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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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Triple Therapy Improves COPD Exacerbations Regardless of Reversibility Status

Single-inhaler triple therapy fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI; Trelegy Ellipta) continues to boast positive findings from the Informing the Pathway of COPD Treatment (IMPACT) study.

In new data to be presented at the 2018 CHEST Annual Meeting in San Antonio, TX, GlaxoSmithKline (GSK) has reported their first-of-its-kind triple therapy inhaler significantly reduced the annual rate of moderate-to-severe and severe exacerbations, improved lung function, and boosted overall quality of life in patients with chronic obstructive pulmonary disease (COPD)—regardless of baseline reversibility.

The IMPACT trial—a 52-week, randomized, double-blind, parallel-group, global analysis involving 10,355 symptomatic patients with COPD who have a history of moderate-to-severe exacerbations—compared Trelegy Ellipta to combination therapies inhaled corticoid steroid/long-acting beta agonist (ICS/LABA) and long-acting muscarinic agonist/long-acting beta agonist (LAMA/LABA).

Trelegy Ellipta, the first triple therapy approved by the US Food and Drug Administration (FDA) for the treatment of patients with COPD on fixed-dose treatment in September 2017, is itself a ICS/LAMA/LABA combination therapy. The original intent of the IMPACT trial was to understand the benefits and risks of the triple combination therapy in treating COPD, in addition to improving the understand of what particular patients need ICS therapy or maximal bronchodilation.

In this newest analyses, led by Robert Wise, MD, of the Johns Hopkins University School of Medicine, patients who were reversible were defined through different between pre- and post-albuterol assessments of forced expiratory volume in 1 second (FEV1) of at least 12% and 200 mL.

Investigators also assessed for the effect of baseline reversibility on treatment response across the 3 treatment arms. Lung function and quality of life were measured by patient responders on the St George Respiratory Questionnaire (SGRQ).

Investigators reported that 18% of patients demonstrated reversibility, with a significant reduction in the rate of moderate and severe exacerbation in both reversible and nonreversible patients administered FF/UMEC/VI versus those administered UMEC/VI. Severe exacerbation reduction rates were 44% (95% CI: 14 – 63) in reversible patients, and 31% (95% CI: 17-44) in nonreversible patients.

Lung function, as measured by change from baseline in trough FEV1 at week 52, was markedly...

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Mouse Study: Lung Inflammation from Childhood Asthma May Be Linked to Later Anxiety

Research has shown that childhood asthma is associated with a two to three times higher chance of developing an internalizing disorder such as anxiety or depression, but the exact reasons for this have remained a mystery.

In a new mouse study at Pennsylvania State University, the researchers suggest that persistent lung inflammation may be one possible explanation for an increased risk of anxiety. They discovered that exposure to allergens early in life was linked with persistent lung inflammation and also tied to changes in gene expression related to stress and serotonin function. They also found that females were more likely to have inflamed lungs for a longer period of time.

“The idea of studying this link between asthma and anxiety is a pretty new area, and right now we don’t know what the connection is,” said Dr. Sonia Cavigelli, associate professor of biobehavioral health. “What we saw in the mice was that attacks of labored breathing may cause short-term anxiety, but that long-term effects may be due to lasting lung inflammation.”

The researchers say that finding the root cause of this connection is difficult because in addition to the biological aspects of asthma, there are also several social and environmental factors that could contribute to anxiety in humans. For example, air pollution or a parent’s anxiety about their child’s asthma could also influence the child’s risk for anxiety.

“With the mice, we can look at the different components of asthma, like the lung inflammation or the airway constriction,” said Jasmine Caulfield, graduate student in neuroscience and lead author on the study.

“A person who’s having an asthma attack may have inflammation in their lungs and labored breathing at the same time, so you can’t separate which is contributing to later outcomes. But in mice, we can isolate these variables and try to see what is causing these anxiety symptoms.”

To help differentiate between these potential causes, the researchers studied a total of 98 mice, divided into four groups: one with airway inflammation due to dust mite exposure; one that experienced episodes of labored breathing; one that experienced both conditions; and one that experienced neither, as a control.

The findings reveal that three months after being exposed to the allergen, the mice still had lung inflammation and mucus, suggesting that even when allergy triggers are removed, there are lasting effects in the lungs long...

