Medical Health Center

Asthma Research Could Lead To Preventing Attacks In Future, Says British Lung Foundation

Research published in the Proceedings of the National Academy of Sciences, USA (PNAS) explores the mechanisms behind the common cold virus and how it causes asthma attacks.

The research, funded by the British Lung Foundation, Asthma UK, the Medical Research Council, Imperial College London and the Wellcome Trust, is good news for the five million asthma sufferers in the UK because it may lead to a way of preventing attacks in future.

“The common cold is the main reason why people with asthma get bad attacks,” says Professor Neil Barnes, spokesperson for the British Lung Foundation. “This research is important because it helps us to understand exactly what happens in our lungs during an asthma attack and it may lead to a way of preventing attacks in future.”

1. The British Lung Foundation is the only UK charity working for everyone affected by lung disease. The charity focuses its resources on providing support for people affected by lung disease today; and works in a variety of ways (including funding world-class research) to bring about positive change, to improve treatment, care and support for people affected by lung disease in the future.

2. It provides information via the website http://www.lunguk.org and telephone helpline 08458 50 50 20.

3. In 2006 the charity launched a membership scheme with the aim of recruiting the 8 million people with lung disease in the UK and anyone with an interest in lung disease.

4. One person in every seven in the UK is affected by lung disease - this equates to approximately 8 million people

5. Respiratory disease is the second biggest killer in the UK (117,456 deaths in 2004) after all non-respiratory cancers combined which only account for slightly more deaths (122,500 deaths in UK in 2004)

6. Respiratory disease now kills one in five people in the UK

7. The UK’s death rate from respiratory disease is almost double the European average and the 6th highest in Europe

8. Respiratory disease is the most commonly reported long term illness in children and the third most commonly reported in adults. One in 7 boys and 1 in 8 girls aged 2 - 15 report having long term respiratory illness in England

British Lung Foundation

Weather Alerts Reduce COPD Hospital Admissions In UK

A weather alert service run by the UK’s Meteorological Office that forecasts when weather is likely to be bad for COPD patients and alerts them to take simple precautions, has achieved a 20 per cent drop in COPD hospital admissions in areas that use the scheme.

According to the Meteorological Office (Met Office), over 8,500 patients from 160 practices are already signed up to the scheme, which essentially does two things: it warns people when the outdoor environment is likely to be bad for their health, and it reminds them what to do to keep themselves well.

Called Healthy Outlook(R) COPD Forecast Alert, the scheme costs 18 pounds per patient per winter (plus a set up fee) and includes training in health forecasting for healthcare professionals, a weekly (twice weekly in the winter) email COPD forecast, a COPD patient register, and a direct to patient contact scheme for when the forecast reaches the “elevated” category.

Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term covering lung conditions like bronchitis and emphysema that are long-term and gradually get worse. There is no cure but a lot can be done to relieve the symptoms of COPD.

According to the British Lung Foundation, the vast majority of people have never heard of COPD, yet it’s the UK’s fifth biggest killer and claims about 30,000 lives a year.

Every year the NHS spends 600 million pounds looking after people with COPD and there are 100,000 COPD-related hospital admissions in England.

The Healthy Outlook scheme issues an email twice a week in winter and once a week in summer. The email forecasts the COPD risk over the coming week, giving it either a “Normal” or “Elevated” category, and it also includes an outlook for the following week.

The scheme includes a direct patient contact register that is triggered when the risk is “Elevated”. Operated in conjuction with Medixine, the system contacts registered patients by telephone to warn them of the expected worsening conditions and asks them to look at their information pack for further advice. It then asks them whether their symptoms are worse than normal, and whether they have enough medication for the next two weeks.

The patients’ practice staff also get an email the day before the calls are made and also when they are complete. The patient’s responses are kept in a database that practice staff can look at to do any follow up.

GPs can put patients on the direct contact register by sending them an invititation letter. They can add patients to the register using a simple web-based form.

The Met Office said areas that joined the scheme last winter include: Rhondda Cynon Taff Local Health Board, East Lothian, Moray and West Glasgow Community Health Partnerships, Worcestershire, Bradford, Cornwall and West Cheshire Primary Care Trusts.

New areas that have signed up to use the scheme this winter include Stoke, Torbay, Devon, and another in Northern Ireland.

