Antipsychotics May Boost Respiratory Failure Risk in COPD

Antipsychotics have been tied to acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD), Taiwanese researchers reported.

In a population-based, case-crossover study, more COPD patients had filled a prescription for antipsychotics 2 weeks before having acute respiratory failure compared with a control period several months prior (11.7% versus 8.8%), Meng-Ting Wang, PhD, of National Defense Medical Center in Taipei, and colleagues reported online in JAMA Psychiatry.

That translated to a significantly higher risk of respiratory failure during the first 2 weeks of antipsychotic use, independent of cardiogenic, traumatic, and septic factors (adjusted OR 1.66, 95% CI 1.34 to 2.05, P<0.001).

"The results of this study indicated a life-threatening adverse respiratory effect of antipsychotic treatment, which has been described previously only in case reports," they wrote.

Antipsychotics have been linked to acute respiratory failure in case reports, but population-level data are lacking, the researchers explained. Also, this effect is of particular concern among COPD patients, who are already prone to respiratory failure and are commonly treated with antipsychotics.

For their study, the team looked at data from the Taiwan National Health Insurance Research Database for patients with COPD who were newly diagnosed with acute respiratory failure in the hospital or in emergency care settings from Jan. 1, 2000 to Dec. 31, 2011. The protocol excluded patients with prior acute respiratory failure, lung cancer, and cardiogenic, traumatic, or septic respiratory failure.

For the main outcome, the study compared self-reported use of antipsychotics in the two weeks before their respiratory failure with a control period of 75 to 88 days prior to the event.

Over a mean of 3.5 years, a total of 5,032 of the 61,620 COPD patients were diagnosed with acute respiratory failure.

The team found that more patients filled at least one prescription for an antipsychotic medication during the case period than during the control period (11.7% versus 8.8%), which corresponded to a significantly higher risk of acute respiratory failure (adjusted OR 1.66, 95% CI 1.34 to 2.05, P<0.001).

There was also a dose-dependent risk of acute respiratory failure associated with antipsychotics (aOR 1.35, 95% CI 1.19 to 1.52, P<0.001), which rose from a 1.52-fold risk for a low daily dose (95% CI 1.20 to 1.92, P<0.001) to a 3.74-fold risk for a...

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Another Reason Not to Smoke While Pregnant

With New Year’s resolutions kicking into high gear in the month of January, why not help your patients truly stop smoking in this New Year. Especially with your pregnant patients, it is even more important to support a high quality smoking cessation program in our daily practices.

Women who smoke during pregnancy may be more likely to have children with kidney damage than mothers who steer clear of cigarettes, a study suggests.

Smoking during pregnancy has long been linked to preterm and underweight babies and a wide range of birth defects. The current study offers fresh evidence that the kidneys are among the organs at risk for damage, said lead author Dr. Maki Shinzawa, a public health researcher at Kyoto University in Japan.

“Cigarette smoking releases nicotine and other harmful or potentially harmful substances, such as nitrogen oxide, polycarbonate, and carbon monoxide, some of which cross the placenta,” Shinzawa said by email. “Some of these trans-placental substances may affect fetal programming of the kidney during pregnancy.”

Shinzawa and colleagues examined data from urine tests from 44,595 children to look for elevated levels of protein in the urine, which can indicate impaired kidney function.

Data on maternal smoking was collected during women’s prenatal checkups, and researchers also had records from their children’s health checkups at four, nine, 18 and 36 months of age.

Overall, 79 percent of women said they never smoked and another 4 percent said they stopped smoking during pregnancy. About 17 percent of the mothers said they continued to smoke while they were pregnant.

The absolute risk of kidney damage among the children was low. But compared with children born to nonsmoking mothers, kids whose mothers smoked while pregnant were 24 percent more likely to show signs of kidney damage in their urine tests by age three.

Urine tests showed elevated protein levels in 1.7 percent of children born to smokers, 1.6 percent of kids whose mothers were former smokers and 1.3 percent of children born to women who never smoked.

