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Quitting Smoking Reduces Risk for Rheumatoid Arthritis

Sustained smoking cessation decreases the risk for seropositive rheumatoid arthritis (RA), according to a new study published in Arthritis Care & Research. Seropositive RA is the most common form of RA and is generally accompanied by more severe symptoms and deformities than seronegative RA.

Previous research has demonstrated that smoking increases the risk for RA. Whether quitting smoking has the opposite effect had remained unclear.

Investigators at Brigham and Women’s Hospital studied the impact of smoking cessation on the development of seropositive RA and seronegative RA. The researchers analyzed 38 years of data from the Nurses’ Health Study and the Nurses’ Health Study II, which investigate risk factors for chronic disease in women. Among 230,732 women, the researchers identified 1528 who had developed RA. Twice as many (63.4%) women had developed seropositive RA (63.4%) as seronegative RA (36.6%).

Smokers were 47% more likely to develop all types of RA than nonsmokers and 67% more likely to develop seropositive RA. Compared with women who had quit smoking within the previous 5 years, women who had quit smoking ≥30 years earlier were 37% less likely to develop seropositive RA. No link was found between seronegative RA and smoking.

The researchers concluded that, in addition to confirming smoking as a strong risk factor for seropositive RA, the results “demonstrate for the first time that a behavior change of sustained smoking cessation could delay or even prevent seropositive RA.”

References:

https://mdspiro.com/breath-co

Liu X, Tedeschi SK, Barbhaiya M, et al. Impact and timing of smoking cessation on reducing risk for rheumatoid arthritis among women in the Nurses’ Health Studies [published online February 21, 2019]. Arthritis Care Res. doi: 10.1002/acr.23837

https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23837

https://www.pulmonologyadvisor.com/home/topics/smoking/quitting-smoking-reduces-risk-for-rheumatoid-arthritis/

https://www.pulmonologyadvisor.com/home/clinical-charts/

https://www.rheumatologyadvisor.com/home/rheumatoid-arthritis-advisor/smoking-and-other-factors-increase-risk-for-rapid-progression-in-rheumatoid-arthritis/

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Study: COPD patients need more support when understanding new chest symptoms

People with Chronic Obstructive Pulmonary Disease (COPD) need more support when understanding and acting on new chest symptoms, a study in the journal Psycho-Oncology reports.

During this unique study, led by the University of Glasgow and University of Surrey, researchers investigated how the experience of COPD, influences how individuals understand new or changing chest symptoms and their decision to seek help from medical professionals.

COPD is the name for a group of lung conditions, including emphysema and chronic bronchitis, which cause breathing difficulties. Incidence of lung cancer is four-times higher in those with COPD compared to the general population and patients often confuse early signs of the devastating disease with a deterioration of their existing condition and do not seek medical advice.

Interviewing 40 participants with COPD, researchers discovered that none of the participants were aware that having the condition put them at increased risk of developing lung cancer. Due to a lack of knowledge and support, participants often attributed chest symptoms to external factors such as the weather or illness.

Researchers found that some participants did not seek medical advice following the development of symptoms as they were keen to 'not make a fuss' and believed that poor health was something to be accepted when diagnosed with the condition. A stigma associated with continued smoking was also identified by researchers, as participants were found to be reluctant in seeking help as they felt the doctor would blame their symptoms on smoking.

Participants also spoke about barriers in accessing care, which included scheduling appointments outside of usual working hours and difficulties in getting to the GP's surgery, when symptoms present themselves.

Early diagnosis of lung cancer is vital to improving survival. Figures from Cancer Research UK reveal that when diagnosed at its earliest stage, almost 6 in 10 people with lung cancer will survive their disease for five years or more, compared with almost 5 in 100 people when diagnosed at a later stage.

Dr. Katie Robb, Senior Lecturer at the University of Glasgow, said: "Healthcare professionals need to do more to educate those with COPD about their increased risk of developing lung cancer and be more vigilant when a patient with the illness presents changing symptoms."

Dr. Katriina Whitaker, Reader in Cancer Care at the University of Surrey, said: "Early diagnosis of...

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Study: E-cigarettes outperform patches and gums in quit-smoking study

New study says e-cigarettes are twice as effective as nicotine gum and patches — the strongest evidence yet that vaping can help smokers quit cigarettes.