According to the BBC, the Met Office has surveyed over 3,000 patients on the scheme and found that one third of them were prompted to contact their GP to get a repeat prescription and 11 per cent asked their doctor about worsening symptoms. Some patients said the service made them feel someone cared, and one patient said it was useful for “adjusting lifestyle to take account of the weather conditions”, and in “planning and ordering medication”.

Chief executive of the British Lung Foundation, Dame Helena Shovelton, told the BBC that the scheme was a “great benefit”, and that:

“Being aware of detrimental weather conditions enables people to plan ahead and avoid situations that could aggravate their condition.”

But she said being on the scheme should not make patients complacent and it should not be seen as a replacement for important services like rehabilitation classes which can help patients increase their lung fitness, and seeing specialist nurses, although she admitted that not everyone has access to these services.

Click here for more information about Healthy Outlook(R) COPD Forecast Alert (Met Office).

Sources: Met Office, BBC.

Written by: Catharine Paddock, PhD
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Asthma, Outdoor Air Quality And The Olympic Games, Canadian Medical Association Journal Review

As we come close to the Beijing Olympic Games, a review article in CMAJ (Canadian Medical Association Journal) reminds us that the heat and humidity in the Beijing region will present a formidable challenge to all athletes. Moreover, poor quality of air can also affect all athletes, especially those with asthma.

“With exposure to an environment that has poor quality, air pollutants may trigger symptoms of asthma in a dose-dependent manner,” say Donald McKenzie and Louis-Philippe Boulet. “With the high minute ventilation (amount of air breathed in one minute) seen during exercise, the effects of exposure to these pollutants are more noticeable in athletes than in non-athletes and likely more evident in people with asthma than in those without asthma.”

Physical activity and regular exercise can improve the control of asthma and is recommended to patients. However, there is mounting evidence that frequent, intense exercise by highly trained athletes could itself contribute to the development of asthma. Long-term endurance training may influence the structure and function of airways in the lungs and make them hyperresponsive, contributing to the development of asthma.

McKenzie and Boulet say that athletes with asthma need an individualized management plan that needs to comply with the anti-doping regulations of the International Olympic Committee and the World Anti-Doping Agency. For example, athletes who wish to use an inhaled medication, such as one of the permissible beta-2 agonists, need to document the need for this medication by appropriate lung function testing and submit an application to the International Olympic Committee’s Medical Commission.

China has implemented strategies in the Beijing region to improve air quality during the Olympic Games. “However, a significant percentage of the pollution (about 35%) at the Olympic Stadium can be attributed to sources outside Beijing. Controlling only local sources of pollution may not be sufficient to achieve the air quality goal set for the Beijing games,” say McKenzie and Boulet.

“Asthma, outdoor air quality and the Olympic Games”
Donald C. McKenzie MD PhD, Louis-Philippe Boulet MD
Canadian Medical Association Journal (CMAJ)
CMAJ 2008 0: cmaj.080982
Click here to view article (PDF)

CMAJ (Canadian Medical Association Journal)

CMAJ is the leading health sciences journal in Canada. CMAJ is a general medical journal publishing original research and review articles, commentaries and editorials, practice updates, an arts and ideas section and health news. Published continuously since 1911, new issues are uploaded on www.cmaj.ca every second Monday at 4:30 p.m. EST/EDT. www.cmaj.ca contains the complete editorial contents of CMAJ, supplemented by a variety of interactive features and additional content.

www.cmaj.ca

AAAAI: Ragweed Allergy Heats Up With Climate Change

If you think your ragweed allergies are getting worse, you may be right. And global warming may be the culprit, according to the American Academy of Allergy, Asthma & Immunology.

That’s not good news for the estimated 36 million Americans who suffer from ragweed allergy, the primary cause of fall allergy symptoms. Ragweed season unofficially begins Aug. 15.

Global climate change is believed to be making ragweed season worse for allergy sufferers. Recent studies suggest that increasing temperatures and carbon dioxide levels are already resulting in longer ragweed seasons and more concentrated pollen counts. The Journal of Allergy and Clinical Immunology (JACI), the official scientific journal of the AAAAI, has devoted its September issue to exploring the effects of climate change on allergic disease - including ragweed allergy.

In a review article to be published next month in the JACI, Richard W. Weber, MD, FAAAAI, and chairman of the AAAAI Aerobiology Committee, writes that “there is now a wealth of evidence that climate change has had, and will have, further impact on a variety of allergenic plants.”

