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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COPD: 5 Must-Know Updates

Chronic obstructive pulmonary disease (COPD) represents a major burden to global health, and it is a leading cause of morbidity and mortality. Intense research has expanded our knowledge of pathophysiology and therapeutic targets and allowed for the personalization of treatment. The following review provides five disease-related COPD updates.

1. Bronchoscopic Lung Volume Reduction

Bronchoscopic lung volume reduction (BLVR) is accomplished by occluding airways proximal to nonfunctioning, hyperinflated areas of the lung. Several different methods, including endobronchial and intrabronchial valves, coils, and thermal ablative techniques, are used to achieve BLVR.[1] To date, data have shown benefits for symptoms and functional outcomes, but proper patient selection is critical. Head-to-head comparisons between therapies are not available, and although guidelines exist,[2] they're largely based on small trials and expert opinions.

Endobronchial coils and thermal vapor therapies are not approved for use in the United States, but the US Food and Drug Administration (FDA) approved two types of endobronchial valves in 2018: the Zephyr Endobronchial Valve (Pulmonx Corporation; Redwood City, California) and the Spiration Valve System (Olympus Respiratory America; Redmond, Washington). To date, there are more data available on Zephyr valves.[3,4,5] However, in general, both valve types improve symptoms, quality of life, and lung function for patients with COPD.[1] Patients who are most likely to benefit have evidence of air trapping on lung testing (typically a residual volume > 175% on plethysmography) and absence of collateral ventilation (CV) distal to the target area. Typically, CV is assessed using quantitative CT software or the proprietary Chartis System (Pulmonx Corporation). These valves should only be placed at centers that have the appropriate software, equipment, and expertise.[1,2]

2. Tailoring Therapies Using Eosinophil Counts

As we're learning more about COPD phenotypes, we're increasingly able to tailor therapies. Although therapy with inhaled corticosteroids (ICS) is recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines,[6] its use is controversial. Several studies show an increased risk for pneumonia when patients with COPD use ICS,[7,8,9] and the 2014 WISDOM study found that discontinuing ICS did not affect exacerbation rates in patients using continued triple therapy [long-acting beta-agonist...

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What to know about stress-induced asthma
Stress is a common trigger of asthma symptoms. Stress and anxiety can also cause asthma attacks.
Asthma is a condition in which the airways become inflamed, making it difficult to breathe. Symptoms typically come and go with triggers, such as irritants, humid weather, and exercise.
According to Asthma UK, 43% of people with asthma report that stress can trigger their symptoms. Managing stress and anxiety can help minimize asthma flare-ups.
In this article, we look at the link between stress and asthma in more detail.
Stress and asthma
When a person feels stressed, they may experience more frequent and severe asthma symptoms.
When a person feels stressed, they may notice that their asthma symptoms flare up. Periods of stress can increase the severity, frequency, and duration of asthma symptoms.
Stress can cause people to become more sensitive to their asthma triggers. Common triggers include pet dander, pollen, humidity, and cold, dry air.
Stressors might include work, school, or family stress. Significant life changes and traumatic experiences can also cause stress.
Stress can make inflammation worse, and it can trigger shortness of breath or breathing difficulties, all of which can exacerbate asthma symptoms.
If a person can manage their asthma, they are less likely to experience stress or anxiety related asthma.
Stress can also indirectly cause asthma flare-ups. A person who is stressed may experience certain emotions, such as anger and irritation, more strongly. Strong emotions can trigger asthma symptoms.
A person who experiences stress for prolonged periods may feel more anxious. Anxiety can trigger panic attacks that can, in turn, cause an asthma attack.
People may also sometimes find that stress leads to unhealthful habits, such as smoking or drinking alcohol. These habits can trigger asthma.
Symptoms of stress-induced asthma
People may notice that their normal asthma symptoms worsen when they feel overly stressed or anxious. This feeling can be temporary, such as before an exam, or it can be due to chronic stress, which occurs over an extended period.
Asthma symptoms are similar regardless of the trigger. Common symptoms of asthma include:
tightness in the chest
trouble breathing
rapid breathing
shortness of breath
Managing stress with asthma
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CVS directs initiative combating youth smoking toward teen e-cigarette use

CVS Health and its foundation are directing their focus on cutting teen tobacco smoking toward a key driver of the worsening problem: e-cigarettes.

Already, CVS was in the midst of a five-year, $50 million initiative called "Be the First" in an effort to be the nation's first tobacco-free generation. Monday, the retailer announced it—along with the Aetna Foundation—will give more than $10 million to organizations around the country to support prevention and education programs with a particular focus on vaping.

“The spread of e-cigarette use among youth jeopardizes the progress made in reducing smoking over the last two decades,” said Troyen Brennan, M.D., chief medical officer for CVS Health, in a statement.  “By collaborating with experts and aggressively investing in innovative strategies, we believe that we can help reverse this disturbing trend.”

The 2018 National Youth Tobacco Survey found 3.6 million middle and high school students indicated they were current e-cigarette users. That was more than double the total number from the previous year. It represented a 78% increase among high school students and 50% increase among middle school students. 

The problem was concerning enough for former Food and Drug Administration Commissioner Scott Gottlieb to declare a youth vaping crisis when he led the agency. "All the dramatic gains we've made in reducing smoking rates in this country, particularly among young people, will be reversed as a result of these products," he warned during an event in March.

In 2014, CVS announced it would no longer sell tobacco products in its stores as its sought to ramp up its role in the U.S. healthcare marketplace. In 2018, CVS completed a $69 billion acquisitionof insurance giant Aetna.  Both companies have said the deal will generate more than $750 million in savings in the first two years by reducing medical costs, closing gaps of care, optimizing sites of care and providing localized services for patients with high-cost chronic conditions. 

Among the projects aimed at reducing teen smoking that will receive grant funding this year: 

  • The CVS Health Foundation is investing in a multiyear, multi-million dollar collaboration with Discovery Education to create and distribute education materials to help middle and high school students learn about the risks of e-cigarette use. The resources will be available at no cost to every school district in the U.S.
  • A new two-year, $2 million grant...
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