COPD World News - 2024

Week of July 14, 2024

Triple therapy inhaler improves lung hyperinflation, exercise endurance time in COPD

San Diego, CA - An inhaler with beclomethasone dipropionate, formoterol fumarate and glycopyrronium lowered lung hyperinflation in patients with COPD, according to research presented at the American Thoracic Society International Conference. Further, this triple therapy inhaler, along with a dual therapy inhaler including beclomethasone dipropionate and formoterol fumarate, benefitted patients by improving exercise endurance time, according to researchers. An inhaler with beclomethasone dipropionate, formoterol fumarate and glycopyrronium lowered lung hyperinflation in patients with COPD, according to presented research.In a randomized, double-blind, three-period crossover, placebo-controlled phase 4 study, Henrik Watz, MD, co-leader of the Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North and member of the German Center for Lung Research, and colleagues assessed 106 patients (38% women) with symptomatic moderate to severe COPD to see how a single inhaler triple therapy, a single inhaler dual therapy and placebo each impact lung hyperinflation and exercise endurance time after 3 weeks of use. Researchers noted that included patients had hyperinflation while receiving stable mono or dual inhaled maintenance COPD treatment. The triple therapy was composed of 100 μg extra-fine beclomethasone dipropionate per actuation, 6 μg formoterol fumarate per actuation and 10 μg glycopyrronium per actuation (BDP/FF/G; Chiesi), whereas the dual therapy only included 100 μg BDP per actuation and 6 μg FF per actuation (BPD/FF). For all three treatments, the administration regimen was two inhalations twice a day. Between baseline and the end of the 3-week treatment period, researchers observed a significantly greater change in 2-hour post-dose inspiratory capacity with BDP/FF/G vs. placebo (0.315 L; 95% CI, 0.25-0.38; P < .001), as well as with BDP/FF vs. placebo (0.223 L; 95% CI, 0.16-0.285; P < .001). Additionally, compared with placebo, the change in 2-hour post-dose exercise endurance time from baseline was better with the triple therapy (69.2 seconds; 95% CI, 32.9-105.5; P < .001) and the dual therapy (70.1 seconds; 95% CI, 33.6-106.6; P < .001). In terms of changes in inspiratory capacity at isotime, which was defined as the “shortest [exercise endurance time] at either the start or end of each treatment period” from baseline, significant improvement was found with BDP/FF/G vs. placebo (0.245 L; 95% CI, 0.147-0.342; P < .001) but not with the dual therapy inhaler vs. placebo. Between the triple therapy inhaler and the dual therapy inhaler, researchers noted that BDP/FF/G improved inspiratory capacity 2-hour post-dose (0.092 L; 95% CI, 0.028-0.157; P = .005) and inspiratory capacity at isotime (0.149 L; 95% CI, 0.052-0.246; P = .003). With no reported safety signals from the researchers, the inhalers appear safe. 

For more information: https://tinyurl.com/je6mkks4

Week of July 7, 2024

Primary Care COPD Clinic Could Be a Model for Lasting Survival Benefit

Hong Kong - A regional primary care, nonphysician-based program for chronic obstructive pulmonary disease (COPD) was associated with improved longer-term survival, a propensity-matched cohort study in Hong Kong showed. COPD patients seen in family medicine and general outpatient clinics that participated in Nurse and Allied Health Clinic-Respiratory Care (NAHC-Respiratory) had lower risks of all-cause mortality through roughly 7 years of follow-up compared with patients who had usual care at other public outpatient clinics (32.1% vs 37.2%, HR 0.84, 95% CI 0.78-0.90), reported Kailu Wang, PhD, of the Prince of Wales Hospital in Hong Kong, and co-authors. NAHC-Respiratory was also associated with significant reductions in various cause-specific deaths:

• Pneumonia mortality (9.6% vs 11.3%, HR 0.85, 95% CI 0.74-0.97)
• Respiratory mortality (14.6% vs 16.8%, HR 0.86 95% CI, 0.77-0.96)
• Cardiovascular mortality (3.2% vs 4.3%, HR 0.74, 95% CI 0.59-0.93)

Exposure to the NAHC-Respiratory program was further associated with reduced rates of both visits to the emergency department (incidence rate ratio [IRR] 0.92, 95% CI 0.86-0.98) and hospitalizations through the emergency department (IRR 0.89, 95% CI 0.83-0.95), Wang and colleagues said in JAMA Health. "This study provides evidence that the care model involving nurses and allied health professionals can facilitate COPD treatment, highlighting that health care professionals other than physicians are important in patient follow-up and disease management in the primary care setting," the authors concluded. The report adds longer-term benefits to the existing evidence of improved lung function and quality of life among NAHC-Respiratory participants after 6 opens and 12 months. NAHC-Respiratory was introduced to Hong Kong primary care settings in 2009 as a program -- primarily coordinated by nurses, physiotherapists, and occupational therapists -- for patients with COPD and those with a high risk of developing COPD referred by physicians. The public sector program offered patient education on physical exercise and lifestyle, smoking cessation, vaccinations, and pulmonary rehabilitation for enrolled patients with a relatively low baseline mortality risk. Wang and colleagues suggested that the benefits they observed may be attributed to influenza and pneumococcal vaccinations and smoking cessation. Notably, the all-cause mortality benefit hinged on age, being statistically significant only for patients 60-79 years old at baseline (HR 0.82, 95% CI 0.74-0.90) and ever smokers (HR 0.75, 95% CI 0.68-0.84). Associations with all-cause mortality were not significant among patients who were under the age of 60, were 80 years old or above, were non-smokers, or for patients without smoking status records. "These findings indicate the program's potential to improve long-term health outcomes of patients with COPD and save health care resources of hospitals through a primary care intervention, although improvement of service provision may be needed for patients younger than 60 years," researchers wrote.

