Level of e-cigarette power contributes to potentially hazardous effects

The higher the power of an e-cigarette, the higher the concentrations of potentially hazardous substances the device produces, including acetaldehyde, acrolein, and formaldehyde.

Those are among the findings presented at an international conference of the American Thoracic Society by lead study author Dr. Daniel Sullivan, an internal medicine resident at the University of Texas Southwestern Medical Center. During his previous training at the University of Alabama, Birmingham, Dr. Sullivan and his associates used a variety of methods including liquid chromatography–mass spectrometry and enzyme-linked immunosorbent assay (ELISA) to study components and nicotine formulations typical of e-cigarette users.

Under some test conditions, formaldehyde levels were comparable to those seen in traditional tobacco cigarettes, he said in a video interview.



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Study shows cost-effective expert recommended asthma test underutilized by physicians

Researchers from the University of Texas Medical Branch at Galveston have found, for the first time, that spirometry was underutilized for asthma diagnosis and management in U.S. adults from 2001 to 2011, despite it's accuracy, cost effectiveness and the publication of national guidelines advocating its use.

Spirometry is a common test that allows physicians to determine how well a person's lungs work by measuring how much air is inhaled and exhaled as well as how quickly the air is exhaled. This test plays a vital role in the diagnosis and management of asthma by providing accurate measurements of air volumes and flows.

The Choosing Wisely initiative of the American Board of Internal Medicine Foundation helps physicians and patients work together to make appropriate, effective and cost-effective health care choices.

Asthma affects about 8 percent of U.S. adults, which cost $56 billion in medical care in 2007. The Choosing Wisely initiative recommends spirometry for diagnosis and follow-up asthma care because it's effective and costs about $42. On the other hand, unnecessary use of an inhaler can cost $200 to $300 a month. An emergency room visit for an asthma episode can total $3,500. Health care use, including emergency department visits and hospitalizations are linked with how well asthma is controlled. Thus, when used in the diagnosis and management of asthma at the recommended times, spirometry should prevent needless expense.

This study evaluated trends, from 2001 to 2011, in the use of spirometry in patients within a year of when they were diagnosed with asthma. The findings are detailed in the American Journal of Medicine.

In all, 134,208 asthma patients were included in the study. Only 48 percent had spirometry performed within one year of diagnosis. Younger patients, males and those residing in the Northeast were more likely to receive spirometry. Eighty percent of patients cared for by specialists received spirometry, while only 23 percent of those cared for by primary care physicians underwent the test. However, even without spirometry, close to 80 percent of patients were prescribed asthma drugs.

"Physicians must be educated about the usefulness of spirometry and given evidence of its medical and monetary value," said Dr. Kristin Sokol, assistant professor of pediatrics in the division of allergy and immunology. "As the Choosing Wisely initiative implies, the underuse of spirometry may lead to misdiagnosis or under...

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Nudging Smokers

In the Issue of the New England Journal of Medicine an investigation of the role of financial incentives and nudges in promoting smoking cessation, with particular emphasis on the importance of loss aversion and pre-commitment is explored.

In the past 40 years, we have seen a revolution in thinking about thinking.  The central idea is that human beings depart, in systematic ways, from standard economic approaches to rationality. Because the departures are systematic and predictable, they can be taken into account by researchers, clinicians, and others who want to improve health and reduce premature mortality.

Behavioral scientists have shown, for example, that people are “loss averse”; they tend to dislike losses more than they like corresponding gains. A 5-cent tax on the use of a grocery bag is likely to have a much greater effect than a 5-cent bonus for bringing one’s own bag. People also suffer from “present bias”: they tend to focus on the short term and sometimes see the future as a kind of foreign country (and their future selves as strangers). Most people tend to be unrealistically optimistic, at least about their own prospects. People are sometimes aware of their own biases and are willing to pre-commit to courses of action that will counteract them.

These and related findings help to explain preventable health problems and also suggest a wide range of potentially promising interventions. Some such interventions involve economic incentives, in the form of subsidies and penalties. Others involve “nudges,” in the form of choice-preserving interventions that do not impose any such incentives; information, warnings, reminders, and default rules are examples of nudges. Still other interventions combine the two, as with nudges designed to encourage people to enter programs that impose economic incentives.

In this issue of the Journal, Halpern and his colleagues investigate the role of financial incentives and nudges in promoting smoking cessation, with particular emphasis on the importance of loss aversion and pre-commitment. They explore two kinds of interventions for CVS Caremark employees and their relatives and friends. The first is a “deposit program,” in which smokers deposit $150, which they can get back if they stop smoking, along with $650 extra. The second is a “reward program,” in which people receive $800 if they stop smoking. Halpern et al. are interested above all in two questions. First, when will...

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Market Forecast 2014-2024: Asthma and COPD Therapies

MD Spiro prides itself on not only offering incredible spirometry products for your practice, but also prides itself on providing articles and industry updates for our customers.  Below is a new study showing you trends, R&D progress, and predicted revenues in Asthma and COPD Therapies.

