Vaccine, drug in development
By Carey Goldberg, Globe Staff  |  June 26, 2006

http://www.boston.com/news/local/articles/2006/06/26/nicotine_fight_aims_at_brain_receptors/?page=full

Smokers are about to get some radically different methods to help them quit, based in large part on scientists' progress in attacking nicotine addiction where it happens: in the smoker's brain.

Last week, patients in a clinical trial at Massachusetts General Hospital received their first doses of an experimental vaccine that keeps most nicotine from entering the brain. By late summer, Pfizer expects to begin selling a new pill that partially blocks a receptor -- a type of on-off switch -- in the brain that seems to be the central culprit in smoking addiction.

Also on its way, researchers say, is an experimental drug that targets receptors first discovered in research on marijuana and the ``munchies." By damping down areas of the brain involved in craving, this drug may help smokers quit without gaining much weight, initial studies suggest.

For the first time in 10 years, ``we have completely new approaches for smoking cessation," and there is hope that the new drugs, because they better target the brain's addiction response, could prove more effective than current treatments," said Dr. Nancy Rigotti, director of Mass. General's Tobacco Research and Treatment Center. She cautioned, though, that none of the new treatments ``is a magic bullet."

New tools to help quit smoking are desperately needed, federal health authorities say. Among the 44 million Americans who smoke, about 70 percent would like to quit and 40 percent really try. But in a given year, fewer than 5 percent of would-be quitters actually succeed, a National Institutes of Health panel said last week.

Current drug treatments are moderately effective, on average doubling the success rate of smokers trying to quit compared with those who attempt to break their addiction without any pharmaceutical assistance, said Rigotti.

The arsenal for quitters includes various types of counseling, nicotine replacement in forms ranging from patches to lozenges to inhalers, and Zyban, an antidepressant found to help smokers kick the habit.

None of these has helped Tim Campbell, 44, of Ipswich. Despite endless urging from his wife and six children, and a half-dozen attempts to quit that have included Zyban, nicotine gum, the patch, and hypnosis, he just cannot beat his pack-a-day habit. In 30 years of smoking, the longest he has ever stayed away from cigarettes was about a month. Cigarettes are the first thing on his mind every morning; he smoked even during a cancer walk with his sister.

``I do want to quit, but I can't," Campbell said.

With the rate of relapse still so abysmal, researchers have been struggling to develop radically new approaches.

In the field, ``Vaccine therapy is really the newest kid on the block," said Dr. Victor Reus, a professor of psychiatry at the University of California at San Francisco, who is overseeing a small clinical trial of the ``NicVax" vaccine like the one at Mass. General. Scientists have been trying for a generation to try to harness the body's immune system to fight addiction, but those efforts are only now beginning to pay off, with at least three companies developing anti-nicotine vaccines.

Reus said drugs of abuse -- such as nicotine or cocaine -- are made of small molecules that easily slip across the ``blood-brain barrier," which is essentially a filter meant to protect the brain from potentially damaging substances. With the vaccine, patients develop antibodies to nicotine, so that when they smoke, the antibodies attach to the nicotine and make the resulting molecule too big to pass into the brain. The result: Smoking stops being pleasurable.

The vaccine is still highly experimental, Reus emphasized, given to only 150 or 200 people nationwide so far, and the current set of clinical trials at nine sites around the country is still trying to determine basic questions like the size of the optimal dose and the best number of injections.

But initial studies showed promise, he said, and there's ``a lot of interest, not just for nicotine vaccines but for cocaine and methamphetamine vaccines, which are also being investigated right now."

There is certainly interest among smokers. Rigotti and Reus both said that as soon as they put out word that their clinical trials were starting, they were swamped with hundreds of would-be patients for the two-dozen spots. Rigotti said she is still seeking patients with vascular disease for a safety trial of another smoking-cessation drug, the new Pfizer pill called Chantix.

Chantix, which received US Food and Drug Administration's approval last month, stems from decades of research into how addictive drugs act inside the brain.

With time, it became ever clearer that a particular receptor in the brain with the cumbersome name of the ``alpha-four-beta-two nicotinic receptor subtype," was absolutely central to nicotine addiction, to the point that mice engineered to lack it cannot become addicted. When the receptor was restored in experiments, the mice returned to normal levels of addiction.

A number of experimental drugs now target this receptor, said Dr. Marina Picciotto, a Yale associate professor of psychiatry involved in scientific work on the receptor but not in the drug's development.

Based on the research, she said, companies decided, ``Let's try to tweak it [the receptor] in a way that will allow us to get smokers to have some stimulation of that receptor without having the addiction." With that limited stimulation, the thinking goes, smokers would not go through withdrawal.

Chantix, the drug Pfizer developed, might be compared to a 40-watt bulb that replaces the flickering 100-watt bulb that is nicotine, said Jotham W. Coe, Pfizer's main inventor of the drug or, as he puts it, the chief ``molecular carpenter and architect."

Nicotine, like other drugs, causes a sudden surge of dopamine, a brain chemical associated with pleasure and reward, but the surge quickly gives way to plummeting dopamine levels, which makes smokers feel bad and crave another cigarette. ``Chantix is like a 40-watt bulb that stays on all the time," he said. ``Chantix really is a shield from the vicious cycle of nicotine addiction."

In initial studies, one in five smokers who used Chantix for 12 weeks remained tobacco-free after one year, Pfizer says.

The drug has been approved for up to six months, and its main side effect is mild nausea, Rigotti said. Yet another drug worth watching, she said, is Rimonabant, which was developed to fight obesity but is also being tested for smoking cessation. Its maker, Sanofi-Aventis, has applied to the FDA for approval, for both obesity and smoking. The drug's brand name would be Acomplia.

Research into how marijuana works in the brain yielded discovery of the ``endocannabinoid system," which appears to be involved with feelings of reward and satiety, Rigotti said. Rimonabant acts to block that system, and in initial reports of its results, one of its great appeals is that the people who use it to stop smoking tend to gain very little weight, she said.

Still more research is being done. Dr. Nora Volkow, director of the National Institute on Drug Abuse, predicts that within five years, enough will be known about the genetics of addiction that it will be possible to test children and determine which are at particular genetic risk of becoming addicted to cigarettes or other drugs. Then -- and this is speculation at this point -- the question could arise of whether such children should be vaccinated against nicotine, or whether some other method might prevent them from getting hooked.

Ultimately, researchers said, it seems likely that smokers who want to quit will be offered a menu of various aids, from nicotine replacement to stop the withdrawal symptoms to -- perhaps -- the vaccine to prevent relapse and other drugs to stem cravings.

Carey Goldberg can be reached at goldberg@globe.com.

© Copyright 2006 Globe Newspaper Company.

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New Kind Of Drug Could Increase Number Who Quit Smoking

http://www.sciencedaily.com/releases/2006/05/060503100419.htm

Source: Blackwell Publishing Ltd.

Posted: May 3, 2006

Smokers who try to quit using existing medications, such as nicotine patches or Zyban, are about twice as likely to succeed as those who don't use medication or are prescribed placebos during clinical trials.

But despite the relative effectiveness of medications currently on the market, more than 80 per cent of quitters will be smoking again within a year, according to a review in the latest IJCP, the UK-based International Journal of Clinical Practice.

A new kind of drug has now been developed that could improve long-term quit rates, according to Dr Jonathan Foulds from the Tobacco Dependence Program at the University of Medicine and Dentistry of New Jersey.

Varenicline is being evaluated by the US Food and Drug Administration under a six-month priority review which began in late 2005.

"Trials carried out so far have yielded promising results, suggesting that varenicline could be a major advance in the treatment of nicotine dependence" says Dr Foulds.

"Drugs are normally earmarked for priority review by the FDA if they are felt to address health needs that are not currently being adequately met.

"What makes varenicline different to existing medication is that it is the first treatment specifically designed to target the neurobiological mechanism of nicotine dependence."

Initial results show that the drug successfully stimulates dopamine -- sometimes called the brain's pleasure chemical -- as well as blocking nicotine receptors. This reduces nicotine withdrawal symptoms and craving and may also prevent a lapse from turning into a full relapse.

Existing quit smoking methods have limited success and studies have found that some 18 per cent of people using them will be smoke free after a year, compared with 10 per cent of people prescribed placebos.

This figure can be increased to 25 to 35 per cent when smokers receive intensive counselling and combined medications are used.

Dr Foulds summarised 141 studies covering just over 48,000 subjects who were randomly allocated different types of medication or placebos.

He found that quit rates with nicotine replacement methods and drugs such as bupropion (trade name Zyban), nortriptyline and clonidine ranged from 14.6 per cent to 24.9 per cent. Smokers who were prescribed placebos (dummy drugs) achieved success rate of between 8.6 per cent and 14.4 per cent.

But clinical trials carried out with varenicline on thousands of smokers suggest that the new drug yield may yield better success rates.

The results of human trials reported in 2005 and 2006 found that short and long-term quit rates were higher when compared with placebos or bupropion (Zyban).

Studies presented at recent scientific meetings have shown that short-term quit rates in the first 12 weeks were approximately four times higher with varenicline than placebos and that long-term abstinence rates, for the first year, were more than twice those of placebos.

"Almost 20 countries and numerous US states have already announced or implemented comprehensive indoor smoking bans and that figure is rising all the time" adds Dr Foulds.

"Here in New Jersey, for example, smoking is very expensive and we have just implemented comprehensive legislation to ban smoking indoors in virtually all pubic places.

"This is good news for smokers and non smokers alike as many smokers are keen to quit and this gives them an added incentive.

"Medicines like varenicline are very important as they will help many more people to quit smoking, including those who have failed with other methods."

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The Association of Cigarette Smoking With HIV Prognosis Among Women in the HAART Era--A Report From the Women's Interagency HIV Study
http://www.ajph.org/cgi/content/abstract/AJPH.2005.062745v1

Joseph G. Feldman ^1*, Howard Minkoff ², Michael F. Schneider ³, Stephen J. Gange ³, Mardge Cohen ⁴, D. Heather Watts ⁵, Monica Gandhi ⁶, Robert S. Mocharnuk ⁷, Kathryn Anastos ⁸

¹ SUNY Downstate Medical center
² Maimonides Medical center
³ John Hopkins School Public Health
⁴ Cook County Hospital
⁵ PAMA NICHD
⁶ University of California at San Francisco
⁷ Univ Sothern California,Keck School of Medicine
⁸ Montefiore Medical Center and Lincoln Medical and Mental Heath Center

^* To whom correspondence should be addressed. E-mail: joseph.feldman@downstate.edu .

Abstract
Objective. We assessed the association of cigarette smoking with the effectiveness of highly active antiretroviral therapy (HAART) among low-income women.

Methods. Data were analyzed from the Women's Interagency HIV Study, a multisite longitudinal study up to 7.9 years for 924 women representing 72% of all women who initiated HAART between July 1, 1995, and September 30, 2003.

Results. When Cox's regression was used after control for age, race, hepatitis C infection, illicit drug use, previous antiretroviral therapy, and previous AIDS, smokers on HAART had poorer viral responses (hazard ratio [HR]=0.79; 95% confidence interval [CI]=0.67, 0.93) and poorer immunologic response (HR=0.85; 95% CI=0.73, 0.99). A greater risk of virologic rebound (HR=1.39; 95% CI=1.06, 1.69) and more frequent immunologic failure (HR=1.52; 95% CI=1.18, 1.96) were also observed among smokers. There was a higher risk of death (HR=1.53; 95% CI=1.08, 2.19) and a higher risk of developing AIDS (HR=1.36; 95% CI=1.07, 1.72) but no significant difference between smokers and nonsmokers in the risk of death due to AIDS.

Conclusions. Some of the benefits provided by HAART are negated in cigarette smokers.

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Chronicle of Higher Education
Senate Bill would require Online posting of Federal Research

Two U.S. senators, eager for access to the results of taxpayer-financed research, introduced a bill on Tuesday that would require that the results of such research be posted free on the Internet.

If the bill is enacted, each federal agency that spends more than $100-million yearly on research, including the National Institutes of Health, the National Science Foundation, NASA, and eight others, would have to create an online repository and require its grantees to place their research papers in it within six months of publication. The bill goes further than a policy in place at the NIH for the past year that merely requests posting in its repository, and suggests doing it within 12 months of publishing (The Chronicle, February 4, 2005).

The bill, which is sponsored by Sen. John Cornyn, a Texas Republican, and Sen. Joseph I. Lieberman, a Connecticut Democrat, has delighted open-access advocates like Peter Suber, director of the Open Access Project at Public Knowledge, a nonprofit group, who called it “superb” in his blog and wrote, “It will make a very large and useful body of research even more useful than it already is by sharing it with all who can apply or build upon it.”