Children exposed to second-hand smoke at home also appeared to have a higher risk of kidney damage than kids who didn’t live with smokers, but the difference wasn’t big enough to rule out the possibility that it was due to chance.

One limitation of the study is its reliance on women to accurately report and recall how much they smoked before or during pregnancy, and a lack of...

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How Do E-Cigarettes Affect the Body?

Many people believe electronic cigarettes (also called e-cigarettes or vapes) are a safe alternative to traditional cigarettes. But with a new report from the U.S. surgeon general calling e-cigarette use “a major public health concern,” this may not be the case. The FDA reports an alarming 900% rise in e-cigarette use among high school students from 2011 to 2015. Get the facts on this popular, and potentially dangerous, product.

How do they work?

You don’t actually “light-up an e-cig”. They’re powered by a rechargeable lithium battery. Instead of burning tobacco, the “e-liquid” is vaporized in a heating chamber when the user inhales.

The replaceable liquid cartridge contains nicotine mixed with a base (usually propylene glycol), along with flavorings and chemicals. The tip often contains LED lights that simulate the glow of a burning cigarette.

E-cigarettes are available in flavors like cherry, bubble gum, and cotton candy, and can be advertised on TV, which may increase their appeal for children and teens.

Are they safe?

Proponents of e-cigarettes claim they’re safer than smoking because they don’t contain the more than 60 cancer-causing chemicals in tobacco smoke. But e-cigs still deliver harmful chemicals, including nicotine, the extremely addictive substance in cigarettes. And studies show that brands claiming to be “nicotine-free” may still have trace amounts. Developing teenage brains are especially sensitive to nicotine's addictive properties.

Is your smoking cessation program in place at your practice?  See how MD Spiro can help!

See what e-cigs do to your body: 



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Thunderstorm’s and Asthma

As we have found with the recent deaths in Australia in the news from “thunderstorm asthma” it is important to remember that storms can trigger your patient’s asthma and allergies that could, in severe situations, kill a patient. 

Asthma and thunderstorms
Thunderstorm asthma is a potentially dangerous mix of pollens, weather conditions and rain that can trigger severe asthma symptoms. People residing in metropolitan, regional and rural areas can be affected.

How does a thunderstorm cause asthma symptoms?
Thunderstorms cause a rapid increase in the number of triggers in the air such as pollens, mold and dust and changes in humidity and temperature. Breathing this air in can irritate the lining of the airway causing swelling and extra mucus to be produced. This causes the airway to narrow and triggers an asthma flare-up. These flare-ups may become severe very quickly.


Do you have to be allergic to pollens or grasses to experience thunderstorm asthma?


Thunderstorm asthma can affect anyone. In fact, during very severe storms, some people who have never been diagnosed with asthma may experience breathing difficulties.

If you have asthma, be alert to the potential dangers of thunderstorm asthma.

What do you do if a thunderstorm is in the forecast?

Always carry your emergency inhaler

  • This is your emergency asthma first aid medication
  • This will provide relief from asthma symptoms within minutes by relaxing the muscles around the airways
  • Ideally use this with a spacer

Know the signs of worsening asthma and the asthma first aid steps

  • If you start developing any signs of asthma, get your reliever and follow the asthma first aid steps
  • If at any point, you are concerned your asthma is rapidly worsening, please call 911 and say you are having an asthma attack.
  • If you know you are sensitive to pollen, you may wish to stay inside on high pollen and windy days, and during and after a thunderstorm. However, this may not always help and you must remain alert to the signs your asthma is worsening.



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Smoking more hazardous for HIV patients than the virus itself

Cigarette smokers who are HIV positive appear to have a higher chance of dying from smoking-related complications than from HIV, according to research published in the Journal of Infectious Diseases.

Numerous health problems are associated with smoking. Smokers have a high chance of developing heart disease, cancer, serious lung diseases, and other infections, such as pneumonia.