Researchers have decisively linked climate change to “longer pollen seasons, greater exposure and increased disease burden for late summer weeds such as ragweed,” Weber writes, citing among other findings that increased carbon dioxide has resulted in pollen production increases of 61-90 percent in some ragweed varieties.

According to data from the AAAAI one ragweed plant can produce 1 billion pollen grains in an average season. Due to the grains’ light weight, they can travel up to 400 miles with the breeze, leaving virtually no outdoor place ragweed-free.

Allergy shots, or immunotherapy, are effective treatment in up to 90 percent of patients with ragweed allergy. Individuals who suffer from ragweed allergy can also take simple steps to prevent or relieve symptoms:

- Keep windows closed to keep pollen outside homes and cars. Use the air conditioner, which filters, cools and dries air.
- Stay indoors when pollen counts are highest, typically between 10 a.m. and 4 p.m.
- Check daily pollen counts for your area at http://www.aaaai.org.
- Change clothing after time spent outdoors and avoid drying laundry outside.
- Sleep well by taking a shower before bed to wash pollen from your hair and face, preventing it from ending up on your pillow.

Many individuals with ragweed allergy also experience symptoms when eating fresh produce such as bananas, cucumbers, melons and zucchini. This occurs when the body confuses proteins in these foods with similar ones in ragweed.

Given its complications, an allergist/immunologist is the best-qualified medical professional to diagnose and treat ragweed allergy and other allergic diseases.

The AAAAI represents allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic disease. Established in 1943, the AAAAI has nearly 6,500 members in the United States, Canada and 60 other countries.

AAAAI

American Lung Association Offers Parents Seven ‘Back To School’ Tips For Kids With Asthma

Nearly 11% of children headed back to school this fall have asthma. Annually, school aged children with asthma miss just under 13 million days in the classroom, making asthma related illness one of the most common reasons kids are absent from school. The American Lung Association offers parents a seven step checklist to ensure a safe and healthy school year for children who suffer from this sometimes debilitating disease.

To minimize asthma’s grip on this school year ahead, parents must first be aware that per government regulation, manufacturers are phasing out production of a common type of albuterol inhaler, often called a CFC inhaler. By December 31, 2008, CFC inhalers will not be available to the consumer public and will be replaced by an HFA inhaler.

The FDA has found that HFA inhalers are safe and just as effective as their CFC counterparts. One significant difference is that HFA inhalers do not contain ozone-depleting chemicals found in CFC inhalers.

“Some kids might find their new inhaler has a slightly different taste or feel,” said Norman Edelman, MD, Chief Medical Officer of the American Lung Association. “Also be aware that your pharmacy won’t be able to simply substitute the new HFA inhaler for your existing CFC inhaler prescription. Your child’s doctor will need to write a new prescription.”

“It is also important for parents to confer with their child’s doctor to ensure each of their asthma prescriptions are current and are best managing the child’s symptoms. This should be done at least once a year,” Dr. Edelman added.

In preparation for the school year ahead, the American Lung Association also urges parents who have children with asthma complete the following checklist:

— Schedule Asthma Check-up Doctor’s Appointment

Even if your child’s asthma is well managed, scheduling a check up with your pediatrician is critical to ensuring your child’s asthma continues to be effectively controlled. This is also an opportunity to evaluate medications and physical activity restrictions.

— Confirm Medicines Are Up-to-Date and Fill Prescriptions

If your child uses an inhaler, ensure you have a current prescription for an HFA inhaler. Check your medicine cabinet to ensure your child’s asthma prescriptions have sufficient refills available and have not expired.

— Know About Prescription Assistance Services

No one should have to do without their asthma medications because offinancial need. Two organizations are available to help.

— Asthma Action Plan

All students with asthma should have a written Asthma Action Plan that details personal information about the child’s asthma symptoms, medications, any physical activity limitations and provides specific instructions about what to do if an asthma attack does not improve with prescribed medication.

— Visit Your Child’s School Nurse and Teachers

All of the student’s teachers, coaches, as well as the school nurse and/or office should have a current copy of their Asthma Action Plan. Discuss with your child’s teachers specific triggers and typical symptoms so that they can be prepared to effectively assist your child should an asthma attack occur during the school day.

— Advocate for Your Child

It is also important to learn if your child’s school allows students to carry and independently administer their asthma medication. Some schools require students to carry a note from their doctor. Learn what steps need to be taken to have your child carry and use their inhaler if recommended by their doctor.