Some publishers, concerned that free access will make readers drop subscriptions, are unhappy, according to an article in today’s Washington Post.

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California sues Big Tobacco to pay in full

By Joan Gralla

NEW YORK (Reuters) - California on Tuesday became one of the first states to sue cigarette-makers to force them to pay their share of the total of $1.2 billion the companies say they do not owe because they lost business to discounters.

In 1998, tobacco companies settled lawsuits brought by states by agreeing to pay $206 billion to provide medical care for ailing smokers. The settlement lets cigarette-makers cut their payments if they lose market share to rivals, often discounters, that did not sign the landmark accord.

Big Tobacco says discounters in 2003 won enough of their business to trigger the reduced payments. But the states say they still are owed the full sums because they met another requirement: they "diligently" collected payments from non-signing companies.

California Attorney General Bill Lockyer in a statement said he had filed papers in San Diego County Court to prevent cigarette-makers from "taking back" at least $154 million that they owe the state.

"Our case is rock solid, and I have no doubts that we will show that to the court's complete satisfaction," Lockyer said.

He added the "Big 3" tobacco companies -- R.J. Reynolds Tobacco Co., Lorillard, and Philip Morris -- and 27 smaller firms are disputing a total of $1.2 billion of payments they owe the 46 states in the settlement.

New York state, which said it too will sue Big Tobacco to collect the disputed payments, took a different tack.

Paul Larrabee, spokesman for New York Attorney General Eliot Spitzer, drew a distinction between the way industry leader and Marlboro-maker Philip Morris was handling the clash and the approach taken by R.J. Reynolds, known for its Camel cigarettes, and Lorillard, which makes Newports.

Philip Morris did not put any of its $3.4 billion payment into the special escrow account set up to handle disputes, Larrabee noted.

In contrast, R.J. Reynolds plunked $647 million of its $2.016 billion annual payment into the dispute account.

Lorillard deposited $108 million of its $666 million into the escrow account.

"We strongly disagree with the decisions of R.J. Reynolds and Lorillard to withhold substantial sums from the states," Larrabee said.

He added: "We intend to file suit to recover the amounts that we believe are due and owed to New York."

States cannot tap the disputed funds until the fight is resolved. Some companies, including Philip Morris, wanted to negotiate a settlement with the states' attorneys general.

R.J. Reynolds Spokesman David Howard said the pact requires the disputes to be settled via arbitration, not in the courts.

However, Peter Aseltine, a spokesman for New Jersey Attorney General Zulima Farber who also filed suit on Tuesday, disagreed. "Each state has a designated master settlement agreement court," he said.

A Lorillard spokesmen was not available to comment.

Iowa Attorney General Tom Miller, who co-chairs the National Association of Attorneys General tobacco committee, said he believes states will prove they diligently collected escrow funds from nonparticipating manufacturers.

"At the end of the day, we'll get the money back," Miller told Reuters in a telephone interview. "States were doing their best with ineffective escrow statutes."

Loopholes in many of the initial escrow statutes allowed nonparticipating firms to avoid big payments, giving them a pricing advantage, he said, but these have since been closed.

Cigarette-makers who signed the accord will likely be back with fresh claims to reduce payments because they lost market share in 2004, Miller said, but he added that these firms won back market share in 2005 and so far in 2006.

(Additional reporting by Jim Christie in San Francisco and David Lawder in Washington, D.C.)

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Research funding gap

Scientists fear proposed federal cuts, shifting priorities will stall new therapies

The San Diego Union-Tribune
By Penni Crabtree 
STAFF WRITER

March 17, 2006

Seth Cohen is one of a growing number of frustrated scientists who are stuck between an academic rock and a venture capital hard place.

For years, scientists like the University of California San Diego cancer researcher could tap into a patchwork of public and private funding to move a fledgling drug discovery from the laboratory bench to the first threshold of commercialization.

But harsh Wall Street realities, along with a reshuffling of federal budget priorities, are plucking at that patchwork and threatening to stall, if not sideline, the development of potential new therapies, say some scientists and drug industry observers.

“My senior colleagues tell me they wouldn't want to be an assistant professor now,” said Cohen, 33, a UCSD assistant professor of chemistry and biochemistry who is seeking funding to explore a promising class of anti-tumor agents called histone deacetylase inhibitors. “Funding has been a struggle; I can't emphasis that enough.

“Federal funding is definitely at a low point now. Every scientist I know says it is very difficult,” Cohen said. “And in terms of venture capital, unlike the biotech boom days, it takes more than a good idea to get VCs interested.”

The problem is acute for so-called translational research funding, a kind of middle-ground between the basic scientific research supported by federal grants and the later-stage product development investments that venture capitalists now favor, many say.

In the not-so-distant past, venture capitalists would often take the risk and fund development of a preclinical compound. But with a 10-year-plus timeline to bring a new drug to market and Wall Street's weak appetite for initial public offerings, the vehicle VCs often use to cash out on their investments, there is reluctance to back any potential drug that hasn't at least made it through a successful Phase 1 human safety study.

On the government side, most grant money is geared for basic scientific research and less to development work. Proposed budget cuts and shifting priorities also are taking a toll.

Last month, President Bush released his proposed federal budget for the fiscal year 2007, which includes flat funding for the National Institutes of Health and a $40 million cut to the National Cancer Institute.

The proposed budget reflects Bush's drive to spend more on preparing for a possible bird flu outbreak and developing countermeasures for biological terrorism.

The new budget priorities and budget cuts aren't the only worry. At the National Cancer Institute, the success rate for getting a research grant has taken a significant drop, from 20 percent in 2004 to 11 percent in the current year.

For academic and institutional scientists, scrounging money to perform the kind of proof-of-concept studies that go beyond what a federal grant will cover but are too early to attract venture capital has become an enormous challenge, many of these scientists say.

“This whole space has been neglected. Federal grants are moving downstream to basic research; they are no longer available for development work, and the VCs have moved upstream to later-stage products,” said Duane Roth, chief executive of Connect, the San Diego biotech and high-tech business networking group. “It's virtually impossible for many of these scientists to access capital to get their discoveries to a certain point where they can be partnered or acquired.”

That trend is worrying for biotech and pharmaceutical companies, which rely on lab bench discoveries to feed their own pipelines of potential drugs. And in San Diego, various business leaders and research institutions are joining together to try to solve the funding gap problem.

Connect and Biocom, the local biotech industry trade group, have formed a joint committee to explore the establishment of a biotech “incubator,” dubbed the San Diego Life Science Accelerator.

The proposed incubator is modeled in part on a $17 million project in Seattle, called the Accelerator Corp. Seattle's version, founded in 2003 and funded largely by venture capitalists, is a biotech investment and development company that provides money, laboratory space, management, accounting help, business development services and scientific advice to help start-ups move their fledgling discoveries to the next stage.

The joint Biocom and Connect committee has bigger ambitions: It hopes to drum up broad community support for the San Diego Accelerator and raise up to $50 million to finance it.

The committee, chaired by Art Benvenuto, CEO of Micell Technologies, will make recommendations on investment structure to support the local Accelerator, recruitment of a management team to run it and evaluate potential facilities to house the incubator and the fledgling companies that come under its wing.

Roth said the idea behind the Accelerator is not to build full-blown biotech companies from the ground up, but to advance early-stage drugs and technologies, helping the scientists hit crucial milestones, and gather the kind of proof-of-concept data needed to gain more financing, a partnership or an interested buyer.

Individual research institutes are also exploring ways to overcome the translational funding gap. On Wednesday, the Sidney Kimmel Cancer Center broke ground on a new research facility that is expected to open in December. Meanwhile, the center launched a campaign to raise $12 million over five years to support efforts by their scientists to more quickly move experimental products and diagnostics into clinical testing.

“There is this funding gap, and it comes at a time where there are more opportunities, more new strategies to fight disease that are dramatically better in concept because they are more selective,” said Dr. Albert Deisseroth, president and chief executive officer of SKCC, a nonprofit research institute in La Jolla. “After 50 years of government spending in developing these new strategies, it's within our grasp – and yet we have this barrier to overcome.”

Penni Crabtree: (619) 293-1237; penni.crabtree@uniontrib.com

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Altria unit loses Supreme Court appeal of $50M California award
By Mark H. Anderson
Last Update: 12:05 PM ET Mar 20, 2006

WASHINGTON (MarketWatch) -- Altria Group Inc.'s (MO) Philip Morris USA unit Monday exhausted its appeals to overturn a $50 million punitive damages award from a deceased smoker lawsuit filed in California.
The U.S. Supreme Court rejected the tobacco company's appeal without comment. Philip Morris has already taken a 3 cent-a-share charge to cover the cost of the court award, and now faces the payment, plus interest.

Philip Morris had asked the high court to rule on whether the punitive damages award in the case was excessive, and whether the Federal Cigarette Labeling and Advertising Act prevented smokers from suing under a California state law that allows "consumer expectations" claims in product liability cases. But the justices, in a brief order, said they won't entertain either question

The $50 million in punitive damages is from a lawsuit brought by the now deceased Richard Boeken is in addition to $5.5 million in actual damages. Boeken's widow will receive the award.

A California jury originally awarded Boeken a record $3 billion in punitive damages. The state trial court reduced the figure to $100 million, and a California appeals court later cut that figure in half to $50 million. The California Supreme Court turned away the company's appeal of the award in August 2005.

Philip Morris, in its appeal, argued the jury award raised questions about the proper ratio of punitive damages to actual damages, and whether federal cigarette labeling requirements bar state-level product liability suits such as the one brought by Boeken.

The 9-1 ratio of punitive damages to actual damages is at the outside edge of guidance the Supreme Court offered in its 2003 State Farm punitive damages decision. But Philip Morris argued the California award violated the precedent set by the State Farm opinion.

"It is simply untenable, after State Farm, to assert than an award producing a ratio of greater than 9:1 comports with due process in this case, especially in light of the substantial compensatory damages imposed," the company said.

Attorney's for Boeken's widow, Judy Boeken, also urged the Supreme Court to take up the appeal, but suggested the justices should rule punitive damages in the case were reasonable. Boeken's attorneys said the high court should clarify its holdings in the State Farm case by telling judges they should be more selective in reducing jury verdicts.

"This court should grant review of this case to put an end to the mistaken approach of the court below and other courts," the attorneys said.

Richard Boeken died in 2002 at the age of 57 from lung cancer. According to the court records, Boeken started smoking in 1957 at the age of 13, and smoked two packs of Marlboro cigarettes a day for decades.

The cases are Philip Morris v. Boeken, 05-594, and Boeken v. Philip Morris, 05-600.

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Lung Cancer and Women: A Mysterious Link
Nonsmoking Women Are Still at Risk for the Deadliest Form of Cancer

March 7, 2006 ­ Dana Reeve's passing from lung cancer highlights a grim but important fact about the disease: It is a common and lethal attacker of women, even among those who have never smoked.

Of the approximately 20,000 to 25,000 nonsmokers diagnosed with lung cancer in the United States each year, a greater proportion of them are women, according to Women Against Lung Cancer.

Unfortunately, the five-year survival rate remains relatively low. Only about 15 percent of people diagnosed survive five years or more. Breast cancer has an 88-percent survival rate, according to the Lung Cancer Alliance.

Why does this discrepancy persist?

Part of it is because lung cancer has no early warning signs and is usually diagnosed after the cancer has spread. Even then, it causes still somewhat hard-to-diagnose symptoms like a chronic cough, hoarseness, wheezing and chest pain, experts say. Reeve, who said she had never smoked, had a persistent cough before she was diagnosed.

While the majority of lung cancer deaths are attributed to smoking, there are still many mysteries about nonsmokers who get lung cancer, said ABC News Medical Editor Dr. Timothy Johnson.

"We really don't know what causes this cancer in nonsmokers. We just can't pinpoint a particular factor," he said.

Part of the problem may stem from a relatively small amount of research funding, according to both the Lung Cancer Alliance and Women Against Lung Cancer. For example, while breast cancer received more than $1.6 billion in funding for research from 1992 to 2004, lung cancer received $33 million, according to the alliance.

"We know very little about the processes that leads to lung cancer, and about why women seem to be affected differently than men," said Jill Siegfried, co-director of the lung and esophageal cancer program at the University of Pittsburgh Cancer Institute, at an annual meeting of the Women Against Lung Cancer.

Source: http://abcnews.go.com/Health/story?id=1695865

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Biomarker Helps Identify Progressive Precancerous Lesions in Lung

C-reactive protein (CRP), a biomarker for inflammation in the blood, can help to identify individuals whose abnormal precancerous lesions will advance closer to invasive lung cancer.

