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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Babies With Gut Yeast May Be At Risk Of Asthma

Asthma affects hundreds of millions of people across the world. New research links the gut's microbes with the risk of developing asthma, and identifies a specific fungus in babies that might increase the risk of childhood asthma.

For the first time, a study links a yeast found in babies' guts with the risk of childhood asthma.

Asthma is a chronic disease of the lungs' airways that affects approximately 334 million people worldwide, and around 25 million people in the United States.

Historically, it was believed that asthma is a disease of high-income countries, but this theory is no longer valid as most people living with asthma are from low- and middle-income countries.

Across the world, asthma prevalence is distributed unevenly. The highest prevalence worldwide occurs in Latin America and in English-speaking countries (where over 20 percent of the population live with asthma), whereas the lowest prevalence (at less than 5 percent) was noted in India, Asia-Pacific, and the Eastern part of the Mediterranean, as well as Northern and Eastern Europe.

Countries such as Canada and Ecuador both have a significant incidence of the disease, with approximately 10 percent of the population living with asthma.

New research suggests that a yeast in the gut of Ecuador-born babies may be a strong predictor for childhood asthma. The study was carried out by a team of researchers from the University of British Columbia in Canada and was led by microbiologist Brett Finlay.

The findings were presented at the annual meeting for Association for the Advancement of Science in Boston, MA.

Pichia fungus increases risk of asthma

In the past, Finlay and his colleagues examined the gut microbiota of Canadian children and its connections to asthma. They found four gut bacteria that appeared to prevent the onset of asthma if they were present in the infants' guts within the first 3 months of life.

Now, in this follow-up study, Finlay and team replicated the experiment in an Ecuadorian village, in an attempt to investigate whether the beneficial role of the gut's microbiome is universal.

Using stool samples and health information from more than 100 children, scientists found that the gut's bacteria do play a key role in preventing asthma. However, among the early-life microbes, a yeast known as Pichia seems to increase the risk of asthma if present in the babies' early days of life.

The research further emphasizes the key role of the gut's...

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New Evidence That Vitamin D Prevents Respiratory Infections

A large-scale meta-analysis using more than 10,000 participants concludes that vitamin D supplementation may help to prevent a major cause of global death - acute respiratory tract infections.

Acute respiratory tract infections are responsible for 10 percent of ambulance and emergency room visits in the United States.

Including anything from the common cold to pneumonia and bronchitis, they were the cause of an estimated 2.65 million deaths globally in 2013.

Respiratory tract infections have a wide array of risk factors, including overcrowding, a damp living environment, air pollution, and parental smoking.

A number of observational studies have also reported a nutritional risk factor - vitamin D deficiency. Some researchers have concluded that vitamin D has the ability to trigger an immune response to certain viruses and bacteria.

However, the links between respiratory tract infections and vitamin D supplementation have remained controversial; some studies support the theory while others are inconclusive. To date, five meta-analyses have been conducted on existing data. Two of these reported significant positive effects, and three found no significant effect.

Diving into the vitamin D data
In an attempt to put this question to bed, the largest meta-analysis to date was published last week in the BMJ.
The analysis, carried out by an international group of researchers, is the first to use individual participant data (IPD), rather than the aggregate methodology that was used in earlier meta-analyses. In this way, changes measured at different points in time within each participant of each trial can be accounted for, rather than taking a summary (aggregate) of the data. IPD is considered the "gold standard" of systematic review.

The team used data from 25 randomized controlled trials investigating vitamin D supplementation. In total, data from 11,321 participants were analyzed.

After adjusting for potentially confounding variables, such as sex, age, and study duration, they found that vitamin D supplementation produced a 12 percent reduction in the proportion of individuals experiencing at least one acute respiratory tract infection.

In simple terms, if 33 people took vitamin D supplements, one acute respiratory tract infection would be prevented. If these results are confirmed, vitamin D supplementation could potentially prevent millions of respiratory infections each year.

Conclusions from the data
When the team drilled...