For more information: https://tinyurl.com/msv7tv2w

Week of June 30, 2024

CDC universally recommends RSV vaccines for oldest US adults

Atlanta, GA - The CDC’s vaccine advisors voted unanimously Wednesday to recommend that everyone aged 75 years or older get vaccinated against respiratory syncytial virus. The Advisory Committee on Immunization Practices (ACIP) also voted unanimously to recommend RSV vaccination for people aged 60 to 74 years who are at high risk for severe RSV disease. The CDC’s ACIP voted to change its RSV vaccination recommendation to a risk-based recommendation for the oldest adult population and those at high risk for severe disease. The votes supplant a weaker recommendation made by the CDC last year that said people aged 60 years or older should talk to their provider about getting vaccinated against RSV. Following the ACIP vote, CDC Director Mandy Cohen, MD, MPH, signed off on the recommendations, making them official. Cohen said the vaccines “provide an extra layer of protection” for patients at highest risk for severe RSV. “There was very strong desire to move away from shared clinical decision-making after hearing a lot of comments that it made it difficult for physicians and pharmacists to implement RSV vaccines,” Healio | Infectious Disease News Editorial Board Member William Schaffner, MD, a professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center and former medical director of the National Foundation for Infectious Diseases, said in an interview after the votes. “So, they looked over their data and went to the highest risk group and voted to make it routine that everybody age 75 and older receive a single dose.” ‘Shared clinical decision-making in sheep's clothing’ Both recommendations received unanimous support from the 11-member ACIP voting body. The committee clarified that only people who have not already received an RSV vaccine shout get a shot. Adults aged 60 to 74 years who are not at an increased risk for severe RSV disease are no longer included in the recommendations. The CDC will publish clinical considerations describing medical conditions and other risk factors for severe RSV disease for providers to reference. Online, the agency lists cardiopulmonary disease, kidney disorders, liver disorders, neurologic or neuromuscular conditions, hematologic disorders, diabetes and moderate or severe immune compromise as risk factors for severe RSV in adults aged 60 years or older. Schaffner said the risk-based approach “is not a lot easier than shared clinical decision-making.” “It's really shared clinical decision-making in sheep's clothing,” he said. “It's as difficult for doctors and pharmacists as shared clinical decision-making.” The ACIP reviewed updated data on the available RSV vaccines, including from Pfizer’s RENOIR trial, which showed that RSV vaccine, Abrysvo, was 89% (95% CI, 52%-97%) effective at preventing hospitalizations and emergency department visits caused by RSV-related lower respiratory tract disease (LRTD) in a study population that was 57% people aged older than 75 years and 14% immunocompromised. Updated data for GSK’s Arexvy showed that, over 2 years, the vaccine was 67.7% effective (95% CI, 52.3%-78.7%) at preventing RSV-related LRTD with a season covariate and 73.3% (95% CI, 60.7%-82.4%) without. Among study participants aged 70 years and older, the vaccine was 74.6% (95 CI, 52.6%-87.5%) and 79.1% (95% CI, 81.3%-89.7%) effective. Moderna presented data that showed its recently approved vaccine, mResvia, was 78.7% effective against RSV-related LRTD with two or more symptoms among adults aged 60 years or older and 80.9% effective against RSV-related LRTD with three more symptoms. Further analysis of 18-month data showed a vaccine efficacy of 50.3% and 49.9%, respectively. While the committee ultimately voted in favor of these changes to RSV vaccine recommendations, concerns were voiced before the vote regarding “backtracking” by removing older adults without underlying conditions or risk factors from the recommendations. “It is OK for us to reevaluate vaccines and use them as they are needed. We're one of the few countries that does not do that,” ACIP chair Helen Keipp TalbotMD, MPH, professor of medicine at Vanderbilt University, said during the meeting. “That only lends us credibility in saying, ‘We have reviewed this. This is the right use of medical funds. This is the right way to save lives. This is the right way to reduce risk of vaccines.’” The ACIP did not hold a vote on whether to recommend RSV vaccination for patients aged 50 to 59 years despite the FDA’s recent decision to extend the approval of GSK’s vaccine for high-risk patients in that age group.

