Statins Significantly Reduce Risk of Hospitalized Exacerbations in Patients With COPD

Statin use was linked with a significant reduction in the risk of hospitalized exacerbations after an initial hospitalized exacerbation among patients with chronic obstructive pulmonary disease (COPD), including specified frequent exacerbators, according to study findings published in the International Journal of Chronic Obstructive Pulmonary Disease.

In patients with COPD, comorbidities such as cardiovascular disease (CVD) and hypertension are common and may contribute to exacerbations. These exacerbations are often caused by systemic inflammation associated with high levels of C reactive protein. Statins have demonstrated anti-inflammatory effects in previous studies, with long-term use shown in a review to reduce mortality and inflammation in COPD. However, the adverse effects associated with statins have caused a debate in its primary use for preventing CVD, contributing to nonadherence among patients.

The potential benefits of statins for the prevention of exacerbations in patients with COPD was noted by the study authors as controversial due to no previous studies having investigated the impact of statins on clinical outcomes in patients with COPD. They sought to delineate this association by examining the risk of subsequent hospitalized exacerbations in patients with COPD in a real-world setting, with an added subgroup analysis of those with frequent exacerbations.

They conducted a population-based cohort study involving patients with COPD with a first hospitalized exacerbation between 2004 and 2012 (n = 139,223), derived from the Taiwan National Health Insurance Research Database. Among the study cohort, those who had a second hospitalized exacerbation within a year after the first exacerbation were defined as frequent exacerbators (n = 35,482).

A ratio of 1 (statin users) to 4 (statin nonusers) was used in the propensity score matching to create matched samples of statin users and nonusers, which was then used in a competing risk regression analysis model to evaluate the association between statin use and exacerbation risk.

In the study findings, statin users with COPD exhibited a significantly reduced risk in subsequent hospitalized exacerbations after their first hospitalized exacerbation compared with nonusers (adjusted sub-distribution HR,  0.89; 95% CI, 0.85-0.93, P <.001). Among frequent exacerbators, this significantly reduced risk was also found in the SHR of statin users (0.88; 95% CI, 0.81-0.94, P = .001).

The study...

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New Data on Ozone Exposure Associated with Asthma Symptoms

Data from digital inhalers reveals an increased use of rescue inhalers for asthma symptoms due to short-term exposure to ozone, even below the ozone level set by the EPA.

New data from digital inhalers confirms that exposure to the air pollutant ozone is strongly linked to increased use of inhaled medications for asthma symptoms, according to a new study from CommonSpirit Health, Propeller Health, University of California, Berkeley, and University of California, San Francisco, published in Environment International.

Asthma is one of the most common chronic respiratory diseases in the United States, resulting in more than $82 billion a year in healthcare costs. In the Sacramento and San Joaquin Valleys of California, people have unusually high levels of asthma-related emergency department visits and hospitalizations. This prompted CommonSpirit to study environmental factors that could be worsening asthma symptoms for its patients.

CommonSpirit partnered with Propeller Health; University of California, Berkeley; and University of California, San Francisco to come up with a solution. Researchers gave connected inhalers to 287 patients in the two areas to manage and track the onset of asthma symptoms. They were able to capture the date, time and location of medication use and determine whether that use was associated with increased levels of ozone in the air. The air pollutant ozone is formed when pollution from cars, power plants and refineries reacts to sunlight. When ozone reaches unhealthy levels, it can cause wheezing, shortness of breath and other adverse symptoms, particularly in people with pre-existing respiratory illnesses such as asthma or chronic obstructive pulmonary disease (COPD).

The U.S. Environmental Protection Agency (EPA) has set the level of safe ozone in the air at 70 parts per billion (ppb). This study found that when ozone concentrations in the air increased by just 17 ppb, children used their rescue inhalers 11.3% more often, and adults used them 8.4% more often, even when average ozone levels in the air in this study (26 ppb) were more than 60% lower than the EPA's recommended level.

"There’s been strong evidence that air pollution leads to more emergency department visits, hospitalizations and mortality for asthma patients, but it’s been very difficult to measure its effect on daily symptoms," said Meredith Barrett, PhD, study co-author and head of Population Health Research at Propeller Health. "By using...

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Study Says: Any Level of Smoking Can Lead to Long-term Lung Damage

Former smokers and people who smoke relatively few cigarettes per day may experience a faster decline in lung function than people who have never smoked, although they still have a slower decline in lung function than current smokers, a new study suggests.

The study, “Lung function decline in former smokers and low-intensity current smokers: a secondary data analysis of the NHLBI Pooled Cohorts Study,” was published in The Lancet Respiratory Medicine.

Smoking is well-established as being detrimental to lung health. In fact, smoking is known to cause the development of chronic obstructive pulmonary disease (COPD). And light smokers are not exempt from causing damage to their lungs, according to the researchers.

“Many people assume that smoking a few cigarettes a day isn’t so bad,” Elizabeth Oelsner, MD, study co-author and a professor at Columbia University Vagelos College of Physicians and Surgeons, said in a news release.

“But it turns out that the difference in loss of lung function between someone who smokes five cigarettes a day versus two packs a day is relatively small,” she said.

In the study, Oelsner and her colleagues analyzed data from the NHLBI Pooled Cohorts Study, which included data from 25,352 people (17–93 years old) who had multiple assessments of lung function, as measured via forced expiratory volume (FEV), the amount of air a person can exhale.

With a median follow-up time of seven years, and at a median age of 57, people who had never smoked experienced a FEV decrease at an average rate of 31.01 mL per year. This was expected, as FEV is known to decrease throughout life starting when people are in their 20s.

In former smokers, the rate of FEV decline was higher at 34.97 mL per year, while in current smokers, it was 39.92 mL per year. This suggests that smoking results in a rapid decline in lung function long after a person has quit.

“That’s consistent with a lot of biological studies,” Oelsner said. “There are anatomic differences in the lung that persist for years after smokers quit, and gene activity also remains altered.”

Using statistical analyses, the researchers calculated effect estimates (how much an activity, in this case smoking, is predicted to have an impact on a measurement, in this case FEV) for current smokers who smoked many or a few cigarettes per day. Among current smokers who smoked 30 or more cigarettes per day, the effect estimate was the loss of 11.24 mL per...

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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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