So where’s the asthma and COPD therapies market heading? Visiongain's brand new report shows you potential revenues to 2024, assessing data, trends, opportunities and prospects there.

This 335-page report provides 264 tables, charts, and graphs. Discover the most lucrative areas in the industry and the future market prospects. This new study lets you assess forecasted sales at overall world market and national level. You will see financial results, interviews, trends, opportunities, and revenue predictions. Much opportunity remains in this growing pharma market.

Forecasts from 2014-2024 and other analyses show you commercial prospects
Besides revenue forecasting to 2024, our new study provides you with recent results, growth rates, and market shares. There you find original analyses, with business outlooks and developments. Discover qualitative analyses (including SWOT and Porter's Five Forces Analysis), company profiles and commercial developments. Read the full transcripts of six exclusive expert opinion interviews from industry specialists informing your understanding and allowing you to assess prospects for investments and sales, including:

-    Clive Page, Professor of Pharmacology, King's College London
-    Monica Fletcher, Chief Executive, Education for Health
-    Daphne Tsitoura, Senior Medical Director, GSK
-    Barbara Yawn, Director of Research, Olmsted Medical Center
-    Ahmed Wagih, Product Manager, Respiratory Franchise, GSK

Discover sales predictions for the world market and submarkets

Along with revenue prediction for the overall world market, you see forecasts to 2024 for the following submarkets:
-    Bronchodilator monotherapy – SABAs, LABAs, anticholinergic drugs
-    Anti-inflammatory drugs – inhaled corticosteroids, anti-leukotrienes, monoclonal antibodies
-    Combination drugs.

Our investigation discusses what stimulates and restrains business. You find dynamics of the industry and assess its potential sales, seeing agents likely to achieve the most success.

See revenue forecasts for products
How will leading drugs and promising products currently in development perform to 2024 at world level? Our study...

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Nationwide Climate Change Initiative Targets COPD and Asthma

Today, is Earth Day.  A statement released by the White House outlines an initiative to combat the health-related effects of climate change, with an emphasis on chronic obstructive pulmonary disease (COPD) and asthma.   

“The Centers for Disease Control and Prevention (CDC) is releasing an Adaptation in Action Report highlighting successful actions state and local leaders are taking to reduce the health impacts of climate change in New York City (NYC), San Francisco, ME, MN, AZ, MI, CA and NY. The CDC is also releasing a Health Care Facilities Toolkit illustrating best practices for promoting resilient health care infrastructure,” the Office of the Press Secretary announced.

In their statement, the White House claimed climate change is not only to blame for extreme weather but also for affecting the quality of life of Americans with pulmonary conditions. Furthermore, they highlighted the poor, children, elderly, and sick as other groups that are especially vulnerable to climate change’s effects.

Extending the Climate Data Initiative — a measure launched in March 2014 which made data on climate change available to prepare communities and businesses — the White House announced they are initiating the “Health Resilience” portion of the plan which would make more than 150 meta-tagged health-related datasets public.    

“The new theme aims to empower America’s people, communities, and health sector to more effectively plan, prepare, and strengthen their resilience to the health-impacts of climate change,” the White House announced.   
As a part of the Initiative, Propeller Health reported they are building an Asthma Risk Map that will allow Americans to gauge their COPD and asthma exacerbations in relation to the weather. The digital respiratory health company claimed this program will gather data through the use of “sensors [which] collect crowd-sourced data on the time and location of inhaled medication use. Using predictive spatial modeling techniques and open government data resources, Propeller will identify areas in US cities where the impacts of climate change will be felt most acutely by people with chronic respiratory disease over the next 10 to 100 years and beyond.” 

Moreover, Propeller Health announced they will also include modifiable factors such as air pollution and transportation to help ascertain which interventions would effectively mitigate COPD- and asthma-related symptoms.

For more information...

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Testing for Inhaled Insulin

Diabetics now have a new option thanks to the breakthrough new medication AFREZZA®, an inhaled insulin now available by prescription. 

The labeling for AFREZZA®, mandates spirometry testing (specifically FEV1) to rule out chronic lung disease prior to initiating therapy, six months after initiation and every year thereafter1. 

MD Spiro offers a number of spirometer options and the expertise to easily integrate spirometry into your practice. From the non-reimbursable, PulmoLife at $195 to the full featured MicroLab at $2,295, Micro Direct has a spirometer designed to meet your needs. 
American Thoracic Society (ATS) Coding Recommendations

To aid in the coding for spirometry testing, the ATS has determined the appropriate ICD-9 codes and CPT codes. The following table lists examples of how to record these diagnosis and billing codes:

Spirometry prior to initiation of therapy  94010*  V72.85 + code for underlying condition (diabetes) as additional diagnosis Spirometry after first 6 months of therapy  94010*  V58.83 + V58.67 + code for underlying condition (diabetes) as additional diagnosis  Annual spirometry testing 94010*  V58.83 + V58.67 + code for underlying condition (diabetes) as additional diagnosis 

* It may also be appropriate to append this code with the “-32” modifier indicating that the test is “mandated” by the FDA as part of the labeling restrictions for inhaled insulin.2

For additional information, call us today at 800-588-3381.

a All Current Procedural Terminology (CPT) 5-digit number codes, descriptions, number modifiers, instructions, guidelines and other material are Copyright © 2014 American Medical Association. All rights reserved. 
1. This information is not a substitute for medical advice and does not provide a complete summary of AFREZZA® or any inhaled insulin product or address all considerations in making treatment decisions regarding their use. Always refer to the complete product information provided by the manufacturer. 
2. Modifier minute: modifier 32. American Academy of Professional Coders website. Accessed December 22, 2014. 