For more information: https://tinyurl.com/vbkj7mad

Week of June 23, 2024

Lung cancer screening program identifies airways disease in previously undiagnosed COPD

San Diego, CA - More than 75% of individuals who underwent lung cancer screening without a reported history of COPD had airways disease, according to research presented at the American Thoracic Society International Conference. Airflow obstruction was also apparent in 36.5% of individuals with previously undiagnosed COPD and spirometry data, according to researchers. “These findings will help the everyday clinician target the most at-risk populations for previously undiagnosed COPD,” Michaela Seigo, DO, chief pulmonary and critical care fellow at Temple Health, told Healio. Using data from the Temple Healthy Chest Initiative (THCI) lung cancer screening program between October 2021 and October 2022, Seigo and colleagues evaluated 2,083 individuals with low-dose CT scans to determine how individuals with vs. without a history of COPD differ based on demographics and pulmonary comorbidities. Notably, the THCI also involves symptom detection during the time of the low-dose CT scan, in which patients report their symptoms through a phone call or a paper survey to a dedicated Nurse Navigator. Researchers divided up patients according to their COPD status noted in the electronic medical record. This record also housed patient demographic information and spirometry data. Between those with vs. without a history of COPD, researchers observed significant differences in mean age (65.8 years vs. 63.9 years), gender (women, 56.6% vs. 50.2%), smoking status (current, 49.2% vs. 59.6%; former, 50% vs. 35.9%) and the classification of a race other than Black, non-Hispanic; Asian/Native American/Pacific Islander; white, non-Hispanic; Hispanic; and unknown (4.3% vs. 5.6%). LungRADS scores also differed between the two groups. Compared with individuals with COPD, a greater proportion of individuals without COPD had a score of 1 (37.3% vs. 32.6%) and 3 (8.3% vs. 6.9%). In contrast, the group with vs. without COPD had a higher proportion of individuals with a score of 2 (52.3% vs. 50.2%) and 4 (7.6% vs. 3.8%). Researchers also found significant differences between the two groups with regard to the prevalence of various pulmonary comorbidities on low-dose CT. Significantly fewer individuals without vs. with a history of COPD had emphysema (27.5% vs. 72.5%), airways disease (76.2% vs. 84%), emphysema plus airways disease (25.9% vs. 32.3%), bronchiectasis (12% vs. 17.9%) and interstitial lung disease (6.7% vs. 11.3%). “We detected pulmonary comorbidities at higher rates than previously published,” Seigo said. “I think this is a reflection of how our population at Temple is unique: it is composed of more city-dwelling, lower income and racial/ethnic minorities/people of color.” Of the total cohort, less than one-third of patients completed a symptom survey (29%) and had spirometry data (30%). Symptom survey results revealed that those without COPD had a significantly higher proportion of individuals deemed less dyspneic than those with COPD (72% vs. 62.8%) and a significantly lower proportion of individuals with ever dyspnea (88.1% vs. 93.6%). Additionally, a significantly lower proportion of those without vs. with COPD had “more cough” (27.4% vs. 34.2%) and agreed with the statement, “breathing affects your ability to do things” (24.5% vs. 56.6%), according to researchers. Airflow obstruction was identified as an FEV1/FVC ratio less than 70% and was observed in 36.5% of those without a history of COPD vs. 69.2% of those with a history of COPD. When considering how future studies will be different, Seigo highlighted AI.“In the future, I think AI will play a dominant role,” she said. “At-risk populations will get [low-dose] CT scans and AI will spit out a list of pulmonary and extra-pulmonary comorbidities that may need to be addressed. “Together, with symptom detection plus strategic and more widely available access to screening in  general, there is a huge opportunity to intervene earlier and potentially save lives,” Seigo continued. 

For more information: https://tinyurl.com/4xykrj89

Week of June 16, 2024

FDA Expands Use of RSV Vaccine to Include More Adults

Silver Spring, Maryland - The FDA expanded the approval of GSK's respiratory syncytial virus (RSV) vaccine (Arexvy) to include adults ages 50 to 59 at risk of RSV-related lower respiratory tract disease (LRTD) due to underlying conditions, the company announced recently. Previously the adjuvanted RSV prefusion F protein-based vaccine had been approved only for adults 60 and older ; it is currently recommended for use via shared decision-making by the CDC and Advisory Committee on Immunization Practices. According to the vaccine maker, an estimated 13 million U.S. adults ages 50 to 59 years have medical conditions -- e.g., asthma, chronic obstructive pulmonary disease, diabetes, heart failure -- putting them at increased risk of RSV-related LRTD and its serious consequences, including pneumonia and death. "When it comes to the risks associated with RSV, age is just a number, an important number, but not the only factor to consider," Ann Falsey, MD, of University of Rochester School of Medicine in New York, said in a statement from GSK. "Many adults in this age group have underlying health conditions that place them at increased risk for serious illness with RSV infection compared with those without these conditions. Now there is a vaccine approved that can help protect them." About 42,000 hospitalizations occur each year in the U.S. among adults ages 50 to 64 years old, according to a systematic review and meta-analysis. That compares to approximately 159,000 annual hospitalizations in U.S. adults 65 and older. The new approval was based on results of a double-blind phase III multinational trial  that demonstrated noninferior immune responses with the vaccine for 1,140 participants ages 50 to 59 (half of whom had high-risk conditions for RSV-LRTD) versus older adults. In both of the younger groups, RSV-A and RSV-B neutralization titers were similar 1 month after administration of a single vaccine dose compared to the older group. Safety and reactogenicity were consistent with the pivotal trial data for adults 60 and over, said GSK, with most adverse events (AEs) being mild to moderate and also transient. In the adults ages 50 to 59, the most commonly reported AEs were pain at the injection site (76%), fatigue (40%), myalgia (36%), headache (32%), arthralgia (23%), erythema (13%), and swelling (10%). Safety information in the labeling also includes warnings about the potential for severe allergic reaction and syncope after administration, and that immunocompromised people may have a diminished immune response. 

