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Smoking cessation and management of patients with asthma

Key Points:

  • Tobacco smoke can be mainstream, side stream or second hand, all of which have a severely negative impact upon asthma symptoms
  • Smoking remains the single biggest cause of premature mortality in the UK
  • Shisha (waterpipe) use is dangerous. Every hour of shisha use is equivalent to smoking 100 cigarettes

Tobacco smoking by the individual causes chemical smoke to enter the lungs, and then chemicals to enter the bloodstream and body tissues. This is known as ‘mainstream smoke’. While much of it is absorbed by the smoker, some is exhaled. While the cigarette, pipe or cigar is lit, the burning end also expels smoke and chemicals, known as ‘sidestream smoke’. ‘Second-hand smoke’ is a combination of both sidestream and exhaled mainstream smoke, and affects both the smoker and non-smokers in the area. Tobacco smoke contains more than 7,000 chemical compounds, present as either gases or as tiny particles.1 These include carbon monoxide, arsenic, formaldehyde, cyanide, benzene, toluene and acrolein. Carbon monoxide reduces the capacity of red blood cells to circulate oxygen.

Smoking remains the single biggest cause of premature mortality in the UK, accountable for more deaths per year than the next six modifiable causes of premature mortality.2-6 One adult smoker in two will die as a consequence of tobacco smoking, losing an average 10 years of life.7 Although smoking rates have considerably reduced over the last few decades, it is still the case that around 19% of adults smoke daily,7 around 9.5 million people, and there are higher rates of smoking in more vulnerable populations. Accurate prevalence figures for adult smokers with asthma are not available for the UK, but international estimates in developed countries suggest 20-25% of asthma patients also smoke,8 and it has been suggested that children and adolescents with asthma are more likely to be smokers.9

For every smoker who dies, 20 are suffering from a smoking-related disease.7 Respiratory diseases for both smokers and non-smokers (as a consequence of second-hand smoke exposure) are, unsurprisingly, a key element of this.

Tobacco smoking has been identified as a causal factor in the development of asthma10 – the likelihood of becoming asthmatic is increased by:10

  • Maternal smoking in pregnancy – children born to mothers who smoked while the baby was in utero are more likely to develop childhood asthma.
  • Parental smoking (especially for children,...
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COPD Market Sales Expected to Reach $14.1 Billion by 2025

The chronic obstructive pulmonary disease (COPD) market is expected to reach $14.1 billion by 2025, according to a recent GlobalData report.

COPD is the fourth leading cause of death in the world. It is characterized as an abnormal inflammatory response and airflow obstruction that cannot be fully reversed. 

GlobalData forecasts that sales for the COPD market will increase from $9.9 billion in 2015 to approximately $14.1 billion in 2025 across the 8 major markets––the United States, France, Germany, Italy, Spain, Australia, Japan, and the United Kingdom.

The rise represents a Compound Annual Growth Rate (CAGR) of 3.7%, and will be driven by an increase in diagnosed prevalent cases and the entry of new bronchodilator drug classes and anti-eosinophilic biologics, according to GlobalData.

Fixed-dose combinations (FDCs) of long-acting beta2-agonists/long-acting muscarinic antagonists (LABA/LAMA) and inhaled corticosteroids (ICS)/LABA/LAMA are 2 new bronchodilator drug classes, which will consist of more expensive bronchodilators and “seize share from LABA and LAMA monotherapies” altering the landscape of COPD management.

“In terms of major players, AstraZeneca and GlaxoSmithKline (GSK) will be in the spotlight of the COPD market by 2025,” Alexandra Annis, MS, health care analyst at GlobalData said in a press release. “Although Boehringer Ingelheim was the market leader in 2015, AstraZeneca and GSK have invested heavily in new products, both with an ICS/LABA/LAMA FDC and biologic in the late-stage pipeline for COPD, generating sales of $3.1 billion and $5.1 billion in 2025, respectively.

“Without a first-in-class COPD late-stage pipeline therapy to offset the patent expiry of Spiriva HandiHaler, Boehringer Ingelheim is expected to lag behind in the COPD market by the forecast end, garnering 2025 sales of $1.6 billion.”