— Know Your School’s Asthma Emergency Plan

Ensure that your child’s school knows how to contact you in case of an emergency. It is also important for parents to know the school’s past history of dealing with asthma episodes. Parents should confirm that school staff– including after-school coaches and bus drivers have been trained in responding to asthma emergencies.

About the American Lung Association: Beginning our second century, the American Lung Association is the leading organization working to prevent lung disease and promote lung health. Lung disease death rates are currently increasing while other major causes of death are declining. The American Lung Association funds vital research on the causes of and treatments for lung disease. With the generous support of the public, the American Lung Association is “Improving life, one breath at a time.”

American Lung Association
http://www.lungusa.org

For Easier Breathing

A chronic cough or change in breathing shouldn’t be dismissed as smoker’s cough or a sign of being out of shape.

These can be early symptoms of chronic obstructive pulmonary artery disease (COPD). The August issue of Mayo Clinic Health Letter discusses COPD, a progressive lung disease usually caused by smoking.

COPD is most commonly a combination of chronic bronchitis — characterized by persistent cough and phlegm production — and emphysema, which causes shortness of breath. These conditions develop gradually and produce few signs and symptoms in the early stages. But COPD, among older adults, is a leading cause of death in the United States.

Fortunately, when COPD is detected at a mild-to-moderate stage — as the majority of cases are — symptoms can remain mild if a person stops smoking and adopts a healthier lifestyle.

Strategies that can help mild-to-moderate COPD include:

– Avoid respiratory infections — Get the pneumonia vaccine and an annual flu vaccination and take basic preventive precautions such as frequent hand washing.

– Get daily exercise — The efficiency of the muscles and circulatory system will increase.

– Use short-acting bronchodilators — They can help relax muscles and prevent spasms and, as a result, relieve coughing and make breathing easier.

– Avoid irritants — Stop smoking and avoid secondhand smoke, air pollution, wood smoke, strong odors and dust.

– Maintain a well-balanced diet and healthy weight — Too thin can lead to frailness, while being overweight can increase shortness of breath.

Treatments for more severe COPD include long-acting bronchodilators, corticosteroids and supplemental oxygen.

Mayo Clinic
200 First St. SW
Rochester, MN 55902
United States
http://www.mayoclinic.com

Molecule CX717 Has Positive Effects In Opiate-Induced Respiratory Depression In A Phase IIa Clinical Study

Cortex Pharmaceuticals, Inc. (AMEX: COR - News) reported that top-line data from its first Phase IIa study in opiate-induced respiratory depression (RD) demonstrated that a single oral dose of 2100mg of AMPAKINE® CX717 achieved statistical significance over placebo on the primary endpoint measure. These results are being presented at the Bank of Montreal Capital Markets Focus on Healthcare Conference in New York City on Wednesday morning, August 6, 2008 at 9:30AM (EDT) by Dr. Roger G. Stoll, President & CEO of Cortex. This placebo controlled, double-blind, randomized two-way crossover trial (RD-02) was performed by Parexel’s clinical research unit in Europe. In this study, eight (8) volunteers per dose group each received either 900mg, 1500mg, or 2100mg of CX717 or matching placebo that was orally administered two hours before each subject received an intravenous infusion of the opiate agonist, alfentanil. The primary performance measures were derived from a CO2 re-breathing procedure that measured the breathing response of the subject to increased CO2 levels in the presence of alfentanil. The primary measure, the minute expiratory volume (VE) at 55mgHg CO2 (VE55), was reversed by 2100 mg CX717 in comparison to placebo (p<0.03).

No reliable responses were seen in the 900mg and 1500mg CX717 groups, but procedural problems were detected by the Data Safety Monitoring Board (DSMB) for this study, which was authorized by the protocol to monitor safety and responses on an interim basis. Corrective procedural changes were instituted before the initiation of the last group of subjects in the 2100mg segment of the study.

“While we initiated this study using oral doses of CX717 and had only eight subjects per treatment group, we were pleased to obtain statistical significance using such small study groups,” said Dr. Roger Stoll the CEO of Cortex. The primary objective was to simply verify that the mechanism, which was seen functioning in animal studies, would also be operative in humans. Substantial investments were required to develop an intravenous dosage form of CX717, including formulation development and stability studies for such a dosage form as well as two species toxicology trials. The Company now feels that it can proceed with such studies. Cortex recently received verification of three months of accelerated stability for the experimental intravenous formulation of CX717 and plans to initiate toxicology trials in the fourth quarter 2008.