Previous research has suggested that each cigarette shortens a person's lifespan by 11 minutes, and that smoking from the age of 17-71 years will decrease life expectancy by an average of 6 ½ years.

HIV is a serious health condition. Untreated, it can lead to AIDS, which is fatal. Once a person has HIV, it will never leave their body. HIV affects the body's immune system, so that it can no longer fight off infections.
In 2014, around 44,073 people were diagnosed with HIV in the United States.

More than 40 percent of people with HIV are smokers, compared with 15 percent for the general population in the U.S. The number of people with HIV who smoke in the U.S. is estimated to be around 247,586. Another 20 percent of people with HIV are former smokers.

HIV patients are more prone to the ill effects of tobacco

Current HIV treatments offer effective protection against the virus, so that people with the virus are living for longer, but people who have HIV remain especially susceptible to the risks of smoking.

Compared with other smokers, they are more likely to experience:

  • Thrush
  • White mouth sores
  • Bacterial pneumonia
  • Pneumocystis pneumonia, a dangerous lung infection
  • Chronic obstructive pulmonary disease (COPD)
  • Heart disease and stroke
  • Lung cancer and other types of cancer.

Researchers from Massachusetts General Hospital and Harvard Medical School in Boston, MA, projected the effects of smoking and HIV on life expectancy.

Patients may lose up to 6.7 years

Using a computer simulation of HIV disease and treatment, the authors calculated the life expectancy of people with HIV, based on whether or not they smoked.

Fast facts about HIV and AIDS:

  • Over 1.2 million people live with HIV in the U.S.
  • From 2005 to 2014, annual diagnoses fell by 19 percent
  • 81 percent of HIV patients are men.

In the U.S., it is common for people with HIV to abandon their drug treatment and care regimen. The current study factored this into the projections, making the results particularly relevant for U.S. patients and health providers.

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World’s second largest tobacco company says to quit smoking

You want a trip to Philip Morris International to feel like a visit to Marlboro Country. But the company's Swiss research center, aka the Cube, just won't play along. Perched above crystalline Lake Neuchatel, southwest of Zurich, the glass hexahedron holds secrets to a future when, Philip Morris says, the world will be blissfully smoke-free. That's right: Philip Morris, of all companies, is telling smokers to quit. Here, beyond the sun-dappled reflecting pool, scientists in lab coats are searching for Big Tobacco's magic bullet: cigarette substitutes that will sell — but won't kill.

The push gained new urgency with news that British American Tobacco was offering $47bn to buy out Reynolds American, a move that would topple Philip Morris as the world's largest publicly traded tobacco company. The stakes could scarcely be higher. Tobacco claims more than six million lives every year. With smoking on the decline around the world, tobacco giants are racing to find new, supposedly safer products to feed nicotine addiction, even as they lean on old-fashioned cigarettes to sustain their profits.

Can Big Tobacco really kick cigarettes? More to the point, can it afford to? 

"We can't stop cold turkey," says Andre Calantzopoulos, the chief executive officer of Philip Morris International. A crucial test could come next year when his next big hope — an iPhone-esque contraption that heats tobacco inside a cigarillo-size tube — potentially hits the US. Quitting old-fashioned smokes won't be easy for tobacco companies or their stakeholders. Philip Morris turned out 850 billion cigarettes last year, generating net revenue of about $74bn. All that tobacco pays off handsomely for global investors: counting dividends, the company's stock has returned roughly 70 per cent over the past five years.

For Calantzopoulos, an electrical engineer by training and reformed smoker who's spent his career at Philip Morris, the challenge will be to come up with new moneymakers as society radically redefines the way it uses tobacco. That, while BAT is grabbing the rest of Reynolds to help power its own push into so-called next generation products. Critics are skeptical. They say Big Tobacco is simply doing what it's always done: selling addictive products, with a gloss of feel-good marketing, while keeping tobacco at the heart of a $770bn global industry.

"Philip Morris has demonstrated time and time again in the past its introduction of new products has led to more...

