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Studies Find: Ozone, Wood Smoke Raise Odds of COPD in Smokers and Nonsmokers

High levels of ozone and wood smoke each increase the risk for lung diseases like chronic obstructive pulmonary disease (COPD) among smokers and nonsmokers alike, two new studies find.

People with COPD gradually lose their ability to draw a decent breath. Cigarette smoking is the leading cause, but COPD also can be caused by regular exposure to lung irritants.

In one study of nearly 1,900 participants, researchers found that exposure to high levels of ozone over a decade increased the likelihood of COPD.

For every 5-parts-per-billion increase in 10-year ozone exposure, the risk for COPD increased 16%, the findings showed.

The same increase in ozone was also linked with greater odds of emphysema and a worse quality of life, the study authors said.

"What really stood out was that the effect was apparent even among current heavy smokers," said researcher Dr. Nadia Hansel, director of the pulmonary and critical care division at Johns Hopkins University School of Medicine, in Baltimore. "This means that active smoking doesn't outweigh this effect of ozone."

Even those already at risk for COPD had an additional increased risk with ozone exposure, she added in a university news release.

"I think this adds to increasing evidence that there is probably no healthy level of ozone," Hansel said.

Her team's findings were published online recently in JAMA Internal Medicine.

In the second study, published recently in the American Journal of Respiratory and Critical Care Medicine, a research team that included Hansel found that the use of wood as a main heating source was tied to an increased prevalence of lung disease among people who had never smoked.

Among 8,500 adults in the U.S. National Health and Nutrition Examination Surveys for 2007 to 2012, the investigators found that the prevalence of COPD among those living in rural areas was 12%, which was double the prevalence of the disease in urban areas.

Delving into the difference, the scientists found that places where a lot of coal or wood was used for primary heating showed greater odds of people having COPD.

A 1% increase in the number of homes using wood for heat was tied with a 12% increase in the odds of COPD among people who had never smoked, the researchers reported.

According to researcher Dr. Sarath Raju, a pulmonary and critical care medicine fellow at Hopkins, "Wood smoke is a household source of pollution that is associated with high levels of particulate matter...

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Not just counterfeit: Legal THC vaping products linked to lung illnesses

New evidence shows that legitimate THC vaping products are also making people sick, meaning that illegal, off-brand vapes aren't the only products to blame for the current outbreak of vaping-related illnesses.

The Massachusetts Department of Public Health reports that at least six patients suspected of having the vaping lung illness purchased THC products at licensed marijuana dispensaries in that state.

Health officials did not reveal which dispensaries or brands bought legally were implicated.

This is not the first time that a case of the lung illness has been linked to a legal product. In September, the Oregon Health Authority announced it was investigating the death of a woman who reported using a vaping device from a cannabis dispensary before becoming ill.

"It's been a real failure of public policy that we have this message that if it's bought in a store, it's going to be safe," said Kevin Sabet, president of Smart Approaches to Marijuana, a nonprofit organization that opposes the legalization of marijuana.

Still, bootleg vapes do appear to be behind a majority of vaping-related cases nationwide. On Friday, the Centers for Disease Control and Prevention reported that 80 percent of hospitalized patients with EVALI, or e-cigarette, or vaping, product use associated lung injury, had used a THC product. By far, the most common product was a counterfeit brand called Dank Vapes, used by 56 percent of patients.

Some patients said they only vaped nicotine, not THC, so the CDC recommends avoiding all vape pens and products until more is known.

Since the EVALI outbreak began, a variety of investigations into the illnesses have pointed to multiple problematic ingredients, such as vitamin E acetate used as a carrier oil, or toxic metals leached from the devices into the e-liquids.

Each finding appears to be just one part of the larger explanation of why vaping can be dangerous, experts who study e-cigarettes say.

In addition to oils and metals, "there may be other contaminants that we don't know about yet because the products are so new," said Thomas Eissenberg, a co-director of the Center for the Study of Tobacco Products at Virginia Commonwealth University.

What's more, ingredients in e-liquid can degrade or change in potentially harmful ways once they're aerosolized. When heated, "those liquids turn into different things that were never in the liquid to begin with," Eissenberg said.

Left unregulated, the vape pen market...

