Pregnant Smokers Often Not Counseled to Quit

A significant knowledge gap about smoking cessation practices among perinatal substance abuse staff at a single center means pregnant women are often not being counseled about the dangers of tobacco and encouraged to quit, new research suggests.

Perinatal substance abuse counselors from the Johns Hopkins Center for Addiction and Pregnancy in Baltimore, Maryland, fared significantly worse than substance abuse staff who worked in Veteran's Administration hospital centers, other hospital-based centers, and community counseling centers throughout the United States.

"We found that they had much less knowledge about smoking cessation practices, and they also were more likely to have negative attitudes about their ability to get these women to stop smoking," senior author Margaret Chisolm, MD, from the Department of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine, in Baltimore, told Medscape Medical News.

The findings were presented here at the American Society of Addiction Medicine (ASAM) 45th Annual Medical-Scientific Conference.

More Harmful Than Illicit Drugs
Nearly 21% of reproductive-age women in the United States smoke cigarettes, and about 13% continue to smoke during pregnancy. This percentage is as high as 90% among pregnant women with substance use disorders, Dr. Chisolm said.

"When I started working here in 2006, this issue literally hit me in the face. These pregnant women who are in our drug abuse program would smoke outside the hospital in between their group sessions, and things like that, so I wanted to know why we were not addressing this in our program, especially since smoking is the leading modifiable risk factor for pregnancy-related morbidity and mortality," she said.

"Smoking is as harmful, if not more harmful, than most of the illicit drugs that pregnant women use," Dr. Chisolm added.

In the study, Dr. Chisolm used the Smoking Knowledge, Attitudes, and Practices (S-KAP) Instrument to compare the knowledge, attitudes, and practices among the 41 perinatal substance abuse staff at her institution with the knowledge, attitudes, and practices among 335 general substance abuse treatment staff from 11 other institutions.

The S-KAP Instrument was developed by Kevin L. Delucchi, PhD, and colleagues from the University of California, San Francisco, and published in the Journal of Drug Issues.

The instrument elicits staff knowledge about the risks of smoking, attitudes toward treating...

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Microparticles and COPD: Cell Injury in Lung Tissues is Closely Connected to Disease Progression in COPD Patients

The International Journal of COPD has published the review, “The role of microparticles in chronic obstructive pulmonary disease”.

As corresponding author Dr. Kubo says “Endothelial damage is believed to affect the pathophysiology of COPD, however, the influence of COPD exacerbation on the endothelium is not clearly understood. In this manuscript, we evaluated the influence of exacerbation on the endothelium by measuring circulating endothelial microparticles (EMPs), which are shed membrane vesicles in circulating blood that originate from activated or injured endothelium.”

Dr. Kubo continues “Several EMPs were significantly increased even at stable condition in COPD patients, but further increased during exacerbation. The increased EMPs were originated mainly from pulmonary capillary endothelial cells, suggesting pulmonary capillary is the main site suffered from exacerbation. Because circulating E-selectin EMPs increased in COPD patients who frequently underwent exacerbation, monitoring of EMP numbers is useful for evaluating endothelial damage in COPD patients and higher E-selectin EMP levels may predict the patients who are susceptible to exacerbation.”

As Dr. Richard Russell, Editor-in-Chief, explains “This is one of the first papers published on this subject. It is good science which is clear and understandable. The potential of the micro-particles both in the aetiology and treatment (even prevention) of COPD is massive.”

To help diagnose and treat COPD, Spirometry could not be an easier way to perform a test on your patients.  Your patients will be correctly diagnosed and treated more accurately and conveniently in your office and Spirometry is FULLY REIMBURSABLE.

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The International Journal of COPD is an international, peer-reviewed journal of therapeutics and pharmacology focusing on concise rapid reporting of clinical studies and reviews in COPD. Special focus will be given to the pathophysiological processes underlying the disease, intervention programs, patient focused education, and self-management protocols. This journal is directed at specialists and healthcare...