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

Week of June 9, 2024

New study claims biologics lower exacerbations, hospitalizations in COPD

San Diego, CA - After 1 year of biologic therapy, patients with COPD and Th2 inflammation experienced fewer exacerbations and hospitalizations, according to research presented at the American Thoracic Society International Conference. “Because we took a real-world approach including all comers with COPD who received biologics, this may be more directly relatable to patients at large and patients being treated by clinicians, primary care doctors and pulmonologists every day in the community,” stated Stephen R. Dachert, MD, a fellow in the department of thoracic medicine and surgery at Temple University Hospital. In a real-world, single-center, retrospective review, Dachert and colleagues evaluated 53 patients (mean age, 70.7 years; 58% women) with COPD and Th2 inflammation and a biologic prescription to find out how 1-year biologic use impacts acute exacerbations of COPD and lung function. Before starting biologic therapy, the average eosinophil count was 471 cells/µL. The most prescribed biologic in this cohort was mepolizumab (n = 40; 66.7%; Nucala, GSK), followed by benralizumab (n = 14; 23.3%; Fasenra, AstraZeneca), dupilumab (n = 5; 8.3%; Dupixent; Regeneron, Sanofi) and tezepelumab (n = 1; 1.7%; Tezspire; Amgen, AstraZeneca). Notably, this sample included patients with mild to severe emphysema and patients with airflow obstruction, which Dachert said are both underrepresented in randomized clinical trials. This cohort was also diverse in race/ethnicity, including white patients (65%), Black/African American patients (20%), Hispanic patients (8.4%) and patients from other racial/ethnic groups (6%). “Being from Temple, we are lucky that we have a very diverse patient population, which oftentimes is not the case in a lot of large, randomized clinical trials,” Dachert said. Compared with the number of exacerbations observed 1 year prior to biologic therapy use, researchers found that 1 year of biologic therapy significantly lowered the number of exacerbations by 1.883 (95% CI, 1.382-2.385). Further, 1 year of biologic use also led to a significant decrease in the number of hospitalizations vs. the year before biologic use (0.783; 95% CI, 0.427-1.14). “The big takeaway in our large, real-world study of diverse patients with a lot of comorbidities, including emphysema and high exacerbation burden, is that we showed a statistically significant reduction in both moderate and severe exacerbations, including hospitalizations,” Dachert said. “Specifically, the hospitalization finding has not been shown before, so we are novel in showing that.” To observe changes in spirometry following biologic therapy use, researchers assessed several measures of percent-predicted lung function: FEV1, FVC, total lung capacity, residual volume and diffusing capacity of the lungs for carbon monoxide (DLCO). For all the above measures, the difference between 1 year before and 1 year after biologic therapy use did not reach significance. The only measure of lung function that “trended towards significance” was an increase in DLCO, according to researchers. Considering the real-world aspect of this study, Dachert emphasized the value of the main findings for clinicians. “This information would be very useful to general clinicians and pulmonologists in that they may find that their patients look more like the patients that we looked at in our study,” he said. Future studies on this topic should strive to include more patients, Dachert told Healio. “In this study, we looked at things like emphysema and varying degrees of airflow obstruction and saw that there was no statistical difference in exacerbations in those specific groups,” Dachert said. “Moving forward, if we’re able to increase the amount of data that we have, we may be able to identify some kind of variable that would be associated with an even higher reduction in exacerbations.” 