Newswise ­ C-reactive protein (CRP), a biomarker for inflammation in the blood, can help to identify individuals whose abnormal precancerous lesions will advance closer to invasive lung cancer.

The results appear in the first issue for March 2006 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

Stephen Lam, M.D., F.R.C.P.C., of the Lung Tumour Group, British Columbia Cancer Agency at the University of British Columbia in Vancouver, Canada, and three associates measured CRP, lung function and other inflammatory markers in 65 individuals. All participants had at least one abnormal cell site in their lungs (bronchial dysplasia) greater than 1.2 millimeters in size, which was biopsied at the start of the study and re-examined 6 months later.

Of the study cohort, 49 individuals (75 percent) were men, with 48 classified as current smokers. On average, study participants were 57 years old and had 52 pack-years of smoking history.

“Lung cancer is a worldwide epidemic,” said Dr. Lam. “More than 300 million people die of this disease annually. In the United States alone, 170,000 new cases of lung cancer are reported each year. Most of these are non-small cell lung cancer and the overall prognosis once diagnosed is dismal. The only reasonable chance of cure is surgical resection for early stage tumors. However, most patients with early lung cancer are asymptomatic. Symptoms usually develop after the tumors become invasive or disseminated and curative resection is infeasible.”

Consequently, researchers have been working to find novel non-invasive or semi-invasive methods of identifying individuals who harbor progressive precancerous lesions. If detected early, these lesions might be treated with a chemopreventive agent to impede progress to invasive carcinoma.

In the study, the level of CRP only differed between individuals who either did or did not develop progression in their bronchial lesions.

“The odds of developing progressive disease were 9.6 fold higher in the group that had CRP greater than 0.5 mg per liter compared with the group less than this threshold,” said Dr. Lam.

There were 32 subjects whose bronchial lesions had progressed to a more abnormal state when biopsied after 6 months.

“These data are consistent with the prevailing hypothesis that squamous cell carcinoma arises from preinvasive lesions in stepwise fashion, which is called the sequential theory of cancer development,” said Dr. Lam. “This hypothesis is supported by animal experiments mimicking human carcinogenesis.”

The authors believe that these results will be helpful in designing future chemopreventive and early detection studies by identifying high-risk subjects for non-small cell lung cancer.

Source: American Thoracic Society (ATS)

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Supreme Court rejects tobacco ad complaint
Two companies said Californian anti-smoking ads smeared reputations
The Associated Press
Updated: 11:35 a.m. ET Feb. 21, 2006

WASHINGTON - The Supreme Court on Tuesday refused to hear an appeal by two tobacco companies who claimed California’s tough anti-smoking ads smeared their reputations.

R.J. Reynolds Tobacco Co. and Lorillard Tobacco Co. had asked the justices to overturn a 9th U.S. Circuit Court of Appeals decision that rejected the companies’ claims that their First Amendment rights were violated by California’s ad campaign.

California uses part of an 87-cent tax on every package of cigarettes to fund health education that includes a campaign to discourage smoking.

The ads included a scene where cigarettes rained down on children playing in a schoolyard as a voice, purportedly of a tobacco executive, announced, “We have to sell cigarettes to your kids. We need half a million new smokers a year just to stay in business ... It’s nothing personal. You understand.”

The companies objected to the state using revenue from taxes on cigarettes, effectively forcing the tobacco industry to pay to vilify itself. The case is Reynolds v. Shewry, 05-867.

© 2006 MSNBC.com

URL: http://www.msnbc.msn.com/id/11477003/

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State becomes first to list secondhand smoke as a pollutant.

By Chris Bowman -- Bee Staff Writer
January 27, 2006

California became the first state in the country Thursday to place secondhand tobacco smoke alongside tailpipe and smokestack exhausts as a toxic air pollutant and candidate for regulation.

The designation, approved 6-0 by the California Air Resources Board, lends heavy ammunition to public health advocates seeking greater protection, especially for children. It is expected to revive legislative efforts to ban drivers from smoking when children are in their vehicles and bolster efforts to curb smoking in multifamily dwellings.

"We're already pushing cities and counties to set aside some apartment complexes for smoke-free housing," said Paul Knepprath, spokesman for the American Lung Association of California. "This is going to help."

California has pioneered some of the world's toughest anti-cigarette laws that ban smoking in nearly all enclosed workplaces, restaurants, bars and public buildings.

Thursday's action alone does not expand smoking restrictions. It merely identifies secondhand smoke a "toxic air contaminant," on a par with cancer-causing diesel soot, asbestos and lead.

But the listing requires the air board to evaluate whether any measures are needed to reduce exposures. Air board officials, who are more accustomed to setting clean-fuel and engine standards, said they didn't expect to impose any mandates.

"Our greatest role will be education about smoking in cars ... because that is a staggering exposure," said Catherine Witherspoon, the air board's executive officer.

Breathable smoke particles in vehicles ranged up to 10 times higher than those found in some smokers' homes, according to the air board's review of studies.

Putting secondhand smoke in the same category as the most-toxic automotive and industrial pollutants should spur more cities, employers and smoking parents to reduce exposure on their own initiative, said Joan Denton, director of the state Office of Environmental Health Hazard Assessment, which conducted the health-effects analyses supporting the new hazard designation.

"Californians, especially parents, would not willingly fill their homes with motor vehicle exhaust, and they should feel the same way about tobacco smoke," Denton said.

In listing secondhand smoke Thursday, the air board accepted findings by the state health hazard group and university scientists that go further than any before in establishing a link between breast cancer and breathing of secondhand smoke.

The scientists made international news last spring in concluding that exposure to tobacco smoke is not merely associated with breast cancer but clearly can cause the disease in young women who never smoked.

They found, from close review of several recent studies, that exposure to tobacco smoke elevates the risk of breast cancer 70 to 120 percent in young women, primarily those who have not reached menopause. The research on postmenopausal women is inconclusive.

The highest risk group would include women working in bars and restaurants in states where smoking is permitted, said Dr. Stanton Glantz, a professor of medicine at the University of California, San Francisco. Glantz was one of nine university-based California scientists who reviewed the state's smoking studies.

Not all health experts, including those with the American Cancer Society and the U.S. Surgeon General's Office, are as sure about the connection to breast cancer, saying more evidence is needed.

After analyzing thousands of studies from around world, the California scientists added premature birth and the induction and exacerbation of asthma in adults to the list of ills that had already been linked to secondhand or "environmental" smoke, including heart disease and lung and nasal sinus cancer in adults.

The research also found stronger links between secondhand smoke and sudden infant death syndrome and respiratory and heart diseases.

Notably absent from the Sacramento meeting were representatives of the tobacco industry.

"We decline to comment," Mike Neese, a spokesman for Philip Morris USA, told The Bee.

Cynthia Hallett, executive director of the nonprofit Americans for Nonsmokers' Rights in Berkeley, predicted that the California smoking studies, the product of more than a decade of research and peer review, will have far-reaching influence across the United States and abroad.

The report probably will come into play in the current debate over smoking restrictions in Utah and in many towns across the Midwest, Hallett said.

Sawyer, who made his debut Thursday as Gov. Schwarzenegger's newly appointed air board chairman, said he just returned from Ireland, where he learned that the California agencies' tobacco research served as the scientific justification for that country's recent smoking ban in pubs and restaurants.

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Ethnic and Racial Differences in the Smoking-Related Risk of Lung Cancer
Christopher A. Haiman, Sc.D., Daniel O. Stram, Ph.D., Lynne R. Wilkens, Dr.P.H., Malcolm C. Pike, Ph.D., Laurence N. Kolonel, M.D., Ph.D., Brian E. Henderson, M.D., and Loïc Le Marchand, M.D., Ph.D.

ABSTRACT

Background There is remarkable variation in the incidence of lung cancer among ethnic and racial groups in the United States.

Methods We investigated differences in the risk of lung cancer associated with cigarette smoking among 183,813 African-American, Japanese-American, Latino, Native Hawaiian, and white men and women in the Multiethnic Cohort Study. Our analysis included 1979 cases of incident lung cancer identified prospectively over an eight-year period, between baseline (1993 through 1996) and 2001.

Results The risk of lung cancer among ethnic and racial groups was modified by the number of cigarettes smoked per day. Among participants who smoked no more than 30 cigarettes per day, African Americans and Native Hawaiians had significantly greater risks of lung cancer than did the other groups. Among those who smoked no more than 10 and those who smoked 11 to 20 cigarettes per day, relative risks ranged from 0.21 to 0.39 (P<0.001) among Japanese Americans and Latinos and from 0.45 to 0.57 (P<0.001) among whites, as compared with African Americans. However, at levels exceeding 30 cigarettes per day, these differences were not significant. Differences in risk associated with smoking were observed among both men and women and for all histologic types of lung cancer.

Conclusions Among cigarette smokers, African Americans and Native Hawaiians are more susceptible to lung cancer than whites, Japanese Americans, and Latinos.

Source Information

From the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles (C.A.H., D.O.S., M.C.P., B.E.H.); and the Cancer Epidemiology Program, Cancer Research Center of Hawaii, University of Hawaii, Honolulu (L.R.W., L.N.K., L.L.M.).

Address reprint requests to Dr. Haiman at USC/Norris Comprehensive Cancer Center, 1441 Eastlake Ave., Rm. 4441, Los Angeles, CA 90089-9175, or at haiman@usc.edu .

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Second-hand smoke hits genetically susceptible kids harder

When U.S. children who possess a variant gene are exposed to second-hand smoke in their homes, they are at a substantially greater risk for developing respiratory illnesses that lead to school absences.

The findings are reported in the second issue of the December 2005 American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

As part of the California-based Child Health Study, Frank D. Gilliland, M.D., Ph.D., of the Keck School of Medicine at the University of Southern California in Los Angeles, and eight associates analyzed 1,351 fourth grade students attending elementary school in southern California.

The researchers performed DNA analysis of cells from each child's cheek (buccal cells) and examined all participants' school absence reports. They found that genetic susceptibility caused by a variant genotype called "tumor necrosis factor 308A" influences the risk of respiratory-related school absences due to second-hand smoke.

Genotyping showed that 24 percent (324) of the fourth graders possessed one or more copies of the problem-causing variant.

According to baseline questionnaires completed by the children's parents, 20 percent had been exposed to second-hand smoke at home. Of those, 6 percent lived with one or more smokers.

Such exposure rates resulted in a 51 percent greater risk of lower respiratory illness compared with those who were not exposed. The researchers qualify this finding by noting that approximately 15 percent of the children involved in the study had physician-diagnosed asthma, which was associated with a 50 percent increase in risk for illness-related school absences.

The study also found that in children who possessed at least one copy of the tumor necrosis factor variant, exposure to two or more household smokers was associated with a four-fold risk of school absence due to lower respiratory illness, when compared with children who had the same variant, but who were not exposed to second-hand smoke.

The researchers added that second-hand smoke exposure increases the possibility of absence by raising the risk for and the severity of respiratory infection, as well as by increasing asthma-related airflow obstruction, inflammation and other symptoms.

"Adverse respiratory outcomes caused by second-hand smoke exposure include increased occurrence and severity of respiratory symptoms, respiratory infections, physician visits, emergency room visits, hospital admissions and transient changes in lung function," said Dr. Gilliland.

According to the Third National Health and Nutrition Examination Survey, the problem of second-hand smoke exposure in children is a serious one: in the United States, 43 percent of kids between the ages of 4 and 11 years are exposed to second-hand smoke in the home.

Contact: Jon Weiner, USC Health Sciences, Media Relations, 1540 Alcazar Street CHP 236, Los Angeles, California 90033, Phone: (323) 442-2831, E-mail: gillilan@usc.edu

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Nicotine vaccine shows promise to help smokers give up

http://www.medicalnewstoday.com/medicalnews.php?newsid=34224&nfid=rssfeeds
29 Nov 2005

A University of Minnesota study indicates that the nicotine vaccine NicVax, which is now being tested in humans, appears safe, well-tolerated, and a potentially effective method for helping smokers kick the habit.

Dorothy Hatsukami, Ph.D., director of the University of Minnesota Cancer Center's Transdisciplinary Tobacco Use Research Center (TTURC), is the lead author on this study. The 38-week study included 68 active smokers who were randomly assigned to receive one of three different doses of the vaccine or a placebo. The findings are published in the current issue of the journal Clinical Pharmacology and Therapeutics.

"The vaccine works by producing antibodies that specifically bind to nicotine and thereby prevent much of the nicotine from entering the brain," Hatsukami said. "This process potentially reduces the pleasurable effects from smoking and reduces the addiction to nicotine."

