understood."One potential mechanism is that menthol stimulates upper-airway cold receptors, which can increase breath-holding time, which may in turn facilitate the entrance of cigarette particulate matter into the lungs," said study author Dr. Nicholas Vozoris of St. Michael's Hospital, in Toronto. "Why smoking mentholated cigarettes would not result in an increase in forms of cardiopulmonary disease, other than stroke, is not clear." Vozoris said the new study has several limitations. The researchers didn't account for drug treatment that might have affected the findings, and the smoking habits were self-reported. Also, former smokers weren't included in the data. Dr. Clinton Wright, an associate professor of neurology at the University of Miami, Miller School of Medicine, said that more study is needed before any conclusions can be drawn about specific health risks associated with specific types of cigarettes."Very little work has been done on mentholated cigarettes," he said. Also, the new study "only shows an association, it does not show any cause and effect," he added. Still, "mentholation may have chemicals involved in the process that may carry their own risks," he said.

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COPD World News Week of April 8, 2012

Biomarkers Help Predict COPD Prognosis

San Francisco, CA - A panel of biomarkers can improve mortality predictions in chronic obstructive pulmonary disease, researchers reported. In a prospective study, the seven biomarkers -- all involved with inflammation -- were each associated with an increased risk of death in COPD patients, according to Bartolome Celli, MD, of Brigham and Women's Hospital in Boston, and colleagues. And taken together, they markedly improved the ability of clinical factors to predict mortality. "COPD is characterized by low-grade inflammation, so we hypothesized that the addition of inflammatory biomarkers to established predictive factors would improve the prediction of mortality," Celli said in a statement. The biomarkers under investigation were white blood cell and neutrophil counts and serum or plasma levels of fibrinogen, chemokine ligand 18, surfactant protein D, C-reactive protein, Clara cell secretory protein-16, interleukin-6 and -8, and tumor necrosis factor alpha. For most of them, Kaplan-Meier analysis showed that levels higher than the median in control participants were significantly associated  with an increased risk of death at 3 years. The suite of biomarkers "was not only elevated in non-survivors in our cohort, but was associated with mortality over three years of follow-up after adjusting for clinical variables known to predict mortality in patients with COPD," Celli said. The researchers cautioned that the study did not attempt to specify causes of death and did not have a validation cohort. As well, they noted, some biomarkers thought to be important in the disease were not studied. Nonetheless, Celli said, "this is the first study to show that the addition of biomarker levels to clinical predictors in COPD patients adds relevant prognostic information."

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COPD World News Week of April 1, 2012

Big tobacco to show chemicals used orders FDA

Silver Spring, Maryland - Starting in June, makers of cigarettes and other tobaccos products will be required to report data on potentially harmful chemicals in their products to the FDA. Companies will eventually have to tell FDA which of 93 chemicals are in their products, but will only be required to report on a list of 20 for which there are established tests by June, Lawrence Deyton, MD, director of the FDA's center for tobacco products, said during a call with media. The chemicals include ammonia, formaldehyde, nicotine, nitrosamines, carbon monoxide, and other chemicals that have been associated with cancer, lung disease, or addiction, Deyton said. Deyton said consumer-friendly information on the quantities of chemicals in the products will be made available by April 2013, and that the agency is currently evaluating the most effective methods for doing so. The FDA provides guidance for companies looking to market their products as lower-risk than other available tobacco products. It tells companies how to apply for this status, as well as what kinds of studies are needed to demonstrate that these products actually reduce harm, Deyton said. He noted that all raw data, both positive and negative, will have to be submitted, and that postmarketing studies will be required. Also, the FDA is recommending that study sponsors have a third party design and conduct the research, he said. "This prohibits companies from marketing their products as less harmful unless specifically authorized by the FDA," Deyton said. "Many of us who have been in this business a long time know that in the past, products marketed as low-tar, low-nicotine, or 'lite' were [perceived by] customers as reducing their risk, but that was not the case." He added that there are currently no low-risk products on the market. There will be two pathways to approval of modified-risk products: one allows for companies to say their products actually reduce harm if they have the science to substantiate that claim. The other allows companies to say that their products reduce exposure to potential harms based on the available science, but they won't be able to claim that they've actually reduced harm.