A second respiratory depression study has been performed by a group in Frankfurt, Germany. This study uses a single dose of 1500mg of CX717 and focuses on both the respiratory depression and the analgesic effects associated with alfentanil. The analysis of the data has been initiated and related results should be reported within a few weeks. Studies of CX717 in animal models by Dr. John Greer at the University of Alberta have shown that the AMPAKINE drugs do not interfere with the analgesic effects of opiates.

Cortex continues to advance other AMPAKINE compounds, particularly those newer compounds that have potential patent lives to 2028. It will also be reported at the BMO Capital Markets conference that Cortex has initiated human phase one safety and kinetic trials with CX1739 in normal volunteers. Assuming successful Phase I human trials with this compound, the Company plans to rapidly pursue the Attention Deficit-Hyperactivity disorder indication for CX1739 in the second half of 2009. The Company will also report on an initial animal trial with CX1942, a unique pro-drug analog of another low impact AMPAKINE drug that is highly water soluble, ideally suited for an intravenous dosage form. This compound rapidly hydrolyzes to the parent AMPAKINE drug in vivo. CX1942 has shown exceptionally rapid results in reversing respiratory depression due to intravenously administered fentanyl in rats. The Company plans to initiate toxicology studies with this unique analog during the last quarter of 2008.

High impact AMPAKINE compounds from recent patent applications are also being advanced with a focus on neurodegenerative diseases, such as Alzheimer’s and Parkinson’s diseases, as well as orphan drug indications like Huntington’s and Fragile X disease.

The conference presentation will be webcast and available for a period of thirty days after the conference by logging on to http://www.bmocm.com/conferences/2008healthcare/default.aspx.

Cortex Pharmaceuticals, Inc.

Cortex, located in Irvine, California, is a neuroscience company focused on novel drug therapies for treating psychiatric disorders, neurological diseases and brain mediated breathing disorders. Cortex is pioneering a class of proprietary pharmaceuticals called AMPAKINE compounds, which act to increase the strength of signals at connections between brain cells. The loss of these connections is thought to be responsible for memory and behavior problems in Alzheimer’s disease. Many psychiatric diseases, including schizophrenia, occur as a result of imbalances in the brain’s neurotransmitter system. These imbalances may be improved by using the AMPAKINE technology. Cortex has an alliance with Schering-Plough Corporation who acquired Cortex’s former partner N.V. Organon in November 2007. As a result of this acquisition, Schering-Plough has two AMPAKINE Phase II compounds Org24448 and Org 26576 for the treatment of schizophrenia and depression. In December 2006 Cortex terminated the research collaboration with Servier enabling Cortex to pursue the use of AMPAKINE compounds in the treatment of neurodegenerative diseases on a global basis. Servier retained the right to select up to three compounds developed during the collaboration for further development for the treatment of neurodegenerative diseases. Cortex may receive additional milestones and royalties if either Organon or Servier is successful in developing and commercializing AMPAKINE compounds. For additional information regarding Cortex, please visit Cortex Pharmaceuticals’ website at http://www.cortexpharm.com.

Forward-Looking Statement

This press release contains forward-looking statements concerning the Company’s research and development activities. The success of such activities depends on a number of factors, including the risks that the Company’s proposed compounds may at any time be found to be unsafe or ineffective for the indications under pre- clinical or clinical tests and that such studies may at any point be suspended or take substantially longer than anticipated to complete. The forward-looking statements are necessarily subject to risks and uncertainties, all of which are difficult or impossible to predict accurately and many of which are beyond the control of Cortex, all as more fully described in the risk factors and other matters set forth in Cortex’s Annual Report on Form 10-K for the year ended December 31, 2007, and Cortex’s other filings with the Securities and Exchange Commission, As discussed in the Company’s Securities and Exchange Commission filings, the Company’s proposed products will require additional research, lengthy and costly clinical testing and regulatory approval. AMPAKINE compounds are investigational drugs and have not been approved for the treatment of any disease. Cortex disclaims any intent or obligation to update any forward-looking statements.

Cortex Pharmaceuticals, Inc.

American Lung Association Offers Olympic Spectators Tips To Stay Healthy In Beijing

Air pollution is a serious health issue, especially in Beijing. For even the healthiest people, air pollution can irritate the respiratory tract and cause serious health problems such as asthma attacks, coughing and wheezing, shortness of breath and chest pain when inhaling deeply. It can also increase the risk of heart attacks, strokes, lung cancer and even early death.