The vaccine may become a new option for helping the approximately 45 million people in the United States who smoke. In 2004, the rate for smoking in Minnesota was about the same as the national average of 20.9 percent.

"More research needs to be done, but at this point, our results show the vaccine is safe and well-tolerated," Hatsukami said. "We found the vaccine has few side effects on the central nervous system because the antibody itself is targeted specifically for nicotine and does not alter any functions of the brain."

Additionally, she says that while this study was not designed to test the treatment effect, 38 percent of the participants in the high-dose vaccine group quit smoking for at least 30 days.

"This result was an impressive and completely unexpected finding because the study was not focused on helping smokers quit smoking," she noted. "In fact, to participate in the study, smokers had to attest that they did not have a planned quit date for the next six months."

Cigarettes are linked to a number of diseases, the leading being lung cancer which is the number one cause of cancer-related deaths in the United States and in Minnesota. This year in the United States, more than 170,000 people will be told that they have lung cancer and 160,000 will die from it. In Minnesota, more than 2,600 residents will be diagnosed with lung cancer this year, and nearly 2,500 people will die from it.

Hatsukami conducted this study in collaboration with researchers at the University of Wisconsin and University of Nebraska. This study was sponsored by the National Institute of Drug Abuse and Nabi Biopharmaceuticals, developer of the NicVax vaccine. Paul Pentel, M.D., with Hennepin County Medical Center in Minneapolis, previously evaluated the vaccine in rats and found that the vaccine-induced antibodies led to reduced levels of nicotine in the brain. His research also showed that the nicotine-vaccinated rats reduced their intake of nicotine compared with rats not given the vaccine. Those results led to testing the vaccine in humans. This study reported by Hatsukami is the latest in several Phase 1 and 2 human clinical trials.

According to Hatsukami, the most commonly reported side effect was an ache and tenderness in the area of the arm where the vaccine was injected. Some of the participants also reported headaches and muscle pain, which in all cases went away in a few days.

"No differences were noted in withdrawal symptoms between participants who received the vaccine and those who got the placebo," Hatsukami said. "We also did not see a compensatory smoking behavior, meaning that vaccinated participants did not puff harder on cigarettes or smoke more cigarettes to make up for the lower levels of nicotine delivered to the brain." More research is required because other questions about the vaccine need to be answered, such as how long the effectiveness of the vaccine will last for a smoker and whether the vaccine can be used to prevent people who quit from relapsing and starting to smoke again.

"Our findings add to scientific information about nicotine vaccine and provide the basis for additional research to answer those questions," Hatsukami said.

Sara E. Buss
buss@umn.edu
University of Minnesota
http://www1.umn.edu/twincities/index.php

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Focus on Lung Cancer: How to Prevent and Treat It

November 2, 2005

Baltimore, Md. -- Since smoking became popular in America in the 1930s, lung cancer rates have continued to climb. Today, it is still the leading cause of cancer-related deaths, with totals more than the other five leading cancers combined.

Armed with these sobering statistics, scientists have launched several innovative projects to find therapies that will effectively treat, and hopefully reduce the overall incidence of lung cancer. Several are being presented today during the American Association for Cancer Research’s 4th annual Frontiers in Cancer Prevention Research meeting in Baltimore.

“We have begun to develop innovative strategies to target lung cancer with targeted medicines and new vaccines, but we have a long way to go,” said William G. Nelson, V, M.D., Ph.D., of Johns Hopkins University and Program Chair of the meeting. “We hope that increased attention to research and treatment options will improve the outlook for the increasingly large patient population.”

Nicotine Vaccine: A Promising Treatment for Nicotine Addiction (Abstract 2565)

To combat cigarette smoking, researchers are seeking ways to combat the habit which affects more than 45 million Americans. One new option is a vaccine that targets the nicotine rather than the brain’s reaction to it. Researchers from the University of Minnesota, supported by the National Institute of Drug Abuse and Nabi Biopharmaceuticals, have tested this new vaccine in humans with positive tolerability and efficacy.

“We are encouraged by the results of this study, which suggest that a nicotine vaccine may be a safe and potentially effective way to reduce tobacco dependence or as a relapse prevention aid,” said Dorothy Hatsukami, of the University of Minnesota and lead author of the study.

The nicotine vaccine in question stimulates the immune system to develop antibodies that specifically attach to the nicotine molecules. The resulting antibody-nicotine combination is too large to pass through the blood to the brain, resulting in less nicotine in the brain.

Animal studies have confirmed that the vaccine works by reducing and also slowing the amount of nicotine that enters the brain, reducing nicotine’s addictive effect.

Preliminary human studies have been conducted to determine the safety of the nicotine vaccine, as well as the best dosage and optimal dosing schedules. A multi-site clinical trial randomly assigned 68 smokers to receive different doses of vaccine, or placebo, and followed them over 38 weeks. The vaccine was well tolerated among the subjects. Aches and tenderness at injection sites were reported; systemic reactions included headaches, malaise or myalgia or muscle pain, although these latter reactions were similar between the vaccine and placebo. Most symptoms were mild and self-limited, resolving within a few days, and none required medical intervention.

There was no evidence of withdrawal after vaccine injection or evidence that smokers increased smoking intensity to compensate for the reduced nicotine in the brain. Preliminary analysis shows that the highest dose of vaccine in participant smokers, who had not necessarily been interested in quitting, showed significantly higher rates of 30-day abstinence than placebo.

“Two additional human clinical trials with other nicotine vaccines have been conducted which showed similar safety profiles and higher abstinence rates in the highest nicotine vaccine dose or antibody level groups, and we hope to conduct further trials to confirm these results,” said Hatsukami.

Chemoprevention of Lung Cancer: What's Next? (Abstract 3474)

Doctors are working diligently to make progress in preventing lung cancer, the deadliest cancer in America today. To do so, researchers are trying to better understand the biology of lung tumor development and design tactics using effective clinical models to interrupt the process without undue side effects. Efficacy and minimal toxicity are critical features of a successful treatment strategy. Doctors are working to identify populations who are at high-risk for the disease outside of tobacco exposure so that prevention strategies can focus on those who are most likely to benefit from them.

Using the documented role of inflammation in cancer development, doctors have identified key enzymes involved in the metabolism of arachidonic acid (AA) as potential targets for the prevention of a variety of epithelial cancers (in cells that line organs). AA, which is involved in inflammatory and other processes that regulate organ function, is generated from lipids and is metabolized by cyclooxygenases (COX-1 and COX-2 enzymes that control the production of prostaglandins and are blocked by aspirin) and lipoxygenases (LOX enzymes involved in diseases like cancer, inflammation, and asthma).

Animal tumor studies have suggested that inhibiting AA interrupts the growth of lung tumors, and have found that glucocorticoids (steroid hormones produced by the adrenal gland) are particularly effective in inhibiting cancer formation in mice. A recent phase IIb study of inhaled budesonide, a corticosteroid, did not show any efficacy in regressing or preventing precursor lesions for squamous cell cancer, but the treatment did reduce peripheral lung nodules, which may be precursors to lung adenocarcinomas. With regard to testing and review mechanisms, the recent availability of improved spiral CT images may now allow for clinical trials that specifically address cancer prevention in the peripheral lung compartment.

Agents that are currently being studied include inhibitors of AA metabolism such as non-steroidal anti-inflammatory agents and the leukotriene inhibitor and anti-asthma drug zileuton. With the promise of COX and LOX inhibitors, researchers are developing dual function COX-LOX inhibitor products to offer an alternative to combination therapies. In addition, PPARg ligands (peroxisome proliferator-activated receptor gamma), which include anti-diabetic drugs, have shown tumor inhibition in a variety of lung cells. Newer molecularly targeted drugs, which are potent anti-cancer drugs in mice, are struggling in lung cancer prevention trials due to concerns with drug-associated side effects.

However, as targeted agents with fewer side effects and preventive efficacy enter clinical trials, researchers will soon be able to evaluate “prevention-relevant” variables during early drug development to evaluate effects on precancerous lesions, providing valuable information for subsequent prevention trials. Such data may help to determine if promising agents that may have some side effects should be investigated further for cancer prevention in people at particularly high risk for lung cancer development.

“A better understanding of the mechanisms leading to the development of lung cancer is crucial to developing targeted therapies for prevention of the disease,” said Eva Szabo, of the National Cancer Institute. “The combination of new clinical trial formats and new chemopreventive treatment options will help provide the answers necessary to reduce the incidence of this devastating disease.”
______________________________________

Founded in 1907, the American Association for Cancer Research is a professional society of more than 24,000 laboratory, translational, and clinical scientists engaged in all areas of cancer research in the United States and in more than 60 other countries. AACR's mission is to accelerate the prevention and cure of cancer through research, education, communication, and advocacy. Its principal activities include the publication of five major peer-reviewed scientific journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; and Cancer Epidemiology, Biomarkers & Prevention. AACR's Annual Meetings attract nearly 16,000 participants who share new and significant discoveries in the cancer field. Specialty meetings, held throughout the year, focus on the latest developments in all areas of cancer research.

Nicotine Vaccine: A Promising Treatment for Nicotine Addiction
Abstract # 2565, Dorothy Hatsukami, University of Minnesota, Minneapolis.
Oral Presentation. 10:30 a.m., Wednesday, November 2, 2005.

Chemoprevention of Lung Cancer: What's Next?
Abstract # 3474, Eva Szabo, National Cancer Institute, Bethesda, Md.
Oral Presentation. 7:00 a.m., Tuesday, November 1, 2005.

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New study shows women more vulnerable to risk of colorectal cancer from tobacco

Another study demonstrates benefits of colon cancer screening in elderly populations

HONOLULU, October 31, 2005 -- A new study of gender and risk factors for colorectal cancer reveals that while both tobacco and alcohol increase risk for colorectal cancer, women who smoke are at higher risk. Researcher Anna L. Zisman, M.D. of Evanston Northwestern Health Care presented these findings at the 70th Annual Scientific Meeting of the American College of Gastroenterology. Another study presented at ACG of patients undergoing colonoscopy demonstrated that patients over 75 benefit from colorectal cancer screening in detecting cancer and potentially cancerous lesions and experience no more complications from colonoscopy than younger patients.

Smoking Significantly Increases Colorectal Cancer Risk in Women
Smoking and alcohol use are well-established risk factors for colorectal cancer. According to Dr. Zisman, "Understanding interactions between genetic and environmental factors, such as smoking and alcohol use, is critical for colorectal cancer risk stratification, and will help us design effective screening strategies."

Dr. Zisman and her colleagues looked at women's susceptibility compared to men. Using the IMPAC Medical Registry Services Cancer Information Resource File, a large database from over 350 teaching and community hospitals, the investigators conducted a regression analysis of gender, tobacco and alcohol use. They found that while age of onset of colorectal cancer was slightly younger in males than females in the non-smoking/non-drinking group, current smokers had a markedly decreased age of presentation for both men and women. Similarly, alcohol use was associated with an earlier age of diagnosis in males and females. An assessment of the differential sensitivity to smoking and alcohol use in men and women revealed that women are sensitive to smoking as a risk factor for colorectal cancer but not alcohol. "We can see that while both men and women who use tobacco and alcohol are diagnosed with colorectal cancer at an earlier age, the effect of tobacco is significantly greater in women," said Dr. Zisman.

Colorectal Cancer Screening Benefits Patients 75 Years and Older
Most guidelines recommend that screening for colorectal cancer should begin at age 50 for individuals at average risk. "However there is no consensus regarding the age at which we should stop screening," commented Aaron Walfish, M.D. of Beth Israel Medical Center in New York. According to Dr. Walfish, "Older patients often have other health problems that increase the risk of undergoing endoscopy, so we need more evidence regarding the usefulness of screening in this older population. Our data support continued screening of elderly patients."

Dr. Walfish and his colleagues conducted a retrospective analysis of 178 patients 75 and older and 318 patients between ages 65 and 69. In both age groups, the researchers found that a similar percentage of patients had polyps or masses (43 percent in the 75 and older group vs. 42 percent in the 65 to 69 group), and that a similar percentage had larger polyps or masses (49 percent in the 75 and older group vs. 58 percent in the 65 to 69 group had polyps greater than or equal to 1 cm.) There were no complications from the screening procedure reported in either age group.