A major new study provides the strongest evidence yet that vaping can help smokers quit cigarettes, with e-cigarettes proving nearly twice as effective as nicotine gums and patches.

The British research, published Wednesday in the New England Journal of Medicine, could influence what doctors tell their patients and shape the debate in the U.S., where the Food and Drug Administration has come under pressure to more tightly regulate the burgeoning industry amid a surge in teenage vaping.

“We know that patients are asking about e-cigarettes and many doctors haven’t been sure what to say,” said Dr. Nancy Rigotti, a tobacco treatment specialist at Harvard Medical School who was not involved in the study. “I think they now have more evidence to endorse e-cigarettes.”

At the same time, Rigotti and other experts cautioned that no vaping products have been approved in the U.S. to help smokers quit.

Smoking is the No. 1 cause of preventable death worldwide, blamed for nearly 6 million deaths a year. Quitting is notoriously difficult, even with decades-old nicotine aids and newer prescription drugs. More than 55 percent of U.S. smokers try to quit each year, and only about 7 percent succeed, according to government figures.

Electronic cigarettes, which have been available in the U.S. since about 2007 and have grown into a $6.6 billion-a-year industry, are battery-powered devices that typically heat a flavored nicotine solution into an inhalable vapor.

Most experts agree the vapor is less harmful than cigarette smoke since it doesn’t contain most of the cancer-causing byproducts of burning tobacco. But there is virtually no research on the long-term effects of the chemicals in the vapor, some of which are toxic.

At the same time, there have been conflicting studies on whether e-cigarettes actually help smokers kick the habit.

Last year, an influential panel of U.S. experts concluded there was only “limited evidence” of their effectiveness.
In the new study, researchers tracked nearly 900 middle-age smokers who were randomly assigned to receive either e-cigarettes or nicotine replacement products, including patches, gums and lozenges. After one year, 18 percent of e-cigarette users were smoke-free, versus 9.9 percent of those using the other products.

“Anything...

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Vaccination Cuts Risk of Severe Flu in Hospitalized Patients With COPD

Hospitalized patients with chronic obstructive pulmonary disease (COPD) who tested positive for the flu and were unvaccinated had worse death rates and more severe illness than those who were vaccinated, according to a recent study.

A large national study from Canada showed influenza vaccination is effective in reducing flu-related hospitalizations among patients with chronic obstructive pulmonary disease (COPD). Hospitalized patients who tested positive for the flu and had COPD and were unvaccinated had worse death rates and more severe illness than those who were vaccinated.

Despite recommendations to get flu shots, patients with COPD have a low uptake of the vaccination—about 50% to 60%. The researchers said initiatives to increase vaccination rates as well as early antiviral use among patients with COPD could reduce flu-related hospitalization, severe illness, and lower healthcare costs.

Previous research inferring poor outcomes in this population of patients with COPD comes from studies of elderly patients with a mix of chronic lung diseases, according to the study, which was published in the journal CHEST.

Forty-six hospitals across 5 Canadian provinces participated in this study. Patients with COPD, hospitalized with any acute respiratory illness or exacerbation, were studied between 2011 to 2015 and were included if their flu vaccination status was known. All patients received nasopharyngeal swabs with polymerase chain reaction (PCR) testing for influenza. The primary outcome was an influenza-related hospitalization.

Among 4755 hospitalized COPD patients, 4198 (88.3%) patients with known vaccination status were analyzed. The adjusted analysis demonstrated a 38% reduction in influenza-related hospitalizations in vaccinated versus unvaccinated individuals.

Compared with hospitalized patients without the flu, patients with influenza (1490/4198, 35.5%) were older (age >75 years; 50.8% vs 47.6%), more likely to be smoking (34.2% vs 26.9%), more likely to reside in long-term care (9.2% vs 7%), and less likely to be vaccinated during the season of hospitalization (58.9% vs 70.6%).

Influenza positive patients (n = 1833, 38.5%) experienced higher crude mortality (9.7% vs 7.9%, P = .047), and critical illness (17.2% vs 12.1%, P <.001) compared with influenza-negative patients. However, in the adjusted analysis, vaccination wasn’t associated with significant mortality reduction (odds ratio [OR], 0.9; 95% CI 0.6-1.4).