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Weather and Your Lungs

"What's the weather going to be today?" It's a frequent question that has larger implications for those with lung disease. Whether it's summer or winter, rainy or windy, people with lung disease should pay attention to the weather report as sudden changes in the weather as well as extreme weather conditions can provoke lung symptoms.

Hot and Humid
Hot weather can be especially hard on people with respiratory disorders. In a 2013 study from the Johns Hopkins University, researchers found a relationship between rising temperatures and the number of emergency hospital admissions for chronic obstructive pulmonary disease (COPD) and respiratory tract infections among people 65 and older. Although the reason behind this correlation is not clear, inhaling hot air is known to promote airway inflammation and exacerbate respiratory disorders like COPD. Hot weather can also be a trigger for people with asthma. Because people with asthma already have inflamed airways, weather is more likely to have an impact, as breathing in hot, humid air induces airway constriction in asthmatics. Air pollution can also be a factor impacting summer breathing in those with lung disease, as increased ozone from smog is often seen in the summer months.

Cold and Dry
Cold weather, and particularly cold air, can also play havoc with your lungs and health. Cold air is often dry air, and for many, especially those with chronic lung disease, that can spell trouble. Dry air can irritate the airways of people with lung diseases. This can lead to wheezing, coughing and shortness of breath.

Be Proactive and Be Prepared
While you can't control the weather, you can reduce the impact it has on your lung disease symptoms. Stay ahead of the curve by monitoring the weather forecasts and identifying your triggers before going outside. You can enjoy your favorite outdoor activities all year round by keeping the following tips in mind:

  • If it's cold outside, loosely wrap a scarf around your nose and mouth to warm the air before it enters your lungs. Breathe in through your nose and out through your mouth.
  • Access to air conditioning can be important during the hot summer months, so add air-conditioning to your home if you can.
  • Monitor air quality forecasts to stay healthy. Air pollution can be very high both in winter and summer and those with asthma and other lung diseases are at higher risk for being impacted by air pollution.
  • Remember to take your prescribed controller...
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Teva Wins U.S. Approval for GSK Advair Copy

Israel's Teva Pharmaceutical Industries has won U.S. approval to market a copy of GlaxoSmithKline's best-selling Advair inhaler, although the real battle is still to come.

Teva's version of GSK's blockbuster medicine, called AirDuo RespiClick, is not directly substitutable for Advair and is only approved for asthma, while Advair is also widely used for chronic obstructive pulmonary disease (COPD).
Teva said on Monday it would launch AirDuo later this year. It has not said how much its product will cost.

AirDuo provides patients with the same two drugs as Advair, fluticasone propionate and salmeterol, but it delivers a lower dose of salmeterol. It also uses Teva's Respiclick inhaler rather than a copy of GSK's device.

Producing cut-price copies of Advair is a major opportunity for generics companies at a time when fewer blockbuster medicines are losing patent protection.

For GSK, it is a challenge since Advair has sold more than $1 billion annually since 2001. Global Advair sales were $5.6 billion in 2015, with half that generated in the United States, although sales are now shrinking.

Teva's product promises to grab some of this business in asthma but the bigger threat will come from fully substitutable generic copies of Advair, which are still pending approval.

The U.S. Food and Drug Administration is due to decide whether to approve the first of these, from Mylan, by March 28. A rival version from Hikma and Vectura is close behind, with an approval date of May 10.
GSK said that as Teva's product was not substitutable for or equivalent to Advair it did not "pose the same competitive dynamics as market entry of generic products in the U.S. would."

Advair is already available generically in Europe, but demand for copies is expected to take off more swiftly in the United States, where managers of prescription plans can quickly drive conversion to such cheaper products.
Investors are watching closely to see how GSK's Advair sales will fare in the face of new competitors. One big unknown is the scale of discounts that will be offered by generic companies.

Reporting by Ben Hirschler
Editing by Susan Fenton

Photo Credit:

Signage for GlaxoSmithKline is seen on its offices in London, Britain, March 30, 2016. REUTERS/Toby Melville/File Photo

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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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