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• Massachusetts' 'Model' Tobacco Cessation Benefit Spurs Unprecedented Drop in Smoking Rates, Heart Attacks, Asthma, and Birth Complications 

A "model" tobacco cessation benefit offered to Massachusetts' Medicaid participants has produced an astounding 26% drop in smoking rates in only two and a half years, and has already been linked to decreases in heart attacks, hospitalizations for asthma and COPD, and a significant decrease in birth complications.

Researchers from the Massachusetts Tobacco Cessation and Prevention Program (MTCP) found that up to 38% fewer MassHealth cessation benefit users were hospitalized for heart attacks in the first year after using the benefit, and that 18% fewer benefit users visited the emergency room for asthma symptoms in the first year after using the benefit. Researchers also found that there were 12% fewer claims for adverse maternal birth complications since the benefit was implemented.

The Massachusetts Executive Office of Health and Human Services said more than 75,000 people -- a full 40% of MassHealth members who smoke -- have used the benefit to try to quit smoking. Cost savings are being studied, and all indications suggest they will be significant.

"It is clear from these latest findings that the Commonwealth's efforts to help people quit smoking is a sound investment," Executive Office of Health and Human Services Secretary JudyAnn Bigby said. . . .

"As the nation debates the future of its health care system, the national significance of this research cannot be understated," said Robert J. Gould, PhD, President and CEO of Partnership for Prevention, a national organization that advances policies and practices to prevent disease and improve the health of all Americans. "These findings demonstrate that prudent investments in preventive health today will have a dramatic and positive effect on our health care system tomorrow."

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• Smoking: why women are at great risk 

Recently, further scientific evidence has emerged to suggest that women may be at particular risk from smoking.

This year, a Norwegian study of almost 2000 women showed that women were at a higher risk of chronic obstructive pulmonary disease (COPD) at a younger age, and after smoking less heavily, than men.

COPD is an umbrella term that incorporates emphysema and chronic bronchitis. There are four stages of the condition, which are ranked in terms of their severity.

"We estimate that 2.1 million people in Australia have some form of COPD, and half of them don't know it," says Heather Allan, director of the COPD National Program at the Australian Lung Foundation. . . .

This isn't the first study that suggests that women may be more at risk from smoking than men. A 2005 Monash University found that women were more susceptible to exposure to smoke than men. Allan says researchers believe this could be because women have narrower and more sensitive airways than men.

A report by the British Lung Foundation in 2005 suggested it may be because women's lung capacity is smaller, and population studies have also suggested that there may be a genetic element involved.

This is why health campaigners are so concerned that more young women in their teens and 20s are starting and continuing to smoke than men. . . .

The reasons for women's increased risk of lung disease have not yet been fully researched. According to NHS Direct in the UK, a gene that speeds up the growth of lung tumours is known to be more active in women.

The female hormone oestrogen is also known to affect the development of such tumours. . . .

For the cost of a local call from anywhere in Australia, the Quitline provides advice and assistance to smokers who want to quit.

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• Tobacco smoke linked with respiratory diseases 

Tobacco smoke is involved in uncontrolled asthma, a diminished response to anti-asthma drugs, rhinitis, nasal obstruction, and deregulation of the immune system according to an international expert at the annual meeting of the American College of Allergy, Asthma and Immunology (ACAAI) in Miami Beach, Fla.

Tobacco smoking has been mainly associated with chronic obstructive pulmonary disease (COPD), and is attributed to being one of the main reasons that COPD disease is the fourth leading cause of death in the United States.

"Recent studies have shown that smoking can be linked with other respiratory diseases such as asthma exacerbations and rhinitis," said Carlos Baena-Cagnani, M.D., faculty of medicine, at Catholic University of Cordoba in Argentina. "Both active and passive smoking has been shown to be involved in uncontrolled asthma and associated with asthma exacerbations in children and adolescents."

According to Dr. Baena-Cagnani, active smoking also causes changes in inflammation in asthma patients, diminishes their response to anti-asthma drugs, and has been found to induce nasal obstruction and decreased mucociliary clearance.

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Wynn Casino Sued over Second-Hand Smoke  

A proposed class action seeks to force The Wynn Hotel and Casino to protect its workers on the casino floor from second-hand smoke. Kanie Kastroll, a dealer at the Wynn, says she suffers with asthma, and the "second-hand smoke she is exposed to ... exacerbates her condition."

Wynn "is aware of the health risks posed by exposure to second-hand smoke," but "has failed to adequately address the problem ... in the gaming area of its casino."

The hotel forbids dealers from designating certain tables as "smoke-free," and they can't request customers to blow smoke away from the table or to move their ashtrays, the lawsuit states. They're also told not to fan their hands at tobacco smoke.

Kastroll says the Wynn even encourages its customers to smoke. "Cocktail servers bring cigars and cigarettes to customers at the gaming tables," and that the hotel gives free smokes to gamblers.

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• Smoking pregnant increases baby's asthma risk: study 

Smoking during pregancy increases the risk of a baby developing asthma up to sixfold, said a Swedish study published at the European Respiratory Society's annual congress on Monday.

The study by Professeur Anders Bjerg of the Sunderby central hospital in Norrbotten and his specialists showed that smoking leads to babies being born underweight, a fact that has an impact on the development of asthma.

The Swedish doctors studied asthma in about 3,400 children between 1996 and 2008.