About the American College of Gastroenterology
The ACG was formed in 1932 to advance the scientific study and medical treatment of disorders of the gastrointestinal (GI) tract. The College promotes the highest standards in medical education and is guided by its commitment to meeting the needs of clinical gastroenterology practitioners. Consumers can get more information on GI diseases through the following ACG-sponsored programs:

1-800-978-7666 (free brochures on common GI disorders, including ulcer, colon cancer, gallstones, and liver disease) 1-866-IBS-RELIEF and www.ibsrelief.org (free educational materials) 1-800-HRT-BURN (free brochure and video on heartburn and GERD) www.acg.gi.org (ACG's Web site)

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Scientist: Quitting may speed healing

October 27, 2005

BY LAURAN NEERGAARD
ASSOCIATED PRESS

Smokers' broken bones take a lot longer to heal. But scientists now will study whether giving up cigarettes for even a week or two after a fracture might make the difference between a speedy recovery and months of easy-to-reinjure mushy bones.

"There's a window," says orthopedic specialist Michael Zuscik of the University of Rochester.

If he's right, it could dramatically change orthopedic practice for the nation's 48 million smokers.

Bone damage is arguably the least publicized of tobacco's harms.

The first time many smokers ever hear of the problem is if they need spinal fusion, a back operation that surgeons often won't perform unless patients kick the habit -- with a urine test to prove they quit. That's because the surgery is far more likely to fail in smokers than nonsmokers.

Smokers who break a leg require 62% more time to heal.

Then there's the silent toll smoking can wreak by contributing to bone-thinning osteoporosis.

Zuscik's theory suggests that nicotine may be a key bone-damaging culprit -- and that it does its dirty work almost immediately by affecting stem cells stored in the bone marrow, called mesenchymal stem cells, that move in to begin healing an injured bone.

"The most important steps that occur involving these mesenchymal stem cells happen during the first days and weeks of the healing process," Zuscik explains. "The whole thing is kind of derailed."

Now, armed with a new $1.4-million grant from the Department of Defense, Zuscik is out to prove that theory, and whether going cold turkey for a short time after breaking a bone or undergoing bone surgery might help smokers heal faster.

It's of interest to the military because surveys show 34% of troops smoke, compared with 22% of the general population, and bone damage, particularly to the arms and legs, is common among soldiers injured in combat.

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Beta-Carotene Associated With Higher Risk of Tobacco-Related Cancers in Women Smokers but Not in Nonsmokers

Sarah L. Zielinski
jncimedia@oupjournals.org
Journal of the National Cancer Institute

A new study of French women has found that high beta-carotene intake­through a combination of diet or supplementation­is associated with a higher risk of tobacco-related cancers in smokers, but the risk of these cancers decreases with increasing beta-carotene intake in nonsmokers. The study appears in the September 21 issue of the Journal of the National Cancer Institute.

Some observational studies have found that beta-carotene consumption is associated with a decreased risk of cancer. However, some intervention studies have suggested that high doses of the antioxidant, given through supplementation, may be associated with an increased risk of lung cancer and digestive cancers in smokers.

To investigate the relationships of beta-carotene intake from both diet and supplementation with the risk of tobacco-related cancers­which include colorectal, thyroid, ovarian, cervical, and lung cancers in addition to less common cancers­Marie-Christine Boutron-Ruault, M.D., Ph.D., of INSERM in Villejuif, France, and colleagues used information from questionnaires given in 1994 to nearly 60,000 women from the French Etude Epidémiologique de Femmes de la Mutuelle Générale de l'Education Nationale (E3N) prospective study. The researchers assessed diet, supplement use, and smoking status in these women and followed them for a median of 7.4 years.

During the follow-up period, 700 women developed a type of cancer known to be related to smoking. Among women who never smoked, beta-carotene intake was inversely associated with the risk of developing a tobacco-related cancer, with a dose-dependent relationship across the considered beta-carotene categories (tertiles of dietary beta-carotene, and supplement use as the fourth category). However, among women who had ever smoked, the results were reversed: cancer risk was highest among women in the high beta-carotene intake group.

In the population studied, the authors calculated that the absolute rates of tobacco-related cancers over 10 years for nonsmokers with low and high beta-carotene intakes were 181.8 and 81.7 cases per 10,000 women, respectively. Among smokers, these rates were 174.0 cases per 10,000 women for those who had low beta-carotene intake and 368.3 cases per 10,000 women for those who had high intake.

"Although beta-carotene may act as a cocarcinogen, there is no evidence that smokers should avoid consuming beta-carotene-rich foods such as fruit and vegetables, in which other components, such as vitamins C and E, may counteract a potentially deleterious interaction of beta-carotene with smoking," the authors write.

In an editorial, Susan T. Mayne, Ph.D., of the Yale University School of Medicine and Yale Cancer Center in New Haven, Conn., and Scott M. Lippman, M.D., of the University of Texas M. D. Anderson Cancer Center in Houston, write that "evidence suggesting that tobacco exposure modifies the chemopreventive efficacy of nutrients/nutrient derivatives continues to mount." However, this new research "should not alter our current policy recommendations with regard to nutrients and cancer risk. Rather, this new research emphasizes the need to examine current, former, and never smokers separately in studies of nutrient supplements and other preventive agent classes in a wide spectrum of cancer prevention settings," they write.

Contacts:

• Article: Séverine Ciancia, INSERM communications/media office, 33.1.44.23.60.98, presse@tolbiac.inserm.fr
• Editorial: Alison Ruffin, Public Affairs, M. D. Anderson Cancer Center, 713-794-1731, arruffin@mdanderson.org
  Citations:

• Article: Touvier M, Kesse E, Clavel-Chapelon F, Boutron-Ruault M-C. Dual Association of Beta-Carotene With Risk of Tobacco-Related Cancers in a Cohort of French Women. J Natl Cancer Inst 2005;97: 1338–44.
• Editorial: Mayne ST, Lippman SM. Cigarettes: A Smoking Gun in Cancer Chemoprevention. J Natl Cancer Inst 2005;97: 1319–2

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Cigarette prices could double
Plans, spurred by less tobacco tax money, would add $2.50 a pack

By Kathleen Wilson
Ventura County Star, September 13, 2005

With tobacco tax dollars dwindling as more California smokers quit, health groups want to pass new taxes that would double the price of a pack of cigarettes to almost $6.

State officials say the numbers tell the story.

California voters passed Proposition 99 in the late 1980s to pay for research, health education against tobacco and healthcare for indigent families.

But statewide revenues from that tax of 25 cents per pack have fallen from $575 million in the early 1990s to $321 million in the current year as the proportion of smoking adults slid to historic lows.

In Ventura County, the program is due to provide about $642,000 for indigent healthcare this year compared with $5.2 million 15 years ago.

Proposition 10, passed in 1998, funded an early childhood initiative promoted by Hollywood director Rob Reiner. The cigarette tax went up an additional 50 cents when voters approved the proposition.

But the tax that brought in $686 million in 1999 is expected to produce only $593 million this year even as the state Legislature has pushed tougher enforcement against cigarette smuggling, counterfeiting and tax evasion.

The county's share of those dollars for early childhood programs has fallen as well, from almost $12 million to $10.4 million last year.

It's a decline that promoters are applauding in the sense that the higher taxes may have deterred smoking, but now some advocates are looking to supplement those levies with new taxes on tobacco.

The California Hospital Association plans to put an initiative on the ballot next year that would place a $1.50 tax on each package of cigarettes, most of it for emergency-room care. Another organization, the Coalition for a Healthy California, is seeking a tax of $1 a pack for various education, health and enforcement programs. Combined, the two taxes would nearly double the price of a package of cigarettes.

Gary Wilde, CEO of Community Memorial Hospital in Ventura, said California emergency rooms could certainly use the proceeds from new taxes.

"I don't know if it should come out of the hide of smokers, but there really is a need in California hospitals with growing numbers of indigent patients using the ER as their primary source for healthcare," he said.

Jan Emerson, spokeswoman for the California Hospital Association, said the measure would raise $1.4 billion a year on top of the roughly $1 billion that tobacco taxes now generate in California.

"Tobacco-related diseases are a huge burden on hospital ERs: people who have strokes, heart attacks, heart disease, all those come to the ERs and add to the burden," Emerson said. "All of us pay for that. We're trying to create a situation where the people that add to the ER's problems pay for it."

While other habits such as alcohol also contribute to health problems, tobacco taxes are a hit with voters. Emerson said the California Hospital Association has looked at other possibilities, but polling shows cigarette taxes will fly. She noted that an effort to raise money for emergency services with a tax on in-state phone calls failed in 2004.

"We believe this is the measure that has the best chance of success," she said. "There's strong voter support for this."

She said more than $900 million would go to hospitals to cover the costs of operating emergency rooms, with the rest devoted to nursing education, tobacco and breast cancer programs, law enforcement to prevent tobacco smuggling, and administrative costs.

About $100 million would go toward existing tobacco-funded programs that have lost revenues.

Critics say tobacco taxes pass for one simple reason.

"Everybody likes the taxes on somebody else," said Jon Coupal, president of the Howard Jarvis Taxpayers Association.

Smokers compose only about 15 percent of the adult population, according to the state Department of Health Services.

Critics say there's a point of diminishing returns with cigarette taxes. To avoid them, some people buy them elsewhere: from the Internet, through the mail or in other states. The state Board of Equalization says tough enforcement has cut down on such problems.

Still, the agency estimates that $54 million is lost annually to such sources and almost $250 million to counterfeiting.

"Smoking is probably the worst habit in the world," handyman Greg Murphy said as he took a cigarette break Monday at the Ventura County Government Center. "If they made the tax so expensive no one could smoke, they'd probably stop."

URL: http://www.venturacountystar.com/vcs/county_news/article/0,1375,VCS_226_4076831,00.html

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Childhood Exposure to Second-Hand Smoke Has Long-Lasting Effects: Fruit Fiber May Help

A new study finds early life exposure to second-hand smoke can produce life-long respiratory problems. The study of 35,000 adult non-smokers in Singapore found that those who lived with a smoker during childhood had more respiratory problems, including chronic cough. Study participants who reported eating more fruit and soy fiber as adults seemed to be protected against some of the negative health effects often associated with early tobacco exposure.

Individuals 18 or younger, living with one or more smokers, were more than twice as likely to suffer from chronic dry cough as adults, according to a new study published by researchers at the National Institute of Environmental Health Sciences (NIEHS), a part of the National Institutes of Health, the University of Minnesota, and the National University of Singapore. This paper, which appears online in Thorax, is the largest study to date on the effects of childhood exposure to environmental tobacco smoke (ETS) on later respiratory disease, and the first to include data on dietary intake.

“This research adds to a growing body of evidence that exposure to second-hand smoke early in life has health consequences that can last a lifetime,” said Dr. David Schwartz, Director of the NIEHS. “In addition to finding ways to reduce the exposure of children to tobacco smoke and other environmental pollutants, we also need to look for ways to reduce the disease burden.”

The data for this study were collected from the Singapore Chinese Health Study, a population of men and women of Chinese ethnicity ranging in ages from 45 to 74 at enrollment, who live in Singapore. The 35,000 non-smokers provided information regarding ETS before and after age 18, a medical history including information on respiratory symptoms of chronic cough, phlegm production and asthma diagnosis, as well as information on dietary intake.

Chronic cough was defined as occurring on most days for at least three months of the year and lasting more than two years in a row. More than 45 percent of the study participants reported having fathers who smoked, and 19 percent reported having mothers who smoked. The researchers found that more smokers in the home during childhood, was linked to a greater incidence of chronic cough, and chronic phlegm.

“Because we had previously found in this Singaporean population data suggesting that a diet high in fruit and soy fiber may reduce the incidence of chronic respiratory symptoms, we decided to study the impact of fiber on problems associated with early tobacco exposure,” said NIEHS researcher Stephanie London, M.D. “We actually found that people who ate even a small amount of fruit fiber had less chronic cough related to environmental tobacco smoke.”

Study participants who ate more than 7.5 grams of fiber each day had fewer health effects associated with ETS. This is equivalent to eating about two apples a day. Dr. London pointed out that the average weight of the Singapore study participants was 127 lbs. She also added that most Singaporeans get their fiber from fruits, vegetables and soy.

“Fiber may have beneficial effects on the lung,” said Dr. London. “It seems to have the ability to reduce blood glucose concentrations, reduce inflammation, and enhance antioxidant processes. All of these may help to protect the lung against environmental insults, such as ETS in childhood. However, the possible benefits of fiber should not lessen the importance of reducing exposure to environmental tobacco smoke.”

NIEHS, a component of the National Institutes of Health, supports research to understand the effects of the environment on human health. For more information about environmental tobacco smoke and other environmental health topics, please visit our website at http://www.niehs.nih.gov/.

The National Institutes of Health (NIH) ­ The Nation's Medical Research Agency ­ is comprised of 27 Institutes and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary Federal agency for conducting and supporting basic, clinical, and translational medical research, and investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

---

Spousal Smoking Raises Risk of Stroke

NEW YORK (Reuters Health) Aug 04 - The risk of stroke, especially ischemic stroke, is several-fold higher among women who smoke whose spouses also smoke, results of a prospective cohort study suggest.