For more information: https://tinyurl.com/bdsww47

Week of June 2, 2024

Inadequate social support contributes to depression, disease impact in COPD

Aalborg, Denmark - Perceived inadequate social support among patients with COPD living with a loved one was linked to more depression symptoms and greater disease impact, according to results published in Respiratory Medicine. “This study underlines the importance of addressing social support in the care for patients with COPD, even if they have a resident loved one,” Anna L. Stoustrup, PT, MSc, PhD fellow at Aalborg University Hospital in Denmark, and colleagues wrote. In a cross-sectional study, Stoustrup and colleagues assessed 191 patients with COPD (mean age, 65.6 years; 53.4% men; mean FEV1 47.3% percent predicted) living with a loved one to determine how inadequate vs. adequate social support impacts eight clinical outcomes: lung function, dyspnea, health status, anxiety symptoms, depression symptoms, care dependency, functional status and mobility.Researchers used the Medical Outcomes Study-Social Support Survey (MOS-SSS) to find out if patients perceived their social support as adequate or i nadequate. The most common relationship patients had with their resident loved one was spouse/partner (97.9%), with fewer patients living with their child (1.6%) or friend (0.5%). Of the total cohort, more patients reported adequate vs. inadequate social support (81.7% vs. 18.3%). In the adequate social support group, the average overall support index score was 4.5 out of 5 points, whereas this score was 2.8 out of 5 points in the inadequate social support group. Three of the eight assessed clinical outcomes significantly differed according to the level of perceived social support, with worse outcomes seen in the inadequate group, researchers wrote. Use of the COPD Test Assessment revealed a higher disease impact among patients with inadequate vs. adequate social support (25 points vs. 21 points; P = .004). To evaluate symptoms of depression and anxiety, researchers used the Hospital Anxiety and Depression Scale (HADS) and found scores signaling more depression symptoms in the group with perceived inadequate social support (8 points vs. 5 points; P = .004). Lastly, inadequate social support was linked to an elevated Care Dependency Scale score, suggesting more care dependency, when compared with adequate social support (69 points vs. 71 points; P = .04) in this study population. Lung function (FEV1 percent predicted), dyspnea (Modified Medical Research Council Dyspnea Scale score), anxiety symptoms (HADS-anxiety score), functional status (Instrumental Activity of Daily Living score) and mobility (Timed Up and Go test) did not significantly differ based on inadequate vs. adequate social support. “The relationship between perceived level of social support and actual support needs is relevant to unravel further when using the MOS-SSS or otherwise assessing social support among patients with COPD,” Stoustrup and colleagues wrote. 

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

Week of May 26, 2024

Increasing doses of varenicline or nicotine replacement helps persistent smokers quit

Houston, TX - For most smokers, quitting on the first attempt is likely to be unsuccessful, but a new study from The University of Texas MD Anderson Cancer Center found patients were more likely to quit if their cessation regimen was altered and doses were increased. Researchers also found that varenicline, a cessation medication, was more effective than combined nicotine replacement therapy (CNRT), such as patches or lozenges. The study, published today in JAMA, revealed smokers who failed to quit with varenicline in the trial’s first phase were seven times more likely to quit by the end of the second phase if varenicline doses were increased. There also was a nearly two-fold increase in those who successfully quit if they were switched from a CNRT regimen to varenicline. These results are favorable compared to the near zero chance of abstinence seen in patients who were switched from varenicline to CRNT or left on the same treatment plans. "These data indicate that sticking to the same medication isn't effective for smokers who are unable to quit in the first six weeks of treatment," said lead researcher Paul Cinciripini, Ph.D., chair of Behavioral Science. “Our study should encourage doctors to check in on patients early in their cessation journey and, if patients are struggling, to try a new approach, such as increasing medication dosage." The double-blind, placebo-controlled trial followed 490 smokers who were randomized to receive six weeks of varenicline or CNRT. After the first phase, those unable to quit were re-randomized to continue, switch or increase medication dose for an additional six weeks. Initial treatment included 2 mg of varenicline or CNRT (21 mg patch plus 2 mg lozenge). Participants who were re-randomized either continued the same varenicline or CNRT dose, switched between varenicline and CNRT, or were given an increased dose of 3 mg of varenicline or CNRT (42 mg patch plus 2 mg lozenge). The study was conducted in Texas from June 2015 to October 2019.Of the patients who received varenicline and had their doses increased, 20% were still abstaining six weeks later. Meanwhile, the abstinence rate was 14% among patients who switched from  CRNT to varenicline or who had their CRNT doses increased. However, varenicline patients who switched to CNRT saw a 0% quit rate. After six months, only those who had their doses increased remained continuously abstinent. Tobacco use remains the leading preventable cause of death and disease in the U.S. Each year, about 480,000 Americans die from tobacco-related illnesses. Currently, more than 16 million Americans suffer from at least one disease caused by smoking, including cancer. Quitting tobacco can improve the chances of survival by 30-40% for cancer patients who smoke. Since the average smoker makes several attempts to quit before successfully beating the addiction, MD Anderson tackles the barriers to cessation at an individual and population level, factoring in cost, access to cessation services, and knowledge gaps among health care providers on treating tobacco addiction. In a larger ongoing trial, researchers are testing several different medication combinations as an alternative for those unable to quit on their initial doses of varenicline or CNRT.