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COPD World News Week of March 25, 2012

New 24-hour long-acting beta2 agonist for COPD

Dorval, PQ - Novartis Pharmaceuticals Canada has introduced a new long-acting beta2-agonist (LABA) for the treatment of Chronic Obstructive Pulmonary Disease (COPD) in adults. According to their press release, this once-daily medication - Onbrez Breezhaler (indacaterol maleate) - offers rapid and sustained improvement in lung function over 24 hours, reduces the need for rescue medication during the day and night and improves patients' quality of life. The approved indication is for long-term, once-daily, maintenance bronchodilator treatment of airflow obstruction in patients with COPD, including chronic bronchitis and emphysema. The recommended dose is 75 mcg once daily. Immediate and sustained bronchodilation is central to managing COPD. “COPD patients want simple, convenient and effective therapies that provide symptom relief. We've seen the Onbrez Breezhaler open narrowed breathing passages within minutes of first dose and keep the airways open for 24 hours," said Dr. Kenneth Chapman, Director of the Asthma and Airway Centre of the University Health Network and Director of the Canadian Registry for Alpha1 Antitrypsin Deficiency. “Patients with COPD will often forget to take their medications if they need to be taken frequently; a once daily regimen is a step forward in insuring that patients enjoy optimal benefit from their medication.”

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COPD World News Week of March 18, 2012

Ban on Public Smoking Linked to Fewer Preterm Deliveries

Glasgow, Scotland - A smoking ban in Scotland is associated with decreases in preterm deliveries and underweight babies, a new study finds. The nationwide ban on smoking in public places took effect in March 2006. The researchers analyzed data on preterm delivery and small-for-gestational-age babies born between January 1996 and December 2009. The number of mothers who smoked dropped from more than 25 percent before the smoking ban to about 19 percent after the ban. The researchers also found that preterm deliveries fell by more than 10 percent, while there was a nearly 5 percent decrease in the number of infants born small and a nearly 8 percent decrease in the number of infants born very small. These decreases in preterm deliveries and underweight babies occurred both in mothers who smoked and in those who had never smoked, a finding that highlights the impact of secondhand smoke, the researchers said. "The results of our study add to the growing evidence of the wide-ranging health benefits of smoke-free legislation and lend support to the adoption of such legislation in countries where it does not currently exist," the study authors, led by Jill Pell of the University of Glasgow, concluded in a journal news release. While researchers found an association between the smoking ban and decreases in preterm births and low birth-weight babies, the study did not prove those decreases were a direct result of the ban.

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COPD World News Week of March 11, 2012

Hot Dogs, Bacon May Worsen COPD

Boston, MA - Patients with chronic obstructive pulmonary disease (COPD) who eat too much cured meat -including bacon and hot dogs - may be putting themselves at risk for a return trip to the hospital, a Spanish study showed. Those who reported eating more than the equivalent of about one slice of ham per day were twice as likely to be readmitted for COPD, according to Judith Garcia-Aymerich, MD, PhD, of the Center for Research in Environmental Epidemiology in Barcelona, Spain, and colleagues. The association appeared to be weaker in patients who were taking inhaled corticosteroids and in those with mild-to-moderate disease, the researchers reported. "This study adds new evidence suggesting that in addition to a possible increase in risk of COPD associated with cured meats, these foods may also increase risk of exacerbations, thus supporting the need of considering specific dietary advice to COPD patients," the authors wrote.Although smoking remains the primary risk factor for COPD, recent studies have identified an association between the consumption of cured meats and the risk of developing the disease. Garcia-Aymerich and colleagues set out to explore whether there's also an association with a worsening of COPD, as indicated by hospital readmission. They examined data from 274 patients with COPD who were recruited during their first disease-related admission to one of nine Spanish hospitals. The patients provided information on how much cured meat -- including cooked ham, Spanish cured ham, sausages, and hot dogs -- they ate in the previous two years. The median reported intake of cured meat was 23 grams per day. Most of the patients (93%) were male, and the average age was 68. A large minority (42%) of the total patient population were current smokers, but significantly more in the high cured-meat-consumption group than the low smoked. Overall, 5% had mild disease, 52% had moderate disease, 37% severe, and 6% very severe disease. Through a median follow-up of 2.6 years, 35% of the patients had at least one COPD readmission. The researchers acknowledged that the study was limited by the possibility of errors in measuring cured meat intake, the potential for survival bias introduced by inclusion of patients who died before the first COPD readmission (although that was only 1%), and the lack of information on dietary changes after baseline.