Although the COPD market continues to grow and FDCs flood the market to prevent exacerbations, there is no clear data indicating improvement in mortality outcomes. But the 2 new biologics currently in the pipeline, mepolizumab (Nucala) and benralizumab, are the only treatments that offer a novel mechanism of action, according to GlobalData.

“These therapies are anticipated to be revered as an add-on therapy for patients with high levels of blood eosinophilia who are poorly controlled with high-dose ICS therapy and at high risk for exacerbations,” Annis said in the release. “Anti-eosinophilic...

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Study Shows Care, Cost Benefits of Asthma Intervention

The economic burden of asthma is estimated to be nearly $81 billion in the 28 countries of the European Union.

A new study by the University of Kent, in England, showed interventions by community pharmacists improve asthma control in patients leading to major cost benefits.

The economic burden of asthma is estimated to be nearly $81 billion in the 28 countries of the European Union, researchers report in the study.

Research by the Medway School of Pharmacy at the University of Kent and the University of Greenwich found that community pharmacists who conduct reviews with asthma patients on the way they use their medicines improved the patients' asthma control.

This improved asthma control produced a cost-effective benefit compared to standard care methods.
Researchers conducted clinical trials of a community-pharmacist intervention known as I-MUHR for asthma with 283 pharmacists and 1,263 patients in Italy.

I-MUHR is a private, structured interview between pharmacists and their patients about asthma symptoms, medicine use, attitude regarding medicines, identification of pharmaceutical care issues and adherence to prescribed medication.

The study shows that after three months, patients who received the I-MUHR intervention were 76 percent more likely to achieve good asthma control than patients in the control group.

The I-MUHR intervention reduced the average number of active ingredients among patients' medications and improved self-reported adherence to treatment.

The study also found that the I-MUHR intervention had a 100 percent probability of being more cost-effective than traditional treatments after nine months.

The study was published in BMC Health Services Research.

References:
http://www.upi.com/Study-shows-care-cost-benefits-of-asthma-intervention/8021496328957/
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-017-2245-9

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Customized, frequent emails show promise in tobacco cessation

Smokers who received frequent, tailored emails with quitting tips, motivational messages, and social support had cessation rates rivaling that of the most effective medication available for cessation, according to a new American Cancer Society study. The study appears in Tobacco Control.

New communication technologies have the potential to provide more cheaply the same kinds of social and other support that have previously proven effective in tobacco cessation. Telephone counselling has been shown to be effective for treating tobacco dependence, but its reach is low. Other modalities using internet and smartphone technologies to deliver evidence-based cessation treatment at the population level have begun to expand and have shown promise.

For the new research, authors studied the use of email, which has the advantage of being read daily or near-daily by most individuals. Email can also provide substantial content within the email, eliminating the need to access a specific website, and with the popularity of mobile phones and tablets, can be read on the go. Emails can also be tailored to address unique characteristics of the recipient.

To explore whether emails could be effective in cessation, researchers led by J. Lee Westmaas, Ph.D., strategic director of tobacco control research at the American Cancer Society, recruited 1,070 smokers who were planning to quit. They were randomly assigned to receive one of three email protocols: 27 tailored cessation emails; 3 to 4 tailored emails with links to downloadable booklets; or a single non-tailored email. All emails included links to quitting resources. To measure success, abstinence was assessed one, three, and six-months post-enrollment by asking whether participants had smoked in the previous seven days.

Across all three follow-up times, the mean abstinence rate was highest for smokers getting the custom emails (34%), followed by receiving three or four emails (30.8%), and a single email (25.8%). Results were independent of baseline cigarettes per day, interest in quitting, whether there was a fellow smoker in household, and the use of nicotine replacement therapy (NRT) or varenicline, a drug also approved for smoking cessation.

"The overall quit rate for the main intervention group is about equivalent to the abstinence rates achieved by the most effective medication for cessation," said Dr. Westmaas. "It appears that the personalization in the emails and their frequency -initially every...