For more information:  https://tinyurl.com/47ve7sv3

Week of May 19, 2024

Forget 'Pack-Years' for Lung Cancer Screening Eligibility, Study Suggests

Boston, MA - Dropping pack-years for lung cancer screening eligibility in favor of a simpler 20-year history of smoking could substantially increase the number of cancers detected and eliminate racial disparities as well, according to an analysis of smokers from two large cohort studies. Under current screening criteria from the U.S. Preventive Services Task Force (USPSTF), which call for a 20-pack-year history of smoking, researchers found that 58% of Black patients with lung cancer in the Southern Community Cohort Study (SCCS) would have been eligible for screening, compared with 74% of white patients with lung cancer in SCCS. But these percentages would increase to 85.3% and 82%, respectively, with the proposed 20-year duration of smoking criteria, "thus eliminating the racial disparity in screening eligibility," reported Chi-Fu Jeffrey Yang, MD, of Massachusetts General Hospital in Boston, and colleagues stated. Additionally, an analysis of the Black Women's Health Study (BWHS) showed a switch to the simpler requirement would have increased the percentage of Black women who qualified for screening from 43% to 64%. "These findings challenge the use of pack-year smoking history in determining lung cancer screening eligibility and support the use of smoking duration cutoffs instead as a simple yet effective change to increase the sensitivity of the guideline and improve equity in opportunities for screening," the researchers concluded. However, while the proposed change would make it easier to identify eligible screening participants and increase sensitivity, the benefits came with a considerable tradeoff -- a "notable decrease in specificity," wrote Hasmeena Kathuria, MD, and Renda Soylemez Wiener, MD, MPH, both of the Boston University Chobanian & Avedisian School of Medicine, said. In the two cohorts, the specificity with the pack-year cutoff (under current USPSTF guidelines) versus the proposed duration-of-smoking cutoff decreased as follows: Black people in SCCS: 63.6% to 29.3%, White people in the SCCS: 49.7% to 38.5%’ Black women in the BWHS: 86.8% to 71.7% "The lower specificity suggests that the proposed criteria would expand screening to many low-risk people who will never develop lung cancer, increasing the number exposed to screening-related harms," the editorialists said. Yang and colleagues acknowledged that under their proposed guidelines a higher percentage of Black individuals would become eligible for screening and be exposed to screening-related harms, such as false-positive findings leading to unnecessary tests, invasive procedures, and treatment." They will not, however, be at greater risk of harm than white individuals," the study authors wrote. "Furthermore, the very low risk of harm from lung cancer screening must be considered, as always, in the context of the life-saving potential of early lung cancer detection." 

For more information: https://tinyurl.com/bdcs6x92

Week of May 12, 2024

Undiagnosed COPD, asthma linked to worse quality of life, more health care use

Ottawa, ON - Compared with healthy individuals, having undiagnosed COPD or asthma negatively impacted quality of life and led to higher health care usage, according to results published in American Journal of Respiratory and Critical Care Medicine. “The detection of undiagnosed COPD or asthma at an earlier stage of disease may enable early interventions to manage disease progression and improve patient outcomes,” Emily Gerstein, research student at the Ottawa Hospital Research Institute, and colleagues wrote. In a multicenter population-based case-finding study in Canada, Gerstein and colleagues assessed adults with undiagnosed COPD/asthma to compare symptoms, quality of life, health care use and work productivity with that of patients with diagnosed COPD/asthma and healthy individuals (controls). Researchers identified those with undiagnosed COPD/asthma in a cohort of 2,857 individuals with respiratory symptoms using pre- and post-bronchodilator spirometry. From this population, 330 individuals (11.5%) met diagnostic criteria for COPD and 265 (9.3%) met the criteria for asthma. The COPD-focused analysis included the previously identified 330 individuals with undiagnosed COPD (mean age, 66.1 years; 63% men; mean BMI, 28.6 kg/m2), 231 healthy individuals (mean age, 61.5 years; 58% men; mean BMI, 28.4 kg/m2) and 101 patients with diagnosed COPD (mean age, 67.3 years; 66% men; mean BMI, 29.9 kg/m2). The asthma focused analysis included the 265 individuals with undiagnosed asthma (mean age, 58.7 years; 56% men; mean BMI, 30.7 kg/m2) identified above, the same 231 healthy individuals and 97 patients with diagnosed asthma (mean age, 60.9 years; 44% men; mean BMI, 31.9 kg/m2). Undiagnosed vs. healthy controls Between those with undiagnosed COPD/asthma and healthy individuals, researchers found worse outcomes in the undiagnosed cohorts. COPD Assessment Test (CAT) total scores showed that respiratory symptom burden had a greater negative impact on health status and daily activities of those with undiagnosed asthma vs. healthy individuals (adjusted mean difference, 11.8; 95% CI, 10.6-13), as well as those with undiagnosed COPD (adjusted mean difference, 13.1; 95% CI, 11.7-14.4). Health-related quality of life, assessed using the St. George’s Respiratory Questionnaire (SGRQ) total score, was also worse among individuals with undiagnosed asthma (adjusted mean difference, 31; 95% CI, 28.3-33.8) and individuals with undiagnosed COPD (adjusted mean difference, 32.6; 95% CI, 29.4-35.9) vs. healthy individuals. Further, both sets of undiagnosed individuals had poorer global health status than healthy individuals when evaluated via the 36-item Short Form Health Survey (SF-36) total score (adjusted mean difference: asthma, –15.9; 95% CI, –18.8 to –13.1; COPD, –20; 95% CI, –23.3 to –16.7), according to researchers. In the past 12 months, only 9% of healthy individuals had a physician visit for breathing difficulties, whereas 33% of individuals with undiagnosed asthma and 26% of those with undiagnosed COPD reported a visit. Lastly, researchers observed poorer work productivity and an impaired ability to do regular daily activities among those with undiagnosed asthma/COPD vs. healthy individuals. More individuals with undiagnosed COPD vs. healthy individuals missed work (14% vs. 2%; P = .002). The proportion of individuals who missed work was similar between the undiagnosed asthma group and the healthy control group.   Gerstein and colleagues wrote that results from a trial including individuals with undiagnosed COPD/asthma assessing intensive early treatment with guideline-based treatment vs. standard care will be shared in 2024. “This trial aims to determine if early intensive treatment for undiagnosed obstructive lung disease provides clinical benefit,” Gerstein and colleagues wrote. 

