Category Archives: Smoking cessation

Mentally Quitting Smoking

Good health habits can only be achieved by our mental outlook on exercise, healthy diet, smoking cessation. Here’s where going to the doctor for a “pill” doesn’t work very well. BTW, do you know why most people have difficulty exercising? Because it hurts! (more on that later)

123MyMD

Teenager_Smoking_1031429

There is no doubt that it is tough to kick the habit when it comes to cigarette smoking. If you ask 100 people how they stopped, the odds are quite strong you will get 100 different answers. But there is usually one consistent comment that comes across. It goes something like this. ‘I was so frustrated with smoking that I finally said, ‘The heck with it. I’m quitting.” It is clear that to finally stop smoking, a person needs to take a mental order to do it. It doesn’t matter whether it’s the latest drugs, acupuncture, or whatever. You have to want to.

 

For more information, please go to www.123MyMD.com.   

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eCigarettes: A Smoking Gun?

Isn’t this just replacing one addition with another?

Relief for your Nose

This week’s announcement that CVS pharmacies will stop selling cigarettes is welcome news to us. Aside from undisputed concerns about smoking leading to death and disease, our resident allergy and sinus expert often lectures patients about the allergic reactions smokers and their nearby victims can experience.

smoking, asthma, allergies, vapor, The chemicals and noxious particles from smoking cigarettes causes inflammation and swelling of nasal passages resulting in sneezing, itchy sinuses, and runny, stuffy noses. For people with asthma, these allergic reactions can lead to more serious symptoms.

Some smokers trying to avoid the potential for disease may resort to the newly popular electronic cigarettes which purport to have fewer amounts of nicotine and chemicals among other benefits. The eCigarettes are battery operated and emit a vapor so the user simulates smoking.

But the Food and Drug Association is not so quick to sign off on this alternative, citing a need for more research. Because…

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Run training with copd

Respiratory illness doesn’t slow him down! Good example for all of us.

COPD ATHLETE

With 10 weeks to go its time to crank up our run training, while most people training for Melbourne Ironman would probably be well on the way to having their run sorted we have only been running 1-2 times a week. Main reason for this is that at best my run is 8 kph , my low lung capacity doesn’t allow me to go any quicker, which means a long time on the run course. It took me 6hrs 34 mins to complete the run leg at Port Macquarie in 2012, my aim for Melbourne is 6hrs. I find running the hardest leg for two reasons, the physical side for obvious reasons, I also struggle mentally because I’m so slow, watching people walk faster than I run is a little deflating sometimes . I am however, grateful that I am well enough to train & compete in triathlons no matter…

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Electronic Cigarettes: Nicotine Comes Around Again

Are we trading one addiction for another?

More@MedLetter

The next issue of The Medical Letter includes an article on electronic cigarettes, which have lately received considerable space in the popular press. With LED bulbs at their tips and flavors like chocolate, it becomes easy to forget that what they bring to the table is nicotine, which has caused a lot of trouble in its day.

Researching our article led us to an excellent old (1998) book called Nicotine Safety and Toxicity, edited by Neal L. Benowitz, which does a fine job of teasing out the toxicity of nicotine, particularly its cardiovascular toxicity, from that of all the other toxins found in cigarette smoke. The increased incidence of cardiovascular disease in smokers, including myocardial infarction, stroke, and peripheral vascular disease, is well documented, but the exact cause is unclear.

Benowitz points out that carbon monoxide and oxidant gases are plausible contributors, in addition to nicotine. But he goes on…

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Graphic cigarette labeling ruled illegal–what do you think?

Because smoking has such an impact on respiratory health, I’m always interested in your feedback on articles that appear in USA Today on health.  What do you think about graphic advertising discouraging the use of cigarettes?

Too graphic?

Should scare people more?

It really doesn’t change behavior?

The full article is listed here:  gory details

Don’t light up! Is This Your New Year’s Resolution?

This is a New Year’s resolution you love to hate.  Success rates for smokers may not look all that great, but you triple your chances of being a “quitter” if you use medications combined with counseling.  This article has lots of quotes that I left as is. 

Despite the known dangers of smoking, about 20 percent of Americans still light up, but almost 70 percent want to quit, a new government report shows.

“This study is reassuring to us,” Dr. Tim McAfee, director of the Office on Smoking and Health at the U.S. Centers for Disease Control and Prevention.
 
There was a concern that there was a group of smokers who would remain smokers and not be interested in quitting, but, “in fact, what this study shows is quite the opposite,” McAfee said.

The percentage of smokers appears to hover around 20 percent as people take up the habit, he said. “But there has been a decline in the last five years in the rate of smoking, and smokers are actually smoking less,” he added.

