COPD World News Week of December 30, 2012

Women Who Quit Smoking Do Live Longer

Oxford, UK - Life expectancy was dramatically improved among participants in Great Britain's Million Women Study who quit smoking compared with continuous smokers, confirming the previously uncertain benefits of smoking cessation in women, researchers said. Although women who stopped smoking around age 50 remained at significantly higher risk of all-cause mortality compared with never-smokers, it was much lower than the tripled risk of death seen in current smokers, according to Kirstin Pirie, MSc, of the University of Oxford in England, and colleagues. "Even cessation at about 50 years of age avoids at least two-thirds of the continuing smoker's excess mortality in later middle age," the researchers wrote online in The Lancet. Deaths from lung cancer were reduced markedly in quitters as well, irrespective of participants' age when they stopped smoking, Pirie and colleagues reported. The Lancet published the report the day before the 100th anniversary of the birth of Richard Doll, MD, who led many of the early studies proving the dangers of smoking. Pirie and most of her co-authors work in the Richard Doll Building at the University of Oxford. Although Doll's research clearly documented the early mortality suffered by smokers, it was conducted at a time when most long-time smokers were men. Smoking among young women did not peak until the 1960s. Thus, the mortality risks faced by women smokers have appeared to be lower in the available data.

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COPD World News Week of December 23, 2012

Smoking More Lethal than HIV

Copenhagen, Denmark- Smoking kills. And among people with well-controlled HIV, that old slogan is even truer, researchers reported. In a large case-control study, smokers with HIV had substantially higher rates of all-cause and non-AIDS mortality than HIV-positive non-smokers, according to Marie Helleberg, MD, of Copenhagen University Hospital, and colleagues. Also, HIV-infected smokers lost more life-years to smoking than to HIV-related causes, Helleberg and colleagues reported online in Clinical Infectious Diseases. The study, carried out in Denmark, establishes the risks of smoking in a situation where HIV care is integrated and anti-retroviral therapy is available at no cost. The bottom line, Helleberg said in a statement, is that "more than 60% of deaths among HIV patients are associated with smoking," compared with slightly more than a quarter associated with HIV. In the general population, Helleberg and colleagues noted, smoking is one of the major factors that reduce life expectancy. Among those with HIV, the advent of highly active anti-retroviral therapy (HAART) has meant that lifestyle factors are increasingly affecting survival, while the mortality risk associated with the virus has diminished. To pin down the effects of smoking on people whose HIV is well controlled, the researchers turned to the Danish HIV Cohort Study, a population-based nation-wide study that includes all HIV-infected individuals treated at Danish HIV centers after Jan. 1, 1995. They analyzed outcomes for all members of the cohort who were older than 16 when they were diagnosed, were treated between Jan. 1, 1995 and Aug. 1 2010, and had smoking status at the time of diagnosis available. Injection drug users were excluded. All told, the researchers reported, the HIV-positive study population included 2,921 people, who were matched for sex and year of birth with up to 4 controls each – a total of 10,642 individuals -- from the prospective Copenhagen General Population Study. They found that a 35-year-old HIV-positive smoker had a median life expectancy of 62.6 years, compared with 69.1 years for previous smokers and 78.4 years for never-smokers. Among never-smokers, having HIV led to 5.1 years of life lost, compared with the controls, Helleberg and colleagues found. That was greater than the 3.6 years lost when smoking controls were compared with non-smokers. But the greatest disparity was the 12.3 years of life expectancy lost when HIV-positive smokers were compared with HIV-positive never-smokers, they reported. Helleberg and colleagues cautioned that it is possible that mortality among the controls was underestimated, which would tend to inflate mortality among the HIV-positive cohort.

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COPD World News Week of December 16, 2012

Even Moderate Smoking Associated with Sudden Death

Dallas, TX - Women who are even light-to-moderate cigarette smokers may be significantly more likely than non-smokers to suffer sudden cardiac death, according to new research in Circulation: Arrhythmia & Electrophysiology, an American Heart Association journal. The findings indicate long-term smokers may be at even greater risk, but quitting smoking can reduce and eliminate the risk over time. “Cigarette smoking is a known risk factor for sudden cardiac death, but until now, we didn’t know how the quantity and duration of smoking effected the risk among apparently healthy women, nor did we have long-term follow-up,” said Roopinder K. Sandhu, M.D., M.P.H., the study’s lead author and a cardiac electrophysiologist at the University of Alberta’s Mazankowski Heart Institute in Edmonton, Alberta, Canada. Researchers examined the incidence of sudden cardiac death among more than 101,000 healthy women in the Nurses’ Health Study, which has collected biannual health questionnaires from female nurses nationwide since 1976. They included records dating back to 1980 with 30 years of follow-up. Most of the participants were white, and all were between 30 to 55 years old at the study’s start. On average, those who smoked reported that they started in their late teens. During the study, 351 participants died of sudden cardiac death. Other findings include: Light-to-moderate smokers, defined in this study as those who smoked one to 14 cigarettes daily, had nearly two times the risk of sudden cardiac death as their nonsmoking counterparts. Women with no history of heart disease, cancer, or stroke who smoked had almost two and a half times the risk of sudden cardiac death compared with healthy women who never smoked. For every five years of continued smoking, the risk climbed by 8 percent. Among women with heart disease, the risk of sudden cardiac death dropped to that of a non-smoker within 15 to 20 years after smoking cessation. In the absence of heart disease, there was an immediate reduction in sudden cardiac death risk, occurring in fewer than five years.

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COPD World News Week of December 9, 2012

Wealth Begets Health, Even in Lung Disease 

Atlanta, GA - Higher socioeconomic status in patients with lung cancer and chronic obstructive pulmonary disease is associated with more favorable prognosis and longer survival, a researcher said here. Diagnoses of non-small cell lung cancer (NSCLC) were significantly more likely to occur at disease stage I in individuals of higher socioeconomic status who also had COPD, and such patients were significantly more likely to receive surgical or first-line chemotherapy, relative to COPD patients of lower status, said Janaki Deepak, MD, of the University of Maryland School of Medicine in Baltimore. Median survival time in higher-status patients also had a mean survival time of 247 days, compared with 201 days for lower-status patients, she told attendees at the American College of Chest Physicians annual meeting. The study was based on data from the federal government's Surveillance, Epidemiology, and End Results (SEER) registry and linked Medicare records. Similar findings were seen among COPD patients diagnosed with small-cell lung cancer, Deepak said. She said the socioeconomic study looked at patients with both COPD and lung cancer because smoking is more common in lower-status individuals and because it's a "common pathway" to both diseases. Moreover, COPD is itself a significant risk factor for lung cancer. Patients with COPD face a 4.5-fold increased risk of lung cancer, Deepak said. She also pointed out that previous studies had documented a decreased likelihood of survival and aggressive treatment associated with lower socioeconomic status in lung cancer patients. But whether that association also applied in patients with both conditions were unclear, she said. In the current analysis, Deepak and colleagues sought to confirm that both COPD and lower socioeconomic status would correlate with later stages of lung cancer diagnosis, lower likelihood of curative treatment, and poorer survival. The comparisons presented by Deepak addressed only the patients with both lung cancer and COPD. She reported that patients with both conditions who were of lower socioeconomic status were significantly more likely to have more comorbidities than the high-status group. Deepak speculated that high-status patients with COPD were more likely to have primary care and/or pulmonologist follow-up, leading to the earlier cancer diagnoses. Such improved care could also translate to better treatment of complications arising from cancer and its therapy, she said. Limitations to the study included its reliance on administrative claims data, use of geographic averages to estimate patients' income and other socioeconomic characteristics, and lack of adjustment for patient characteristics and treatment in the median survival results.

