Tobacco.org

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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Judith Palfrey: Is Asthma in Children Preventable?  

The worldwide increase in asthma is thought to be due to many factors, including air pollution, climate change, environmental allergens, respiratory infections, and stress. By keeping the home environment free of triggers such as dust, mites, animal dander, and cockroaches, parents can minimize the chance that children will have wheezing attacks. To protect children from infections that can trigger asthma, parents should ensure that children keep on up-to-date on their immunizations as recommended by the American Academy of Pediatrics, including an annual flu shot. Children should all be taught good hand-washing techniques.

One of the major causes of asthma and many other childhood afflictions is smoking. Parents who smoke are more likely to have premature babies whose lungs are more prone to develop asthma. Once the baby is born, parental smoking makes the asthma come on more frequently and worsens attacks. The Julius B. Richmond Center of Excellence at the American Academy of Pediatrics offers great tips for families to stop smoking so that their children will not suffer asthma as the result of a truly preventable cause.

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• Impact of Environmental Tobacco Smoke and Active Tobacco Smoking on the Development and Outcomes of Asthma and Rhinitis  

Summary: Several deleterious effects have been described in asthma because of smoking: accelerated decline in lung function, more severe symptoms, impairment in quality of life and diminished therapeutic response to steroids. The harmful effect of tobacco smoking is not only on asthma but also on rhinitis playing a role in disease outcomes. Tobacco exposure can influence innate immunity diminishing innate production of antigen-presenting cells cytokines, as well as an impaired response to toll-like receptor ligands. Active smoking is associated with current symptoms of asthma and rhinitis and seems to be a risk factor for developing new asthma in patients with rhinitis. Tobacco smoking has been also found among the factors inducing nasal obstruction and decreased muco-ciliary clearance in nonallergic rhinitis. . . .

The early exposure to ETS, both prenatal and postnatal, increases the risk of IgE sensitization to indoor inhalant and, in particular, food allergens[13••,14] and subsequently may have effects on atopy and airway hyperresponsiveness, with the consequent presence of atopic diseases.[15,16]

More studies are needed to gain insight in the relationship between tobacco smoking, ETS and the immune response and inflammatory lower and upper respiratory illnesses. . . .

All these findings suggest tobacco exposure control should be a tool in the management of asthma.

Conclusion

1. Tobacco smoking provokes a strong immunological imbalance to those exposed. The innate immunity is impaired by tobacco exposure.

2. As a consequence, typical allergic diseases such as rhinitis and asthma could initiate or aggravate preexisting conditions or both. Active smoking is a factor for nasal obstruction in NAR.

3. Tobacco smoking (and probably ETS also) has a detrimental effect on the efficacy of inhaled corticosteroids, leukotriene receptor antagonists and on those patients in programs for controlling asthma in deprived populations.

4. Robust evidence is provided in order to empower both primary and secondary prevention by physicians.

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Asthma and Smoking Could Be Dangerous Combo  

Doctors say smoking and asthma can also be a dangerous combination. “None of your medications will work,” says Dr. Kay Walker, an allergies and asthma physician. “Not only just your simple quick inhaler, but the long term medications which cut down on the inflammation simply cannot be as effective in somebody who is an active smoker.”

Doctor Walker says the chemicals in cigarettes paralyze parts of the lungs that clear out dust and particles. The damage can also prevent inhalers and medicines from helping you during a life-threatening asthma attack. “Because you are continually damaging the lungs, you are continually causing more inflammation, which overwhelms our ability to try and control it.”

Second-hand smoke can also be a problem for asthma sufferers of all ages.

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Top notch decisions in the developing airways bring insights into lung disease 

In the normal lung, the airways are lined by a balanced mixture of ciliated, secretory and neuroendocrine cells which perform functions as diverse as air humidification, detoxification, and clearance of environmental particles. This balance can be altered dramatically by faulty adaptation responses of the lung to cigarette smoke or allergens in patients with Chronic Obstructive Pulmonary Disease (COPD) and asthma.

How these different cell types emerge from lung progenitor cells and how these fates are balanced in developing airways, remain an open question. A study from a research team led by Wellington Cardoso, MD, a professor at the Pulmonary Center Boston University School of Medicine and Director of the Program in Lung Development and Progenitor Cell Biology, sheds light into this problem.