For more information: https://tinyurl.com/2fx7rtcu

Week of May 5, 2024

Race-neutral lung function equations impact spirometry interpretation

Rochester, Minnesota - Use of race-neutral vs. race-specific lung function equations led to different interpretations of spirometry findings, especially among Black individuals, according to study results. “[Global Lung Function Initiative (GLI)] Global offers a ‘race-neutral’ approach to the interpretation of lung function measurements, motivated by efforts to eliminate health disparities and structural racism in medicine,” Amjad N. Kanj, MD, MPH, pulmonary and critical care fellow at Mayo Clinic in Rochester, Minnesota, and colleagues wrote. Use of race-neutral vs. race-specific lung function equations led to different interpretations of spirometry findings, especially among Black individuals, according to study results. Image: Adobe Stock In a multicenter cross-sectional study published in American Journal of Respiratory and Critical Care Medicine, Kanj and colleagues assessed 109,447 individuals with spirometry tests to determine how predicted lung function measurements change with use of GLI Global race-neutral reference equations vs. GLI-2012 race-specific equations. The total cohort included 101,010 white individuals (mean age, 59.5 years; 51.6% women), 4,476 Black individuals (mean age, 52 years; 58.6% women), 236 Northeast Asian individuals (mean age, 53.9 years; 54.7% women), 1,472 Southeast Asian individuals (mean age, 51.9 years; 52.9% women) and 2,253 mixed/other race individuals (mean age, 48.7 years; 51.1% women). At baseline, researchers evaluated dyspnea in each group using the modified Medical Research Council (mMRC) scale score and found that 36.7% of Black individuals had a score of two or higher. The highest proportion of individuals meeting this score was found in this group compared with the other four groups. Researchers also noted differences in absolute FEV1 and FVC percent predicted based on race/ethnicity with use of GLI-2012 reference equations. For white and Northeast Asian individuals, FEV1 was between 2.47 L to 2.51 L and FVC was between 3.19 L to 3.36 L. Black, Southeast Asian and mixed/other race individuals had lower measures of lung function. White and Northeast Asian individuals continued to have higher measures of mean FEV1 and FVC percent predicted after use of GLI race-neutral equations. For Black, Southeast Asian and mixed/other race individuals, these measures went down, with the greatest decline observed in the Black cohort (FEV1, –8.4%; FVC, –8.6%). Use of race-neutral vs. race-specific equations further resulted in more Black individuals with possible restriction (33.1% vs. 21.9%). The only other group with an increase in individuals with possible restriction was the Southeast Asian group (19.1% vs. 13.9%). The cohort of white individuals was the only racial/ethnic group who had more individuals with obstruction after use of race-neutral vs. race-specific equations (21.6% vs. 19.7%). After representing each group included in this study equally, 10.2% of the total cohort had a different interpretation of lung function results with use of race-neutral vs. race-specific equations. Compared with white, Southeast Asian, Northeast Asian and mixed/other race individuals, more Black individuals had changes in the interpretation of their spirometry test results with the neutral equations, including a higher prevalence of abnormal test results (relative increase, 32.9%). Lastly, among those with obstruction according to race-neutral vs. race-specific equations, these individuals faced a higher likelihood for an mMRC score of at least two (OR = 1.7; 95% CI, 1.2-2.5) and air trapping (OR = 2.6; 95% CI, 1.4-5.1). Among those with possible restriction based on race-neutral vs. race-specific equations, researchers found a heightened likelihood for low total lung capacity (OR = 3.3; 95% CI, 2.7-4.2). “It is crucial to consider the intended use of spirometry interpretation and acknowledge the continued importance of placing these data within an appropriate clinical context,” Kanj and colleagues wrote. “More research is needed to understand the clinical implications of the changes in interpretation we observe using the GLI Global reference equations.” 

