Passive Smoking Among Children with Chronic Respiratory Disease

The purpose of this study was to determine the prevalence and source of passive smoke exposure among children with chronic respiratory diseases and compare these to both a well child and nonrespiratory chronic illness child population. Rates and source of passive smoke exposure were compared among four child groups: asthma, cystic fibrosis, rheumatoid arthritis, and well children using a questionnaire mailed to the parents of the selected children. Twenty percent of respondents reported current smoking with a significantly higher rate among the cystic fibrosis and rheumatoid arthritis groups. One-third of all children surveyed were exposed to passive smoke at home and/or day care on a daily basis. Over 80% of the asthma and cystic fibrosis respondents reported a change in smoking behavior (i.e., smoking outside the home or smoking fewer cigarettes) after the diagnosis of their child's illness as compared with only 40% of the nonrespiratory groups. Health care providers need to inquire about potential sources of passive smoke exposure in their patients, particularly children with chronic respiratory disease.     

戒烟与慢性阻塞性肺疾病

世界卫生组织统计表明,在冠心病、脑卒中和其他心脑血管疾病的病死率都已出现下降的今天,慢性阻塞性肺病（chronic obstructive pulmonary disease,COPD）的病死嘛却仍在增加,1990年名列第六,但现已跃居第四,预计2020年将上升至第三位。据统计,国内COPD患者人数约为4300万,其中吸烟者患病率（13．29／5）远高于不吸烟者（5．2％）,     

Smoking Is Underrecognized as a Risk Factor for Chronic Pancreatitis

Background/Aims: Smoking is an established risk factor for chronic pancreatitis (CP). We sought to identify how often and in which CP patients physicians consider smoking to be a risk factor. Methods: We analyzed data on CP patients and controls prospectively enrolled from 19 US centers in the North American Pancreatitis Study-2. We noted each subject's self-reported smoking status and quantified the amount and duration of smoking. We noted whether the enrolling physician (gastroenterologist with specific interest in pancreatology) classified alcohol as the etiology for CP and selected smoking as a risk factor. Results: Among 382/535 (71.4%) CP patients who were self-reported ever smokers, physicians cited smoking as a risk factor in only 173/382 (45.3%). Physicians cited smoking as a risk factor more often among current smokers, when classifying alcohol as CP etiology, and with higher amount and duration of smoking. We observed a wide variability in physician decision to cite smoking as a risk factor. Multivariable regression analysis however confirmed that the association of CP with smoking was independent of physician decision to cite smoking as a risk factor. Conclusions: Physicians often underrecognize smoking as a CP riskfactor. Efforts are needed to raise awareness of the association between smoking and CP.     

Alcoholism/Addiction as a Chronic Disease

Summary

Although characterized as a chronic disease for more than 200 years, severe and persistent alcohol and other drug (AOD) problems have been treated primarily in self-contained, acute episodes of care. Recent calls for a shift from this acute treatment model to a sustained recovery management model will require rethinking the natural history of AOD disorders; pioneering new treatment and recovery support technologies; restructuring the funding of treatment services; redefining the service relationship; and altering methods of service evaluation. Recovery-oriented systems of care could offer many advantages over the current model of serial episodes of acute care, but such systems will bring with them new pitfalls in the personal and cultural management of alcohol and other drug problems.     

Chronic Kidney Disease as a Coronary Heart Disease Risk Equivalent

Tailoring therapeutic targets to patients’ risk is a fundamental principle of many coronary heart disease (CHD) treatment guidelines. Although the National Cholesterol Education Program’s guidelines do not include chronic kidney disease (CKD) as a CHD risk equivalent, the National Kidney Foundation and American Heart Association have recommended its inclusion in the highest-risk grouping for the prevention and treatment of cardiovascular disease. In three population-based studies, the risk of cardiovascular disease was higher among participants with established CHD when compared to their counterparts with CKD. Although there are other reasons for including CKD as a CHD risk equivalent in treatment guidelines (eg, higher case fatality rates from CHD and stroke), the inclusion of CKD as a CHD risk equivalent has treatment implications for a large number of US adults. Randomized trials assessing the benefits and drawbacks of aggressive CHD risk reduction among patients with CKD are needed.     