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COPD World News Week of December 2, 2012

COPD awareness returns to 2008 levels, according to new NIH survey

Bethesda, Maryland- Physicians note that a major barrier to diagnosis is under-reported symptoms. Awareness of chronic obstructive pulmonary disease (COPD) has been rising gradually in recent years, but the results of a national survey show current awareness levels have returned to those of 2008. The survey was released today by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. Sixty-five percent of adults reported that they have heard of COPD, compared to 71 percent in 2011. Among people most at risk for COPD, awareness stood at 74 percent for current smokers and 73 percent for former smokers; in 2011 these values were 78 percent and 76 percent, respectively. COPD, which in 2010 surpassed stroke to become the third leading cause of death in the United States, is a serious and progressive lung disease that makes breathing difficult and can affect quality of life. COPD, includes conditions such as emphysema and chronic bronchitis, and has been diagnosed in an estimated 12 million men and women in the United States, with just as many more likely remaining undiagnosed. "Although these current numbers do not indicate a trend, we are concerned that the awareness level has not continued to increase. We plan to use this as an opportunity to mobilize and re-energize our efforts." said James P. Kiley, Ph.D., director of the NHLBI Division of Lung Diseases. "COPD is the only major chronic disease where deaths are not decreasing, which makes it critical for people to understand whether they are at risk for it and recognize its symptoms as early as possible. COPD can be treated — but the challenge is that more than 1 in 3 Americans do not know what it is or what its health outcomes are." Kiley noted that the NHLBI plans to engage more with COPD patients, caregivers, and members of advocacy organizations including the American Lung Association and COPD Foundation, and medical societies like the American Thoracic Society. The NHLBI will also work with partners through the COPD Learn More Breathe Better campaign to expand mobilization of local COPD coalitions and state COPD task forces to enhance message penetration and activation at the community level. In 2007, the NHLBI along with leading professional societies, health organizations, and advocacy groups, launched the COPD Learn More Breathe Better campaign to raise public awareness and understanding of COPD. The campaign encourages people at risk for COPD to get a simple diagnostic breathing test and talk to their health care provider about selection of treatment options; the campaign also encourages those diagnosed with COPD to take personal ownership of and responsibility for their overall care and treatment plans. COPD develops slowly, and its symptoms — which can include shortness of breath, chronic coughing or wheezing, production of excess sputum, or a feeling of being unable to take a deep breath — are often mistaken for a consequence of aging or being out of shape. Therefore, many people dismiss their symptoms early on and delay seeking diagnosis and treatment until the disease is in its late stages. According to the results of a parallel survey of health care providers, 48 percent of primary care physicians say that one of the biggest barriers to diagnosing COPD is that patients do not fully report these kinds of symptoms. "Early diagnosis and treatment can go a long way toward improving quality of life for those with COPD, but the first step to breathing better is reporting symptoms to a health care provider," said Kiley. "That’s why it is so vital that we do more to not only raise awareness of COPD, but also increase public understanding of how COPD can affect daily life." COPD most often occurs in people age 40 and older with a history of smoking. However, as many as 1 in 6 people with COPD have never smoked. COPD also can occur in people with a genetic condition known as alpha-1 antitrypsin deficiency or through long-term exposure to substances that can irritate the lungs, such as dust or fumes.

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COPD World News Week of November 25, 2012

When a Smoker Strokes, Outcome Is Worse

Melbourne, Australia - Being a smoker at the time of a stroke appears to increase the risk of a poor outcome over the next decade, researchers found. Compared with individuals who had never smoked, the risk of death, MI, or recurrent stroke in the next 10 years was significantly higher among those who were smokers when they had a stroke (HR 1.30, 95% CI 1.06 to 1.60), according to Amanda Thrift, PhD, of Monash University in Melbourne, Australia, and colleagues. After excluding patients who died within 28 days of having a stroke, the risk was elevated in both current smokers and ex-smokers at the time of their stroke, the researchers reported. "Our finding is important as it provides further evidence of the poor outcome among those who smoke," they wrote, noting that current smokers and ex-smokers were younger than those who had never smoked. "Because of the potential years of healthy life that is lost, smoking will indirectly be making a major contribution to the costs of stroke." Previous studies have shown that smoking is associated with worsened outcomes in studies of acute MI, but the data are mixed with regard to the relationship between smoking status at the time of stroke and long-term outcomes. Looking at stroke subtype, smoking status was associated with 10-year outcomes among those who survived at least 28 days for ischemic stroke but not for intracerebral hemorrhage, a finding possibly related to the small number of patients with hemorrhage, according to the researchers. They acknowledged some limitations of the analysis, including possible inaccuracies in patient classification, the limited information on smoking duration and number of cigarettes smoked, the lack of information on whether participants quit smoking after their stroke, and the lack of information on some factors that could be associated with post-stroke outcomes, including obesity, serum cholesterol levels, alcohol consumption, and family history of stroke.

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COPD World News Week of November 18, 2012

Chantix Safe for Smokers with Depression

San Diego, CA - The smoking cessation drug varenicline (Chantix) may not be as risky for depressed individuals as once thought, according to trial results announced by drug maker Pfizer. Depression and suicidality scores showed no differences between the drug and placebo in patients with current or past major depressive disorder, according to a press release providing top-line trial results. "Smoking is common in psychiatric patients, including depressed patients, and it is important to have treatment options to help them quit," principal investigator Robert Anthenelli, MD, of the University of California San Diego and VA San Diego Healthcare Systems, explained in the release. The FDA has warned about reports of new onset depression, agitation, and suicidality with varenicline. The drug carries a boxed warning about those risks, noting that safety and efficacy haven't been established in major depressive disorder. At the request of European regulators, the study randomized 525 adults in the U.S. and Europe to double-blind treatment with varenicline at 1 mg twice daily versus placebo for smoking cessation. Patients had either a current diagnosis of major depressive disorder or a history of it in the prior 2 years, but no psychotic features. The study also excluded patients on bupropion (Wellbutrin, Zyban, and others) or nortriptyline (Aventyl, Pamelor) -- antidepressants that have also been used for smoking cessation -- and those with substance abuse or suicidality at baseline. For the primary endpoint, more varenicline users were able to stay off tobacco for the final 4 weeks of the 12-week course of treatment than were those in the placebo group (36% versus 16%). The proportion who stayed free of tobacco through to the end of follow-up at week 52 was doubled with the drug as well (20% versus 10%). Neuropsychiatric events seen in at least 2% of the varenicline-treated patients were anxiety, agitation, depression, tension, depressed mood, sleep disorders, hostility, and restlessness. However, no differences between groups turned up for any psychiatric scores.