For more information: https://tinyurl.com/55v37nc3

Week of April 28, 2024

Quebec announces that shingles vaccine will be free for people aged 75 years+

Quebec City, PQ - The Minister of Health, Christian Dubé, as well as the Minister responsible for Seniors and Minister for Health, Sonia Bélanger, announce that the shingles vaccine will be free for people aged 75 years and over as of May 1st. It was previously offered to people aged 80 and over. Expanding the shingles vaccination program will help reduce the number of shingles cases and associated complications. The vaccine will be offered to people aged 75 and over from May 1 at local service points (PSL) as well as in pharmacies. It provides excellent long-term protection against the most common complications of this disease, notably post-herpetic neuralgia (PHN), with pain that can persist for several months, or avoid hospitalizations or deaths. In Quebec, each year there are approximately 27,000 cases of shingles, 600 hospitalizations and 10 deaths caused by the disease, approximately 80% of which occur in people aged 80 and over (MSSS, 2023). This is another step in the government's approach to prevention, according to the vision expressed in the Health Plan. “Expanding access to the shingles vaccine is part of one of the priorities of the Health Plan, which is to do more prevention. We aim to offer Quebecers complete protection against this disease, the complications of which can be very painful and, sometimes, fatal. I encourage all eligible people to take advantage of this opportunity to take advantage of the doses offered to reduce the risk of infection or complications,” said Christian Dubé, Minister of Health. Sonia Bélanger, Minister responsible for Seniors and Minister for Health added,  “Each process of expanding free eligibility for a vaccine is a step that we are taking in the right direction to ensure we have a population in perfect health, but also to reduce pressure on the health and care network. social services. I am all the more happy because this program mainly targets seniors and I invite them to take advantage of this opportunity. I thank all the teams as well as the health professionals who are mobilizing to help seniors stay healthy." 

For more information: Pour une meilleure prévention - Le vaccin contre le zona offert gratuitement aux personnes de 75 ans et plus (newswire.ca)

Week of April 21, 2024

Higher abstinence rate with e-cigarettes vs. nicotine gum

Peking, China - Individuals using e-cigarettes for smoking cessation had a higher 6-month abstinence rate than nicotine replacement therapy users and a similar rate to varenicline users, according to results published in JAMA Internal Medicine. “[E-cigarettes] were as effective in helping smokers quit as varenicline and more effective than nicotine chewing gum when all three products were provided with minimal behavioral support,” Hao-Xiang Lin, DrPH, of the Institute for Global Health and Development at Peking University in China, and colleagues wrote. In a multicenter, randomized clinical trial in China, Lin and colleagues assessed 1,068 individuals (mean age, 33.9 years; 33.5% women) smoking a daily minimum of 10 cigarettes to determine how e-cigarette use for 12 weeks compares with 12-week nicotine replacement therapy (NRT) and varenicline (Chantix, Pfizer) in terms of sustained abstinence at 6 months. Of the total cohort, 409 (38.3%) individuals received a cartridge-based e-cigarette with a 30 mg/mL nicotine salt dose for the first 2 weeks and then a 50 mg/mL dose. The varenicline group also consisted of 409 individuals, and the dosing of this drug started as 0.5 mg once daily for 3 days, followed by 0.5 mg twice daily for 4 days and 1 mg twice daily for the remainder of the time. Fewer patients randomly received nicotine chewing gum (n = 250; 23.4%), and the dose of this therapy was based on level of smoking (2 mg ≤ 20 cigarettes/day, n = 197; 4 mg, > 20 cigarettes/day, n = 53). Researchers additionally noted that each smoker was invited to join a self-help internet forum regardless of their cessation method group. Around 80% of individuals from each group had 6-month follow-up data. Using an expired-air carbon monoxide reading (< 8 parts per million), individuals using e-cigarettes had the highest abstinence rate at 6 months (15.7%), followed closely by varenicline users (14.2%) and then nicotine gum users (8.8%). Between the e-cigarette group and the varenicline group, researchers found similar quit rates (absolute risk reduction, 1.47%; 95% CI, –1.41% to 4.34%). However, when compared with the nicotine gum group, e-cigarette users had a higher likelihood of quitting (OR = 1.92; 95% CI, 1.15-3.21). Researchers continued to see the above results after controlling for education level and Fagerstrom Test for Cigarette Dependence baseline scores. 

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

Week of April 14, 2024

New study shows vaping may help people quit smoking cigarettes

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

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

Week of April 7, 2024

Flu vaccine uptake tripled with simple promotion

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

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

Week of March 31, 2024

Childhood cigarette smoking heightens COPD risk in adulthood

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

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

Week of March 24, 2024

Commonly Used Fingertip Pulse Oximeters Not Up to Snuff

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

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

Week of March 17, 2024

New government repeals New Zealand's tobacco ban

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

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

Week of March 10, 2024

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

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

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

Week of March 3, 2024

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

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

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

Week of February 25, 2024

Even Moderate Exposure to Radon Tied to Increased Stroke Risk

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

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

Week of February 18, 2024

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

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

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

Week of February 11, 2024

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

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

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

Week of February 4, 2024

Palliative telecare team improves quality of life in COPD

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

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

Week of January 28, 2024

Global tobacco use tumbles despite industry lobbying

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

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

Week of January 21, 2024

Inhaled corticosteroids increasingly used for COPD outside recommended indications

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

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

Week of January 14, 2024

Daily nitrate-rich beetroot juice decreases blood pressure in COPD

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

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

Week of January 7, 2024

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

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

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