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Feds announce much tougher e-cigarette, cigar rule

Big news unfolded yesterday, May 05, 2016!  Electronic cigarettes will now be regulated much like tobacco cigarettes and their sale to children banned, according to a new federal rule issued.

Under the rule, the U.S. Food and Drug Administration would have to approve all tobacco products not currently regulated that hit stores after February 2007. The e-cigarette industry was virtually non-existent before then.

Premium, hand-rolled cigars, as well as hookah and pipe tobacco, are also included in the new regulation, which federal officials call "historic." The rule prohibits selling "covered tobacco products" to people younger than 18, and buyers must show photo ID. It also requires health warnings be displayed on cigarette tobacco, roll-your own tobacco, and covered tobacco product packages and in advertisements; and bans free samples and the sale of covered products in vending machines not located in adult-only facilities.

The Tobacco Control Act of 2009 sets Feb. 15, 2007, as the latest date by which all tobacco products would have to have to be grandfathered in. Mitch Zeller, head of the FDA's Center for Tobacco Products, has said publicly that he couldn't choose a later date, although industry officials disagree.

That means nearly every e-cigarette on the market — and every different flavor and nicotine level — would require a separate application for federal approval. Each application could cost $1 million or more, says Jeff Stier, an e-cigarette advocate with the National Center for Public Policy Research and industry officials.

An amendment to appropriations legislation working its way through the House would change the date so more e-cigarettes would be grandfathered in. White House Press Secretary Josh Earnest said Thursday that President Obama "takes a very dim view of attaching ideological riders to appropriations bills," but stopped short of threatening a veto of any legislation.

The proposed rule was released more than two years ago, in April 2014, and the final rule gives the industry two additional years to comply. The industry will have had "plenty of time to submit their applications," says Robin Koval, CEO of the Truth Initiative, an anti-tobacco health group.

However, stores have to comply with the rule in about three months (90 days from its publication May 10), and Zeller says contractors tasked with enforcement will be ready to "hit the ground running" on Day 91.
Koval says "it's perfectly reasonable"...

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Prenatal exposure to BPA associated with pediatric wheeze

Diminished lung capacity and development of persistent wheeze in children were associated with prenatal but not postnatal exposure to bisphenol A, according to recent study data.

Adam Spanier, MD, PhD, MPH, FAAP, associate professor of pediatrics and behavioral pediatrics medical director, University of Maryland Midtown Campus, and colleagues studied 398 pregnant women between March 2003 and January 2006 in the Cincinnati area who were aged 18 years or older, were at 16 weeks’ gestation and lived in a home built before 1979. The women were tracked through pregnancy, and children were tracked through age 5 years. Gestational and child bisphenol A (BPA) exposure were assessed through maternal urine samples during pregnancy at 16 and 26 weeks and child urine samples annually.

Main outcomes included parent-reported wheeze every 6 months for 5 years, and child FEV1 measured at ages 4 and 5 years. Associations of BPA exposure with respiratory outcomes (FEV1, child wheeze and wheeze phenotype) were studied.

Data for maternal urinary BPA concentrations and FEV1, assessed for 208 children, showed a mean range of 0.53 to 293.55 mcg/g creatinine (geometric mean, 2.4; 95% CI, 2.1-2.7 mcg/g creatinine). Urinary BPA concentrations and parent-reported wheeze results, available for 360 children, ranged from 15.9% (at 30 months) to 24.1% (at 12 months).

“In multivariable analysis, every 10-fold increase in the mean maternal urinary BPA concentration was associated with a 14.2% (95% CI, –24.5% to –3.9%) decrease in the percentage of predicted FEV1 at 4 years, but no association was found at 5 years,” the researchers wrote. “Every 10-fold increase in the mean maternal urinary BPA concentration was marginally associated with a 54.8% increase in the odds of wheezing (adjusted OR=1.55; 95% CI, 0.91-2.63).”

There was a 10-fold increase in 16-week maternal urinary BPA concentration associated with an increase in persistent wheeze odds (aOR=4.27; 95% CI, 1.37-13.3). No association, however, existed between the mean maternal urinary BPA concentration and wheeze phenotype.

There were no associations between child urinary PBA concentrations and FEV1 or wheeze.

“If future studies confirm that prenatal PBA exposure may be a risk factor for impaired respiratory health, it may offer another avenue to prevent development of asthma,” the researchers concluded.