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Vaping Cases Continue to Climb

Another 121 people have fallen ill, and three more people have died from a vaping lung disease that has now sickened 2,172 people and killed 42, the Centers for Disease Control and Prevention said November 14th.

Federal health officials have been trying to control an outbreak of a mysterious lung disease since the summer. They’re calling the illness EVALI, short for e-cigarette, or vaping, product use associated lung injury.

The CDC last week reported a possible breakthrough in the investigation. Officials found vitamin E acetate in all 29 lung tissue samples tested, calling the compound a “potential toxin of concern.” The oil, typically used in lotions and vitamin supplements, is increasingly emerging in illegal THC vaping products.

Dr. Anne Schuchat, the CDC’s principal deputy director, brought a vial of vitamin E to Capitol Hill this week to show the Senate Committee on Health, Education, Labor and Pensions. She and Mitch Zeller, director of the FDA’s Center for Tobacco Products, testified on their agencies’ response to the outbreak.

FDA labs have received more than 1,000 samples from 25 states, including 850 samples connected to patients, Zeller said. Of the 69 samples from patients that have been examined, 80% contain THC and 75% have vitamin E acetate, he said.

“Lab testing is providing important new information, but no single product, brand, substance or additive has been identified in all of the cases at this point,” Schuchat told lawmakers Wednesday. “It may be that there is one cause or that there are many problematic substances causing lung injury. And there may be complex root causes for this outbreak.”

Patients who develop EVALI typically report symptoms like coughing, shortness of breath, nausea and fever. The severity of their illness can vary. Doctors in Michigan this week said they performed the first double lung transplant on someone with EVALI, an otherwise healthy 17-year-old boy.

“We know that some individuals will have very long-term damage and not even be able to breathe without new lungs,” Schuchat said, referring to the transplant. “But we don’t have the full story on the spectrum of illness or of injury or of how people will do.”

 

The FDA and CDC are urging people not to vape THC, the compound that produces a high in marijuana. Most of these products are illegal and unregulated.

Cannabis lab testing company CannaSafe analyzed the vapor produced by illegal cartridges...

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Associations Between Sex Hormones and Asthma in Adults

In adults in the United States, sex hormones play a role in gender differences in asthma, and obesity modifies the effects of these hormones, according to a study published in the American Journal of Respiratory and Critical Care Medicine. Elevated levels of free testosterone in serum are associated with reduced odds of asthma in women, elevated levels of serum estradiol are associated with reduced odds of asthma in nonobese men, and elevated levels of both estradiol and free testosterone are associated with reduced odds of asthma in obese women.

Asthma prevalence is higher among women than men, and the current study was designed to assess whether sex hormone levels play a role in sex differences in asthma. Data were taken from the 2013 to 2014 and 2015 to 2016 study cycles of the US National Health and Nutrition Examination Survey, which is a cross-sectional nationwide survey designed to assess health and nutrition, in which ethnic minorities (Hispanics, non-Hispanic Asians, and non-Hispanic blacks), low-income whites, and persons aged over 80 years are oversampled to increase statistical power for data analysis in these groups. Participants analyzed for this cross-sectional study (N=7615 adults; aged 18-79 years; 3953 men, 3662 women) had both serum levels of estradiol and free testosterone available as well as current asthma status. Multivariate analysis of sex hormones (divided into 4 quartiles) was performed separately in women and men using logistic regression to test for an interaction between obesity and sex hormones on current asthma.

Free testosterone levels in women without asthma were significantly higher than in those with current asthma. In a model unadjusted for serum estradiol level, women whose levels of free testosterone were in the 4th quartile compared with the 1st quartile had 30% to 45% lower odds of current asthma (odds ratio [OR], 0.56; 95% CI, 0.39-0.80). In a model unadjusted for serum free testosterone levels, women with serum estradiol levels in the 3rd quartile compared with the 1st quartile had 34% lower odds of current asthma. After analysis was stratified by obesity, in quartile 4 compared with quartile 1, elevated levels of free testosterone and estradiol in obese women were associated with lowered odds of current asthma (OR, 0.59; 95% CI, 0.37-0.91; and OR, 0.43; 95% CI, 0.23-0.78, respectively), and elevated serum estradiol levels in nonobese men were associated with reduced odds of current asthma (OR, 0.44; 95% CI,...