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Poor Diets Contributing to Increased Asthma Prevalence
The spread of poor diets with large amounts of processed food, fat and refined sugar could be leading to increasing levels of inflammation in the body and, as a result, contributing to increased asthma prevalence, say researchers.
The researchers looked at the Dietary Inflammatory Index (DII) in people with asthma compared with healthy controls to relate the index to the risk of asthma, lung function and systemic inflammation.
Ninety nine people with stable asthma and 61 healthy controls were studied. Lung function was tested through blood tests and spirometry, and the DII was worked out from questionnaires on food frequency of the subjects.
“Consumption of pro-inflammatory foods in the diet may contribute to worse asthma status”
The mean index score for people with asthma was found to be greater than that for healthy controls. The indication was that diets of people with asthma were more pro-inflammatory than those of controls and for each unit increase in index score there was a 62% rise in the chance of having asthma.
Lung function was also found to have a significant link with the index score, with a lowering of roughly 10% in the third of patients with the highest index score, compared with the third of patients with the lowest.
A further inflammation indicator − levels of inflammatory marker interleukin-6 in the blood − was positively linked with index score.
The index score was linked to lower lung function and greater systemic inflammation, said Lisa Wood, head of the Nutrition program at the Centre for Asthma and Respiratory Diseases, University of Newcastle in New South Wales.
“The usual diet consumed by asthmatics in this study was pro-inflammatory relative to the diet consumed by the healthy controls, as assessed using the DII score,” she said.
“The DII score was associated with lower lung function and increased systemic inflammation,” she said. “Hence, consumption of pro-inflammatory foods in the diet may contribute to worse asthma status.”
The researchers are now designing more studies to look at how dietary components reduce inflammation and clinical asthma outcomes, for example dietary fiber and antioxidants.
The index was developed in 2009 at the University of South Carolina, and it was validated to assess individual diets’ inflammatory potential.
The study was presented at the meeting of...
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Exercise May Curtail COPD Complications
Exercise might help reduce the risk of hospital readmission in people with a progressive lung condition called chronic obstructive pulmonary disease (COPD), a new study finds.
"Our findings suggest that regular physical activity could buffer the stresses of hospitalization," said study author Huong Nguyen, of the Kaiser Permanente Southern California Department of Research and Evaluation.
"Future studies will focus on determining whether we can reduce hospitalizations by improving physical activity in patients with COPD," Nguyen added.
COPD refers to a group of diseases, including emphysema and chronic bronchitis, that cause airflow blockage and breathing problems. Fifteen million Americans report they have a COPD diagnosis, according to the U.S. Centers for Disease Control and Prevention.
For this study, published April 9, 2014 in the Annals of the American Thoracic Society, researchers analyzed the health records of more than 6,000 California patients, aged 40 and older. All were hospitalized with COPD during 2011 and 2012. The patients provided information about their physical activity levels.
Compared to inactive patients, those who exercised 150 minutes a week (the equivalent of a half-hour, five days a week) or more were 34 percent less likely to be readmitted to the hospital within 30 days. Those who exercised less than 150 minutes a week still had a 33 percent lower risk compared to those who didn't exercise at all, the study found.
"The results of this study are groundbreaking because measures of physical activity were derived from routine clinical care, instead of lengthy physical activity surveys or activity devices in smaller research samples," Nguyen said in a Kaiser news release.
"Previous research has only analyzed the relationship between physical inactivity and increased [death] rate and hospitalizations, but not 30-day readmissions in patients with COPD," Nguyen added.
The study included white, black, Hispanic and Asian/Pacific Islander patients.
Many health care systems are looking at ways to reduce hospital readmissions, Nguyen said. "This study is novel in that we were able to capture information about patients' usual physical activity well before the initial hospitalization and provides evidence that supports the promotion of physical activity across the COPD care continuum," Nguyen added.
While the study doesn't establish a...
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Smoking Ban Reduces pre-term births, childhood asthma
On Friday, March 28, 2014, researchers stated that bans on smoking in public and the workplace led to a 10 percent drop in premature births and in emergency asthma treatment for children.
The evidence, based on the records of more than two million children, comes from 11 published investigations into the impact of local or national smoking bans in the United States, Canada, and four European countries.
Researchers found, within a year of a ban being imposed, rates of pre-term births and hospital treatment for childhood asthma each fell by more than a tenth.
Premature births are associated with a low birth weight and health problems for the child later in life.
Previous research into the benefits of smoking bans have focused mainly on adults, but children are disproportionately affected by passive smoking because their developing lungs and immune systems are more easily irritated.
A previous study in 2011, of 192 countries, found that children account for more than a quarter of the annual toll of 600,000 deaths attributed to second-hand smoking.
The new investigation, published in The Lancet, covered more than 2.5 million births and 250,000 hospital admissions of children who suffered an asthma attack. The data was for the period 2008-2013.
"Our research shows that smoking bans are an effective way to protect the health of our children," said Jasper Been of the University of Edinburgh's Centre for Population Health Sciences in Scotland.
"These findings should help to accelerate the introduction of anti-smoking legislation in areas not currently protected."
In a comment, smoking experts Sara Kalkhoran and Stanton Glantz at the University of California in San Francisco said the figures showed, among other things, that smoking bans pay for themselves.
"Medical expenses for asthma exceeded $50 billion (36.5 billion euros) in the USA in 2007 and $20 billion in Europe in 2006," they said.