References: 
www.mdspiro.com 
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PCOS, Overweight, Obesity Increase Risk for Asthma

Independent associations were found between asthma and polycystic ovary syndrome as well as overweight and obesity, according to results presented here.

“The results of this study need to be confirmed with results in other populations, and exploration of these relationships in longitudinal studies is needed,” Anju Elizabeth Joham, MBBS, FRACP, an endocrinologist and postdoctoral research fellow at Monash University in Melbourne, said in a press release.

Joham and colleagues evaluated data from the Australian Longitudinal Study on Women’s Health on the survey responses of 9,145 women aged 28 to 33 years about their PCOS and asthma status. Researchers sought to determine the prevalence of asthma and the impact of obesity on the prevalence of asthma in women with and without PCOS.

Prevalence of PCOS was 5.8%. There was a 15.2% prevalence of asthma in women with reporting PCOS compared with 10.6% of those not reporting PCOS (P = .004).

Mean BMI was significantly higher in women reporting PCOS and asthma (BMI, 29.9 kg/m2) compared with women reporting asthma but not PCOS (27.7 kg/m2; P < .001).

PCOS was associated with increased odds of asthma (OR = 1.34; 95% CI, 1.004) after adjustment for age, BMI, PCOS and smoking status on multivariable regression analysis. Increased odds of asthma were linked with BMI in the overweight (OR = 1.24; 95% CI, 1.02-1.5) and obese range (OR = 1.77; 95% CI, 1.46-2.15).

“A greater proportion of women with PCOS report asthma, and the results of this study suggest that asthma is associated with PCOS and excess weight,” Joham said in a press release. “These findings highlight that PCOS is a complex disorder that includes significant inflammatory underpinnings. These results also raise awareness of the need to consider higher risks in other health areas in this condition.” – by Amber Cox

References:
http://www.mdspiro.com 
http://www.healio.com/endocrinology/reproduction-androgen-disorders/news/online/%7B1568e866-b1b8-4aaa-bb4d-934ee12fb6d0%7D/pcos-overweight-obesity-increase-risk-for-asthma 
http://www.healio.com/endocrinology/reproduction-androgen-disorders/news/online/%7Ba685adbd-3aeb-429c-8c87-b31ba80deff4%7D/cvd-risk-higher-for-women-aged-at-least-30-years-with-pcos
http://www.healio.com/allergy-immunology/asthma-lower-airway-diseases/news/online/%7B513d2e64-ab31-458b-8321-47e86ef77a2a%7D/prenatal-exposure-to-bpa-associated-with-pediatric-wheeze 
Joham AE, et al. Poster SAT 186. Presented...

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Excessive Iron in the Lung Implicated in COPD

Excessive iron build-up in the lungs could be a major cause of chronic obstructive pulmonary disease (COPD), Weill Cornell Medicine scientists find in a new study. The investigators also believe that they have identified the culprit for the excess: A gene they previously found to increase patients' susceptibility to the progressive lung disease.

For their study, published online on Jan. 11 in Nature Medicine, researchers examined a gene that is tasked with regulating iron uptake in cells, called iron-responsive element-binding protein 2 (IRP2). They discovered that mice that express IRP2 developed the hallmark symptoms of COPD — a condition defined by obstruction to expiratory airflows that makes breathing difficult — when exposed to cigarette smoke, while rodents that lacked the gene remained healthy. A drug given to the symptomatic mice prevented additional lung damage and even reversed COPD's effects.

The investigators say their discovery is significant because they validate the results of a 2009 study that implicated IRP2 in the disease's development and demonstrate how the gene supports COPD. The findings also illustrate that IRP2 may be a powerful therapeutic target.

"At the end of the day, we always like to have an impact on human disease, whether it's improving diagnostics, prevention or therapeutics, and this study actually gets to the therapeutic angle," said senior author Dr. Augustine Choi, the Weill Chairman of the Weill Department of Medicine at Weill Cornell Medicine. "Not only does it validate our previous work, but it also provides us with a really good understanding of how IRP2 functions and facilitates the development of COPD."

COPD, which includes smoking-induced emphysema, chronic bronchitis and non-reversible asthma, is the third-leading cause of death in the United States, affecting more than 20 million people nationwide. It's commonly associated with smoking cigarettes and long-term exposure to air pollution, second-hand smoke, dust fumes and chemicals. But investigators have long wondered if there is a genetic predisposition to the disease.