Before spectators leave for Beijing, the American Lung Association advises all Olympic travelers to plan in advance for any health emergencies that may arise. Those individuals with conditions such as asthma, COPD (emphysema and chronic bronchitis), heart disease and diabetes are encouraged to make a doctor’s appointment before making the trip.

“Your doctor will be able to help you determine if you will be able to sufficiently tolerate conditions in Beijing,” said Dr. Norman Edelman, Chief Medical Officer for the American Lung Association. “Your doctor will also be able to work with you to develop a disease management plan to ensure the healthiest trip possible. That may include increasing the dosage levels of certain medications while in Beijing.”

“Smokers are also encouraged to take steps to quit,” advised Edelman. “Not only does smoking add to the pollution, but will also make for an even greater strain on your lungs. The American Lung Association’s Freedom From Smoking online program is a valuable resource for those who want to break free from nicotine.”

For even the healthiest people, air pollution can irritate the respiratory tract and cause serious health problems such as, coughing and wheezing, shortness of breath and chest pain when inhaling deeply. It can also increase the risk of heart attacks, strokes, lung cancer and even early death.

The American Lung Association encourages all Olympic travelers to plan in advance for any health emergencies that might arise. It is important to be aware of what medical services that will be available to you while in China and how your medical insurance deals with incidents that happen while on international travel.

“To keep healthy while in Beijing, limit or avoid outdoor exercise,” said Dr. Edelman. “If you choose to exercise, do so early in the day or in the evening. If you feel any discomfort, including coughing or wheezing, you should stop immediately.”

“If at any time you are outdoors and experience shortness of breath or excessive coughing or wheezing, go inside immediately and take appropriate action,” said Dr. Edelman.

“Don’t assume face masks are going to solve the problem,” said Janice Nolen, an air quality policy analyst for the American Lung Association. “While N95 face masks may provide some benefit, most commercially available air masks were not designed to protect against all forms of air pollution. For example, they don’t protect against gases, like ozone smog, which will be one of the important components of the air in Beijing.”

“The Beijing Olympics calls the world’s attention to the seriousness of air pollution. That focus needs to continue long after the Games end,” said Nolen. “Decades of hard work tackling air pollution in the United States mean that we no longer have Beijing-levels of air pollution, but even our problem isn’t solved. We still have too many Americans breathing dangerous — sometimes fatal — air pollution in their own backyards.”

The American Lung Association is dedicated to preventing lung disease and is working to improve air quality for all Americans. For more information or to support the American Lung Association’s clean air initiatives, visit http://www.lungusa.org.

About the American Lung Association: Beginning our second century, the American Lung Association is the leading organization working to prevent lung disease and promote lung health. Lung disease death rates are currently increasing while other major causes of death are declining. The American Lung Association funds vital research on the causes of and treatments for lung disease. With the generous support of the public, the American Lung Association is “Improving life, one breath at a time.”

American Lung Association
http://www.lungusa.org

Scottish Study Adds Support For World-Wide Ban On Smoking In Public Places

NHS Health Scotland, the national health improvement agency, has found a 17 per cent fall in admissions for heart attacks just one year after the smoking ban1 came into force.

Undertaken by the University of Glasgow, this study is one of the most robust of its kind, and was commissioned as part of a national evaluation of the impact of Scotland’s smokefree legislation. Published this week in the New England Journal of Medicine, the results from a study of nine Scottish hospitals2 demonstrate the positive impact going smokefree can have on the health of the population.

The evaluation of Scotland’s smokefree law found that after the legislation came into force there was:

? a 17 per cent reduction in heart attack admissions to nine Scottish hospitals. This compares with an annual reduction in Scottish admissions for heart attack of 3 per cent per year in the decade before the ban
? an 86 per cent reduction in second-hand smoke in bars
? a 39 per cent reduction in second-hand smoke exposure in 11-year-olds and in adult non-smokers
? an increase in the proportion of homes with smoking restrictions
? no evidence of smoking shifting from public places into the home
? considerable public support for the legislation even among smokers, whose support increased once the legislation was in place

Professor Jill Pell, University of Glasgow who conducted the study said: “Previous analyses of routine hospital admission data from the US and Italy have reported reductions in heart attacks following the introduction of smoking bans. However, our Scottish study, is the first to examine the impact of the legislation on smokers and non-smokers separately. We have been able to demonstrate that two-thirds of the observed reduction in heart attack has occurred in non-smokers and the results of the blood tests confirmed a reduction in exposure to second-hand smoke among non-smokers. We believe that most of the reduction can be attributed to the introduction of the Scottish smoking ban.”