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COPD World News Week of November 11, 2012

Water exercise boosts endurance in COPD

Randwick, Australia - Water workouts may trump land-based exercise for people with chronic lung disease and other health problems, according to a small study. Australian researchers found that exercising in a pool boosted physical endurance and energy levels in people with chronic obstructive pulmonary disease, or COPD, and physical complaints such as obesity or back pain "Participants in the water-based exercise training group reported an improvement in many functional aspects of their daily life such as improved stamina and ability to complete tasks such as walking long distances when shopping," said Renae McNamara, a physical therapist at The Prince of Wales Hospital in Randwick. "They reported less fatigue, as well as less breathlessness when completing activities of daily living such as showering and dressing," she told Reuters Health by email. COPD includes various lung diseases that cause breathlessness, such as emphysema and chronic bronchitis. About 65 million people have moderate to severe COPD, according to the World Health Organization. There are drugs to quell symptoms of the disease, and exercise is recognized to improve the breathing problems and fatigue associated with the condition. But many drop out of training programs, which can be particularly strenuous for people who also have other health issues. The new study, published in the European Respiratory Journal, is the first to test the benefits of exercise in this group of patients, McNamara said. They enrolled 53 patients in the study, assigning them randomly to workouts in a hydrotherapy pool, gym-based training or standard medical care without exercise. The exercise programs include three weekly one-hour sessions over two months and 45 patients completed the study. Whether they worked out on land or in water, patients were able walk faster after the training than when they just got usual care. But those who exercised in the pool reported less fatigue than the gym trainers and also developed more physical endurance. On a test wherein they had to walk as far as they could at a constant speed, patients who'd exercised in water outpaced those trained in a gym by 228 meters (748 feet). Researchers consider a difference of 203 meters important. "We believe that water-based exercise training was more beneficial for a number of reasons," McNamara said. "The water environment is unique because of the effect of buoyancy which supports the body weight, reduces forces on joints and allows greater movement; warm water assists with pain control by increasing circulation; and the water provided resistance to all movements, unlike moving on land." There had been some concerns that people with COPD might not tolerate the pressure from the water on the chest, which makes it harder to breathe. But the researchers saw no drop-outs due to worsening COPD in patients training in the pool - they did see some in the gym group - although they caution that most of the participants in the study did not have severe disease. McNamara said patients "also reported a very high level of enjoyment in the group water-based exercise sessions and many said they felt less depressed and felt a great sense of achievement in being able to participate in exercise training which was previously too difficult or painful on land." Water therapy exercises are already used to treat other problems, such as arthritis and joint pain. McNamara said people interested in joining a pool-based exercise program should contact their local hospital or health provider. "These groups may be run in hydrotherapy pools or local swimming pools," she said. "Having a supervisor to instruct, monitor and progress their exercise program is very beneficial as is the group interaction and social support which can be gained in a group session."

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COPD World News Week of November 4, 2012

Smokers fare worse after knee surgery

Nashville, TN - Smokers have worse outcomes after knee surgery than non-smokers, including less-complete healing and more surgical complications, according to a new analysis. Smoking has a profound effect on circulation, "so that means it even affects musculoskeletal healing," said Dr. Kurt Spindler, an orthopedic surgeon at Vanderbilt University in Nashville, Tennessee, who wasn't involved in the new research. Dr. David Flanigan, one of the authors of the review paper and a sports medicine doctor at The Ohio State University in Columbus, said surgeons had a hunch smoking was related to worse outcomes after knee surgery. He and his colleagues wanted to get a sense of what studies on the topic had found. They gathered the results of 14 studies, eight of which looked at surgical repair of knee ligaments, including the anterior cruciate ligament (ACL), and six of which examined repair of knee cartilage. The studies looked at a variety of outcomes, such as how well people were able to get around after surgery, whether they could return to sports and if the surgery was considered to have excellent results. All but one of the studies on ACL surgery found smokers tended to do worse afterward, the researchers report in The American Journal of Sports Medicine. For instance, smokers were less likely to return to their pre-injury level of sport and experienced more pain. One study from the University of Pittsburgh School of medicine found surgery patients who smoked were 64 percent less likely to report a successful outcome than non-smokers. The one study that did not find any difference between smokers and non-smokers examined patients' risk of developing osteoarthritis in the knee. Four studies on cartilage surgery found that smokers were less likely to have excellent results after surgery, had less improvement in the knee years later or had fewer beneficial proteins in the knee fluid than non-smokers. In contrast, two studies found no differences between smokers and non-smokers on measures of pain and function. There are about 150,000 ACL injuries in the United States every year, according to the American Orthopaedic Society for Sports Medicine. Flanigan said he wasn't able to quantify just how much worse smokers tended to fare after surgery than non-smokers overall. "We don't have a percentage to point to. I say (to patients), we do know this has increasing rates of failure, increasing rates of people not doing well compared to people who are not smokers," he told Reuters Health. The individual studies also couldn't prove that smoking, itself, was responsible for the negative outcomes seen in smokers. Flanigan said he'd like to see more research on the biology of smoking and knee repair to determine what is causing those worse outcomes. Spindler told Reuters Health the consistency of the studies' findings implicates smoking. "It makes me believe this is a powerful variable that does influence your outcome," he said.

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COPD World News Week of October 28, 2012

Lung-Shrinking Coils Show Promise in COPD

Atlanta, GA - Metal coils that grab and compress diseased portions of the lung in emphysema patients produced significant functional improvements in a mid-stage trial, a researcher reported here.  Patients randomized to receive the coils had significantly lower scores on the St. George's Respiratory Questionnaire (SGRQ) after 90 days relative to a supportive-care group in the open-label, 45-patient study, said Zaid Zoumot, MBBS, of the Royal Brompton and Harefield Hospital Trust in London. After adjusting for differences in baseline variables, the between-group difference in mean SGRQ scores after treatment was 8.35 points, favoring the coil group, Zoumot reported. The coil treatment also was associated with significant improvements in 6-minute walk distance and lung function as measured by forced expiratory volume in 1 second (FEV1), he told attendees at a late-breaking abstract session during the American College of Chest Physicians annual meeting. Safety results were also very acceptable, Zoumot said. In advanced emphysema, a major form of chronic obstructive pulmonary disease (COPD), diseased portions of lung become hyperinflated when patients breathe in, pressing on and impairing the remaining healthy lung tissue. The hyperinflation also pushes on the diaphragm to add to patients' breathing difficulties. When bronchodilator treatment provides inadequate relief, patients often undergo lung reduction surgery. The coil-based treatment is intended to offer a less invasive alternative to reduce lung volume. The coils used in the current study are shaped into a simple loop that measures 10 to 15 cm in length when completely stretched. Called RePneu, they are made of a metallic "memory" material called Nitinol that reliably returns to its intended shape after repeated stretches and compressions. When inserted via a bronchoscope into the airways in diseased lung sections, the RePneu coils reassume their looped form, essentially grabbing lung tissue and pulling it inwards to reduce the volume in these sections. This action then allows healthy tissue to inflate more normally. Zoumot explained that a minimum of 10 coils per lung are typically needed to reduce lung volume enough to show significant clinical benefits. In general, the more coils placed the better, but about 12 per lung is usually the practical maximum Zoumot said that participants were being followed to 12 months after final treatment, with results still pending. He added that a pivotal trial with 330 patients was expected to begin next month.