While passive exposure to cigarette smoke is known to increase the risk of heart disease, its effect on stroke has not been elucidated, Dr. Adnan I. Qureshi and colleagues note in their report, published in the September issue of Stroke. They therefore followed 5379 female participants in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study.

The research team, based at the University of Medicine and Dentistry of New Jersey in Newark, used data regarding risk factors collected during a first visit between 1982 and 1984, then followed the women for the next 10 years.

Among women who smoked, the relative risk of all strokes was 5.7 when their husbands also smoked; the relative risk for ischemic stroke was 4.8.

The investigators observed no association between spousal smoking and risk of strokes among nonsmoking women. They suggest that the smoking spouse may be more likely to quit during follow-up if their wives do not smoke, or they may make efforts to not smoke in close proximity to their wives.

"If physicians are to make a real impact on reducing stroke risk among their patients, they should not only address their patients' smoking habits but also those of their spouses or partners," Dr. Qureshi said in a statement.

Stroke 2005.

---

The following is a posting from HealthDay News

Copyright © 2005 ScoutNews, LLC.

Peter Jennings Loses Battle With Lung Cancer

MONDAY, Aug. 8 (HealthDay News) -- Newsman Peter Jennings' death Sunday from lung cancer, four months after he revealed he had been diagnosed with the disease, hammers home the overwhelming health threats posed by smoking -- even to ex-smokers, experts say.

Jennings , the face of ABC News for more than two decades, quit smoking 20 years ago. But he admitted starting again after the Sept. 11, 2001, terrorist attacks.

According to the American Lung Association, about 87 percent of lung cancer cases are caused by smoking, and 40 percent to 50 percent of new cases may occur in former smokers.

Because most lung cancers are diagnosed at a late stage, the five-year survival rate is only 15.2 percent, compared with 63 percent for colon cancer, 88 percent for breast cancer and 99 percent for prostate cancer, according to the lung association.

In 2005, lung cancer will take about 163,500 American lives and will maintain its place as the number one cancer killer, outpacing deaths from the second, third, fourth and fifth most common causes of cancer deaths combined, Dr. Bill Solomon, and associate professor of medicine at SUNY Downstate Medical Center in New York City, told HealthDay last spring.

Ninety percent of people who are diagnosed with lung cancer will eventually die of the disease, added Dr. Jay Brooks, chairman of hematology/oncology at the Ochsner Clinic Foundation in New Orleans.

Not everyone who smokes will get lung cancer and not everyone who quits will be protected. Why? No one knows for sure.

People who smoke have a 10- to 15-fold greater risk of developing lung cancer than those who never light up, experts say. And, for the most part, the more you smoke -- or smoked in the past -- the greater your accumulated risk.

"The risk does decline with time after you stop but those numbers aren't clear," Dr. Norman Edelman, chief medical officer of the lung association, told HealthDay.

A landmark study published last year in the British Medical Journal found that cigarette smokers die an average of 10 years sooner than nonsmokers. At least half, and possibly up to two-thirds, of people who smoke from youth on are eventually killed by their habit, a quarter of them in middle age, the study reported.

But the study also found that quitting can offer big advantages. Stopping at age 50 cuts the risk of dying in half, while quitting at age 30 almost eliminates the risk.

But individuals are still, well, individuals. Jennings, who was 67 when he died, quit smoking 20 years ago but admitted starting again after 9/11. That might have further damaged lungs that were not yet healed, Brooks said.

There were likely other factors at play as well.

"We're gambling with other things in the environment or genes or both," Edelman said. "The fact that Jennings smoked for a long period of time increased his risk of getting lung cancer. How much that risk was dissipated by stopping for 20 years I don't know, but it was obviously not entirely."

The ABC News anchor joins a long list of celebrities who smoked and developed lung cancer, including Yul Brynner, Nat King Cole, Gary Cooper, Walt Disney, Duke Ellington, Betty Grable and George Harrison.

Lung cancer isn't the only pitfall of smoking. "Smoking is also responsible for many cases of bladder cancer in males, head and neck cancer, esophageal cancer and pancreatic cancer," Solomon said.

Actor Michael Landon's four-pack-a-day habit likely contributed to his fatal pancreatic cancer. Humphrey Bogart and Sammy Davis Jr. both were smokers and both developed throat cancer.

Experts advise that if you're an ex-smoker with a cough, get to a doctor and get screened.

If you're a smoker, stop.

"Quitting is good. It's always good to quit, no matter how long you've smoked," Edelman said. "You'll reduce your risk of lung cancer, reduce the degree to which you have chronic obstructive pulmonary disease, reduce your risk of other types of cancer and of heart disease. The data is very clear. Even if you're 75, you can benefit from stopping."

More information

For more on quitting smoking, visit the American Lung Association.

---

June 30, 2005
CDC National Center for Chronic Disease Prevention and Health Promotion

Smoking cost the nation about $92 billion in the form of lost productivity in 1997-2001, up about $10 billion from the annual mortality related productivity losses for the years 1995-1999, according to new data from the Centers for Disease Control and Prevention. The new lost productivity estimate when combined with smoking-related health-care costs, which was reported at $75.5 billion in 1998, exceeds $167 billion per year in the United States.

The report also finds that during 1997-2001 an estimated 438,000 premature deaths occur each year as a result of smoking and exposure to secondhand smoke. In comparison, approximately 440,000 smoking-related deaths were estimated to have occurred annually from 1995-1999.

“Cigarette smoking continues to impose substantial health and financial costs on individuals and society,” said CDC Director Dr. Julie Gerberding. "We’ve made good progress in reducing the number of people who smoke, but we have much more work to do. If we want to significantly reduce the toll in this decade, we must provide the 32 million smokers who say they want to quit with the tools and support to do so successfully.”

This latest study updates the number of deaths due to smoking during 1997-2001, specifically updating the 1995-1999 average estimates previously released. It also reports productivity losses from deaths and finds that smoking causes 3.3 million years of potential life lost for men and 2.2 million years for women. Smoking, on average, reduces adult life expectancy by approximately 14 years.

“Despite the slow steady declines in prevalence in the United States, cigarette smoking still causes hundreds of thousands of preventable deaths each year," said Dr. Corinne Husten, acting director, CDC Office on Smoking and Health. “It’s in everyone’s best interest to prevent and reduce tobacco use. People will have longer, healthier lives, and there will be fewer smoking-related costs."

For more information about tobacco use and smoking cessation, visit the Office on Smoking and Health Web site at http://www.cdc.gov/tobacco. One resource now available to all smokers is HHS’ 1-800-QUIT-NOW (1-800-784-8669). The toll-free number is a single access point to the National Network of Tobacco Cessation Quitlines. Callers are automatically routed to their state’s quitline services.

---

FRESNO BEE
June 26, 2005

Grant funds lung study

By Jim Steinberg

Professor Henry Jay Forman will use $420,000 in state cigarette tax revenue for research at UC Merced that could help smokers, others who involuntarily breathe second-hand toxins from tobacco smoke and about 3.6 million residents who merely inhale the San Joaquin Valley's heavily polluted air.
 
Forman, a professor of biological sciences, is studying a natural process involving enzymes that help lungs defend the body against cigarette smoke and other toxic compounds. Unfortunately, the defense these enzymes provide for smokers and nonsmokers is less than total.
 
"It would be nice if we could understand how this defense system occurs," Forman says. "Living in an area like Fresno, you breathe in a lot of particles and gases not tremendously dissimilar from cigarette smoke."
 
Nonsmokers breathe hazardous gases and particles in significantly lower concentrations than smokers, Forman says, but his research is intended to help both groups. Air pollution afflicts people around the world, so Forman's research has potentially global applications.
 
Biochemist Kamlesh Asotra is research administrator for cardiovascular disease and general biomedical sciences with the Tobacco-related Disease Research Program. The program operates with funds from Proposition 99, an initiative that California voters approved in 1988, appropriating 5% of cigarette tax revenue for research on diseases linked with tobacco. It is unusual for an applicant to win such a tobacco disease grant on his first try, Asotra says. Another applicant who has won three grants from the National Institutes of Health has been trying for a tobacco grant like Forman's for several years, Asotra says.
"This is the only state-funded agency that is funding research into the ill effects of tobacco on lung capacity," Asotra says.
 
Forman has achieved international prominence in his research in toxicology, Asotra says, and his three-year tobacco grant evolved from that.
 
Cigarette smoke inhaled directly or from other smokers also causes emphysema, Forman says.
 
"Almost every cigarette smoker is developing emphysema," he says. "It doesn't manifest itself until it becomes severe, and a lot of people outlive the disease" and die of other causes, sometimes unaware that they even had emphysema.
 
Maria Pallavicini, UC Merced's dean of natural sciences, calls Forman's work "stellar basic research to understand the response of cells to damage" and an example of academic science that can improve Valley residents' lives.
 
Forman explains how his research connects with smokers as well as all people living in polluted air, which means virtually everyone in the San Joaquin Valley and such places as Los Angeles, New York, Chicago and Denver.
 
"The whole issue of second-hand smoke has been a controversy," Forman says, "but you get the same things as with air pollution. It's just a question of how much. The evidence is that people in bars and confined places are subjected to as much as the smoker. … Incidence of lung diseases is enormously higher in these people than in people who haven't been exposed."
 
Forman is exploring an enzyme that protects the linings of the lungs against cigarette smoke, pesticides and other toxins. The research involves determining how individual proteins are "turned on" so that different proteins respond in varied ways to other substances.
 
That variation is key, Forman says: "That was the breakthrough we came up with. It excited the scientists reviewing our application enough to make the recommendation" for the grant.
 
"The enzymes are not an absolute defense," he says. "I am not saying, 'Take these enzymes, and go smoke.' That is absolutely not what I am saying."
 
Just the opposite, Forman says. Cigarette smoke contains about 4,000 toxic compounds. "It is overwhelming," he says, "like a bomb."
 
Forman hopes that research by his team can find a way to "help ameliorate the problem."

---

California Smoking Rates Drop 33 Percent Since State's Anti-Tobacco Program Began
Wednesday April 20, 12:02 pm ET
Largest Smoking Decline Reported by Females

SACRAMENTO, Calif.--(BUSINESS WIRE)--April 20, 2005--California's adult smoking rate dropped to a historic low of 15.4 percent in 2004, a 32.5 percent decrease since 1988, when California voters passed Proposition 99, the landmark initiative that established the state's anti-tobacco program, State Public Health Officer Dr. Richard J. Jackson announced today.

"Every year, more Californians are making the commitment to live tobacco-free," said Jackson. "Our messages about the dangers of tobacco use, secondhand smoke and the tobacco industry's misleading marketing practices are resonating with all Californians."

According to the California Department of Health Services, the state's latest survey shows the adult smoking prevalence rate was 15.4 percent last year, compared with 22.8 percent in 1988. Smoking among California females has dropped 41 percent, from 20.5 in 1988 to 12.1 percent in 2004. Among California males, smoking has dropped 25 percent, from 25.1 percent in 1988 to 18.7 percent in 2004.

State health officials credit California's smoke-free policies, comprehensive local and school-based tobacco education programs, aggressive media campaign and increased tobacco taxes as key factors in the unprecedented statewide smoking reductions.

"The decrease in smoking rates is having a profound effect on the health of Californians," said Jackson. "As a result of fewer Californians smoking, rates of cancer of the lung or bronchus in California are going down at three times the rate of the rest of the country."

Although smoking has declined among all age groups, 18 to 24 year olds continue to have the highest smoking rate of any age group in California. The smoking rate among this age group was 18.3 percent in 2004, down from 22.2 percent in 2003.

Data released earlier this year show California youth also are smoking at historic lows. According to the 2004 California Student Tobacco Survey, 13.2 percent of the state's high school students smoked last year, which is 41 percent lower than the national rate of 22.3.

Among middle school students in grades six through eight, 3.9 percent reported smoking last year, which is 52 percent lower than the national rate of 8.1 in 2004.

"California's youth are choosing tobacco-free lifestyles because smoking is no longer seen as a social norm in this state and is no longer tolerated in public places," said State Health Director Sandra Shewry. "We have smoke-free restaurants, shopping malls, schools, playgrounds, parks and beaches. We have created a healthier California."

Added Jackson, "Despite these vast reductions in smoking, the battle against this very dangerous addiction must continue. There are nearly four million Californians who still smoke and thousands of teenagers who start smoking every year. As long as tobacco products are sold, California must continue its anti-tobacco programs to educate people about the dangers of smoking, the hazards of secondhand smoke and the marketing tactics of the tobacco industry."