In 2009, Dr. Choi and colleagues published a study in the American Journal of Human Genetics that analyzed the genes of patients with COPD and their family members to determine if there was a common genetic link. IRP2 was one of the top hits.

To validate that finding and determine the gene's functional role, the researchers exposed two sets of mice to cigarette smoke...

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Study links e-cigarettes to incurable disease called 'Popcorn Lung'

In analyzing 51 different flavored e-cigarettes, author of the study Joseph Allen and his team found at least one of three top toxins — diacetyl, acetoin and 2,3-pentanedione — in 47 of the e-cigs. Not only that, "the amount of diacetyl in 39 of the e-cigs exceeded the amount that was able to be detected by the laboratory."

"Diacetyl and other related flavoring chemicals are used in many other flavors beyond butter-flavored popcorn, including fruit flavors, alcohol flavors, and candy flavored e-cigarettes," said Allen, assistant professor of exposure assessment science at Harvard.

He found this particularly disturbing because of the appeal fruity e-cigarettes such as "Cotton Candy, Fruit Squirts, and Cupcake" may have to young people.

Since e-cigarettes are a fairly new technology, the study's co-author David Christiani, Elkan Blout Professor of Environmental Genetics, warns that Popcorn Lung may be just the tip of the iceberg when it comes to the dangers e-cigs pose to their users:

“Since most of the health concerns about e-cigarettes have focused on nicotine, there is still much we do not know about e-cigarettes. In addition to containing varying levels of the addictive substance nicotine, they also contain other cancer-causing chemicals, such as formaldehyde, and as our study shows, flavoring chemicals that can cause lung damage.”

We are here to help you support your patients.  Contact us at MD Spiro about our smoking cessation products, today!

References:
www.mdspiro.com
http://news.discovery.com/human/health/could-e-cigs-give-you-popcorn-lung-151208.htm
http://www.hsph.harvard.edu/news/press-releases/e-cigarette-flavoring-chemicals-linked-to-respiratory-disease/
http://www.hsph.harvard.edu/joseph-allen/
http://www.wkbw.com/news/us-news-world/e-cigarettes-linked-to-incurable-popcorn-lung-disease
http://www.abc15.com/news/national/e-cigarettes-linked-to-incurable-popcorn-lung-disease 
http://www.aol.com/article/2015/12/09/study-links-e-cigarettes-to-incurable-disease-called-popcorn-lu/21281029/?a_dgi=aolshare_facebook

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The Differences Between Asthma and COPD

Asthma and chronic obstructive pulmonary disease (COPD) are both health conditions involving the respiratory system and can lead to difficulty breathing. There is some overlap between the two conditions and it is estimated that approximately 40% of patients with COPD also suffer from asthma.

However, there are some distinct differences between the two conditions, in their pathophysiology, presentation of symptoms and the optimal management plans. The key differences to aid in diagnosis and treatment decisions are outlined below.

Characteristics of Asthma
Asthma is a chronic inflammatory disorder of the airways that leads recurrent episodes of symptoms such as wheezing, breathlessness, chest tightness and coughing, which commonly occur at night or in the early morning.

These flare up periods are associated with triggers that cause obstruction of the airways, which is usually reversible.

Diagnosis of asthma most commonly occurs during childhood, in individuals that have a history of dry cough in the night, although it can present at any age.

View asthma animated:

https://youtu.be/7EDo9pUYvPE

Characteristics of COPD
COPD is a disease characterized by the progressive obstruction of the airways that leads to a reduction in airflow and respiratory function. These changes are not completely reversible and inhaled noxious particle or gases, such as cigarette smoke, are associated as risk factors for the condition.

Diagnosis of COPD usually occurs in older adults with a history of smoking or chronic exposure to other inhaled irritants.

View how chronic obstructive pulmonary disease (COPD) develops:

https://youtu.be/iYjKZHmzWEA

Key Differential Factors
Both asthma and COPD are chronic inflammatory diseases of the small airways involving mucus and bronchoconstriction that limit the airflow. However, the differences between the two conditions are important and affect the way we manage them.

The reversibility of the damage to the airways is a major difference between asthma and COPD. The airways obstruction in asthma is largely reversible in patients with asthma, whereas the obstruction in COPD is considered to be irreversible or less reversible.