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COPD World News Week of October 21, 2012

Secondhand Smoke Takes Big Illness, Expense Toll

San Francisco, CA - Secondhand smoke has a substantial health and economic impact, especially among black Americans, a new study shows. Researchers analyzed data from more than 12,000 adults to assess the number of deaths, the years of potential life lost and the value of lost productivity caused by secondhand smoke in 2006. That year, more than 41,000 American adults and nearly 900 infants died of secondhand smoke-related diseases, according to a journal news release. The study found that blacks had significantly higher levels of exposure to secondhand smoke than whites. The highest exposure was among black men aged 45 to 64 (nearly 64 percent), followed by black men aged 20 to 44 (nearly 63 percent). Black women aged 20 to 44 had a higher exposure rate (nearly 63 percent) than any other women. In 2006, black infants accounted for 24 percent to 36 percent of deaths caused by mothers smoking during pregnancy, even though they accounted for only 13 percent of the infant population. The toll from just two adult and four infant conditions linked to secondhand smoke in 2006 was 42,000 deaths, 600,000 years of potential life lost and $6.6 billon in lost productivity. Blacks and Hispanics had the highest value of lost productivity per death. "With the high rates of smoking prevalence and the resulting high rates of [secondhand smoke] exposure in the United States and in many parts of the world, interventions need to be designed that target particularly vulnerable groups and that reduce the health and economic burden of smoking on smokers and non-smokers alike," wrote Wendy Max, of the Institute for Health & Aging in San Francisco, and colleagues. The study was published online Sept. 20 in the American Journal of Public Health.

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COPD World News Week of October 14, 2012

COPD patients experience poorer sleep quality and lower blood oxygen levels

Dublin, Ireland - Patients with chronic obstructive pulmonary disease (COPD) experience poorer sleep quality than people of a similar age without COPD, according to research published in the journal Respirology. Researchers also found an independent relationship between how well patients with COPD slept and the oxygen levels in their arterial blood. “Patients with COPD frequently report fatigue, sleepiness and impaired quality of life,” says Professor Walter McNicholas from the Department of Respiratory and Sleep Medicine at St. Vincent’s University Hospital, Dublin, Ireland. “The study carried out by our group, which has been researching sleep and breathing for more than 25 years, showed that such patients experience poor sleep quality, which may contribute to these debilitating symptoms.” COPD is the name for a collection of lung diseases, including chronic bronchitis, emphysema and chronic obstructive airways disease. People with COPD have trouble breathing in and out because of long-term damage to their lungs, usually because of smoking. COPD is now the fourth leading cause of chronic death and ill health in the USA and is projected to rank fifth in the burden of disease worldwide. The current study provides a secondary analysis of two previously published trials investigating the impact of long-acting bronchodilators on night-time oxygen saturation in 106 patients with established, moderate to severe COPD. Bronchodilators make breathing easier by relaxing the muscles in the lungs and widening the airways. Poor sleep quality was measured in a number of ways, including a reduced percentage of rapid eye movements (REM), which occur during the deepest level of sleep. The patients covered by the study had an average age of just over 66 years, 67 per cent were male and all were current or former smokers, with a smoking history of ten or more years. Strict clinical criteria were applied to the subjects, which are outlined in full in the paper. Key findings of the study included:  Patients with severe COPD experienced poorer sleep quality than people without COPD of a similar age.  Daytime hypoxemia (low arterial blood oxygen levels) is associated with sleep efficiency, but airflow obstruction is not. Hypoxemia is thought to impact on certain neurotransmitter levels and these mechanisms can contribute to poor sleep efficiency. COPD patients took longer to fall asleep than the age-matched controls after the lights had been turned off (sleep latency) and spent less of their time in bed sleeping (sleep efficiency). They also experienced greater differences in the way they slept, with more sleep at the lightest level (stage one) and less at REM (stage five, the deepest level). Slow wave sleep (stages three and four) was reasonably well preserved. “Our study highlights poor sleep quality in patients with COPD and demonstrates an association between daytime hypoxemia and sleep efficiency,” concludes Professor McNicholas. “However, sleep quality in COPD is determined by several factors and further studies on this topic are necessary to fully evaluate the relationship. This may identify therapeutic interventions that might improve the overall quality of life in COPD patients.”

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COPD World News Week of October 7, 2012

Teen Obesity Linked to Mom's Smoking in Pregnancy

Toronto, ON - New research suggests how smoking during pregnancy may increase a child's risk of obesity during adolescence. Children born to mothers who smoked while pregnant show structural changes in their brains, which make them more partial to fatty foods and prone to subsequent weight problems, the study found. "The fact that prenatal smoking is associated with a high risk of obesity in offspring has been known, but the potential mechanism that may lead to this risk was not fully understood," said study author Dr. Zdenka Pausova, a scientist at the Hospital for Sick Children in Toronto. "Our study suggests that maternal smoking may cause structural changes in the part of the brain that processes reward and may increase preference for fatty food." Still, more study is needed to validate the findings, she said. Not all mothers who smoke are destined to have obese children, she added. Smoking during pregnancy is one of many factors that may tip the scales in favor of teenage obesity. The new study, published online Sept. 3 in the Archives of General Psychiatry, included 378 adolescents aged 13 to 19. Of these, 180 kids had mothers who smoked more than one cigarette a day during the second trimester of pregnancy. The average was 11 cigarettes a day. As expected, babies born to mothers who smoked weighed less at birth. They also tended to be breast-fed for shorter periods of time, and were more likely to weigh more as teens than their peers whose moms did not smoke while pregnant. What's more, scans showed that teens whose mothers were smokers during pregnancy had a significantly lower volume in the reward center of the brain, the amygdala. When the researchers assessed the participants' dietary fat intake, they found an inverse correlation between amygdala volume and fat consumption, meaning the more fat consumed, the lower the amygdala volume. Dr. Lorena Siqueira, director of adolescent medicine at Miami Children's Hospital, said the new findings provide one more reason that mothers-to-be should not smoke. "We have known that smoking during pregnancy increases the risk for low birth weight babies and preterm delivery," she said. Calling the findings "fascinating, but preliminary," she said that maternal smoking history may not be the sole reason why some teens crave fatty foods. "This needs to be looked at more as a lot of what we are seeing may be due to access to salty, fatty foods that we all have a taste for." While the study found an apparent link between maternal smoking and fatty food cravings in teens, it didn't prove the existence of a cause-and-effect relationship.

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COPD World News Week of September 30, 2012

Secondhand Smoke Permeates Many Apartment Buildings

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 September 23, 2012

Tobacco smoke tied to flu complications in kids

New York, NY - Kids hospitalized with the flu are more likely to need intensive care and a longer stay if they've been exposed to second-hand smoke at home, a small new study finds. Analyzing the records of more than 100 kids hospitalized with flu in New York state, researchers found those exposed to second-hand smoke were five times more likely to be admitted to the intensive care unit and required a 70 percent longer stay in the hospital, compared to the kids not exposed to smoke. "People are being a bit complacent and thinking that because they don't see smoking as often…that it's not a problem anymore," said Dr. Karen Wilson, of Children's Hospital Colorado, in Aurora, who led the study. "But we still need to be vigilant about protecting kids from second-hand smoke." According to the Centers for Disease Control and Prevention, passive smoking causes ear infection, breathing problems and lung infections in children, and leads to the hospitalization of up to 15,000 children under the age of 18 months every year. Hospital stays were up to 70 percent longer for smoke-exposed kids, with kids staying in for four days on average, compared with 2.4 days in non-exposed kids. If kids had a chronic illness as well as the flu, their length of stay increased to about 10 days, on average, if they had been breathing second-hand smoke, versus about three days in non-exposed sick kids. "We've known that (second-hand smoke) is bad for children in a whole variety of ways," said Dr. Susan Coffin, who has studied flu complications in children at the Children's Hospital of Philadelphia. "With this (study) we see that smoke exposure not only increases risk of hospitalization but it specifically makes the course of illness worse. This is a preventable cause of severe flu, and it's sad that children are in a position to be exposed even though these serious complications can occur," said Wilson. "Obviously not smoking and protecting children from smoke won't stop them from getting influenza, but it may help it from becoming a severe illness or (preventing) complications that we sometimes see," she added.