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Study Shows: COPD Patients with NTM-PD Face Higher Mortality

Patients with chronic obstructive pulmonary disease (COPD) who also have non-tuberculous mycobacterial pulmonary disease (NTM-PD) are more likely to be hospitalized and die, according to a German study that urges improved care for this particular disease.

The study, Burden of non-tuberculous mycobacterial pulmonary disease in Germany,” appeared in the European Respiratory Journal in an article.

In the past decade, the incidence of infections caused by Mycobacterium tuberculosis have decreased in the industrialized world. However, infections caused by other Mycobacterium strains have started to be recognized worldwide.

Although over 150 different species are linked with NTM-PD, the disease is most commonly associated with Mycobacterium avium complex. Because it doesn’t always present signs of active infection and because its symptoms often overlap with those of other chronic pulmonary diseases, NTM-PD can be difficult to diagnose and even harder to eradicate — requiring prolonged therapy regimens with high risk of recurrence or relapse of infection.

In the present study, authors evaluated the real NTM-PD burden by comparing 125 newly diagnosed NTM-PD patients with 1,250 matched control patients over a 39 month-period. They found that although the incidence of NTM-PD was only 2.6 per 100,000, those with NTM-PD had a nearly fourfold increase in mortality (22.4 percent) than those in the control group (6 percent).

Among COPD patients with NTM-PD, the mortality rate was 41.5 percent, compared to 15.9 percent for COPD patients without the disease. In addition, hospitalization costs were three times higher for NTM-PD patients (accounting for 63 percent of total costs).

Even so, the authors noted discrepancies across individual treatments. Only 54 percent of the NTM-PD patients analyzed had received antibiotics on diagnosis, while 26 percent received no antibiotics at all. They also counted 29 different drug combinations across all treatments, suggesting a lack of treatment guidelines for this condition.

“Although NTM-PD is considered rare, these findings highlight that the burden of the disease is high,” the study’s author, Michael Loebinger, said in a press release. “Treatment can be hard to tolerate and may be unsuccessful, making treatment decisions complex. To help with this challenge, the British Thoracic Society will be releasing new guidelines this year.”

 

References:

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Asthma: Why Early Diagnosis is Vital

Globally, World Health Organization (WHO) estimates that 235 million people suffer from asthma. It also indicates that asthma is not just a public health problem for high income countries, but it occurs in all countries regardless of the level of development.

The study further shows that over 80 per cent of asthma deaths occur in low and lower-middle income countries.
In Rwanda, according to the WHO data published in May 2014, asthma deaths reached 267 or 0.39 per cent of total deaths. The age adjusted death rate was 5.62 per 100,000 of the population, ranking Rwanda 80 in the world.
Treatment should be a priority.

Prof Joseph Mucumbisti, a pediatrician at King Faisal Hospital, Kigali, and president of Rwanda Heart Foundation, says that with time, the rate of asthma cases can be unpredictable, or even higher in the future if awareness on its treatment and diagnosis isn’t put into effect.

“Asthma is quite a common health issue, it’s part of the non-communicable diseases (NCDs), which can’t be transmitted from one person to another. It’s part of the big four NCDs including cardiovascular diseases, diabetes, cancer and the group of chronic respiratory diseases,” he says.

Therefore, there is need for both medical practitioners and the whole public to be aware of the disease, as well as get the proper treatment required to get rid of it completely.

Mucumbisti explains that, in most cases, asthma tends to continue from childhood to adulthood, that’s if the patient doesn’t get proper treatment and management. However, this can be easily prevented if its cause is treated at a young stage.

“The challenge that we have is that most people tend to dwell on prescribing medicines that are meant to relieve the acute asthma attack,” he says.

He explains that these medicines are in form of inhalers which ensure healing within three to five days. Although this ensures relief, unfortunately, it doesn’t ensure its treatment completely which leads to the inflammation of the disease.

“When this happens, the patient will continue to have asthma even in their entire life. And the longer one has it, the more the impact on their life increases,” he adds.

Mucumbisti, however, notes that as a result of prolonged asthma, one is likely to suffer from chronic diseases of the lungs and the heart, therefore the earlier its detection, the earlier the treatment, thus the prevention of consequences later in life.