The difference in reversibility is highlighted in the results from lung function tests, such as spirometry. Both show a reduction in airflow, but assessing the effect of bronchodilator administration can help to differentiate between the conditions. Asthma exhibits greater...

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Teen vapers more likely to turn to tobacco products

The debate about e-cigarettes and the relationship to tobacco products has moved up a notch following a new study about teen vapers in the U.S. The study shows a link to tobacco products.

Vaping (the use of electronic cigarettes) is seen by many, including those who market the products, as a safer alternative to smoking tobacco products (e-cigarettes contain the addictive chemical nicotine but no known carcinogens.) However, the arguments used by the main manufactures (many of them tobacco companies that have diversified) relates to how the product is used to wean people away from traditional tobacco product, as a step to giving up smoking anything at all. For this reason, in parts of the U.K., electronic cigarettes have medicinal status and can be prescribed by a medical doctor to a patient in a quest to give up smoking.

There is other evidence, such as from the U.S. Centers for Disease Control and Prevention (CDC), that suggests the marketing of e-cigarettes, especially the types infused with flavors like bubblegum, are designed to appeal to young people who have never smoked before.

This tendency has been picked up in a new study that suggests that vaping may encourage tobacco smoking by teens (traditional cigarettes or the use of a hookah) who would have seemed the least likely to take up the habit.
The concern here is that the e-cigarettes are a stepping stone to tobacco products. There are also concerns that the chemicals in e-cigarettes and the long-term effects on the human body is unknown (this is an issue raised by the World Health Organization.)

The new study comes from Dr. Thomas Wills, of the University of Hawaii Cancer Center in Honolulu. Wills told Science News: " All the information that’s come out in the past few months suggests that there is a risk associated with e-cigarette use."

The study was based on a review of 2,200 children (in the 9th and 10th grades.) Information was gathered about e-cigarette and traditional cigarette use. Those who vaped were three times more likely that those who had never vaped to take up the smoking of tobacco products.

The study also included a personality assessment. Those teens who considered themselves to be, or who displayed characteristics of, rebelliousness, were most likely to make the transition over from e-cigarettes to tobacco products.

The research is published in the journal Tobacco Control. The paper is headed "Longitudinal study of e-cigarette use and onset of...

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Pre-existing asthma may strongly predict future chronic migraine attacks

Pre-existing asthma may be a strong predictor of future chronic migraine attacks in individuals experiencing occasional migraine headaches, according to researchers from the University of Cincinnati (UC), Montefiore Headache Center and Albert Einstein College of Medicine, and Vedanta Research. The findings were published online in November in the journal Headache, a publication of the American Headache Society.

"If you have asthma along with episodic or occasional migraine, then your headaches are more likely to evolve into a more disabling form known as chronic migraine," said Vincent Martin, M.D., professor of medicine in UC's division of general internal medicine, co-director of the Headache and Facial Pain Program at the UC Neuroscience Institute, and lead author of the study.

Dr. Martin teamed with Richard Lipton, M.D., and Dawn Buse, Ph.D., both of Montefiore Headache Center and Albert Einstein College of Medicine; and Kristina Fanning, Ph.D.; Daniel Serrano, Ph.D.; and Michael Reed, Ph.D., all from Vedanta Research, to study about 4,500 individuals who experienced episodic migraine or fewer than 15 headaches per month in 2008.

"Migraine and asthma are disorders that involve inflammation and activation of smooth muscle either in blood vessels of in the airways," said Richard Lipton, M.D., director of Montefiore Headache Center and vice chair of neurology, and the Edwin S. Lowe Chair in Neurology, Albert Einstein College of Medicine, and founder of the American Migraine Prevalence and Prevention Study. "Therefore, asthma-related inflammation may lead to migraine progression."

About 12 percent of the U.S. population experiences migraine, according to the American Migraine Prevalence and Prevention (AMPP) Study. This condition is three times more common in women than men, including 18 percent of American women and 6 percent of American men. Individuals with chronic migraine have headaches occurring 15 or more days per month; this condition affects one percent of the U.S. population and takes a severe toll on sufferers who often miss work and social events. The World Health Organization (WHO) rates migraine as the world's seventh most disabling medical condition.

The researchers analyzed data from the AMPP Study. Study participants completed written questionnaires both in 2008 and 2009. Based on responses to the 2008 questionnaire, they were divided into two groups—one with episodic migraine and coexisting asthma and another with...

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