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COPD World News Week of September 16, 2012

Alarming smoking habits found in poorer countries

Buffalo, NY - Two fifths of men in developing countries still smoke or use tobacco, and women are increasingly starting to smoke at younger ages, according to a large international study which found "alarming patterns" of tobacco use. Despite years of anti-smoking measures across the world, most developing countries have low quit rates, according to the study. There are wide differences in the rates of smoking between genders and nations, as well as major disparities in access to effective anti-smoking treatments. "Although 1.1 billion people have been covered by the adoption of the most effective tobacco control policies since 2008, 83 percent of the world's population are not covered by two or more of these policies," said Gary Giovino of the University at Buffalo School of Public Health and Health Professions in New York, who led the research. Measures include legislation banning smoking in public places, imposing advertising bans and requiring more graphic health warnings on cigarette packets. The findings come as the world's leading tobacco firms, British American Tobacco, Imperial Tobacco, Philip Morris and Japan Tobacco lost a crucial legal appeal in Australia this week against the introduction of plain tobacco packaging. Australia's planned "no logo" laws are in line with World Health Organization (WHO) recommendations and are being watched closely by Britain, Norway, New Zealand, Canada and India, which are considering similar measures. Tobacco kills up to half of its users, according to the WHO. Smoking causes lung cancer, often fatal, and other chronic respiratory diseases. It is also a major risk factor for cardiovascular diseases, the world's number one killers. Other forms of tobacco use include snuff or chewing tobacco. Matthew L. Myers, president of the U.S.-based Campaign for Tobacco-Free Kids, said the study "underscores the enormity of the global tobacco epidemic". "Without urgent action, tobacco use will claim 1 billion lives this century," he said, urging poorer countries to "act now and address a crisis they can ill afford." Using data from Global Adult Tobacco Surveys (GATS) carried out between 2008 and 2010, Giovino's team compared patterns of tobacco use and cessation in people aged 15 or older from 14 low- and middle-income countries. They included data from Britain and the United States for comparison. They found disproportionately high rates of smoking among men - at an average 41 percent versus 5 percent in women - and wide variation in smoking prevalence, ranging from about 22 percent of men in Brazil to more than 60 percent in Russia. Rates of female smoking ranged from 0.5 percent in Egypt to almost 25 percent in Poland. Women in Britain and the United States also had high smoking rates, at 21 percent and 16 percent respectively. The study found that around 64 percent of tobacco users smoke manufactured cigarettes, although loose-leaf chewing tobacco and snuff were particularly common in India and Bangladesh. With an estimated 301 million tobacco users, China has more than any other country, closely followed by India with almost 275 million. Other countries included in the study were Bangladesh, Mexico, Philippines, Thailand, Turkey, Ukraine, Uruguay and Vietnam. The researchers said the rise in tobacco use among young women was of particular concern. The WHO says tobacco already kills around 6 million people a year worldwide, including more than 600,000 non-smokers who die from exposure to second-hand smoke. By 2030, if current trends continue, it predicts tobacco could kill 8 million people a year.

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COPD World News Week of September 9, 2012

Smoking Cessation Lowers Risk of Brain Bleed

Seoul, Korea - Smokers have nearly triple the likelihood of having a subarachnoid hemorrhage, but the risk for many individuals falls significantly 5 years after kicking the habit, a case-control study demonstrated. The adjusted odds ratio for subarachnoid hemorrhage among individuals who currently smoked was 2.84 compared with those who had never smoked, according to Byung-Woo Yoon, MD, and colleagues from Seoul National University Hospital in Korea. But 5 years after quitting, there had been a significant 59% reduction in among those who smoked less than a pack a day, the researchers reported in the Journal of Neurology, Neurosurgery, and Psychiatry. The risk remained elevated, however, for individuals who had been heavy smokers, they found. The many benefits of smoking cessation on cardiovascular health are well recognized, with excess risks for coronary heart disease and ischemic stroke all but disappearing 5 to 10 years after smoking cessation. Less is known, however, about the effects of smoking -- and quitting -- on risks for subarachnoid hemorrhage, which carries a death rate of approximately 50%. The overall risk remained at 2.7 times higher for smokers who quit less than 5 years before. When not associated with trauma, subarachnoid hemorrhage most often results from a ruptured aneurysm in the brain. The potentially reversible effects of smoking that could contribute to this event include structural effects on vessel walls as well as increased coagulability and elevations in blood pressure. And while some changes to blood vessel walls caused by smoking may be irreversible, the findings of this study suggest that smoking could be considered "a modifiable risk factor for subarachnoid hemorrhage." "Vigorous efforts of government officials and health workers to promote smoking cessation should be performed to reduce the risk of [subarachnoid hemorrhage], a disastrous disease for patients and family members," Yoon and colleagues concluded. Limitations of the study included likely recall bias associated with self-report of smoking, possible unmatched confounding factors, and the use of a hospital-based population. "To confirm our results, population-based case control studies or prospective large cohort studies are needed," the authors concluded.

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COPD World News Week of September 2, 2012

Artery Size May Predict COPD Flares

Vienna, Austria - In patients with chronic obstructive pulmonary disease (COPD), unusually large pulmonary artery diameter was strongly associated with future risk of serious exacerbations, researchers said. Having a ratio of pulmonary artery diameter to aortic diameter (PA:A) greater than 1 at baseline roughly tripled the risk of severe exacerbations within 2 to 3 years, according to J. Michael Wells, MD, of the University of Alabama at Birmingham, and colleagues. While a causal relationship could not be determined, the ratio could be a valuable metric for assessing COPD exacerbation risk, as it is based on ordinary CT chest scans that require minimal training to interpret, they wrote online in the New England Journal of Medicine. The paper is accompanied by a presentation at the European Respiratory Society meeting in Vienna. Use of the ratio, rather than simply the measurement of pulmonary artery diameter, automatically corrects for size differences among patients as well as for the algorithms used to create CT images. It also "provides an internal control that allows the ratio to be compared over time and across cohorts, a feature not shared by other CT markers of exacerbation risk," Wells and colleagues wrote. But in an accompanying editorial, a Canadian researcher questioned their conclusions and argued that attempts to validate the PA:A ratio as a predictive tool would likely fail. Matthew Stanbrook, MD, PhD, of the University of Toronto, contended that the ratio may simply be detecting pulmonary hypertension or other comorbidities that clinicians would already know about in a given patient. Wells and colleagues, in their study, adjusted for the presence of coexisting conditions but not their severity, Stanbrook observed. He also noted that anti-inflammatory drugs are known to reduce exacerbations, an effect that is hard to explain if flares are "driven by heart disease, thromboembolic disease, or impaired pulmonary reserve." Additionally, Stanbrook pointed out that CT scans are expensive and carry some risk from radiation exposure. "We may need to pay more attention to unraveling the heterogeneous causes of exacerbations, so that we may more effectively deliver the right treatment to the right patient with COPD," he wrote. In their study, Wells and colleagues first examined utility of the PA:A ratio in 2,985 patients participating in a study called COPDGene, primarily intended to identify genetic risk factors for the disease. These were a subset of the study's overall 10,300 participants, restricted to those with so-called GOLD stage II to IV COPD, and for whom follow-up data on later exacerbations were available.

