When It Pays to Quit, More People Do!

Financial rewards and personalized support can improve a smoker's chances of quitting, a new study finds.

"Our results show that a successful intervention to help [low-income] individuals quit smoking should be multifaceted and focus on both assisting with resources and, when possible, providing financial incentives," said lead author Dr. Karen Lasser. She's a general internist at Boston Medical Center and an associate professor of medicine at Boston University School of Medicine.

In the study of more than 350 adults, one group of smokers was provided a "patient navigator" to help them get prescriptions for nicotine replacement products and referrals for counseling. They were also offered a monetary reward ($250) if they quit within six months. They received an additional $500 if they were not smoking after 12 months.

Those who did not quit within six months were given a second chance to earn $250 if they quit within 12 months.

A control group of smokers was only given information about resources to help them quit smoking.

After six months, nearly 10 percent in the intervention group had quit smoking, compared with less than 1 percent in the control group. After 12 months, researchers found 12 percent of the intervention group had stopped smoking, compared with 2 percent who only received information about quitting.

"Most of the participants who quit smoking utilized patient navigation, but it's unclear whether navigation alone would achieve the rates of smoking cessation we observed," Lasser said in a medical center news release.

She and her colleagues said older smokers, women and nonwhites were most likely to benefit from the personal support and payments.

The study was published Oct. 30 in the journal JAMA Internal Medicine.

The American Cancer Society offers a guide to quitting smoking.



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Can Young People Get COPD?

Many chronic diseases have an age dimension. As we grow older, the body’s ability to repair itself changes, and damage can accumulate in various parts of the body. Cancer, arthritis, cardiovascular disease, Type 2 diabetes, osteoporosis and dementia are all diseases that tend to afflict older adults more frequently than younger adults.

Chronic obstructive pulmonary disease also has an age component. Because this incurable and progressive lung disease usually results from years of damage to the tissues of the lungs, it’s more common in older adults. The Mayo Clinic reports that “most people are at least 40 years old when symptoms begin.” These symptoms include shortness of breath, especially when engaging in physical activity, wheezing or chest tightness, a chronic cough, lack of energy and frequent respiratory infections. These symptoms may be mistaken for simple signs of aging, but over time they will increase to the point of requiring treatment. And if it’s COPD, it’s not just age – the symptoms are being caused by real damage to the lungs that can’t be reversed but can be managed to maintain a better quality of life.

A lengthy history of cigarette smoking is the biggest risk factor for developing COPD, but the National Heart, Blood and Lung Institute reports that about 15 percent of COPD patients have never smoked. These people may have encountered occupational hazards such as coal dust or other airborne particles that damaged the lungs, or had other exposures to inhaled irritants that did permanent damage to the inside of the lungs.

Although COPD can be considered a disease of aging, there are some other factors that can lead to COPD at a younger age in some people.

Genetic Susceptibility
One factor that can put nonsmokers and younger people at risk for developing COPD is a genetic condition called alpha-1 antitrypsin deficiency. Patients with this hereditary condition have a delivery problem with alpha-1 antitrypsin enzyme. The liver manufactures the enzyme, but it can’t exit the liver properly, so it’s not delivered to the lungs where it does most of its work. This can lead to problems with both the lungs and the liver.

“Alpha-1, for short, is primarily a genetic condition that increases the risk of things injuring the lung and liver that normally wouldn’t injure them,” says Dr. Robert Sandhaus, pulmonologist at National Jewish Health in Denver.

“People with this deficiency are 100 times more...

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The Looming Consequences of Breathing Mold

Flooding means health issues that unfold for years

The flooding of Texas and Florida is a health catastrophe unfolding publicly in slow motion. Much of the country is watching as gallons of water rise around the chairs of residents in nursing homes and submerge semi-trucks. Some 20+ trillion gallons of water are pouring onto the urban plain, where developers have paved over the wetlands that would drain the water.

The toll on human life and health so far has been small relative to what the images suggest. But the impact of hurricanes on health is not captured in the mortality and morbidity numbers in the days after the rain. This is typified by the inglorious problem of mold.

Submerging a city means introducing a new ecosystem of fungal growth that will change the health of the population in ways we are only beginning to understand. The same infrastructure and geography that have kept this water from dissipating created a uniquely prolonged period for fungal overgrowth to take hold, which can mean health effects that will bear out over years and lifetimes.

