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Risk Factors and Viruses Associated With Hospitalization Due to Lower Respiratory Tract Infections in Canadian Inuit Children: A Case-Control Study 

Conclusions: Smoking during pregnancy, place of residence, Inuit race, lack of breast-feeding, and overcrowding were all independently associated with increased risk of hospital admission for LRTI among Inuit children less than 2 years of age. Future research on the role of adoption and genetics on the health of Inuit children are required.

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No Additional Benefit With Combo Therapy in COPD 

Action Points

* Explain to interested patients that no additional benefits were seen when inhaled corticosteroids were added to beta-agonist therapy in chronic obstructive pulmonary disease.

* Also tell them that the combination therapy was associated with increased risk of pneumonia and other adverse events.

Inhaled corticosteroids did not improve the efficacy of long-acting beta agonist therapy among patients with chronic obstructive pulmonary disease (COPD), a systematic review has found.

The combination treatment failed to significantly decrease the number of severe COPD exacerbations (RR 0.91, 95% CI 0.82 to 1.01) or all-cause mortality (RR 0.90, 95% CI 0.76 to 1.06), according to Gustavo J. Rodrigo, MD, of the Hospital Central de las Fuerzas Armadas in Montevideo, Uruguay, and colleagues.

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ATS: Childhood Secondhand Smoke Effects Persist 

The effects of exposure to secondhand smoke in childhood may persist for decades, a researcher said here.

In a large cohort of nonsmokers, early signs of emphysema were noticeable on CT scans among those who had lived with one or more smokers in childhood, according to Gina Lovasi, Ph.D., of Columbia University.

Those signs -- a significant increase in the number of "air-like spaces" -- were not accompanied by any clinical symptoms, Dr. Lovasi said at the annual meeting of the American Thoracic Society.

"We do see a difference" in the structure of the lung, Dr. Lovasi told reporters, "but it's important to note that we didn't see a difference in lung function."

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Smoking cessation interventions in COPD: a network meta-analysis of randomised trials 

The aim of this study was to rank order the effectiveness of smoking cessation interventions for chronic obstructive pulmonary disease (COPD) patients.

We searched 10 databases to identify randomised trials of smoking cessation counselling (SCC) with or without pharmacotherapy or nicotine replacement therapy (NRT). We conducted a network meta-analysis using logistic regression analyses to assess the comparative effectiveness of smoking cessation interventions while preserving randomisation of each trial. . . .

A small body of evidence suggests that SCC combined with NRT is more effective than other combinations and single smoking cessation treatments in COPD, but substantially more research is needed for this most important COPD treatment.

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Second-hand smoke exposure in cars and respiratory health effects in children 

We examined potential associations of ever asthma, and symptoms of wheeze (past 12 months), hay fever, eczema and bronchitis (cough with phlegm) among school children exposed to second-hand smoke (SHS) in cars, using a modified Irish International Study of Asthma and Allergies in Childhood (ISAAC) protocol. . . .

Approximately one in seven Irish schoolchildren are exposed to SHS in cars and could have adverse respiratory health effects. Further studies are imperative to explore such associations across different population settings.

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• Passive smoking in cars linked to hayfever and wheezing in children 

Children who are regularly exposed to second-hand tobacco smoke when traveling by car have significantly higher rates of hayfever and wheezing than those without such exposure, results of an Irish study show.

Writing in the European Respiratory Journal, Luke Clancy, from the Tobacco Free Research Institute in Dublin, and team explain: “Children may be more vulnerable to second-hand smoke-induced respiratory diseases due to smaller airways and greater oxygen demand, as well as a less-mature immune system.”

But they add that “there is no evidence quantifying second-hand smoke-induced respiratory health effects in children exposed to second-hand smoke in cars.”

To address this, the team studied 2809 children, aged 13–14 years, selected randomly from schools throughout Ireland.

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Group pushing for smoking ban in new Kansas casinos, arguing ADA problem looms for state  

An advocacy group wants Kansas to ban smoking at its new casinos.

Smoke-Free Gaming, based in the Denver area, argues Kansas will violate the federal Americans with Disabilities Act if it allows customers to light up inside.

It says the state will be responsible for denying full access to individuals with lung and breathing problems because its lottery is legal owner of the new gambling in three planned casinos.