Chronic Kidney Disease as a Coronary Artery Disease Risk Equivalent

Chronic kidney disease (CKD) is associated with accelerated cardiovascular disease (CVD) risk and a higher CVD event rate. Substantial data from prospective cohort studies support the concept that dialysis patients as well as those with advanced stage (stages 3–5) CKD are associated with an increased risk for all-cause and cardiovascular mortality. The risk for coronary artery disease (CAD) increases exponentially with declining kidney function, i.e., stage 3 or higher CKD. Indeed, CVD accounts for more than 50 % of deaths in patients with CKD. CKD patients are more likely to die of CVD than to progress to end stage kidney disease. This increase in CV risk is commonly attributed to co-existence of numerous traditional and nontraditional risk factors for the development of CVD that frequently accompany reduced kidney function. Therefore, CKD itself is now considered an independent CVD risk factor and a coronary artery disease (CAD) equivalent for all-cause mortality. All patients at risk for CAD should be evaluated for kidney disease. Treatments used for management of established CAD might have similar benefits for patients with concomitant CKD.     

Peyronie's Disease as a Complication of Chronic Graft versus Host Disease

Apart from one report of phimosis, involvement of the penis has not been reported as a complication of chronic GVHD. We report a patient with recurrent chronic GVHD who developed skin discoloration of the penile shaft, together with erectile dysfunction consistent with Peyronie's disease. Histological features were consistent with sclerodermatous change. These features suggest that the penis may be a target organ in chronic GVHD.     

Symmetric Dimethylarginine as a Proinflammatory Agent in Chronic Kidney Disease

Summary

Background & objectives

Chronic kidney disease (CKD) is characterized by chronic inflammation, considered a nontraditional risk factor for cardiovascular disease, the major cause of death in CKD. Symmetric dimethylarginine (SDMA) was recently demonstrated to induce reactive oxygen species in monocytes. The present study further investigates the inflammatory character of SDMA compared with its structural counterpart asymmetric dimethylarginine (ADMA).

Design, setting, participants, & measurements

In vitro, the effect of SDMA on intracellular monocytic expression of IL-6 and TNF-α was studied followed by an evaluation of nuclear factor (NF)–κB activation. Additionally, an association of SDMA with inflammatory parameters in consecutive stages of CKD was evaluated in vivo.

Results

Monocytes incubated with SDMA showed increased IL-6 and TNF-α expression and a rise in active NF-κB. N-acetylcysteine abrogated both these effects. No significant effects were observed with ADMA. In vivo, 142 patients (67 ± 12 years) at different stages of CKD showed an inverse association between serum SDMA and ADMA and renal function. Correlations between SDMA and IL-6, TNF-α, and albumin were more significant than for ADMA, while multiple regression analysis only retained TNF-α at a high significance for SDMA (P < 0.0001). In receiver operating characteristic analysis for inflammation, defined as an IL-6 level above 2.97 pg/ml (median), the discriminative power of SDMA (area under the curve [AUC]: 0.69 ± 0.05) directly followed that of C-reactive protein (AUC: 0.82 ± 0.04) and albumin (AUC: 0.72 ± 0.05; for all, P < 0.0001) and preceded that of ADMA (P = 0.002).

Conclusions

The present study shows that SDMA is involved in the inflammatory process of CKD, activating NF-κB and resulting in enhanced expression of IL-6 and TNF-α, which is corroborated by the clinical data pointing to an in vivo association of SDMA with inflammatory markers in CKD at different stages.     

Associations of Self-Reported Cigarette Smoking with Chronic Obstructive Pulmonary Disease and Co-Morbid Chronic Conditions in the United States

Background: The question of how smoking, COPD, and other chronic diseases are related remains unresolved. Therefore, we examined relationships between smoking, COPD, and 10 other chronic diseases and assessed the prevalence of co-morbid chronic conditions among people with COPD.