The Notch pathway is a major regulator of cell fate decisions in developing cells from fruit flies to humans. Using mouse genetic models, the BU researchers inactivated Notch signaling in the lung and discovered that airways no longer formed secretory cells. Instead they became populated almost exclusively by ciliated cells. The researchers showed that this imbalance seems to result from the loss of a mechanism of cell fate choice triggered by the Notch called lateral inhibition.

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Tobacco finds willing victims in teens  

Kaushal (name changed), a teenager who got into the habit of smoking, is now finding it difficult to quit the habit that has started to take its toll on his health. Worst still, addiction of other tobacco forms, including paan masala, has almost pushed him on the brink of oral cancer and he is undergoing treatment at the Banaras Hindu University.

The teenager is not alone as a number of youth, including teenagers, are forced to visit hospitals with various complications, a majority of them related to tobacco smoking and chewing- a sign enough to indicate the fact that the addiction is still finding acceptance amongst youth despite legislative and restrictive measures taken by the government from time to time.

"A growing number of youth are coming to the out-patient department (OPD) with breathing problems with symptoms of asthma these days," acknowledged Dr JK Samaria of department of chest and respiratory diseases, BHU, while talking to TOI on Saturday. "In addition, a high number of these youth are reported to have history of tobacco intake in one form or the other," he informed.

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Charges tied to smoking in front of children  

A Clarence man was arrested late Monday afternoon after being accused of pushing his wife during an argument over his smoking in front of his asthmatic children.

Erie County Sheriff's Deputies Robert Rine and James Bauer arrived at the Hillcrest Road residence to find Jeffrey Andruschat, 40, smoking in front of the children.

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Allergy season: Cigarettes to the rescue? 

Everyone knows that smoking can kill you, but did you know that it may help with your allergies? A new study shows that cigarette smoke can prevent allergies by decreasing the reaction of immune cells to allergens.

Smoking can cause lung cancer, pulmonary disease, and can even affect how the body fights infections. Along with many harmful effects, smoking cigarettes has a surprising benefit: cigarettes can protect smokers from certain types of allergies. Now, a study recommended by Neil Thomson, a member of Faculty of 1000 Biology and leading expert in the field of respiratory medicine, demonstrates that cigarette smoke decreases the allergic response by inhibiting the activity of mast cells, the major players in the immune system's response to allergens.

Researchers at Utrecht University in the Netherlands found that treatment of mast cells with a cigarette smoke-infused solution prevented the release of inflammation-inducing proteins in response to allergens, without affecting other mast cell immune functions.

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Cigarette smoke suppresses in vitro allergic activation of mouse mast cells 

Background

Mast cells are important effector cells in innate or acquired immunity that contribute to host defence. Excessive activation of mast cells can result in the development of allergic diseases, including atopic asthma. . . .

Our study suggests that exposure to cigarette smoke may lead to a reduced allergic activation of mast cells without affecting their response to activation via e.g. bacterial-derived LPS.

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Hopes high of fall in asthma rate  

RESEARCHERS are hoping a study into asthma in Scotland will show the smoking ban has had an impact north of the Border.

For the past 45 years, the Aberdeen Schools Asthma Survey has provided researchers in the city with an unparalleled insight into the prevalence of asthma in Scotland.

Previous research has shown asthma levels have begun flattening out following a significant risebetween 1964 and 1999.

Dr Steve Turner, the respiratory paediatrician heading the research, said the introduction of the smoking ban in public places and the promotion of heathy lifestyle and diet choices for children could signal a fall in the asthma rate for the first time in almost 50 years.

Next month, questionnaires will be sent to schools in the city in the latest follow-up to a study which was launched in 1964.

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Letter: Smoke keeps me out of state restaurants 

I suffer from asthma and my condition is severely exacerbated with the exposure to tobacco smoke.

Socializing in any public area that allows smoking is not possible due to my health concerns. When meeting family or friends even for a quiet restaurant meal, I travel to Minnesota to be in a smoke-free environment.

I would like to patronize local businesses and certainly save the expense and time of travel. I am in favor of restricting smoking in public areas as secondhand smoke is detrimental to all.

