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.

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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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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.


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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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