"If asthma emergency department visits and admissions to hospitals decreased by even 10 percent, the savings in the USA and Europe together would be $7 billion annually."
A 2012 analysis found a 15 percent reduction in heart attacks and strokes and a 24 percent drop in hospital admissions for respiratory disease after anti-tobacco laws were passed.
For more information on Smoking Cessation products for your practice, visit MD Spiro, your breathing...
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Removing mold may reduce adult asthma risk
Reuters Health reports that mold exposure in the home raises the risk of asthma symptoms, researchers found.  Men were especially vulnerable after recent exposure to visible mold.
"The mold exposure that we were talking about is the typical mold that we all see in our homes from time to time, that is, mold that you see in the wet areas of the house, e.g., bathroom, kitchen and laundry," John Burgess told Reuters Health in an email.
Burgess, a researcher with the Melbourne School of Population and Global Health at the University of Melbourne, co-led the study with colleague Desiree Meszaros.
"We were not talking about 'whole-house' mold infestation that might occur under special circumstances such as following the house being flooded," Burgess said.
While a number of previous studies have examined indoor air pollutants and asthma, the majority focused on children and adolescents, Burgess said, but little research has looked at the relationship between these exposures and asthma in middle-aged adults.
About 25 million Americans have asthma, according to the National Heart, Lung and Blood Institute, and 7 million of them are children. Asthma typically begins in childhood, and often occurs in kids with allergies.
Burgess and his colleagues were interested in the effect of indoor air pollutants on adults' asthma symptoms and also in any differences between responses by those with allergic asthma and those with non-allergic asthma.
The research team used data from an ongoing study that began in 1968 when the participants were seven years old. In 2004, a total of 5,729 participants filled questionnaires about a variety of health topics, including respiratory symptoms and their home environment.
Participants were asked about asthma, asthma symptoms, amount of visible mold in the home, the number of smokers and types of heating and cooking appliances they had.
About 11.6 percent of the participants had asthma at the time of the 2004 questionnaire. About 17 percent had chest tightness at night and 23 percent reporting wheezing during the previous year. About 30 percent of the participants were smokers and about 15 percent of households included at least one regular smoker other than the study participant.
Almost half reported ever having had mold on any home surface, and about a third said they'd seen mold at home within the last 12 months, according to the results...
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Doctors are Missing Chances to Diagnose COPD Earlier
A retrospective study of almost 39,000 patients shows that opportunities to diagnose chronic obstructive pulmonary disease (COPD) at an earlier stage are frequently being missed in both primary and secondary care in the UK. The findings, published in The Lancet Respiratory Medicine, reveal missed opportunities to diagnose COPD occurred in up to 85 percent of people. 
"The substantial numbers of patients misdiagnosed and under diagnosed in this study is a cause for concern. It is important that COPD is diagnosed as early as possible so effective treatment can be used to try to reduce lung damage, improve quality of life, and even life expectancy", explains author Dr Rupert Jones from Plymouth University Peninsula School of Medicine and Dentistry, Plymouth, UK.
"The first signs of lung disease should prompt appropriate investigations such as pulmonary function tests (spirometry). However, both general practitioners (GPs) and patients are failing to recognize the significance of symptoms."
The UK Department of Health estimates that around 2.2 million people in the UK are undiagnosed and state that earlier diagnosis and treatment could save the National Health Service more than £1 billion over 10 years.
Using data from the General Practice and Optimum Patient Care Research databases, the researchers assessed whether a COPD diagnosis might have been made in an earlier primary or secondary care visit. They identified 38 859 patients aged 40 years or older who had received a COPD diagnosis between 1990and 2009 and for whom data was available for at least two years before and one year after diagnosis.
Results showed that in the 5 years before diagnosis, 85% of patients had visited their GP or a secondary care clinic at least once with lower respiratory symptoms. These consultations represent missed opportunities to further investigate patients for a possible diagnosis of COPD. Opportunities for diagnosis were missed in 58% of patients in the 6–10 years before diagnosis and 42% in the 11–15 years before diagnosis.
Over the 20 year study, a significant increase in the number of chest x-rays in the 2 years before diagnosis was noted, but only a third of these patients were also given spirometry testing.
They researchers say, "Although we have seen small improvements in earlier diagnosis over the past 20 years, many patients are still being diagnosed with severe or very severe airway...
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Secondhand Smoke Could Cancel out Asthma Treatment
It isn’t rocket science that parents should not be smoking at home with children that suffer from asthma.  A new study finds, that secondhand smoke may be counteracting the effects of the child’s asthma treatment.
The study, published in the journal Chest, finds that the oxidants in cigarette smoke were shown to be capable of destroying key anti-inflammatory enzymes in asthma medicine.  Great.
“Passive smoking in the home and in cars is damaging to the lungs,” lead researcher Professor Peter Barnes told Medical Daily. “What our study shows is that it can stop a key asthma treatment — inhaled steroids — from working properly, so it means that asthma is not as well-controlled.”
Because asthma is characterized by chronic inflammation in a person’s airways that makes breathing difficult, asthmatics rely on inhalers to deliver corticosteroid, which helps to stop the abnormal inflammation signal.  Children that live in homes where smoking transpires, Barnes explains, were shown to have the same resistance to these steroids as adults who actively smoke.
For more information on Smoking Cessation and integrating it into your practice, to help save the children in smoking homes, visit MD Spiro’s Breath CO section today.
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