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• Study arms smoking foes  

Las Vegas casino dealers are exposed to a host of harmful chemicals through secondhand smoke while on the job, according to a new National Institute for Occupational Safety and Health study.

The study, the first to examine the effects of secondhand smoke in Las Vegas casinos, reported that the dealers had traces of a tobacco-specific carcinogen in their urine.

The results were drawn from 124 casino dealers at Bally’s, Caesars Palace and Paris Las Vegas who wore portable pumps that measured the level of tobacco smoke in the air during their shifts. In addition, 114 dealers submitted urine samples to the agency before and after their shifts.

The institute conducted research and interviewed workers during three on-site visits from July 2005 through January 2006.

Anti-smoking advocates hailed the results of the long-awaited study, which mirror previous government and privately funded research on secondhand smoke and are expected to provide ammunition to those pressuring the gaming industry to implement smoking bans. . . .

The institute’s report found that a majority of the 147 dealers who completed a separate health survey reported symptoms such as red or irritated eyes, a cough, stuffy nose, runny nose and headache. In total, 11 percent of the dealers studied, who did not work in poker rooms at the time, had been diagnosed with asthma, while 35 percent had symptoms suggestive of work-related asthma. Many poker rooms have voluntarily banned smoking.

“That strikes me as enormous,” considering that only about 7 percent of the national population suffers from asthmatic symptoms, said James Repace . . .

A spokesman for Harrah’s Entertainment, which owns the casinos at issue in the study, declined to comment on specific findings, saying the company is still reviewing the report.

In response to the smoking ban recommendation, spokesman Gary Thompson said the company would consider a nationwide smoking ban provided that it includes all gambling venues, such as racetracks and tribal casinos.

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SHORT COMMUNICATION Reduced exhaled breath condensate pH in asthmatic smokers using inhaled corticosteroids 

Background and objectives: Exhaled breath condensate (EBC) pH has been proposed as a biomarker of airway inflammation and oxidative stress in asthma. Cigarette smoking reduces EBC pH in mild asthma. The effects of smoking on EBC pH in more symptomatic asthmatic patients using inhaled corticosteroids (ICS) are unknown. We aimed to compare EBC pH in asthmatic smokers (AS) and non-smokers (ANS) with moderate to severe disease, who were taking ICS. We also investigated the relationship between EBC pH and biomarkers of airway inflammation and oxidative stress. . . .

Conclusions: EBC pH appears to be a biomarker of the level of oxidative stress in smokers with moderate to severe asthma. EBC pH may have applications for the longitudinal monitoring of the effects of smoking on the airways of asthmatic patients.

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SHORT COMMUNICATION Reduced exhaled breath condensate pH in asthmatic smokers using inhaled corticosteroids 

Background and objectives: Exhaled breath condensate (EBC) pH has been proposed as a biomarker of airway inflammation and oxidative stress in asthma. Cigarette smoking reduces EBC pH in mild asthma. The effects of smoking on EBC pH in more symptomatic asthmatic patients using inhaled corticosteroids (ICS) are unknown. We aimed to compare EBC pH in asthmatic smokers (AS) and non-smokers (ANS) with moderate to severe disease, who were taking ICS. We also investigated the relationship between EBC pH and biomarkers of airway inflammation and oxidative stress. . . .

Conclusions: EBC pH appears to be a biomarker of the level of oxidative stress in smokers with moderate to severe asthma. EBC pH may have applications for the longitudinal monitoring of the effects of smoking on the airways of asthmatic patients.

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Breath test predicts airway damage in asthmatic smokers 

The oxidative airway damage that smoking causes in patients with asthma can be easily assessed by measuring the pH of their breath, UK researchers believe.

“Exhaled breath condensate (EBC) is a non-invasive method for sampling the airways,” explain Binita Kane (Wythenshawe Hospital, Manchester) and co-workers.

“Methodological issues have hampered the use of many EBC biomarkers, but EBC pH is a robust, easily and rapidly measurable, and reproducible biomarker of inflammation,” the authors write, adding that “there is evidence that EBC pH is lower during asthma exacerbations, and that the pH is related to airway neutrophilia.”

Together, these observations suggest that EBC pH predicts airway inflammation. Indeed, EBC pH is known to be reduced in individuals with chronic obstructive pulmonary disease and smokers with normal lung function.

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