In November 1988, Proposition 99 was approved by California voters, instituting a 25-cent tax on cigarettes and earmarking 5 cents of every cigarette pack sold to fund the California Tobacco Control Program, the nation's longest running and most emulated anti-tobacco program.

Source: California Department of Health Services

---

Novartis Buys the Rights to Develop a Lung Drug
by Tom Wright

LAUSANNE, Switzerland, April 13 - Novartis , the Swiss drug maker, agreed Wednesday to pay two British companies up to $375 million for an experimental treatment for chronic obstructive pulmonary disease, also known as smokers' lung.

The new drug, known as AD 237, dilates passages to the lungs that have been damaged, most often by smoking.

The drug, which is being developed by Arakis and the Vectura Group, two British drug makers, is taken once a day through an inhaler and is in late-stage clinical trials.

Novartis will pay an initial $30 million for the right to develop the drug, and other payments will follow after clinical and commercial targets are met, Arakis and Vectura said. The deal is one of the largest ever in European biotechnology.

Chronic obstructive pulmonary disease, which is not curable, causes chronic bronchitis and eventually lung failure, and is a leading cause of death in the United States, according to the American Lung Association. Some 118,000 people in the United States die of it each year, the association said.

Novartis will develop AD 237 both as a single treatment and in combination with QAB149, a similar drug Novartis has in trials. Novartis does not expect to submit QAB149 for approval until 2007, and AD 237 is not scheduled to go before regulators until 2010.

The market for such drugs is currently dominated by Spiriva, which was introduced last year by Pfizer of New York and Boehringer Ingelheim of Germany.

Both companies expect the drug to become a blockbuster - generating sales of $1 billion a year - by the end of this year.

Developing medicine for smokers with lung problems is a growing business. The market is now worth $4 billion a year, but could grow to $10 billion by the end of the decade, Novartis said.

"This is a market where other drugs out there have blockbuster potential," said John Gilardi, a Novartis spokesman. "We see it as a market with unmet medical need, and which is growing."

The deal adds to Novartis's already strong pipeline, analysts noted. While some European companies are struggling to develop new products, Novartis has a number of drugs in late-stage trials, including a much-awaited diabetes treatment, LAF237. In February, Novartis also announced acquisitions that would make it the world's largest producer of generic medicines.

"With this agreement, our late-stage pipeline now contains two promising" drugs for smokers with lung disease, said Jörg Reinhardt, head of development at Novartis in Basel. "Respiratory disease is one of our key therapeutic areas of focus."

Daniel L. Vasella, chief executive of Novartis, told the German magazine Capital that he expected to make further acquisitions in 2005, without elaborating. Cancer drugs, including the blockbuster Glivec, will be behind most of the growth at Novartis in the next four years, Mr. Vasella said.

For the British companies, the Novartis venture is a coup, analysts said.

Arakis, a privately held company based near Cambridge, will get capital to help it develop other drugs. Arakis, which was founded in 2000, has raised $93 million in private equity deals, and is now considering going public.

It has four drugs in trials, including AD 237, none of which have yet reached the market.

Vectura, a loss-making company that listed in Britain last year, has been working with Arakis in a joint venture to develop AD 237. Vectura owns the patent for an inhalation device that delivers drugs more effectively to diseased lungs.

---

Stroke Awareness Low Among Women, Especially Minorities

15 March 2005  

Knowledge of stroke warning signs remains low among U.S. women, particularly among racial and ethnic minorities, according to a national survey reported in a special disparities themed issue of Circulation: Journal of the American Heart Association.

Each year about 700,000 Americans have a new or recurrent stroke and nearly 40,000 more women than men die of a stroke, according to American Heart Association/American Stroke Association statistics. "Yet only one-third of women surveyed in 2003 said that they felt very well or well informed about stroke," said Anjanette Ferris, M.D., lead author of the report and a clinical fellow in cardiovascular disease at Columbia University Medical Center in New York City.

African-American women are 1.5 times more likely to have a stroke and 1.3 times more likely to die of a stroke than white women. "Our study documents a knowledge gap between racial/ethnic minorities and whites regarding stroke warning signs," Ferris said. "It is paradoxical that racial and ethnic minorities at highest risk were least aware. As with heart attack, it is critical that women at risk for stroke know the warning signs because delayed treatment can lead to greater disability or death."

The American Heart Association-sponsored telephone survey included 1,024 women ages 25 and older. Among participants, 68 percent were white, 12 percent African American and 12 percent Hispanic. The remaining 8 percent were of other ethnicities.

The survey was the third conducted since 1997 to assess trends in awareness and knowledge of heart disease and stroke, the nation's first and third leading causes of death. Questions covered knowledge of stroke warning signs, risk, prevention and treatment, among other topics. Results include:

Awareness

. Nearly one third of Hispanic women reported that they were not informed about stroke compared to 20 percent of African-American and 10 percent of white women.

. 61 percent of Hispanic women compared to 74 percent of African-American and 82 percent of white women reported that they had heard or read information about cardiovascular disease within the past 12 months.

Stroke warning signs

. More white women correctly identified stroke warning signs than did African-American or Hispanic women.

. 39 percent of white women, 32 percent of African-American women and 29 percent of Hispanic women identified sudden weakness or numbness of the face or limb on one side of the body as a warning sign.

"A significantly higher percentage of African-American respondents correctly believed that African-American women are more likely to die of a stroke than white women," Ferris said. "However, African-American women were still less likely to correctly identify stroke warning signs."

Treatment

. More white women (92 percent) knew treatment exists that can break up blood clots and reverse the course of an ischemic stroke if patients arrive at a hospital soon after the onset of symptoms. Comparable figures were 84 percent for African-American and 79 percent for Hispanic women.

"These data support the need for targeted educational programs on the warning signs of stroke and underscore the importance of public health programs to improve awareness and prevention of stroke among women, especially among minority women who are at highest risk," Ferris said.

Co-authors are Rose Marie Robertson, M.D.; Rosalind Fabunmi, Ph.D.; and Lori Mosca, M.D., Ph.D., M.P.H.

Editor's Note: The disparities themed issue features original research articles solicited by the editors of Circulation: Journal of the American Heart Association and conference proceedings from the association's "Discovering the Full Spectrum of Cardiovascular Disease: The Minority Health Summit 2003." Summit attendees included health care leaders from the National Medical Association, Association of Black Cardiologists, International Society on Hypertension in Blacks and the Robert Wood Johnson Foundation.

Statements and conclusions of study authors that are published in the American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect association policy or position. The American Heart Association makes no representation or warranty as to their accuracy or reliability.

American Heart Association special journal report

NR05 - 1035 (Circ/Ferris)

Contact: Carole Bullock
carole.bullock@heart.org
214-706-1279
American Heart Association
http://www.americanheart.org

---

Study Examines Racial Differences Among Children To Environmental Tobacco Smoke Exposure

CINCINNATI -- A new study may help explain why African American children suffer disproportionately from tobacco-related illness.

The Cincinnati Children's Hospital Medical Center study shows that African American children with asthma have significantly higher levels of cotinine -- a substance produced when the body breaks down nicotine -- even though these children's parents report lower exposure to environmental tobacco smoke, commonly known as second-hand smoke.

"There are at least two possible reasons why African Americans have higher levels of cotinine," says Stephen E. Wilson, MD, a scientist at the Cincinnati Children's Center for Environmental Health and the study's lead author. "Numerous studies have demonstrated significant racial differences in the metabolism of tobacco-related products. But differences in additives to cigarettes commonly smoked by African Americans, such as menthol, could also explain the observed racial differences."

The study will be published in the March issue of Environmental Health Perspectives and is currently available online at http://ehp.niehs.nih.gov/

The study is based on data from the Cincinnati Asthma Prevention study, an ongoing study of the Cincinnati Children's Center for Environmental Health. Dr. Wilson and his colleagues measured cotinine in the blood and hair of 222 children with asthma. Cotinine is considered the best marker of environmental tobacco smoke exposure. The investigators also assessed exposure to environmental tobacco smoke using a validated survey.

Surprisingly, the investigators found that African American children with asthma had higher levels of cotinine in the blood (1.41 ng/ml vs. 0.97 ng/ml) and hair (0.25 ng/mg vs. 0.07 ng/mg) compared to white children. This pattern held true even after taking into account tobacco smoke exposure, size of home and other sociodemographic characteristics, according to Dr. Wilson.

"These differences in cotinine could provide clues to the racial differences in tobacco-associate morbidity and mortality," says Dr. Wilson. "If African American children are more susceptible to tobacco-induced toxicity, we should target policy initiatives to reduce exposure among this population."

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More ills laid at feet of secondhand smoke

By Edie Lau and Dorsey Griffith -- Sacramento Bee Staff Writers
Published 2:15 am PST Thursday, March 10, 2005

A sweeping study led by California state scientists on the health risks of breathing second-hand smoke adds breast cancer and premature birth to an already long list of ills associated with cigarettes.

The findings, which go further in establishing the link between cigarettes and breast cancer than any before, are sure to be debated for months. But the draft study already has spurred discussion in California and the nation about regulating tobacco use in private venues such as cars.

"It's another indictment of tobacco and the health effects of secondhand smoke on healthy people, especially children," said Paul Knepprath, vice president for government relations with the American Lung Association of California.

"It provides an opportunity for California to continue its leadership in reducing exposure to the public."

The analysis was conducted by scientists at the Office of Environmental Health Hazard Assessment, a respected research arm of the California Environmental Protection Agency. The team considered the results of about 1,000 studies to come up with its conclusions.

The newest, most attention-getting finding is that exposure to secondhand smoke may increase a woman's risk of breast cancer nearly twofold. Though several earlier studies found no such link, the researchers said that recent and better controlled studies consistently identified elevated risk, particularly in younger women.

"What this really does say is that tobacco smoke is a risk factor for breast cancer," said Melanie Marty, who led the team.

Oddly enough, smoking itself is not thought to elevate breast cancer risk. Marty said that may be because active smoking reduces levels of estrogen, a hormone in the body that fuels tumor growth.

"We think that partially mitigates the risk and confuses the picture," she said.

Inhaling smoke secondhand, however, may not significantly dampen estrogen levels.

Evidence of a link between breast cancer and tobacco was strongest among younger, pre-menopausal women. Dr. Scott Christensen, associate clinical professor of oncology at UC Davis Medical Center, was not surprised. He said that during a woman's menstrual cycle, hormones cause cells to grow and divide, making their DNA more susceptible to cancer-causing damage.

Making associations between environmental toxicants and cancer is extremely difficult, Christensen added, because studies must involve large numbers of people and many years to be conclusive. "It's gratifying the work is being done," he said.

On average, women in the United States have a one in eight chance of developing breast cancer. "It's a complex disease, with lots of factors," Marty said. "This is just one of the factors."

Joel London, a spokesman for the U.S. Centers for Disease Control and Prevention, said the federal government would like to see more research into the possible link. "It will stimulate continued and accelerated scientific evaluation of the smoking and breast cancer issue," he said.

In addition to identifying an elevated risk for breast cancer, state scientists found that exposure to secondhand smoke raises by 50 percent to 80 percent the risk of premature birth.

Marty said scientists previously had associated passive smoking with low-birthweight babies, but the finding about premature birth is new.

The study was requested by the California Air Resources Board, which is considering whether to define environmental tobacco smoke as a toxic air contaminant.

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Brain activity of men and women can differ greatly during hostile or impulsive acts, but less so on nicotine

Medical News Today
18 Feb 2005   

UC Irvine researchers have uncovered significant differences in the brain activity of men and women when engaged in a broad range of activities and behavior - differences that are even more acute during impulsive or hostile acts.

But when men and women have nicotine in their bodies, these brain activity differences practically disappear. Among both smokers and non-smokers on nicotine, during aggressive moments such as impulsive or hostile acts, there are virtually no differences in brain activity between the sexes - illustrating how nicotine can impact brain function. Results of the study, conducted by Brain Imaging Center researchers supported by the UCI Transdisciplinary Tobacco Use Research Center, are published in the online edition of the International Journal of Neuropsychopharmacology, and will be available in print next month.

The researchers found during behavioral and brain-imaging tests on hostility and impulsive reaction that brain-metabolism activity - which indicates when neurons are working - was much higher in many brain areas of women than men. But when the test subjects were given nicotine, metabolic activity significantly declined in the women and slightly increased in men - the original differences all but disappeared.

According to Dr. Steven Potkin, who along with neuroanatomist James Fallon led the study, these results shed light on two issues. First, brain activity areas involved in choice, attention, short-term memory, planning, mood, emotion and language are different in men and women - differences exaggerated during moments of hostility or impulsiveness. In addition, the study provides new evidence that men's and women's brains respond differently to the same stimuli -
a result sure to fuel the ongoing debate over fundamental variations in brain function based on gender. Since these differences are present even in non-smokers, they appear to be inherent differences in brain metabolism and function between men and women.