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Researchers Study Diagnostic Error in Asthma, COPD

Researchers at the University of Illinois at Chicago have been awarded a $1.5 million grant from the Agency for Healthcare Research and Quality to study the impact of diagnostic error on outcomes for pulmonary patients and the use of lung-function testing in primary care.

More than 30 million adults in the U.S. have been diagnosed with asthma or chronic obstructive pulmonary disease, which includes emphysema and chronic bronchitis, and many receive daily treatment. However, studies suggest 30 to 50 percent of these patients may have an incorrect diagnosis.

Spirometry is the nationally and internationally recommended test for diagnosing asthma and COPD and who better to partner on spirometry with then MD Spiro.

"Despite the clinical guidelines supporting the use of spirometry to identify asthma and COPD, many patients do not receive the test prior to receiving a diagnosis," says Dr. Min Joo, principal investigator on the grant and associate professor of medicine in the UIC College of Medicine.

Spirometry tests lung function by measuring how much and how fast a patient can move air out of the lungs. The patients take a big breath and exhales as hard and long as possible into a machine.

Joo says that without a spirometry test, patients are at risk for worse sickness and even death, as well as unnecessary medical costs that disproportionately affect African Americans and underserved minority populations.

"A shocking number of patients are misdiagnosed and face a two-fold danger," she said.

"First, they are taking medication for a condition they may not have, creating unnecessary exposure to the side effects and complications of those medications, such as pneumonia from using inhaled corticosteroids. Second, their real conditions are left unidentified and untreated. This may be particularly true for minority and underserved populations who are known to have multi-morbidities and therefore have a number of potential causes for shortness of breath and other breathing-related issues," Joo said.

One study found that up to 65 percent of COPD patients seen in a federally qualified health center turned out not to have COPD when spirometry was later performed.

"In the past, attempts to increase the use of spirometry in a primary care setting have had limited long term success, and a new approach is needed to reduce diagnostic error and better understand its impact on patient safety and outcomes," Joo said. "Our study will test an approach...

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Be a Hero.  Help Your Patients Quit Today.

Introducing the New Freedom From Smoking® Plus from the American Lung Association

About 70 percent of smokers say they want to quit and 40 percent will make a quit attempt this year.

In order to continually provide the most comprehensive and effective smoking cessation program in the country, the American Lung Association unveiled its newest addition to the Freedom From Smoking® program: an interactive, online quit-smoking experience for the 19.4 million tobacco users who make a quit attempt every year.

Coupled with the Freedom program and our smoking cessation product the SmokeCheck Breath CO Monitor, you can help empower your patients to “Be a Hero” for themselves and their family.  

Freedom From Smoking® Plus will help smokers quit for good through a new highly engaging platform that includes activities, videos, quizzes and more. Over the course of nine sessions, users create a personalized quit plan, learn about medications to help them quit, get through the rough patches and transition to a smoke-free lifestyle.  In addition, individuals using the program can lean on the support network of the American Lung Association that includes:

  • An online support community with other quitters who understand how hard it can be to quit and can help motivate each other to stay smoke-free.
  • Certified tobacco cessation counselors at the Lung HelpLine that are available through 1-800-LUNGUSA any time a quitter has a question or needs extra support during the quitting process.

See in action on your desktop, tablet or smartphone and share this new tool with friends and loved ones that want to quit smoking.

For over 35 years, our Freedom From Smoking® program has helped hundreds of thousands of people break their addiction to tobacco through our group clinic and through our self-help guide. Thanks to our efforts and those of our partner organizations, there are now more former smokers than current smokers in the United States. With the addition of Freedom From Smoking® Plus, the American Lung Association is poised to help even more people be smoke-free for good.  

To celebrate the successes of people that have found smoke-free freedom, we are sharing personal stories from former smokers. Through the EACH Breath blog, ten individuals will share how they were able to break their addiction to tobacco and encourage smokers to give quitting a try.

You can follow their stories on Facebook and Twitter with...

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