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Putting the Brake on E-Cigarettes

The FDA has launched strong regulatory and enforcement moves against the industry, branding the use of e-cigarettes among teens and ‘epidemic.’

In a pronouncement, Food and Drug Administration Commissioner Scott Gottlieb on Sept. 12 declared e-cigarette use "epidemic" among teens, signaled a possible ban on flavored e-cigarette liquids and launched sweeping enforcement efforts against retailers who sell e-cigarettes to minors.

"I use the word epidemic with great care," Gottlieb said in a statement. "The FDA won't tolerate a whole generation of young people becoming addicted to nicotine as a tradeoff for enabling adults to have unfettered access to these same products."

The enforcement action against nearly 1,300 retailers is the largest organized crackdown of its kind in FDA history, Gottlieb said. The agency issued warning letters and imposed fines ranging from $279 to $11,182 on 130 repeat offenders. A ban on flavorings could put the brakes on a fast-growing market. Average monthly sales grew 132 percent between 2012 and 2016, according to a study published in August by the Centers for Disease Control and Prevention.

Joanna Cohen is the Bloomberg professor of disease prevention and director of the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health.

JOHNS HOPKINS UNIVERSITY

Gottlieb hinted at preliminary FDA data, not yet published, indicating that e-cigarette use is soaring among high school students. In August, the CDC reported that e-cigarette use increased 900 percent among U.S. high schoolers from 2011 to 2015, making them the most commonly used source of nicotine in this group, driven by aggressive marketing and appealing flavors.

Officials say that e-cigarettes may be a safer way to deliver nicotine and may help smokers reduce their risk of smoking-related illnesses and death, but they worry about the rapid rise of e-cigarettes among teens and young adults.

The Vapor Technology Association, a trade group representing more than 600 members, accused the FDA in a statement of "kowtowing to hysterical public health groups," taking a "giant step backwards" in smoking prevention and reinvigorating "Big Tobacco."

Joanna Cohen, the Bloomberg professor of disease prevention at the Johns Hopkins Bloomberg School of Public Health and director of the Institute for Global Tobacco Control, spoke to U.S. News about the FDA's growing authority to rein in e-cigarette manufacturers and...

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Testosterone Replacement Therapy Can Slow Men’s COPD, Study Finds

Testosterone replacement therapy can help slow the progression of chronic obstructive pulmonary disease (COPD) in men, a new study shows.

Men with COPD tend to experience shortness of breath, leading physicians to prescribe them long-term steroid-based medications. While these medications help treat pulmonary symptoms, they are also associated with testosterone dysfunction.

Accordingly, previous studies have shown that men with COPD have low testosterone levels, which could lead to a worsening of the condition.

“Previous studies have suggested that testosterone replacement therapy may have a positive effect on lung function in men with COPD,” Jacques Baillargeon, the study’s author and a professor in preventive medicine and community health at University of Texas Medical Branch at Galveston, said in a press release.

The study, set to be published in the journal Chronic Respiratory Disease, was designed to determine whether testosterone replacement therapy (in which patients are prescribed testosterone) could help reduce the risk of hospitalization due to respiratory disease in middle-aged and older men with COPD.

Baillargeon noted that “we are the first to conduct a large-scale, nationally representative study on this association.”

Baillargeon and his colleagues used the Clinformatics Data Mart dataset, which comprises one of the largest commercially insured populations in the United States. They examined data from 450 men ages 40-63 with COPD who began testosterone replacement therapy between 2005 and 2014.

Researchers also used the national Medicare database to study data from 253 men age 66 and up with COPD, and who initiated testosterone replacement therapy between 2008 and 2013.

Researchers found that patients who underwent testosterone replacement therapy had a greater reduction in respiratory hospitalizations when compared to patients who did not receive the therapy.

“Specifically, middle-aged testosterone replacement therapy users had a 4.2 percent greater decrease in respiratory hospitalizations compared with non-users,” Baillargeon said. “Older testosterone replacement therapy users had a 9.1 percent greater decrease in respiratory hospitalizations compared with non-users.”

References:

https://copdnewstoday.com/2018/09/04/testosterone-replacement-therapy-can-slow-mens-copd-study-finds/

https://copdnewstoday.com/what-is-copd/

https://www.utmb.edu/

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