Methods: We analyzed cross-sectional data from 405,856 US adults aged 18 years or older in the 2011 Behavioral Risk Factor Surveillance System. We used log-linear regression to estimate prevalence ratios (PRs) and their corresponding 95% confidence intervals (CIs) for these relationships adjusting for age, gender, race/ethnicity, marital status, educational attainment, annual household income, and health insurance coverage.

Results: Overall, 17.5% reported being current cigarette smokers, 6.9% reported having COPD, and 71.2% reported another chronic condition. After age-adjustment, prevalence of COPD was 14.1% (adjusted PR = 3.9; 95% CI: 3.7, 4.1) among current smokers and 7.1% (adjusted PR = 2.5; 95% CI: 2.4, 2.7) among former smokers compared to 2.9% among never smokers. The most common chronic conditions among current smokers after age-adjustment were high cholesterol (36.7%), high blood pressure (34.6%), arthritis (29.4%), depression (27.4%), and asthma (16.9%). In separate multivariable models, smoking and COPD were associated with each of the 10 other chronic conditions (p < 0.05), which also included cancer, coronary heart disease, diabetes, kidney disease, and stroke; COPD modified associations between smoking and co-morbidities, while smoking did not modify associations between COPD and co-morbidities. Conclusions: Our findings confirm previous evidence and highlight the continuing importance of comprehensive care coordination for people with COPD and co-morbid chronic conditions and also tobacco prevention and control strategies.     

Surfactant Protein D as a Biomarker for Chronic Obstructive Pulmonary Disease

Abstract

Clinical research in chronic obstructive pulmonary disease (COPD) has been hampered by the lack of validated blood biomarkers. The ideal COPD biomarker would have the following characteristics: (1) it would be a lung specific protein that could be assayed in blood; (2) it would change with disease severity or during exacerbations; (3) it would be specific for COPD; and would be responsive to change with effective treatments. One such candidate is the lung specific protein surfactant protein D (SP-D). In this review, we discuss the evidence supporting SP-D as a COPD biomarker.     

Alcohol and Smoking as Risk Factors in Chronic Pancreatitis and Pancreatic Cancer

The aim of this study was to compare alcohol andsmoking as risk factors in the development of chronicpancreatitis and pancreatic cancer. We considered onlymale subjects: (1) 630 patients with chronic pancreatitis who developed 12 pancreatic and 47extrapancreatic cancers; (2) 69 patients withhistologically well documented pancreatic cancer and noclinical history of chronic pancreatitis; and (3) 700 random controls taken from the Verona pollinglist and submitted to a complete medical check-up.Chronic pancreatitis subjects drink more than controlsubjects and more than subjects with pancreatic cancer without chronic pancreatitis (P < 0.001).The percentage of smokers in the group with chronicpancreatitis is significantly higher than that in thecontrol group [odds ratio (OR) 17.3; 95% CI 12.6-23.8; P < 0.001] and in the group with pancreaticcarcinomas but with no history of chronic pancreatitis(OR 5.3; 95% CI 3.0-9.4; P < 0.001). In conclusion,our study shows that: (1) the risk of chronic pancreatitis correlates both with alcoholintake and with cigarette smoking with a trendindicating that the risk increases with increasedalcohol intake and cigarette consumption; (2) alcoholand smoking are statistically independent risk factors forchronic pancreatitis; and (3) the risk of pancreaticcancer correlates positively with cigarette smoking butnot with drinking.     

尼古丁药贴对慢性阻塞性肺疾病和肺心病患者的戒烟效果

目的:了解尼古丁药贴对慢性阻塞性肺疾病与肺心病患者的戒烟效果.方法:将412位吸烟者随机分为3组:尼古丁药贴组(药贴组)138人,卫生宣教组(宣教组)135人及对照组139人.药贴组按处方用药,12周;宣教组每2周访视1次,宣传、规劝戒烟,12周;对照组不予干预.结果:12周戒烟率药贴组、宣教组及对照组分别为60.9%、8.9%和5.8%,6个月后的戒烟率分别为40.6%、11.1%和5.8%.药贴组12周及6个月戒烟率均明显好于宣教组和对照组,差异均有统计学意义(P＜0.001).药贴组中有23人因不能坚持戒烟而退出;19人有皮肤过敏、恶心、呕吐等反应,其中6人仍达到了即刻戒烟.结论:尼古丁药贴是帮助烟民戒烟的有效方法,而宣传教育是基础,也有一定的戒烟效果.     