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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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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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Smoke exposure interacts with ADAM33 polymorphisms in the development of lung function and hyperresponsiveness  

Introduction: ADAM33 is the first identified asthma gene by positional cloning, especially asthma combined with bronchial hyperresponsiveness (BHR). Moreover, ADAM33 is associated with early-life lung function and decline of forced expiratory volume in 1 s (FEV1) in the general population. In utero and postnatal cigarette smoke exposure (CSE) are associated with reduced lung function, and development of BHR and asthma. We hypothesized that this may occur via interaction with ADAM33.

Aim: To replicate the role of ADAM33 in childhood lung function and development of BHR and asthma. Furthermore, we investigated gene–environment interaction of ADAM33 with in utero and postnatal CSE in the Dutch PIAMA cohort. . . .

Conclusions: We confirm associations between ADAM33 and the development of asthma (+BHR). This is the first study suggesting that interaction of in utero CSE with ADAM33 results in reduced lung function and the development of BHR, which needs further confirmation.

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ADAM33 genotype ‘interacts with in utero smoke exposure’ 

Variations in the so-called asthma gene, ADAM33, interact with exposure to cigarette smoke in utero to influence lung function in childhood, a study has found.

The research, if confirmed, underlines the importance of maternal cigarette smoking as an environmental risk factor for reduced lung function, acting in concert with genetic factors such as ADAM33.

The finding is reported in the journal Allergy by Dutch researchers, who analyzed data from a birth cohort study, the Prevention and Incidence of Mite Allergy. The study, which began in 1996, included 4146 children, 1327 of whom were considered at high risk based on a positive maternal history of atopy.

Dirkje Postma (University of Groningen) and fellow authors first sought to verify the previously reported association between ADAM33 genotype and asthma risk.

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• Passive smoking in pregnancy linked to asthma risk in children 

Children born to women exposed to environmental tobacco smoke (ETS) during pregnancy face an increased risk for asthma symptoms in early life, researchers warn.

“Smoking during pregnancy has been shown to be a considerable risk factor for changes in growth and maturation of the fetal lungs and the later development of wheeze and asthma,” explain Paraskevi Xepapadaki (University of Athens, Greece) and team in the journal Pediatric Allergy and Immunology.

But they add it is not known whether passive smoking in pregnancy is associated with an increased risk for asthma and allergies in offspring.

To investigate, the researchers studied data on 2374 preschool children, aged between 1 and 6 years, from 115 nurseries in five counties of Greece.

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Association of passive exposure of pregnant women to environmental tobacco smoke with asthma symptoms in children  

Environmental tobacco smoke (ETS) is a significant risk factor for the presence and increased severity of asthma- and allergy-related symptoms in children. Smoking during pregnancy has detrimental effects on asthma-associated outcomes in childhood. Whether passive exposure of pregnant women to ETS may also lead to asthma in their offspring, is not known. The aim of this study was to investigate the association of passive exposure of pregnant women to ETS and asthma- and/or allergy-related symptoms in Preschool children. Cross-sectional data were collected with questionnaires from 2374 Preschool children, recruited from public and private nurseries and day-care centers. Parental smoking was significantly associated with wheezing symptoms in their children. Mother's active smoking during pregnancy significantly increased the risk for occurrence of asthma symptoms and/or medically diagnosed asthma in Preschool children in a dose-dependent manner. Passive exposure to ETS, mainly during the third trimester of pregnancy, was significantly associated with asthma- and allergy-related symptoms after adjusting for several confounders in a multivariate analysis (current wheeze: OR = 1.42, 95% CI = 1.06–1.91, pruritic rash ever: OR= 1.45, 95% CI = 1.01–2.08). Passive exposure of pregnant women to ETS during the third trimester is positively associated with asthma- and allergy-related symptoms in their Preschool age children. Public health policies should be oriented not only towards smoking cessation, but also reinforce elimination of ETS exposure of pregnant women.

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Parental stress increases the effect of traffic-related air pollution on childhood asthma incidence  

These results suggest that children from stressful households are more susceptible to the effects of TRP and in utero tobacco smoke on the development of asthma.

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Stressed parents up asthma risk 

Stressed parents may play a role in childhood asthma, researchers believe.

They found the children of tense parents who lived in polluted areas were far more likely to have asthma than friends in the same neighbourhood.

The University of Southern California team believe parental anxieties combine with other known risk factors to increase a child's asthma risk.

They told Proceedings of the National Academy of Sciences there might be an underlying biological explanation. . . .

These results suggest that children from stressful households are more susceptible to the effects of traffic-related pollution and in utero tobacco smoke on the development of asthma

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Parental Stress Boosts Kids' Asthma Risk  

Air pollution from cars can increase a child's chances of developing asthma, but add parental stress and the odds for asthma get even higher, a new study finds.

For children exposed to smoking while still in the womb, another asthma risk, parental stress also increases the risk for asthma, the researchers noted.

"There is an association between air pollution and asthma, and it grows with increasing exposure to stress in the household," said lead researcher Ketan Shankardass, a postdoctoral research fellow at the Centre for Research on Inner City Health at The Li Ka Shing Knowledge Institute of St. Michael's Hospital in Toronto.

"The cause of asthma is still unknown," Shankardass said. "It's a major illness that affects a lot of people all around the world and we still don't really have a handle on what causes it so we can't control it very well. But this finding contributes to our understanding of that causal process."

The report is published in this week's online edition of the Proceedings of the National Academy of Sciences.

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News briefs from the July issue of Chest 

SMOKING CESSATION MAY PROVIDE IMMEDIATE BENEFIT TO HEART

A new article suggests smoking cessation provides immediate benefits to patients. Researchers from the Feinstein Institute for Medical Research in Manhasset, NY, examined specific inflammatory biomarkers associated with cardiovascular disease (CVD) in "at risk" women during the smoking cessation process. . . .

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