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Lung Institute Plans Initiative to Decrease Number of COPD Patients with Depression

To shine a light on the link between chronic obstructive pulmonary disease (COPD) and depression, the Lung Institute is starting an initiative to help combat depression in COPD patients. It kicked off on World Health Day, April 7.

The initiative will seek to decrease the prevalence of depression in people with COPD by helping them improve their quality of life.

Depression affects an estimated 300 million people worldwide, including 16 million American adults, according to the National Institute of Mental Health. It’s particularly prevalent in COPD. About 40 percent of the 24 million Americans with the disease experience depression, according to the Lung Institute.

An article titled “Depression in COPD – management and quality of life considerations” spells out the problem. It was published in The International Journal of Chronic Obstructive Pulmonary Disease.

“Many of our COPD patients suffer from depression. It is what is known in medicine as a co-morbidity,” Jack Coleman, Jr., MD, senior medical director of the Lung Institute, said in a press release.

“When you suffer with COPD, life’s smallest activities like bathing and walking can be a daily struggle; leaving the house can be overwhelming, which may lead to isolated living conditions. You can become cut off from the things you enjoy and, too often, the ones you love.”

Depression can significantly worsen the physical burden of COPD. That makes it important for doctors and their patients to create a plan to deal with it.

The Lung Institute says COPD and depression don’t need to co-exist. Managing the depression that does exist can improve patients’ outlook, it adds.

The institute offers regenerative cell therapy to those with lung disease. This involves using a person’s stem cells, which can generate other cells types, to regenerate lung tissue. The ultimate goal is to improve the quality of life of COPD patients.

After treatment, many patients are ready to engage in the simple tasks they used to do, and pursue activities they once thought impossible, the institute says.

“I could barely leave the house and I couldn’t move. It was hard to get [up] out of a chair. I went into a depression of losing my life, the life I had and the life I loved,” said a patient at the Lung Institute, David V. “But [having] the stem cell [treatment] freed me up to be able to move again. That was the move that saved my life.”

Stem cell therapy involves...

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Few Smokers Receive Treatment To Help Them Quit While In The Hospital

It's never too late to quit smoking.

Even after heart surgery, research has shown that quitting smoking reduces the risk of a heart attack, stroke or death. Yet only about one-third of smokers hospitalized for heart attacks and other serious heart problems received proven smoking-cessation therapy while they were in the hospital, according to research scheduled for presentation at the American College of Cardiology's 66th Annual Scientific Session. Moreover, data showed that amid mounting evidence of the dangers of tobacco smoke, use of smoking-cessation treatments only increased by 10 percent in hospitals nationwide over the last decade.

"Hospitalization is usually a highly teachable moment, when patient motivation to quit smoking is really high," said Quinn R. Pack, MD, MSc, a preventive cardiologist at Baystate Medical Center in Springfield, Massachusetts, and lead author of the study.

"Yet our study suggests that two-thirds of these patients leave the hospital without having been given evidence-based smoking-cessation tools that we know can help them quit."

Pack and his colleagues examined diagnostic and billing data from 282 hospitals to determine how often smokers hospitalized for heart attacks or heart surgery received smoking-cessation counseling, nicotine replacement therapy (such as the nicotine patch, gum, lozenge or inhaler) or a smoking-cessation medication (varenicline or bupropion) during their hospital stay. The researchers reviewed data for 36,675 patients coded as active smokers at hospital discharge between 2004 and 2014. Nearly 70 percent were men, their average age was 58, and 63 percent of them were hospitalized for a heart attack. The hospitals were located across the country and ranged from medium-sized community hospitals to large university-affiliated medical centers. All of the hospitals had voluntarily submitted the data, stripped of information that might identify individual patients, to a large quality-improvement database.

Overall, about 30 percent of the patients received at least one smoking-cessation therapy during their hospital stay. Of those, about 20 percent were given the nicotine patch, which was the most commonly given treatment, and about 10 percent received professionally delivered smoking-cessation counseling. Few patients received medication or other forms of nicotine replacement therapy such as nicotine gum or lozenges. Smokers who had lung disease, used alcohol, were depressed or were...

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