Patients...

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Reducing drinking could help with smoking cessation, research finds

If quitting smoking is one of you or your patient’s New Year's resolutions, you might want to consider cutting back on your drinking, too.

New research has found that heavy drinkers who are trying to stop smoking may find that reducing their alcohol use can also help them quit their daily smoking habit. Heavy drinkers' nicotine metabolite ratio -- a biomarker that indicates how quickly a person's body metabolizes nicotine -- reduced as they cut back on their drinking.

Past research has suggested that people with higher nicotine metabolism ratios are likely to smoke more and that people with higher rates have a harder time quitting. Slowing a person's nicotine metabolism rate through reduced drinking could provide an edge when trying to stop smoking, which is known to be a difficult task, said Sarah Dermody, an assistant professor at Oregon State University and the study's lead author.

"It takes a lot of determination to quit smoking, often several attempts," Dermody said. "This research suggests that drinking is changing the nicotine metabolism as indexed by the nicotine metabolite ratio, and that daily smoking and heavy drinking may best be treated together."

The study was just published in the Oxford Academic Journal Nicotine & Tobacco Research.

Dermody, who is based in in the School of Psychological Science in OSU's College of Liberal Arts, studies risky behaviors such as alcohol and nicotine use with the goal of better understanding factors that contribute to alcohol and nicotine use and how best to intervene with problematic use of these substances.

Use of both alcohol and cigarettes is widespread, with nearly 1 in 5 adults using both. Cigarette use is especially prevalent in heavy drinkers. Drinking is a well-established risk factor for smoking, and smoking is well-established risk factor for drinking.

Dermody and colleagues at the Centre for Addiction and Mental Health in Toronto, Canada, wanted to better understand the links between the two. They studied the nicotine metabolite ratio, an index of nicotine metabolism, in a group of 22 daily smokers who were seeking treatment for alcohol use disorder -- the medical term for severe problem drinking -- over several weeks.

"What's really interesting is that the nicotine metabolite ratio is clinically useful," Dermody said. "People with a higher ratio have a harder time quitting smoking cold turkey. They are also less likely to successfully quit using nicotine replacement...

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Scientists found molecular ‘switch’ for allergic asthma treatment

A team of Russian scientists identified the role of the interleukin-6 molecule in the development of allergic asthma. Now it can be a new target for the treatment of this disease. The results are published in Frontiers in Immunology.

About 300 million people worldwide suffer from asthma, one of the most common chronic lung diseases in developed countries. Asthma is considered to be caused by an inadequate response of the immune system to allergens: pollen of trees, herbs, mold fungi, fur of cats and dogs or dust mites. This leads to chronic inflammation, bronchi narrowing and respiratory failure. The task of immune scientists is to figure out which internal signals and which cell types direct this immune response in asthma. Understanding the "molecular language" of cell communication, based on cytokines may help to control the immune response by blocking "inadequate" signals and "switching" the course of the disease from severe to lighter.

Clinical studies of sputum samples from patients with bronchial asthma show a high content of interleukin-6, one of the key indicators of inflammatory processes in the body. Therefore, scientists from the laboratory of the molecular mechanisms of immunity of Engelhardt Institute of Molecular Biology in Moscow wondered which immune cells produce it and how its blockage will affect the course of the disease.

"One of the directions in the study of the" language "of cytokines consists in correlating their" useful "and" disease-causing "signals with specific types of producer cells. This paradigm has been formed over the last 10-15 years while studying another molecule, the tumor necrosis factor", says Sergey Nedospasov. "For example, in rheumatoid arthritis, tumor necrosis factor molecules from macrophages trigger inflammation, while molecules produced by lymphocytes, on the contrary, can suppress them. We assumed that similar patterns can be found for interleukin-6."

Experiments were performed on unique genetically modified mice in which the interleukin-6 production was turned off in a specific type of immune cells: dendritic cells (representing alien objects to T-lymphocytes) or macrophages (cells that absorb alien objects). To induce asthma, mice were injected with dust mite extract. This allergen is most often responsible for asthma in humans.

"Just like humans, a mouse has regular contact with dust and dust mites living in it. So this can lead to irritation of the mucous membranes of the respiratory...

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This is why it's so hard to quit smoking.