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COPD World News Week of August 26, 2012

Alarming smoking habits found in poorer countries

Buffalo, NY - Two fifths of men in developing countries still smoke or use tobacco, and women are increasingly starting to smoke at younger ages, according to a large international study which found "alarming patterns" of tobacco use. Despite years of anti-smoking measures across the world, most developing countries have low quit rates, according to the study. There are wide differences in the rates of smoking between genders and nations, as well as major disparities in access to effective anti-smoking treatments. "Although 1.1 billion people have been covered by the adoption of the most effective tobacco control policies since 2008, 83 percent of the world's population are not covered by two or more of these policies," said Gary Giovino of the University at Buffalo School of Public Health and Health Professions in New York, who led the research. Measures include legislation banning smoking in public places, imposing advertising bans and requiring more graphic health warnings on cigarette packets. The findings come as the world's leading tobacco firms, British American Tobacco, Imperial Tobacco, Philip Morris and Japan Tobacco lost a crucial legal appeal in Australia this week against the introduction of plain tobacco packaging. Australia's planned "no logo" laws are in line with World Health Organization (WHO) recommendations and are being watched closely by Britain, Norway, New Zealand, Canada and India, which are considering similar measures. Tobacco kills up to half of its users, according to the WHO. Smoking causes lung cancer, often fatal, and other chronic respiratory diseases. It is also a major risk factor for cardiovascular diseases, the world's number one killers. Other forms of tobacco use include snuff or chewing tobacco. Matthew L. Myers, president of the U.S.-based Campaign for Tobacco-Free Kids, said the study "underscores the enormity of the global tobacco epidemic". "Without urgent action, tobacco use will claim 1 billion lives this century," he said, urging poorer countries to "act now and address a crisis they can ill afford." Using data from Global Adult Tobacco Surveys (GATS) carried out between 2008 and 2010, Giovino's team compared patterns of tobacco use and cessation in people aged 15 or older from 14 low- and middle-income countries. They included data from Britain and the United States for comparison. They found disproportionately high rates of smoking among men - at an average 41 percent versus 5 percent in women - and wide variation in smoking prevalence, ranging from about 22 percent of men in Brazil to more than 60 percent in Russia. Rates of female smoking ranged from 0.5 percent in Egypt to almost 25 percent in Poland. Women in Britain and the United States also had high smoking rates, at 21 percent and 16 percent respectively. The study found that around 64 percent of tobacco users smoke manufactured cigarettes, although loose-leaf chewing tobacco and snuff were particularly common in India and Bangladesh. With an estimated 301 million tobacco users, China has more than any other country, closely followed by India with almost 275 million. Other countries included in the study were Bangladesh, Mexico, Philippines, Thailand, Turkey, Ukraine, Uruguay and Vietnam. The researchers said the rise in tobacco use among young women was of particular concern. The WHO says tobacco already kills around 6 million people a year worldwide, including more than 600,000 non-smokers who die from exposure to second-hand smoke. By 2030, if current trends continue, it predicts tobacco could kill 8 million people a year.

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COPD World News Week of August 19, 2012

Heavy Smoking May Be a Genetic Thing

St. Louis, MO - Patients who start smoking at a younger age appear to have a genetic susceptibility to heavy smoking as adults, researchers found. In a meta-analysis, smokers who started at age 16 or younger and had at least one mutation in a non-synonymous single-nucleotide polymorphism in CHRNA5 --rs16969968 -- had a significantly greater risk for heavy smoking in adulthood than those who started smoking later (OR 1.45, 95% CI 1.36 to 1.55, P=0.01), according to Laura Bierut, MD, of Washington University School of Medicine in St. Louis, Mo., and colleagues. "The finding of a stronger genetic risk in early-onset smokers supports public health interventions to reduce adolescent smoking," they wrote in the Aug. 6 issue of Archives of General Psychiatry. The results are supported by earlier studies in animal models showing that "the developing adolescent brain [is] particularly vulnerable to addictive effects of nicotine and by human studies suggesting that adolescent neurodevelopment is a particularly vulnerable period for the development of addiction," the authors explained. The researchers analyzed a sample of 33,348 ever-smokers from 43 studies and stratified participants into early-onset -- those who started smoking at 16 or younger -- and late-onset smokers or those who started after age 16. Additionally, participants had presence of the rs16969968 genotype, or an analogous SNP called rs1051730, measured against heavy and light smoking status. The analogous gene was included, the authors wrote, because it provided "statistically equivalent results and there is biological evidence that rs16969968 alters receptor function." "An unresolved issue is whether rs16969968 plays a role in the heightened susceptibility to nicotine dependence in early-onset smokers," they added. Heavy smoking status was defined as more than 20 cigarettes per day, while light smoking was defined as 10 or fewer cigarettes per day, with moderate smoking status excluded from the analysis. They found that the overall risk for heavy smoking in participants who initiated smoking early was significant at an odds ratio of 2.63 (95% CI 2.49 to 2.78, P<0.001). They also reported that early-onset smoker participants with mutated AG or AA alleles -- versus wild-type GG alleles -- of the rs16969968 genotype had a 1.45 and 2.10, respectively, increased OR for heavy smoking (95% CI 1.36 to 1.55 and 1.97 to 2.25). In late-onset smokers with the same genetic mutations, the OR was 1.27 (95% CI 1.21 to 1.33) for those with an AG allele (P=0.01). Bierut and colleagues added that because early-onset smoking was a strong risk for smoking in later life and that age of smoking onset is a heritable characteristic, "we must consider the possibility that a shared genetic factor could lead to early-onset smoking and heavy smoking in adulthood" but that there did not seem to be a shared genetic factor between early-onset smoking and heavy smoking (P=0.77 for association). "Accordingly, early use may not cause greater vulnerability to addiction; instead, early use and vulnerability to addiction may have a shared etiology," they wrote. The authors noted that their study was limited by a number of factors, including heterogeneity of samples with differential assessment of measures, inconsistent genetic markers between studies, and lack of external modifiers to smoking behavior, such as parental monitoring and peer smoking. They also noted that future research could investigate the interactions of these external modifiers and their associations with cigarettes smoked per day with a genetic component.