Sally Haw, Principal Public Health Adviser at NHS Health Scotland, co-ordinated the research programme: “This evaluation of impact of smokefree legislation is the most comprehensive yet conducted and the findings have exceeded our greatest expectations. As well as the dramatic 17 per cent reduction in heart attacks, we found clear evidence of: improvements in the respiratory health of bar workers; reductions in second-hand exposure in bar workers, and adults and children the general population; and changing socio-cultural norms about smoking and the acceptability of exposing others to SHS.

“The findings from the Scottish study of heart attacks are of worldwide importance and the combined results from the evaluation provide a compelling case for other countries to implement a comprehensive ban on smoking in public places as soon as possible, thereby reducing the harm caused by second-hand smoke. However, it is essential that smokefree legislation is set within the context of wider tobacco control activity as outlined in the WHO Framework Convention on Tobacco Control - an international treaty designed to reduce both the demand for and the supply of tobacco products. 3″

Deputy Chief Medical Officer Professor Peter Donnelly said: “This raft of research demonstrates the significant public health benefits that the smoking ban is already having in Scotland. It provides evidence that the legislation is improving the health of everyone in Scotland - including smokers, non-smokers, children and barworkers. One of the most important findings is the reduction in heart attacks. We believe that the smoking ban was a large contributory factor to this drop and I am confident that we will continue to see the positive effects of the ban in years to come.”

The publication of this study comes together with other good news internationally; Mayor Michael Bloomberg and Bill Gates announced in New York last week a further $375 million investment ($250 million from the Bloomberg Family Foundation and $125 million from the Bill & Melinda Gates Foundation) in tobacco control activity in developing countries4; while China has made the forthcoming Olympics a smokefree event when it takes the world stage in August.

1. The Smoking, Health and Social Care (Scotland) Act came into force in Scotland on 26th March 2006 and prohibits smoking in virtually all enclosed public places including bars restaurants and cafes.
2. The heart attack admissions to the nine study hospitals account for 63 per cent of all Scottish admissions for heart attack.
3. Link to WHO FCTC
4. Link to Bloomberg/Gates story

NHS Scotland
http://www.scot.nhs.uk

Note To People With Scarred And Stiffened Lungs: Monitor Your Sleep Before Severe Fatigue Sets In

Mother’s legacy shows impact of severe fatigue, $2 million in research funding to help study disease

Family, friends and neighbors remember Lisa Sandler Spaeth as an active mother of two in Potomac, Md., with a lot on the go, juggling her son’s baseball games and her daughter’s horseback-riding lessons with numerous committee obligations, organizing women’s activities at her local synagogue. Add to this Spaeth’s thriving home business turned wholesale supplier - making custom hair accessories for children - which she founded with her mother.

But Spaeth was also diagnosed with pulmonary fibrosis, a hard-to-treat disease that progressively damages the lungs and starves the body of oxygen. For two years after her diagnosis, until her death in May 2007, at age 44, Spaeth was beset by fatigue. Her energy levels sank as her lungs deteriorated. Breathing became difficult, and she could no longer attend many of the sporting events, trade fairs and women’s groups that filled her life.

It is with people like Spaeth in mind that researchers at Johns Hopkins and elsewhere have found what is likely to be the first evidence linking the extreme fatigue in the lung-scarring disease, which has no known cause, to the poor quality of sleep that results - as much as a 25 percent loss in body-rejuvenating R.E.M. sleep. And they have also gauged the detrimental effects this has on people’s daily lives, nearly halving test scores used to assess physical and mental quality of life.

In a report appearing this month in the journal Chest, senior study investigator and pulmonologist Sonye Danoff, M.D., Ph.D., who treated Spaeth, found more than twice the amount of nighttime sleep disturbances and double the number of daytime episodes of drowsiness among 41 men and women with so-called idiopathic pulmonary fibrosis than in people with healthy lungs.

“Physicians should strongly consider monitoring people with this scarring lung disease for sleep disorders as part of their standard care, because poor sleep has a profound effect on their quality of life,” says Danoff, an assistant professor at the Johns Hopkins University School of Medicine.