“Perhaps the most dangerous situation we are in is we have seen over the past five years a flattening of the downward trend in youth initiation. We are very worried that there are a number of things that have been happening in terms of tobacco industry marketing techniques that affect youth,” McAfee said.

The report was published in the Nov. 11 issue of the CDC‘s Morbidity and Mortality Weekly Report.

According to the report, 68.8 percent of current smokers say they want to quit and 52.4 percent tried to quit during the past year.

In addition, 48.3 percent of smokers who saw their doctor in the past year say they got advice to quit. Moreover, 31.7 percent had counseling alone or with drugs to help them quit in the past year. And about 6 percent quit successfully in the past year. 

McAfee noted that most smokers who manage to quit do so without the help of drugs or counseling. “About 20 percent of people take medication or sign up for counseling,” he said.

Other factors that are equated with quitting are education, where 11 percent of those with a college degree were able to quit, compared with 3 percent of those who did not graduate from high school, McAfee said.

In addition, blacks had the highest interest in quitting and the highest quit attempt rate than any other group, but blacks also had the lowest rate of successful quitting, McAfee said. Blacks were also less likely to use medication or counseling, he noted.

In addition, blacks were more likely to smoke menthol cigarettes, which decreases the rate of quitting, McAfee said.

If you can’t quit by yourself, the best way to quit is with a combination of counseling and drugs like Zyban, Chantix or other nicotine replacement therapy, the CDC report said.

“Smokers who try to quit can double or triple their chances by getting counseling, medicine or both,” CDC director Dr. Thomas R. Frieden said in a statement.

The CDC is releasing the report as part of the annual Great American Smokeout on Nov. 17. The event is sponsored by the American Cancer Society, and encourages smokers to make a plan to quit, or quit smoking that day.

The report also notes that the growth of smoke-free workplaces and public places offer smokers another incentive to quit.

Smoking is still the leading preventable cause of death and disease, including cancer, chronic obstructive pulmonary disease and other lung diseases. Each year in the United States, smoking and exposure to secondhand smoke kill some 443,000 people, the report noted.

In addition, for every smoking-related death there are 20 people living with a smoking-related disease, the agency said.

Vince Willmore, vice president of the Campaign for Tobacco-Free Kids, said that “the CDC report confirms that most smokers want to quit, but too many don’t get the help they need to succeed.”

“To help more smokers quit, it is critical that all private and government health plans provide affordable and accessible coverage for smoking-cessation medication and counseling, and that states use more of their tobacco revenues to properly fund tobacco prevention and cessation programs,” he said.

States must also continue to enact policies that encourage quitting, including higher tobacco taxes and smoke-free air laws, Willmore said.

In a related move, the U.S. Food and Drug Administration said Thursday that most of the warning letters it recently sent to more than 1,200 tobacco retailers were about illegal sales of cigarettes and smokeless tobacco products to minors.

FDA inspections of tobacco retailers found that most are in compliance with the law, but some still sell tobacco products to youngsters. Retailers who continue to violate the law could face fines.

“It should worry every parent that 20 percent of U.S. high school students smoke cigarettes,” FDA Commissioner Margaret A. Hamburg said in an agency news release.

“For many young people, that first cigarette or use of smokeless tobacco will lead to a lifetime of addiction, and for many, serious disease,” she said. “More than 80 percent of adult smokers begin smoking before 18 years of age. Retailers are vital partners in the FDA’s efforts to prevent tobacco use among kids.”

With all this bad news, is there anything that can be done?  Oklahoma State University is now a smoke-free campus since 2008–way to go Pokes! 

The More Ya Know, the Less Ya Know!

I have just returned from the Annual Meeting of the American College of Allergy, Asthma, and Immunology held in Boston from Nov 3-8.  Sure the meeting was good, but the food was even better.  Consider the oldest “active” restaurant in America, Union Oyster House–the stew was delightful and if you’re bored with allergies, peruse the menu on-line and dream of dining with JFK (he has a booth in his name there). 

On to what’s new in allergy & asthma….

My, how things have changed!

Environmental Tobacco Smoke

Smoking bans in Tulsa have stirred some vigorous debate this year (see link).  Most importantly, do they work? Information presented last week would suggest a resounding YES!  In the U.S. more than 200,000 asthma admissions per year are attributed to Environmental Tobacco Smoke (ETS). Smoking bans can prevent this complication!  The Scottish health system has the database to measure the effects of a community-wide smoking ban and their intervention was associated with an 18% reduction in hospital admissions for asthma (NEJM 2010). Wow

If you have to smoke inside, HEPA filters reduced asthma visits in 6-12-year-old children by 18%.