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COPD World News Week of August 12, 2012

Pipes and Cigars Gain as Smokers Still Light Up

Washington, DC - Americans are smoking fewer cigarettes, but the use of other forms of combustible tobacco has jumped dramatically, the CDC is reporting. Over a 12-year period, total consumption of cigarettes fell 32.8%, the agency reported in the Aug. 3 issue of Morbidity and Mortality Weekly Report. But over the same time, the use of pipe tobacco and large cigars skyrocketed, by factors of 5.82 and 3.33 respectively, the agency reported. Overall, the agency found, smoking registered a steady decline – adding up to 27.5% over the whole study period -- but the decline in cigarette consumption was partly offset by an increase in the use of other forms of smoke-able tobacco, which more than doubled from 2000 through 2011. The consumption estimates come from an analysis of excise tax information from the Treasury Department's Alcohol and Tobacco Tax and Trade Bureau. Using monthly tax data, the CDC researchers estimated the per unit consumption of each type of product. To allow comparisons with pipe tobacco and roll-your-own tobacco, the agency converted the data from pounds of tobacco to a per-cigarette equivalent, in which 0.0325 oz. of tobacco equals one cigarette. Over the study period, the agency found: Total consumption of all combustible tobacco fell from 450.7 billion cigarette equivalents in 2000 to 326.6 in 2011, or 27.8%. Per capita consumption fell from 2,148 cigarette equivalents to 1,374, a 36% decrease. Total cigarette consumption fell from 435.6 billion in 2000 to 292.8 billion in 2011, a 32.8% decrease, while per capita cigarette consumption decreased 40.7%, from 2,076 to 1,232 over the same period. On the other hand, total consumption of non-cigarette combustible forms of tobacco grew from 15.2 billion cigarette equivalents in 2000 to 33.8 billion in 2011, a 2.23-fold rise, and over the same time per capita consumption increased from 72 to 142, a 96.9% increase. The increase in non-cigarette combustible tobacco use was mainly driven by increases in the use of pipe tobacco and large cigars, the agency found, probably because of tax changes that favored those products. "The rise in cigar smoking, which other studies show is a growing problem among youth and young adults, is cause for alarm," said Tim McAfee, MD director of CDC's Office on Smoking and Health and one of the report's authors. The authors cautioned that the numbers only reflect legal sales and use of tobacco; illicit, untaxed tobacco would not be captured in the analysis.

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COPD World News Week of August 5, 2012

More College Women Smoking Hookahs

Providence, RI - Many believe the water pipes are safer than cigarette smoking, but researchers say they're bad for lungs, gums. First-time use of a hookah (water pipe) to smoke tobacco is increasingly common among U.S. female college students in their freshman year, a new study finds.  Researchers surveyed 483 female college freshman and found that 343 had not used a hookah before college. Of those 343 students, 23 percent tried hookah smoking during their first year of college.  Hookah use appeared to be linked to alcohol and marijuana use. The more alcohol the students consumed, the more likely they were to try hookah smoking. Students who used marijuana engaged in hookah smoking more often than others. The researchers also found that certain personality traits, such as a higher level of impulsivity and a strong tendency to compare oneself to others, predicted frequency of hookah use. The study was published online in the journal Psychology of Addictive Behaviors. The findings are troubling because there's been a dramatic increase in hookah smoking rates among young adults in the United States over the last two decades, said the researchers at Miriam Hospital in Providence, R.I. Some studies suggest that levels of hookah smoking among young adults are on par with cigarette smoking. Many college students mistakenly believe that hookah smoking is safer than cigarettes, but hookah smoking has been linked with many of the same diseases caused by cigarettes, including lung cancer, respiratory conditions and gum disease, the researchers noted. "The popularity and social nature of hookah smoking, combined with the fact that college freshmen are more likely to experiment with risky behavior, could set the stage for a potential public health issue, given what we know about the health risks of hookah smoking," lead author Robyn Fielder, a research intern Miriam Hospital's Centers for Behavioral and Preventive Medicine, said in a hospital news release. 

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COPD World News Week of July 29, 2012

Ex-smokers have higher risks for bowel diseases

Boston, MA - Compared to people who've never smoked, former smokers have a higher risk of developing two inflammatory bowel diseases, Crohn's disease and ulcerative colitis, according to a new study. "The increased risk of ulcerative colitis following smoking cessation persisted even two decades after cessation," said Dr. Leslie Higuchi, the lead author of the study and a researcher at Children's Hospital Boston and Harvard Medical School. Following up on earlier shorter-term studies of the subject, Higuchi and her team collected information from nearly 230,000 female nurses who were surveyed about their behavior and health status from 1976 and 1989. Over time, Higuchi and her colleagues found, 144 out of about 124,000 never-smokers developed Crohn's disease, while 117 out of 51,000 ex-smokers and 75 out of 53,500 smokers also developed the autoimmune disease. After taking into account other risk factors, such as age, weight and hormone therapy use, they determined that smokers were 90 percent more likely to develop Crohn's than women who never smoked and ex-smokers were 35 percent more likely. The more people smoked, the higher their risk. For instance, women who had smoked a pack a day for 10 to 25 years were 1.7 times as likely to develop Crohn's as someone who never smoked, while women who smoked a pack a day for more than 25 years were 2.3 times as likely. The researchers found that smoking was also tied to ulcerative colitis, an inflammation of the colon that can cause pain, diarrhea and bleeding. Higuchi's group found that 190 non-smokers, 167 former smokers and 43 current smokers developed colitis during the study period.

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COPD World News Week of July 22 ,2012

FDA approves Tudorza Pressair to treat chronic obstructive pulmonary disease

Washington, DC - The U.S. Food and Drug Administration today approved Tudorza Pressair (aclidinium bromide) for the long-term maintenance treatment of bronchospasm (narrowing of the airways in the lung) associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. COPD is a serious lung disease that makes breathing difficult. Cigarette smoking is the leading cause of COPD, according to the National Heart, Lung, and Blood Institute. COPD is the fourth leading cause of death in the United States. Symptoms can include chest tightness, chronic cough, and excessive phlegm. Tudorza Pressair, a dry powder inhaler used twice daily, is a long-acting antimuscarinic agent that helps muscles around the large airways of the lungs stay relaxed to improve airflow. “COPD is a serious disease that gets worse over time,” said Curtis Rosebraugh, M.D., M.P.H., director of the Office of Drug Evaluation II in FDA’s Center for Drug Evaluation and Research. “The availability of long-term maintenance drugs for COPD provides additional treatment options for the millions of people who suffer with this debilitating disease.” The safety and efficacy of Tudorza Pressair were demonstrated in three randomized, placebo-controlled confirmatory clinical trials that included 1,276 patients ages 40 and older with a clinical diagnosis of COPD. Those treated had a smoking history of at least one pack a day for 10 years. Tudorza Pressair may cause serious side effects, including paradoxical bronchospasm, new or worsened increased pressure in the eyes (acute narrow-angle glaucoma), or new or worsened urinary retention. Tudorza Pressair should not be used as a rescue therapy to treat sudden breathing problems (acute bronchospasm) and is not recommended for people younger than 18 years. The most common side effects reported by patients using Tudorza Pressair include headache, inflammation of the nasal passage (nasopharyngitis), and cough. Tudorza Pressair is distributed by St. Louis-based Forest Pharmaceuticals, a subsidiary of Forest Laboratories.