The latest study results back up previous research by Danoff and other sleep experts at Johns Hopkins, which showed that 18 of 22 people with fibrosed lungs had problems breathing while asleep. The majority of them dropped out of R.E.M. sleep during the night, losing 25 percent of total R.E.M. sleep time.

It is during the R.E.M. period that rapid eye movements occur (hence the name), that people dream and that the body recovers from the previous day and builds up energy for the next.

Pulmonary fibrosis makes people highly vulnerable to sleep problems, Danoff says, because they often breathe twice as fast to supply the body with oxygen. And just as breathing and other body functions naturally slow down at the onset of R.E.M. sleep, these people who depend on a higher rate of breathing are constantly being pushed to wake up from a lack of oxygen.

“Essentially,” she adds, “the body’s internal alarms go off as people enter the most rejuvenating part of sleep. And when people don’t get a good night’s sleep, they cannot function normally the next day. It’s a slippery slope that gets progressively worse over time.”

Also in this latest Johns Hopkins study are survey results assessing quality of life and quality of sleep, which showed that people with stiffened lungs and sleep problems have 40 percent lower scores in physical activities compared to the general U.S. population. Rated activities included basic tasks, such as going to the mailbox and walking to the car. Mental and social activities, such as carrying on a conversation with a store clerk or telephoning friends and family, were reduced 48 percent.

Sleep quality was assessed on a scale comprising 36 different sleep measurements, such as the length of time it took to fall asleep and overall time spent sleeping.

Moreover, the team’s analysis showed that sleep problems could not be predicted by other demographic factors, such as age, gender, race or weight. Nor were they linked, researchers say, with other lung function and more noticeable disease symptoms, including shortness of breath and cough.

“Because there is so much about pulmonary fibrosis that we cannot yet fix, we need to focus on what we can fix while we wait for research to catch up with treatments that can prevent or reverse the disease,” says Danoff.

Current treatments for pulmonary fibrosis are limited to steroids and other immune-system-lowering drugs that help slow down lung tissue deterioration as the thin walls of the air sacs stiffen and lose capacity to freely expand and contract.

More than 200,000 Americans suffer from pulmonary fibrosis, whose cause remains unknown. And the lung disease kills nearly 40,000 each year.

“If we had been able to treat Lisa Spaeth’s fatigue from poor quality sleep, then she might have had more time to lead her life as fully as she had been prior to getting sick,” says Danoff.

Despite Spaeth’s death, her zest for life carries on. Her mother, Froma Sandler, maintains the business. And through the encouragement of family and friends, more than a thousand people have donated to medical research in Spaeth’s honor. The largest-ever contributions arrived in May, just prior to the first anniversary of Spaeth’s death, when the Maryland-based Robert M. Fisher Memorial Foundation pledged $2 million to Johns Hopkins to help fund Danoff’s future studies into pulmonary disease.

“This research funding will lay the groundwork for a more consolidated and comprehensive look at the many factors that may improve and extend the lives of patients with pulmonary fibrosis: from rehabilitation of the lungs to the development and testing of new medications to offset losses in quality of life from fatigue,” says Danoff.

Danoff plans to use some of the funding to support studies that monitor patients with pulmonary fibrosis for problems in sleep patterns, especially in deep-sleep R.E.M. patterns, to target for treatment.

Another phase of research, she says, involves testing new devices to support breathing during sleep and to see if these devices improve quality sleep time and abate fatigue.

Funding for this latest study was provided by a fellowship grant from the CHEST Foundation, the philanthropic arm of the American College of Chest Physicians, which also publishes the journal Chest, and by The Johns Hopkins Hospital’s General Clinical Research Center.

In addition to Danoff, other Hopkins researchers involved in these studies, conducted solely in Balimore, were Vidya Krishnan, M.D.; Meredith McCormack, M.D., M.H.S.; Stephen Mathai, M.D., M.H.S.; Maureen Horton, M.D.; and Nancy Collop, M.D. Additional assistance was provided by Shikhar Agarwal, M.D., from the Johns Hopkins University’s Bloomberg School of Public Health; Brittany Richardson, from the University of Maryland; and Albert Polito, M.D., from Mercy Medical Center.

For additional information, go to:
http://www.hopkinsmedicine.org/pulmonary/clinics/interstitial_lung_disease.html
http://www.chestjournal.org/

Johns Hopkins Medicine