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COPD World News Week of March 4, 2012

Poor Lung Function Linked to Heart Failure in Study

Chapel Hill, NC - Reduced lung function and obstructive airway disorders such as chronic obstructive pulmonary disease (COPD) increase the risk of heart failure, a new study has found. In patients with heart failure, the heart can't pump enough blood to meet the body's needs. For the new study, researchers analyzed data from 16,000 people in the United States, aged 45 to 64, who took part in the Atherosclerosis Risk in Communities study and were followed for an average of 15 years. The results showed that the long-term risk of developing heart failure increased as lung function decreased. Lung function was determined using a test known as forced expiratory volume (FEV1) by spirometry, which measures how much air a person can exhale in one second. The findings did not change even after the researchers accounted for age, prior heart disease or cardiovascular disease risk factors such as smoking. The results, published in the Feb. 25 issue of the European Journal of Heart Failure, support a link between low lung capacity and development of heart failure, said first author Dr. Sunil Agarwal, from the University of North Carolina, Chapel Hill. "This risk, given a low FEV1, is similar in magnitude -- and may be stronger -- than that seen for common and modifiable risk factors such as diabetes or hypertension. The public health implications are huge, particularly since smoking and air pollution affect lung function adversely," Agarwal said in a journal news release. "So it will be important to determine whether interventions that sustain or improve FEV1 are associated with lower risk of heart failure," Agarwal added.The researchers noted that it's common for patients with heart failure to have COPD, and vice versa. But only recently has prior COPD been shown to be a long-term risk factor for heart failure. An editorial accompanying the study said that the report "strengthens the hypothesis that pulmonary obstruction itself is a major risk factor for heart failure." The editorial also stated that "thinking of heart failure as a possible cause in any patient with shortness of breath and fatigue, or an increase in such symptoms, irrespective of other disease labels, including COPD, means that physicians need to 'reset' their clinical reasoning," and reconsider their patients' drug treatment plans. While the study uncovered an association between poor lung function and heart failure, it did not prove a cause-and-effect relationship.

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COPD World News Week of February 26, 2012

DRIVE4 COPD busts up in Daytona

Daytona Beach, FL - NASCAR's Nationwide DRIVE4 COPD 300 ended up more like a Saturday night demolition derby with several tons of scrap metal littering the 2.5 mile oval at Daytona International Speedway. Danica Patrick's weekend went from excellent to exasperation when her car was touched by a teammate's fender. Patrick was entering Turn 3 on Lap 49 of Saturday's Drivefor COPD 300 at Daytona International Raceway, when she was tapped by her JR Motorsports teammate Cole Whitt. The contact sent Patrick’s No. 7 Chevrolet down to the apron where it turned right and went up into the outside wall. With much public acknowledgement on Friday she became only the second woman to win a pole in a NASCAR Nationwide Series race, was forced to the garage for extensive repairs. It was 21-year-old James Buescher, a virtual unknown outside of the garage area, who beat the big names like Tony Stewart, Dale Earnhardt Jr. and Danica Patrick to the checkered flag.DRIVE4 COPD is the nation's single largest awareness campaign for chronic obstructive pulmonary disease (COPD). Launched in February 2010 by Boehringer Ingelheim Pharmaceuticals, Inc., this landmark public health initiative is working to help people recognize the signs and symptoms of COPD and take action to see if they may be at risk.

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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."

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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.

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COPD World News Week of February 5, 2012

Statins use tied to lung abnormalities

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. "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.

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COPD World News Week of January 29, 2012

Millions of Smokers Don't Tell Docs that They Light Up

Washington - More than one smoker in 10 tries to hide his or her tobacco use from physicians, according to a survey by an anti-tobacco group. Top reasons cited by the 13% who said they concealed their smoking habit were wanting to avoid a lecture and being ashamed, the American Legacy Foundation reported. 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."

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COPD World News Week of January 22, 2012

Report says extra oxygen may harm emergency patients

Amsterdam, Netherlands -That oxygen mask they strap on patients rushed to the ER after a heart attack or a stroke could be doing more harm than good in many cases, Dutch researchers say in a new report. 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.

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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.

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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."

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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 lifestyleHere 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.

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