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COPD World News Week of July 15, 2012

Adult Lungs Can Sprout New Growth

Boston, MA - The lungs may have greater capacity for regeneration in adults than thought, according to a case report of new growth after lung cancer resection. A woman who had her right lung removed at age 33 because of cancer showed progressive growth in the left lung over the next 15 years, Steven J. Mentzer, MD, of Brigham and Women's Hospital and Harvard, and colleagues found. Not only did the size of the lung increase, but new alveoli developed. She had a 64% increase in the number of these tiny gas exchange units, the group reported in the July 19 issue of the New England Journal of Medicine. Compensatory lung growth after pneumonectomy wasn't a surprise, but the mechanism was, they explained. "The prevailing concept has been that lung regeneration after pneumonectomy occurs in the young through the growth of new acinar units and alveoli, whereas in adult humans, parenchymal hyper-expansion and alveolar dilatation -- not growth -- are thought to occur," Mentzer and colleagues wrote. Prior studies have shown that lung capacity, not surprisingly, is cut in half after removal of a lung in adults, which was taken as evidence for no true growth. However, some suggestive experimental evidence for adult lung growth in dogs suggested a long-time scale for growth -- on the order of months or years. So the researchers looked at lung growth over a period of 15 years in the 33-year-old woman who had a right-sided pneumonectomy in 1995 for adenocarcinoma after a 32-pack-year history of smoking. After surgery and chemotherapy, her lung capacity had dropped substantially from the baseline of at least 100% forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) down to 35% and 49% of the predicted value, respectively. But by the end of the 15-year follow-up period, progressive improvements in spirometry brought the FEV1 up to 60% and FVC to 73%. Those represented 51% and 35% relative improvements, respectively, compared with the expected 11% and 9% declines expected with aging by 15 years. Annual surveillance CT imaging showed that the remaining lung progressively enlarged, herniating partially into the right hemithorax. That lung expansion included both gas and total lung volume increases along with a gradual, sustained rise in tissue volume to about double what it had been immediately after the surgical resection. An experimental MRI scan using hyperpolarized helium-3 gas to measure apparent diffusion of inhaled gas showed dimensions in the part of the airways where the alveoli are that were consistent with an increase in the number of alveoli rather than in the size of existing alveoli. The alveolar depth in the growing lung, though, was shallower than in normal lungs (70 µm versus 138). Factors that may have contributed to the growth were the relatively young age of the patient at the time of surgery and stretching of the lung from post-pneumonectomy syndrome and exercise, the researchers suggested. After getting a prosthetic volume expander in the right lung cavity to ease dyspnea at 18 months, the patient exercised daily with a regimen of walking, cycling, and yoga. "We hypothesize that, reminiscent of the role of stretch in lung development, cyclic stretch as such may be an important trigger for new lung growth," the group concluded. "Regardless of the specific mechanism, the findings in this patient support the concept that new lung growth can occur in adult humans."

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COPD World News Week of July 8, 2012 

Inactivity May Kill as Many Worldwide as Smoking

Boston, MA - Inactivity is a major cause of death worldwide, with new research suggesting that a sedentary lifestyle is on par with both smoking and obesity when it comes to raising the risk for disease and mortality. In four research papers published online July 18 in a special physical activity-themed series in The Lancet, a number of investigating teams peg the number of inactivity-related deaths at 5.3 million worldwide as recently as 2008. This figure attributed to an inactivity-related risk for major killers such as breast and colon cancer, type 2 diabetes and heart disease amounts to roughly one out of every 10 deaths globally, a tally more or less equivalent to the number of people who die as a result of smoking. Although the report cites the inactivity-mortality association as most critical in low- and middle-income nations, researchers depict the situation as a problem with global dimensions. One-third of all adults -- globally amounting to about 1.5 billion people -- face a 20 percent to 30 percent greater risk for disease due to failing to engage in the kind of routine physical activity (150 minutes of moderate exercise per week) typically recommended by public health authorities. That figure rises dramatically among adolescents, among whom four in five engage in a risky sedentary lifestyle. Researchers from Brigham and Women's Hospital and Harvard Medical School in Boston noted that, globally, about 6 percent of coronary heart disease cases stem from a lack of adequate exercise, which they also linked to an average of about 7 percent of type 2 diabetes cases. Physical inactivity also accounts for an average of about 10 percent of breast and colon cancer cases worldwide, they added. Not all parts of the world are affected equally, however, as inactivity patterns vary widely region-by-region. For example, while about 43 percent of North Americans are deemed to be inactive, that figure is just 17 percent among southeast Asians. In Europe, inactivity figures run the gamut, ranging from a high of roughly 70 percent in Malta and Serbia to a low of 17 percent to 18 percent in Estonia and the Netherlands. Accordingly, inactivity-related disease incidence differs by region as well. Heart disease deaths brought on by a sedentary lifestyle appears to be most problematic in Europe, the researchers noted, where 121,000 fatalities were linked to inactivity in 2008. By comparison, there were 60,000 such deaths in North America and 44,000 in the eastern Mediterranean area. Yet, amidst a generally pessimistic overview, the research team strikes a hopeful note, suggesting that if physical inactivity rates were to be cut by as little as 10 percent globally, as many as 533,000 lives could be saved. That figure would rise to as high as 1.3 million if inactivity were to be sliced by as much as 25 percent. A group of researchers from the University of Tennessee point to a number of public health measures that could be taken to do just that. "Because even moderate physical activity such as walking and cycling can have substantial health benefits, understanding strategies that can increase these behaviors in different regions and cultures has become a public health priority," Gregory Heath, of the University of Tennessee, said in a journal news release. Heath and his colleagues highlight the potential benefits of mass media campaigns designed to promote activity, alongside the promotion of social support networks in the form of activity clubs and free community-based exercise classes. Efforts to create safe public spaces for biking and walking are also touted as helpful in the effort to get people moving. Meanwhile, a team led by Michael Pratt of the U.S. Centers for Disease Control and Prevention pointed to the promise of cellphones, and in particular text-messaging, as a way to deliver a pro-exercise message to the general public. "With the high prevalence of both physical inactivity and the rapid growth of the mobile phone sector in low-income and middle-income countries, there is the potential for population-level effects that could truly affect global health," Pratt noted in the news release.

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COPD World News Week of July 1, 2012

Smoking Might Raise Your Odds for Skin Cancer

Nottingham, UK - Smoking has long been tied to a number of cancers, and now another tumor type, skin cancer, may join that list. A new review of data finds that lighting up may boost the risk of a common type of non-melanoma skin cancer. Researchers sifted through the results of 25 studies conducted in 11 countries worldwide. Most of the studies included middle-aged to elderly people. This "meta-analysis" revealed that smoking was associated with a 52 percent increased risk of cutaneous squamous cell carcinoma skin cancer, according to Jo Leonardi-Bee, of the U.K. Center for Tobacco Control Studies at the University of Nottingham in England, and colleagues. Squamous cell and basal cell carcinomas -- collectively known as non-melanoma skin cancer -- account for about 97 percent of all skin cancers. The incidence of non-melanoma skin cancer is rising worldwide, with about two million to three million new cases each year. The authors said they found no clear association between smoking and basal cell carcinomas. The findings were published online June 18 in the journal Archives of Dermatology, "This study highlights the importance for clinicians to actively survey high-risk patients, including current smokers, to identify early skin cancers, since early diagnosis can improve prognosis because early lesions are simpler to treat compared with larger or neglected lesions," the researchers concluded. This isn't the first time smoking has been link to skin cancer. In December, researchers reporting in the journal Cancer Causes Control said that women diagnosed with squamous cell carcinoma were twice as likely to have been smokers than those who were free of the disease. The study, led by Dana Rollison, an associate member in the Moffitt Cancer Center department of cancer epidemiology, in Tampa, Fla., also found that men who were long-term smokers were at slightly higher risk for basal cell carcinomas. Speaking at the time, Dr. Jeffrey Dover, associate clinical professor of dermatology at Yale University Medical School, said the findings weren't surprising because "we know cigarette smoke contains carcinogens" and smokers are "blowing the smoke and ash around their faces all day." Squamous cell cancer occurs in the epidermis, the top layer of skin, and can spread to other organs. Basal cell skin cancer occurs in the dermis, the skin layer beneath the epidermis. While it does not spread to other organs, it is far more common than squamous cell cancer.

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