AFREZZA® is a registered trademark owned by MannKind Corporation. 
Micro Direct, Inc./MD Spiro is not sponsored by nor has any affiliation with Sanofi, US, Inc., MannKind or the AFREZZA® trademark.
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Time is Right for E-Cig Regulation

Reducing the risks of e-cigarettes to smokers, encouraging the smoking-cessation potential, and restricting access by nonsmokers offer a regulatory trifecta that can be implemented immediately, according to a former FDA official.

The "roadmap" to effective regulation hinges on implementation of the pending FDA deeming rule, which is expected to go into effect later this year. Regulation could begin almost immediately without the need for additional research, Eric Lindblom, JD, of Georgetown University Law Center in Washington, argues in the March issue of Food and Drug Law Journal.

"The minute [the deeming rule] comes out, the FDA has a terrific opportunity to immediately start regulating e-cigarettes," Lindblom, former director of the policy office at the FDA's Center for Tobacco Control, told MedPage Today.

"Right now, it's sort of like the Wild West, as has been often said about e-cigarette regulation in the U.S.," he added. "There really isn't any right now.

"Some in the industry think that any regulation at all is bad, but I think some thoughtful regulation could get rid of the bad actors and minimize the risks and potential harms and actual harms from e-cigarette use. At the same time, they can realize their potential to help people quit or as a less harmful alternative for smokers. Let's let them do that, but let's do it in a careful, regulated way that doesn't cause any unnecessary harms."

By itself, the deeming rule will not reduce the potential harms or maximize potential benefits, he added. Implementation of the rule will extend the FDA's regulatory reach to a wide range of tobacco products, including e-cigarettes and hookah or water-pipe tobacco. Whether the agency chooses to exercise its regulatory authority without additional studies remains to be seen.

The debate over e-cigarette regulation has gained momentum as the popularity and sales of the the various devices and products have taken off. In his article, Lindblom notes that public health officials remain divided over the form that regulation should take.

Supporters of a "soft approach" want to ensure that regulation does not become an obstacle to e-cigarettes' potential to help smokers quit or switch to potentially less harmful alternatives to conventional cigarettes. The "hard approach" camp emphasizes that nicotine -- in any form -- remains addictive and poses substantial harms as compared with no smoking. They also have expressed concern that smokers may use...

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Smoking Cessation is Important for YOUR Heart’s Health

The link between smoking and cancer is well known, but there’s another major killer associated with smoking that often goes unnoticed – heart disease.

“Smoking not only causes cancer. Smoking is also a significant contributor to heart disease, the top cause of death for men and women in the U.S.,” said Paul Fitzpatrick, manager of the Defense Health Agency’s (DHA) “Quit Tobacco” program.

DHA wants to spread awareness about how smoking and tobacco use contributes to heart disease. DHA is also promoting heart-healthy lifestyles and tobacco cessation through TRICARE, the health plan for service members and their families, and through the Quit Tobacco website.

Approximately 600,000 people die of heart disease each year in the U.S. – about one in every four deaths, according to the Centers for Disease Control and Prevention. Of these, 107,000 men and women die of heart disease related to smoking and smoke-less tobacco products, deaths that are largely preventable. On average, smokers die 13-14 years earlier than non-smokers.

Here’s how smoking causes heart disease, according to the American Heart Association:

•    Reduces the amount of oxygen your heart gets
•    Raises your blood pressure
•    Speeds up your heart rate
•    Makes clots more likely, which can lead to heart attack or stroke
•    Decreases exercise tolerance
•    Causes inflammation of blood vessels including those in your heart

Heart disease has become the number one cause of smoking-related deaths in women. Wow.

“This finding is important to men, too, because most of us have women in our lives as wives, mothers, daughters and sisters. Everyone wants their loved ones to live longer,” Fitzpatrick said.

Women who smoke and use oral contraceptives are even more vulnerable. Smoking greatly increases their risk of coronary artery disease and stroke, compared to non-smoking women who use oral contraceptives, according to the AHA.

Quitting smoking before the age of 40 reduces the risk of dying from smoking-related disease by about 90 percent, according to CDC research. However, it’s never too late to quit. If you become one of the millions of people who quit tobacco successfully each year, you can feel benefits almost immediately and will be on your way to a longer, healthier life.

What better way to celebrate the month of love by getting your patients in a smoking cessation program at your practice.  This could be the year YOU...

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