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How Juul’s reputation went from high-tech cool to hazardous and deadly

The pendulum swing in the reputation of Juul Labs — from a less-harmful cigarette alternative to a public danger — has engulfed the vaping company in crisis.

The company ousted its CEO, suspended advertising and committed to back the Trump administration's eventual regulations on e-cigarettes.

Taken together, the developments underscore how Juul is scrambling to preserve its core business, not long after the company was flying high based on targeted marketing and flavored liquids that are now facing a potential federal ban.

The company is expected to lose about 75% of its sales due to the Food and Drug Administration's crackdown on e-cigarettes, estimated CFRA Research senior equity analyst Garrett Nelson, who tracks Juul investor and tobacco giant Altria Group, the company that makes Marlboro cigarettes.

But Nelson said Juul will "probably not" go out of business.

"What we think is going to happen is they're going to pull all flavored e-cigarettes from shelves and there's going to be a process where they're going to have to reapply and get approval from the FDA," Nelson said.

Critics also expect Juul to emerge from the crisis intact by following a similar playbook used by cigarette companies, which also agreed to advertising restrictions to assuage public concerns.

 

"The fear that I think exists and should exist is that they will be successful in navigating this crisis to somehow cement themselves as the legal leader in permissible electronic cigarettes," said Jonathan Gdanski, a trial attorney for Schlesinger Law Offices in Fort Lauderdale, Florida, who has sued Juul and tobacco companies. "This is just Juul literally copying what Philip Morris did."

In response to questions on whether the company could collapse, Juul spokesman Josh Raffel pointed to a statement released Wednesday by the company's new CEO, K.C. Crosthwaite.

"I have long believed in a future where adult smokers overwhelmingly choose alternative products like JUUL. That has been this company's mission since it was founded, and it has taken great strides in that direction," Crosthwaite said.

"Unfortunately, today that future is at risk due to unacceptable levels of youth usage and eroding public confidence in our industry. Against that backdrop, we must strive to work with regulators, policymakers and other stakeholders, and earn the trust of the societies in which we operate. That includes inviting an open dialogue, listening to others and being...

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Identifying Protein Biomarkers for COPD from Exhaled Air Condensate

Chronic obstructive pulmonary disease (COPD) is a medical condition where damage to the airway leads to a chronic inflammatory response. In Chronic obstructive pulmonary disease (COPD) is a medical condition where damage to the airway leads to a chronic inflammatory response. In th this case study, scientists from Peking and Shanghai identified novel protein biomarkers from exhaled air condensate provided by patients with COPD. These samples were analyzed by liquid chromatography coupled to mass spectrometry (LC-MS).

The research is featured in the Journal of Proteomics.

COPD is associated with long periods of smoke inhalation, e.g. from cigarettes or burning of biomaterials. The smoke irritates the tissues of the airways, eliciting inflammatory responses and subsequently, breathing difficulties.

In the late stages of the disease, the inflammatory reaction does not cease when the exposure to smoke inhalations ends. Hence, it is of great interest to identify new biomarkers for the early detection of COPD.

The search for COPD biomarkers has focused on the analysis of exhaled air, which contains aerosols produced when air passes through the airways. Exhalations are usually trapped in condensation chambers as exhaled air condensates (EAC) that can be analyzed by conventional techniques.

While several biomarkers have been found in previous research, EAC samples are usually small and insufficient for extensive analysis. In fact, previous investigations had to use pooled EAC samples from multiple patients or control participants, instead of analyzing each individually.

Researchers from China and Shanghai university hospitals in collaboration with scientists from CapitalBio Technology Inc. demonstrated that EAC samples from individual study participants can be used for proteomics analysis by nano ultra-high performance liquid chromatography coupled to Orbitrap mass spectrometry (nanoLC-Q-MS).

Tandem Mass Tag Multiplexing for High Throughput Proteomics

The investigators conducted a clinical study with adult COPD outpatients aged 40-75 years and compared their results against healthy study participants of the same age range. Around 2ml samples of EACs were collected and the protein fraction prepared for proteomics by standard techniques (protein purification followed by enzymatic digestion to peptide fragments).