The documented dangers of excessive mold exposure are many. Guidelines issued by the World Health Organization note that living or working amid mold is associated with respiratory symptoms, allergies, asthma, and immunological reactions. The document cites a wide array of “inflammatory and toxic responses after exposure to microorganisms isolated from damp buildings, including their spores, metabolites, and components,” as well as evidence that mold exposure can increase risks of rare conditions like hypersensitivity pneumonitis, allergic alveolitis, and chronic sinusitis.

Twelve years ago in New Orleans, Katrina similarly rendered most homes unlivable, and it created a breeding ground for mosquitoes and the diseases they carry, and caused a shortage of potable water and food. But long after these threats to human health were addressed, the mold exposure, in low-income neighborhoods in particular, continued.

The same is true in parts of Brooklyn, where mold overgrowth has reportedly worsened in the years since Hurricane Sandy. In the Red Hook neighborhood, a community report last October found that a still-growing number of residents were living in moldy apartments.

The highly publicized “toxic mold”—meaning the varieties that send mycotoxins into the air, the inhaling of which can acutely sicken anyone—causes most concern right after a flood. In the wake of Hurricane...

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More Depressed Pregnant Women are Smoking

Smoking during pregnancy is on the rise among American women with depression, a new study finds.

Researchers analyzed data from more than 8,500 mothers-to-be who took part in an annual government health survey. It found a 2.5 percent rise in smoking rates among pregnant women with depression between 2002 and 2014.

Smoking rates among other groups fell during that time, according to the study published online in the October issue of the journal Drug and Alcohol Dependence.

"An increase in smoking rates in any population is concerning given the general overall downward trends we are seeing today," said study leader Renee Goodwin. She's an adjunct associate professor of epidemiology at Columbia University's Mailman School of Public Health.

More than a third of pregnant women with depression smoke, compared with 1 in 10 who are not depressed, according to the study.

Goodwin said the link between depression and prenatal tobacco use has increased over time, suggesting that depression is an important -- but rarely treated -- barrier to quitting smoking.

She noted that smoking during pregnancy is more common among women who are unmarried, less educated and have lower incomes. "Notably, these are also groups who often have less access to prenatal care," she added in a Columbia news release.

Goodwin said many women may be unaware that depression is interfering with their ability to stop smoking and may need extra help to quit.

"Public health campaigns to educate people about the importance of quitting smoking during pregnancy is highly recommended. Treatment for depression in conjunction with smoking cessation efforts may also be the critical component to help women succeed in quitting," Goodwin concluded.



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Weight Loss Surgery Tied to Fewer Hospital Visits for COPD

Obese people with chronic obstructive pulmonary disease (COPD) who get weight loss surgery may go to the hospital less often with acute breathing problems after their operations, a U.S. study suggests.

Among obese adults with COPD who had what’s known as bariatric surgery to lose weight, the proportion of patients who needed emergency room or inpatient hospital care for the lung disorder fell by more than half after the operations, the study found.

“If you are morbidly obese and suffering from COPD, bariatric surgery could mitigate COPD-related symptoms,” said lead study author Dr. Tadahiro Goto, an emergency medicine researcher at Massachusetts General Hospital in Boston.

COPD is usually caused by smoking, and symptoms include breathing difficulty, cough, excessive phlegm production, and wheezing.

Treating obesity in patients with COPD is controversial because that excess weight has been linked to both worse lung function and better survival odds, Goto said by email. Recently, some small studies have suggested weight loss might benefit COPD patients, but the current study is the largest to date to provide evidence that bariatric surgery may help ease severe symptoms, Goto added.

The researchers examined data on 481 obese adults aged 40 to 65 who had COPD and underwent bariatric surgery in California, Florida and Nebraska.

They followed patients from 2005 through 2011 to see how hospital and emergency room visits for COPD in the two years before weight loss surgery compared to the two years afterwards.

At the start of the study, when patients were 13 to 24 months away from getting their operations, 28 percent of them had an emergency department (ED) or hospital visit for acute COPD symptoms, researchers report in Chest.

During the second year of the study, the 12 months right before surgery, these rates didn’t change much.

But compared with that first year of the study, the chances of an ED or hospital visit dropped by 65 percent in the first year after bariatric surgery. Just 12 percent of patients had a COPD visit during that time.