Smoking status as a vital sign

OBJECTIVE: We conducted this study to determine if a smoking status stamp would prompt physicians to increase the number of times they ask, advise, assist, and arrange follow-up for African-American patients about smoking-related issues. DESIGN: An intervention study with a posttest assessment (after the physician visit) conducted over four 1-month blocks. The control period was the first 2 weeks of each month, while the following 2 weeks served as the intervention period. SETTING: An adult walk-in clinic in a large inner-city hospital. PARTICIPANTS: We consecutively enrolled into the study 2,595 African-American patients (1,229 intervention and 1, 366 control subjects) seen by a housestaff physician. INTERVENTIONS: A smoking status stamp placed on clinic charts during the intervention period. MAIN RESULTS: Forty-five housestaff rotated through the clinic in 1-month blocks. In univariate analyses, patients were significantly more likely to be asked by their physicians if they smoke cigarettes during the intervention compared with the control period, 78.4% versus 45.6% (odds ratio [OR] 4.28; 95% confidence interval [CI] 3.58, 5.10). Patients were also more likely to be told by their physician to quit, 39.9% versus 26.9% (OR 1.81; 95% CI 1.36, 2.40), and have follow-up arranged, 12.3% versus 6.2% (OR 2.16; 95% CI 1.30, 3.38). CONCLUSIONS: The stamp had a significant effect on increasing rates of asking about cigarette smoking, telling patients to quit, and arranging follow-up for smoking cessation. However, the stamp did not improve the low rate at which physicians offered patients specific advice on how to quit or in setting a quit date.     

Cigarette Smoking in Crohn''s Disease

Crohn's disease is a chronic disease of unknown etiology. Previous reports have suggested that cigarette smoking may be associated with the development of Crohn's disease. To examine this association, we conducted a case-control study of patients referred to a single practice over a 7-month period. The cigarette-smoking habits of 115 patients with Crohn's disease were compared with the cigarette-smoking exposure of 109 patients with the irritable bowel syndrome. Patients with Crohn's disease were more likely to smoke at the time of symptom onset than were irritable bowel syndrome controls (age and sex adjusted odds ratio 3.71, 95% confidence interval 1.93-7.13). After the diagnosis of Crohn's disease, patients were less likely to quit smoking (odds ratio 0.35, 95% confidence interval 0.18-0.69) than controls. This study demonstrates an association and a temporal relationship between cigarette smoking and Crohn's disease. For the exposure to be considered an etiologic factor for disease, biologic plausibility and pathophysiologic mechanisms require elucidation.     

Morning Blood Pressure Surge as a Predictor of Development of Chronic Kidney Disease

Blood pressure (BP) usually increases upon awakening––a physiological mechanism called morning BP surge (MBPS). BP values above the MBPS threshold are associated with target organ damage, including left ventricular hypertrophy and proteinuria. Despite these data, there have been no studies that have investigated the association between elevated MBPS and the development of incident chronic kidney disease (CKD). In this study, patients with essential hypertension were included and underwent ambulatory BP measurements and MBPS. Patients were followed for a median of 3.33 years. In total, 622 patients were enrolled. The mean age of patients was 57.6±12.4 years, 54.0% were men, 16.7% had diabetes, and 10.6% had prevalent cardiovascular disease. During follow‐up, 32 patients developed CKD. Higher MBPS, analyzed both as continuous and categorical variables, was associated with incident CKD in all models. Elevated MBPS is associated with kidney function deterioration and the development of CKD. Studies are needed to further examine underlying mechanisms regarding MBPS and these renal outcomes.