For multiplexing, a tandem mass tag (TMT) was used. TMTs are molecules with functional groups that react with proteins and...

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Study Questions Mainstay Treatment For Mild Asthma

Steroid inhalers commonly used to prevent asthma attacks may not work any better than a placebo for many people with mild asthma, according to recent research.

Synthetic corticosteroids mimic the steroid hormone cortisol, reducing inflammation in the airways. But the drug targets a type of inflammation that may be found in far fewer patients than previously thought, research in a recent issue of the New England Journal of Medicine finds. Among patients age 12 and older in the study who had mild, persistent asthma, more than half did just as well, or better, on a placebo as they did on a steroid inhaler.

"We're suggesting that it's time to reevaluate what the standard recommended form of treatment is for these milder patients," says Stephen Lazarus, a pulmonologist at the University of California, San Francisco, and the study's lead author.

Since the early 1990s, the international guideline for treating patients with mild, persistent asthma has been to use a low-dose steroid inhaler twice a day. The recommendation was based mainly on studies of people with severe asthma; the thinking was that if people with mild symptoms used the steroid inhaler early on, it would prevent damage to their airways later.

But when the medications didn't seem to reduce asthma attacks, doctors blamed the patients.

"For many years, I think we've attributed their poor asthma control to the fact that they weren't taking their medicines," Lazarus says, "and it may be that many of them were taking their medicines — they just weren't working."

Lazarus and his team studied around 300 patients who had mild asthma. The vast majority — 73% — did not have Type 2 inflammation, an inflammation characterized by a high level of eosinophilic white blood cells, which are believed to be much more prevalent among asthma patients.

Of those patients, 66% did just as well, or better, on a placebo as on the steroid inhaler mometasone in terms of urgent care visits, days when they had trouble breathing or nights when they woke up because they were unable to breathe.

Merck, the drug company that makes mometasone, declined to comment on the study.

"We may be giving people steroids, subjecting them to potential adverse effects and the increased costs, without a significant clinical benefit," Lazarus says.

While inhaled steroids are generally safe, there is some risk for bone loss, cataracts, glaucoma and thinning of the skin.

Bone loss has long been a concern for...

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Study: Pediatrician Intervention to Help Parents Quit Smoking

Parents who smoke cigarettes put their children and others around them at risk for bronchitis, pneumonia and a variety of other ailments. But a new study offers another method to help them quit lighting up.

Researchers tested a smoking cessation program in five states in the South and the Midwest, finding it had success in helping some parents to kick the habit, according to research published Monday in JAMA Pediatrics.

About 58 million non-smokers in the United States take in secondhand smoke, including 14 million children between ages 3 and 11, according to the Centers for Disease Control and Prevention. And roughly one in five babiesborn to mothers who smoke while pregnant will have a low birth rate.

"The people who are most likely to have another pregnancy are the ones who already have a baby and are coming into the pediatrician's office," Emara Nabi-Burza, a researcher at Massachusetts General Hospital for Children and lead author of the study, said in a news release. "If we want to prevent smoking during pregnancy, one of the best strategies is to get parents of young children to quit."

The researchers tested an intervention called the Clinical Effort Against Secondhand Smoke Exposure to help parents quit smoking. The program included nearly 8,200 parents from Indiana, North Carolina, Ohio, Tennessee and Virginia.

After bringing their children to doctor's appointments, parents could opt to answer questions from an electronic survey about whether they wanted to quit smoking and provided their nicotine patches or gum to help with that effort.

In addition, the pediatricians offered parents a chance to enroll in their state's quitline and the national SmokeFreeTXT. Finally, parents received motivational texts from the pediatricians to quit smoking, whether they opted to participate in other aspects of the intervention or not.

Of parents who completed the survey, just over 44 percent received "meaningful treatment," with the intervention helping to reduce smoking among parents by 2.7 percent.

The researchers point to the use of electronic tablets to manage the questionnaire, which also included a motivational video customized to each parent's state and other characteristics, as a key part of the program that helped parents quit.

"We knew the pediatric visit was a teachable moment to help parents quit smoking," said Dr. Jonathan Winickoff, who also directs pediatric research at the MGH Tobacco Research and Treatment Center....

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