During the last year of the study, 13 to 24 months after surgery, the odds of an ED or hospital visit were 61 percent lower than in the first year of the study.

One limitation of the study is that it focused on people with severe COPD symptoms, and the results might not apply to people with well-controlled disease, the authors note.

It’s also possible that insurance might not...

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Consuming Fish Oil May Reduce Asthma Symptoms

A common asthma symptom is an exercise-induced bronchoconstriction – the constriction of the airways. Researchers investigated the potential of fish oil to improve asthma symptoms.

Exercise-induced bronchoconstriction (EIB) is a prominent and common symptom in individuals with asthma. It even affects up to 50% of elite athletes, making it a concern for any individuals participating in physical activity. EIB is defined by the constriction of the airways that results in difficulty breathing. Several breathing aids exist to alleviate symptoms, but they are only a temporary measure to a long-term problem. Thus, dietary changes that have potential to induce more long-term improvement are being investigated.

The authors of a recent study published in the British Journal of Nutrition drew their attention to n-3 polyunsaturated fatty acids (PUFAs), a type of fatty acid that has shown some promise in alleviating EIB. One of the main ways to consume supplementary PUFA is to take commercial fish oil pills. However, this can be considered costly and excess PUFA consumption can lead to digestion problems. To avoid this complication, the researchers studied the effects of low-dose PUFA.

Two groups of eight participants were included in the study. One group was medically diagnosed with asthma and suffered from EIB. The other group consisted of control subjects that took fish oil pills. The study took place over 14 consecutive weeks, with a daily consumption of 8 fish oil pills: four in the morning and four in the afternoon for 21 days, followed by 14 days of fish oil abstinence. At the beginning and end of fish oil consumption, the likelihood of getting EIB was measured in all participants. Urinary and blood analysis were also performed to assess immune response and overall health.

The results showed that for improving asthma symptoms, consuming low-dose PUFA was just as effective as a high-dose. Thus, n-3 PUFA supplementation is a potential dietary means of controlling EIB, allowing people to exercise without fear of airway constriction.

For more information on our spirometry offerings for your practice, please check out our products today!

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E-Cigarette Use Linked to Smoking-Cessation Increase

Study suggests vaping MAY help smokers quit. Do you agree?

Between 2014 and 2015 the population-level rate of smoking cessation increased in the United States for the first time in at least 15 years, and researchers credit the use of electronic cigarettes by smokers trying to quit for much of the decline.

Dual e-cigarette and traditional cigarette users attempted smoking cessation and succeeded in quitting at a higher rate than non-e-cigarette users who smoked, according to the analysis, which is based on the largest representative sample of e-cigarette users to date.

There was a statistically significant 1.1% increase in the smoking cessation, or "quit," rate during the study's 12-month period, which coincided with a dramatic rise in e-cigarette use starting around 2010, Shu-Hong Zhu, PhD, of the University of California, San Diego, and colleagues wrote in BMJ.

In an interview with MedPage Today, Zhu explained that quit rates in the U.S. remained steady, at around 4.5% a year, until 2014 when they increased to 5.6%.


"The quit rate at the population level is very hard to move, and tends to remain stagnant. A 1.1% increase doesn't sound like much, but that represents an additional 350,000 smokers who quit during this 12-month period."

He and his colleagues credited the Centers for Disease Control and Prevention's national TIPS from Former Smokers media campaign, which began airing in 2012, for some of the rise in smoking cessation at the population level, but Zhu said the campaign alone cannot possibly explain the population-level smoking-cessation increase seen: "I am very confident that the increase in e-cigarette use during this period contributed greatly to the quit-rate increase. It doesn't explain it all, but it played a big part."

The researchers explained that the population-level smoking quit-rate increase is particularly remarkable given that the introduction of accepted smoking-cessation measures -- including the nicotine patch, the drug Chantix, and huge cigarette tax increases -- appeared to have little or no impact on smoking-cessation rates among U.S. adults at the population level.

"This is the first statistically significant increase observed in population smoking-cessation rates among U.S. adults in the past 15 years," the team noted.

Stanton Glantz, PhD, of the University of California, San Francisco's Center for Tobacco Control Research and Education, called the study "well done."

Glantz has been a...

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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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