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Table of Contents (September 2009, 34 [3]) 

Original Articles: COPD and smoking-related disorders:

W. M. Vollmer, Þ. Gíslason, P. Burney, P. L. Enright, A. Gulsvik, A. Kocabas, and A. S. Buist Comparison of spirometry criteria for the diagnosis of COPD: results from the BOLD study Eur Respir J 2009 34: 588-597.

G. Zhu, A. Agusti, A. Gulsvik, P. Bakke, H. Coxson, D. A. Lomas, E. K. Silverman, S. G. Pillai ICGN investigators CTLA4 gene polymorphisms are associated with chronic bronchitis Eur Respir J 2009 34: 598-604.

D. Hsia, R. Casaburi, A. Pradhan, E. Torres, and J. Porszasz Physiological responses to linear treadmill and cycle ergometer exercise in COPD Eur Respir J 2009 34: 605-615.

I. Klagas, S. Goulet, G. Karakiulakis, J. Zhong, M. Baraket, J. L. Black, E. Papakonstantinou, and M. Roth Decreased hyaluronan in airway smooth muscle cells from patients with asthma and COPD Eur Respir J 2009 34: 616-628.

Z. Kabir, P. J. Manning, J. Holohan, S. Keogan, P. G. Goodman, and L. Clancy Second-hand smoke exposure in cars and respiratory health effects in children Eur Respir J 2009 34: 629-633.

R. Strassmann, B. Bausch, A. Spaar, J. Kleijnen, O. Braendli, and M. A. Puhan Smoking cessation interventions in COPD: a network meta-analysis of randomised trials Eur Respir J 2009 34: 634-640.

C. Crim, P. M. A. Calverley, J. A. Anderson, B. Celli, G. T. Ferguson, C. Jenkins, P. W. Jones, L. R. Willits, J. C. Yates, and J. Vestbo Pneumonia risk in COPD patients receiving inhaled corticosteroids alone or in combination: TORCH study results Eur Respir J 2009 34: 641-647.

P. W. Jones, G. Harding, P. Berry, I. Wiklund, W-H. Chen, and N. Kline Leidy Development and first validation of the COPD Assessment Test Eur Respir J 2009 34: 648-654. [Abstract] [Full Text] [PDF]

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KOMAR: Nothing to Get Scared About / Living Will Gives Me Peace of Mind 

I am 82 years old, have had a wonderful life and, although there are things I would still like to accomplish, I am not interested in merely extending my life via a much-diminished existence. As a result of smoking for many years, I have chronic obstructive pulmonary disease, or COPD. It is a debilitating disease. I can't walk very far without getting out of breath.

And I have a living will.

My disease is not curable, and it's only going to get worse, so several decades ago I drew up a document specifying exactly what medical care I do, and do not, want in my final days. . . .

The proposed health reform legislation would provide reimbursement for seniors to review their living wills every five years, which seems sensible.

Based on experiences during my last hospitalization for COPD, I revised my living in 2004 to specify that I do not want to be treated with a breathing tube, should I have another crisis. In research I did on intubation, I learned that inserting a breathing tube is a difficult and traumatic procedure from which I would anticipate a long and difficult recovery that at best would leave me even more incapacitated than I am now. For me, it isn't worth it. Someone else in my condition might well make a different choice, but this is the choice I have put in my living will for my doctors and family to follow. . . .

We all have to die someday. But unlike billions of people who lived before us, we have a few choices regarding our final days. Why would we not exercise them?

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Smoking in pregnancy linked to reduced lung function in offspring 

Maternal smoking during pregnancy is associated with poorer lung function among offspring in early adulthood, results of an Australian study show.

Lead researcher M Hayatbakhsh (University of Queensland, Herston) and team explain that there is strong evidence to suggest that in utero exposure to maternal smoking results in childhood lung function deficits.

However, they add: “There is uncertainty about whether this effect persists to early adulthood or whether there may be a period of catch-up growth.”

The researchers therefore assessed data on 2409 young adults and their mothers who participated in the Mater–University of Queensland Study of Pregnancy.

The team compared maternal smoking during and after pregnancy with lung function in offspring at the age of 21 years.

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Maternal smoking during and after pregnancy and lung function in early adulthood: A prospective study  

Results: In utero exposure to maternal smoking was associated with a reduction in FEV1 and FEF25-75 in males (regression coefficient = -0.16, 95% confidence interval: -0.30, -0.02), after accounting for maternal smoking after pregnancy. At least part of the effect of in utero smoking on young adult's lung function was explained by child birth weight and subsequent asthma.