The science behind why it's so difficult to quit smoking is crystal clear: Nicotine is addictive – reportedly as addictive as cocaine or heroin.

Yet any adult can stroll into a drug store and buy a pack of cigarettes, no questions asked.

"From a scientific standpoint, nicotine is just as hard, or harder, to quit than heroin but people don't recognize that," said Dr. Neil Benowitz, a nicotine researcher at the University of California, San Francisco.

Smoking is the world's leading preventable cause of death. More than 1.1 billion people worldwide smoke, according to the World Health Organization. And more are continually joining the ranks. Every day in the US alone, more than 3 200 youth 18 and younger smoke their first cigarette, while another 2 100 youth and young adults move from smoking occasionally to having a daily habit.

In 1964, the US surgeon general's famous report, "Smoking and Health", linked smoking to cancer. Two decades later in 1988, another landmark surgeon general's report on nicotine addiction declared nicotine to be as addictive as cocaine or heroin.

"Every drug of abuse, including nicotine, releases dopamine, which makes it pleasurable to use," said Dr. Benowitz. "And when you stop smoking, you have a deficiency of dopamine release, which causes a state of dysphoria: You feel anxious or depressed."

Nicotine also acts as a stimulant, said Dr. Benowitz. "It helps people concentrate, and if they don't have a cigarette, they have trouble focusing."

Cigarette epidemic

The US Food and Drug Administration (FDA) intends to implement new rules that would reduce the level of nicotine in tobacco products to "minimally addictive" or "non-addictive" levels. It's not clear when the FDA will issue its new ruling.

Dr. Benowitz said he's "cautiously optimistic" that the FDA will force tobacco companies to make cigarettes non-addictive. "If they did, I think that would really be the end of the cigarette epidemic," he said.

Meanwhile, debate rages over increasingly popular e-cigarettes, which are marketed as a healthier alternative to traditional cigarettes. E-cigarette vapor doesn't contain as many toxic chemicals as the smoke from regular cigarettes. However, most e-cigarettes contain nicotine and some deliver dangerous chemicals such as formaldehyde.

Critics of e-cigarettes complain that makers are marketing them to youth by selling them in a variety of kid-friendly flavors, from pizza to...

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Philip Morris stop-smoking campaign attacked as a PR stunt

Marlboro cigarette maker Philip Morris International (PM.N) drew accusations of hypocrisy after using a four-page newspaper advertisement to urge smokers to quit cigarettes.

The wraparound advertisement covering Monday’s Daily Mirror tabloid is part of Philip Morris’s 2 million pound ($2.61 million) “Hold My Light” campaign, in which the world’s biggest international tobacco company is pushing a 30-day challenge for people to give up smoking.

The campaign also features a video and a website where smokers can sign up for the challenge and gain information to help them to kick the habit.

Cigarettes account for the vast majority of Philip Morris’s revenue, but the company has repeatedly stated a longer-term vision to replace cigarette sales with products such as its IQOS tobacco-heating device, which it says is less dangerous.

“This is staggering hypocrisy from a tobacco company to promote its own smoking-cessation products in the UK while continuing to promote tobacco cigarettes across the world,” Cancer Research UK said. 

“The best way Philip Morris could help people to stop smoking is to stop making cigarettes.”

Philip Morris has said that Britain, where advertising and marketing of cigarettes is prohibited, could eradicate cigarettes in coming years. British health regulators have also endorsed e-cigarettes as a way to help people to quit.

“This campaign is simply PR puff,” said Hazel Cheeseman, director of policy for Action on Smoking and Health.

“If they were serious about a smoke-free world they wouldn’t challenge tobacco legislation around the world but instead support regulations that will really help smokers quit and prevent children from taking up smoking.”

Last year Reuters published a special report on efforts by Philip Morris to subvert the World Health Organization’s global tobacco treaty, which is aimed at reducing smoking worldwide.

References:
https://www.reuters.com/article/us-health-ecigarettes-waste/e-cigarette-policy-should-consider-environmental-effects-expert-says-idUSKCN1N403P 
https://www.reuters.com/article/us-pmi-who-fctc-specialreport/special-report-inside-philip-morris-campaign-to-subvert-the-global-anti-smoking-treaty-idUSKBN19Y18T

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