VCD–Vocal Cord Dysfunction

I have a post on this blog describing VCD or paradoxical vocal cord motion.  Our terminology is now changing and instead of VCD, I like the term” irritable larnyx syndrome (WILS).”  The vocal cords are “housed” in the larynx and many structures and muscles have to work correctly in order for the vocal cords to allow air in and out of the lungs. This implies that multiple triggers will cause an attack and patients with difficult asthma may have a laryngeal dysfunction not just VCD. If you don’t believe me, look at this study.  World-wide recognition (AJRCCM, a study from Australia).

Tiotropium–alias Spiriva

Way too many choices in the treatment of asthma!  Why would you consider Tiotropium or Spiriva for asthma?

Picture says 1,000 words!

1.  Tiotropium works as step-up therapy in adult asthma.  Some patients just can’t tolerate albuterol or Xopenex™ because of tremor and other side effects.  Now you have an alternative: There were similar improvements in lung function and symptom-free days with Spiriva as adding long acting bronchodilator (NEJM 2011).

2.  Tiotropium does fit into the Asthma Guidelines (2007) and works better than increasing the dose of inhaled steroids (yea, less steroids) and is equal to salmeterol (Serevent).

3.  This report is from England, so BEWARE!  The Respimat inhaler isn’t used in the United States and should you read about this study, it doesn’t apply to patients in the US.  (Recent BMJ meta-analysis showed increased cardiovascular mortality with that formulation in COPD) (BMJ, 2011).Anti IL-13 (lebrikuzumab)–Did you say leprechaun?

There is one take home message with the use of lebrikuzumab:

1.  Personalized medicine is here!  In this study, patients that improved with anti IL-13 also had elevated levels of periostin in blood tests. Periostin is a marker of airway remodelling and gives us a clue as to why and how IL-13 contributes to asthma.  Lebrikizumab improved FEV1, but there was no improvement in symptoms or medication use (NEJM 2011).

Antibiotics

This comes from the literature review at the College meeting—1 of every 6 children with asthma seen the ED are prescribed antibiotics. Don’t you think this is high for a “practice” that is supposed to be very selective in who gets antibiotics?  Generally, antibiotics are not helpful in asthma anyway. More than 2 courses of antibiotics for cough in a 6-month time frame should warrant consideration of asthma as a cause (Pediatrics, 2011).

Mold allergy

In a study in Arizona, Fernandez et al. showed skin testing to Alternaria to be surprisingly accurate.  Ninety-six percent of patients with a positive skin test to this mold had a positive bronchial provocation test with Alternaria. In Arizona, Alternaria has surpassed dust mite as number one allergen in asthma (due to dry climate).  I wonder what results would be in Oklahoma?  Here’s what alternaria looks like: 

Alternaria under a microscope
Alternaria in real life

Immunotherapy

Come on now, do allergy shots REALLY work? Shots with dust mite allowed for inhaled steroid reduction by 50% in children with asthma vs. 30% in controls. Not bad! Do I have to take my medication with shots? Adding dust mite shots to pharmacologic treatment was an effective and safe strategy to reduce corticosteroid doses while maintaining disease control in children with mite-induced allergic asthma (JACI 2011).

Asthma

Which inhaled steroid to use?  Does it matter?  QVAR™ & Alvesco™ have said for quite some time that small particles penetrate the airways of an asthmatic better than the competition.  They may be right– small particle size inhaled steroids may allow for equal efficacy (benefit) with 1/2 to 1/3 the dose of a larger size of same steroid. Marketing isn’t bad, sometimes it’s just delayed results.

SABA update: Levalbuterol (Xopenex™) may not have any real-life advantages over albuterol. Even in the Xopenex™ package insert, there is  mention that there was no difference in heart rate or tremor.  In patients who swear by Xopenex™, there’s no reason to change, just start out with cheaper albuterol. 

Antihistamines for asthma?

Many patients take antihistamines every day like vitamins.  They feel better if an antihistamine is “on-board.”  Once again, learn from your patient….they will often give you clues to what medications work.  Symptom scores in asthma patients show comparable improvement when given desloratadine (antihistamine) compared to montelukast. Use of antihistamine may prevent the development of asthma in some predisposed children.  Well I’ll be….

Grandpa can’t breathe!

Asthma in the elderly

The majority of asthma deaths are in patients older than 65.

Asthma in adults/elderly is still predominantly an atopic disease. This means, it’s still due to allergy.  Don’t forget to test your older population.  In a University of Michigan study, 77% of adult asthma patients were skin test positive.

Depression is definitely underdiagnosed in our loved ones who have retired (ie, grandma & grandpa).  Why? They should have a carefree life during retirement, but they don’t. Depression is a significant factor for poor asthma quality of life in the elderly. You are 10x more likely to suffer from psychological dysfunction if you have more than 3 exacerbation of asthma in a single year. 

Just goes to show you that allergic respiratory disease is a very complicated condition and every year I’m challenged with new treatments!  I can’t ask for anything more.