Conclusions: Adverse affect of antenatal smoking on development of airway growth may persist into early adulthood. Gender differences noted in this longitudinal cohort needs to be further explored.

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Exposure to Tobacco Smoke Before Birth Affects DNA  

Women who smoke while pregnant increase their unborn child's long-term risk for health problems, including childhood asthma, cardiovascular disease and lower pulmonary function, and a new study may help experts understand why.

Researchers at the Keck School of Medicine of the University of Southern California (USC) found that maternal smoking actually changes the unborn child's DNA patterns.

The new study found that fetal exposure to maternal smoking was linked to differences in DNA methylation, an epigenetic mechanism.

Epigenetics is the study of how chemicals that attach to DNA can switch genes on and off, which leads to differences in gene expression without changing basic genetic information, according to background information in a USC news release about the study.

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• EDITORIAL: COPD—more than just tobacco smoke 

On Sept 12—16, Vienna hosts the European Respiratory Society's annual congress, the largest in pulmonary medicine in the world. As a prelude to the meeting, The Lancet today is devoted to chronic obstructive pulmonary disease (COPD). WHO estimates that 210 million people have COPD worldwide. This number could be higher because many people with COPD often do not seek medical help until the disease worsens. COPD is now an umbrella term to cover emphysema and chronic bronchitis, among others, all of which used to be considered separate conditions. The disease is the fourth leading cause of death in the world, but by 2030 it is expected to be the third, behind ischaemic heart disease and cerebrovascular disease.

With such a high burden, emphasis on better diagnosis, management, and identification of at-risk groups must be achieved . . .

For a long time COPD has been thought of as a smokers' disease, and not without reason. Those who smoke damage their lungs and create the pathophysiological environment for this disease. However, as Holger Schünemann points out in a Comment in today's issue, a worldwide ban on tobacco would indeed benefit health substantially both at the population and individual level—yet the world is not ready for such a bold ban. Sundeep Salvi and Barnes explore the aetiology of COPD and highlight the need for greater focus on risk factors other than smoking. They argue that smoking is not the biggest risk factor for COPD, and that this has been reported as early as 1963. Interest in COPD in non-smokers has increased in the past 5 years, although smoking has still remained the emphasis of most research. . . .

Chronic asthma is also of interest because it carries a greater risk of developing COPD than that caused by smoking. If asthma development is on the increase around the world, COPD incidence is likely to increase as well, perhaps even more so than the current predictions. Biomass fuel (coal, wood, and charcoal) has an exposed population of 3 billion, compared with 1 billion for those exposed to tobacco—making such fuel an important target in COPD prevention. This problem is not just one for developing countries. Even if over half of those who have COPD are non-smokers, the battle against smoking and health promotion to quit smoking should continue. However, the identification and education of those who are at risk from other inhalation exposures, both at home and at work, especially in developing countries, also needs to become a priority.

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Screening for and early detection of chronic obstructive pulmonary disease 

Chronic obstructive pulmonary disease (COPD) is a substantially underdiagnosed disorder, with the diagnosis typically missed or delayed until the condition is advanced. Spirometry is the most frequently used pulmonary function test and enables health professionals to make an objective measurement of airflow obstruction and assess the degree to which it is reversible. As a diagnostic test for COPD, spirometry is a reliable, simple, non-invasive, safe, and non-expensive procedure. Early diagnosis of COPD should provide support for smoking cessation initiatives and lead to reduction of the societal burden of the disease, but definitive confirmation of both proves elusive. Despite substantial effort and investment, implementation of quality spirometry is deficient because of several hurdles and limitations, described in this Review. All in all, spirometry is recognised as the essential test for diagnosis and monitoring of COPD.

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Chronic obstructive pulmonary disease in non-smokers 

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Tobacco smoking is established as a major risk factor, but emerging evidence suggests that other risk factors are important, especially in developing countries. An estimated 25—45% of patients with COPD have never smoked; the burden of non-smoking COPD is therefore much higher than previously believed. About 3 billion people, half the worldwide population, are exposed to smoke from biomass fuel compared with 1·01 billion people who smoke tobacco, which suggests that exposure to biomass smoke might be the biggest risk factor for COPD globally. We review the evidence for the association of COPD with biomass fuel, occupational exposure to dusts and gases, history of pulmonary tuberculosis, chronic asthma, respiratory-tract infections during childhood, outdoor air pollution, and poor socioeconomic status.

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