The study also found that nicotine can be an "equalizer" of the sexes in brain activity, with nicotine reversing brain responses that would otherwise take place. Along with better understanding nicotine's grip on the brain, when it comes to smokers, this finding will enhance researchers' appreciation for the distinctions between the sexes.

"Gender differences regarding the effects of nicotine on brain function and metabolism have been largely unstudied and unidentified," Potkin said. "Understanding brain activity will provide new light into understanding smoking behavior. For instance, we already know that men and women smoke cigarettes with varying rates and reasons. We also know women take fewer and shorter puffs of cigarettes than men. Women also are less successful using the nicotine patch or gum therapies when trying to quit smoking."

To better understand how nicotine impacts brain activity, Potkin and Fallon tested the behavior of smokers and non-smokers when subjected to different tests. For example, during one experiment, researchers had participants play a "hostility" game - a game that allowed the winner to choose the loudness of a noise blasted at the losing player, with the opponent then having an opportunity to retaliate. The researchers found among all participants, behavioral responses differed by gender, with men retaliating by cranking up the volume in a short blast, while women sustained the noise longer, which one of the researchers referred to as shouting for the men and nagging for the women. Differences in brain activity also was split by gender: Among men and women who smoked, while their behavior differed by gender, their brain activity was virtually identical following nicotine.

Similar findings resulted when testing impulsive responses.

Potkin conducted the research using brain-imaging technology. This study included 42 females and 77 males, 64 of whom were non-smokers. The 55 smokers smoked at least 10 cigarettes, but fewer than two packs, per day for at least one year. Thus, these brain metabolism findings apply to most smokers. Nicotine was administered by a patch.

Potkin, who holds the Robert R. Sprague Chair in Brain Imaging, is director of the Brain Imaging Center, and Fallon is a professor of neurobiology and anatomy. David Keator, James Mbogori and Derek Taylor in the UCI School of Medicine assisted with the study.

---------------------

About the UCI Transdisciplinary Tobacco Use Research Center: UCI TTURC is funded jointly by the National Institute of Drug Abuse and National Cancer Institute in partnership with the Robert Wood Johnson Foundation. The major research focus of the center is to identify key factors that underlie susceptibility to nicotine addiction in adolescents and young adults.

Contact: Louri Groves
lgroves@uci.edu UCI Web Site

http://www.medicalnewstoday.com/

---

More ills laid at feet of secondhand smoke

By Edie Lau and Dorsey Griffith -- Sacramento Bee Staff Writers
Published 2:15 am PST Thursday, March 10, 2005

A sweeping study led by California state scientists on the health risks of breathing second-hand smoke adds breast cancer and premature birth to an already long list of ills associated with cigarettes.

The findings, which go further in establishing the link between cigarettes and breast cancer than any before, are sure to be debated for months. But the draft study already has spurred discussion in California and the nation about regulating tobacco use in private venues such as cars.

"It's another indictment of tobacco and the health effects of secondhand smoke on healthy people, especially children," said Paul Knepprath, vice president for government relations with the American Lung Association of California.

"It provides an opportunity for California to continue its leadership in reducing exposure to the public."

The analysis was conducted by scientists at the Office of Environmental Health Hazard Assessment, a respected research arm of the California Environmental Protection Agency. The team considered the results of about 1,000 studies to come up with its conclusions.

The newest, most attention-getting finding is that exposure to secondhand smoke may increase a woman's risk of breast cancer nearly twofold. Though several earlier studies found no such link, the researchers said that recent and better controlled studies consistently identified elevated risk, particularly in younger women.

"What this really does say is that tobacco smoke is a risk factor for breast cancer," said Melanie Marty, who led the team.

Oddly enough, smoking itself is not thought to elevate breast cancer risk. Marty said that may be because active smoking reduces levels of estrogen, a hormone in the body that fuels tumor growth.

"We think that partially mitigates the risk and confuses the picture," she said.

Inhaling smoke secondhand, however, may not significantly dampen estrogen levels.

Evidence of a link between breast cancer and tobacco was strongest among younger, pre-menopausal women. Dr. Scott Christensen, associate clinical professor of oncology at UC Davis Medical Center, was not surprised. He said that during a woman's menstrual cycle, hormones cause cells to grow and divide, making their DNA more susceptible to cancer-causing damage.

Making associations between environmental toxicants and cancer is extremely difficult, Christensen added, because studies must involve large numbers of people and many years to be conclusive. "It's gratifying the work is being done," he said.

On average, women in the United States have a one in eight chance of developing breast cancer. "It's a complex disease, with lots of factors," Marty said. "This is just one of the factors."

Joel London, a spokesman for the U.S. Centers for Disease Control and Prevention, said the federal government would like to see more research into the possible link. "It will stimulate continued and accelerated scientific evaluation of the smoking and breast cancer issue," he said.

In addition to identifying an elevated risk for breast cancer, state scientists found that exposure to secondhand smoke raises by 50 percent to 80 percent the risk of premature birth.

Marty said scientists previously had associated passive smoking with low-birthweight babies, but the finding about premature birth is new.

The study was requested by the California Air Resources Board, which is considering whether to define environmental tobacco smoke as a toxic air contaminant.

If it does, the board known for its trendsetting regulations on motor vehicles could extend its reach to cigarette fumes.

At Philip Morris USA in Richmond, Va., spokeswoman Jennifer Golisch would not discuss the study.

She said the tobacco company has not decided whether to file a comment on the report.

A panel of scientists from leading California universities has been reviewing the study since late November. Once they complete their review, which could happen Monday, the report goes to the Air Resources Board.

Air board spokeswoman Gennet Paauwe said any regulation that results from a declaration of tobacco smoke as a toxic air contaminant would be years away.

"This is a long process," she said, declining to give examples of ways in which secondhand smoke might be restricted.

California has been a national leader in restricting smoking in public places. The Legislature in 1994 passed the California Smokefree Workplace Act, prohibiting smoking in nearly all enclosed places of employment. Bans on smoking in taverns and gaming facilities followed in 1998. Legislators since have banned smoking from tot lots and playgrounds and kept smokers 20 feet from government buildings.

Knepprath of the American Lung Association said the study should revive failed legislative efforts to ban drivers from smoking in cars when children are present. And he suspects it could ignite attempts to curb smoking in multifamily dwellings.

Barbara Brenner, executive director of Breast Cancer Action, an advocacy group in San Francisco, said the study should help guide the nation in developing stronger protections.

"People who are involuntarily exposed should be protected wherever they go," she said. "We need a national campaign to implement the kind of restrictions already in place in California."

 

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American College of Physicians public release date: 14-Feb-2005

PHILADELPHIA -- (Feb. 15, 2005) In a new study of 5,887 middle-aged smokers with mild lung disease, those who were randomly assigned to a quit-smoking program had a lower death rate than those assigned to usual care, even though only 21.7 percent of them actually quit smoking.

The annual death rates were 8.8 per 1000 participants in the quit-smoking program and 10.4 per 1000 in the usual care group. The annual death rates for those who actually quit was even more positive: 6.0 per 1000 patients compared with 11.0 per 1000 in those who did not quit smoking.

Overall, the death rate of those in both groups who were able to quit smoking was 46 percent lower than those who did not quit.

The study, "The Effects of a Smoking Cessation Intervention on 14.5-year Morality," is the first experimental study to show that stopping smoking adds years to life. It is published in the Feb. 15, 2005, issue of Annals of Internal Medicine .

The findings were based on data from the Lung Health Study. Randomized trials like the Lung Health Study are widely regarded as the gold standard for proof among clinical studies.

"We know that people who smoke should quit smoking," said one of the study authors, John E. Connett, PhD, professor of biostatistics of the University of Minnesota School of Public Health.

"This study showed that with very simple lung function tests -- spirometry -- we can find people who can benefit the most from an intensive quit-smoking program," Connet said. "And it not only made them healthier and feel better, it caused substantial reductions in death rate."

The participants in the study all had mild lung disease, which itself increases risk for more serious lung disease down the road.

In an editorial, "Smoking Kills, Experimental Proof from the Lung Health Study," Jonathan M. Samet, MD, MS, of the Johns Hopkins Bloomberg School of Public Health, says that the importance of the new findings is that the study was randomized and was large enough and long enough to truly test whether smoking cessation reduces all-cause mortality. Previous studies linking smoking to death from specific diseases, such as lung cancer and heart disease, were based on observation rather than on experiment.

These new findings "prove that smoking causes increased risk for death in smokers," Dr. Samet said in the editorial. "No one can make a serious claim to the contrary in light of this randomized trial evidence."

A surprising finding, according to Dr. Connett, was that the reduction in death rate was more significant in younger people, 35 to 45, than older people.

"Current guidelines suggest that smokers over age 45 should be screened, but our study found that younger people have more to gain from being screened than older people," Connett said. "Young people who are found to have abnormal lung function should be put into an aggressive quit-smoking program."

Dr. Connett commented on the unusual study finding that even those who did not quit smoking completely had lower death rates than the people who continued to smoke throughout.

"One might have thought that this program was not working, because by most standards, only 20 percent or so of the people who were enrolled in it quit smoking continuously," Connett said. "People quit, restarted, and quit again. However, quitting had such a statistically large impact on the overall population that even though many people quit and started smoking again, as long as they were smoke-free for periods of time, they had better outcomes than those who continued to smoke."

Emphysema Is Irreversible, Smoking Main Cause
Monday, January 24, 2005 [from WebMD]

By Michael W. Smith, MD

Johnny Carson , late-night talk show host for 30 years, died from emphysema , a common lung disease.

Carson was diagnosed with emphysema in 2002.

What is emphysema, can it be prevented, and how can it be treated? WebMD turned to The Cleveland Clinic and the American Lung Association for answers.

What is emphysema?

Emphysema is irreversible destruction of the walls of the air sacs located at the end of the bronchial tubes . The damaged air sacs, called alveoli , are not able to exchange oxygen and carbon dioxide between the lungs and the blood. As a result a person develops progressive symptoms of the disease including shortness of breath, cough, and limited ability to exert him- or herself.

The lung tissue loses its elasticity and collapses when the person exhales, trapping air in the lungs. The trapped air keeps fresh air and oxygen from entering the lungs.

What causes emphysema?

Cigarette smoking causes approximately 80 to 90 percent of deaths due to emphysema. Air pollution and occupational dusts may also contribute to emphysema, especially when the person exposed to these substances is a cigarette smoker. A genetic abnormality called alpha-1-antitrypsin deficiency can also cause emphysema.

Cigarette smoke causes emphysema by destroying the tiny air sacs in the lungs. Damage to these air sacs leads to holes in the lung tissue. It typically takes years of smoking before emphysema symptoms develop -- but once the damage is done, it can't be reversed.

How many people have emphysema?

The number of people with emphysema has gone from 2.3 million in 1982 to 3.1 million in 2002. Many people with emphysema also have chronic bronchitis , another lung condition largely caused by smoking. Heart disease, also commonly caused by smoking, is also often present.

Emphysema generally occurs after the age of 45. Men tend to develop emphysema more frequently. However, it's unclear if emphysema rates in women will rise since smoking is now more common among women.

Together with other lung conditions that are largely caused by smoking, such as chronic bronchitis, emphysema is the fourth leading cause of death in the U.S. , claiming the lives of more than 120,000 Americans per year.

What are the symptoms of emphysema?

Early symptoms include shortness of breath and cough. People with emphysema often also have chronic bronchitis, in which the person develops a long-lasting cough that produces mucus. Wheezing is often also present in people with emphysema.

How is emphysema treated?

Lung damage due to emphysema is irreversible. The single most important treatment is to stop smoking. Quitting smoking helps slow the progression of emphysema. Treatment also improves shortness of breath.

Medications, including inhalers to help relax the lung and open the airways, are often used. Anti-inflammatory steroids are also used if the person has a sudden worsening with increased shortness of breath.

Exercise can be very helpful to help strengthen the breathing muscles and improve overall condition.

Rarely, surgery is performed. Lung transplantation can be effective in some cases. A relatively new surgery, called lung volume reduction surgery, can help improve breathing. In this surgery the most severely diseased portion of the lung is removed. This procedure is very risky in people with very severe emphysema and research has shown that these people are at an increased risk of death with this surgery.

What is the prognosis of emphysema?

Although emphysema cannot be cured, its symptoms can be treated and your quality of life can be improved. The prognosis or outlook for the future depends on how well the lungs are functioning, symptoms, and how well the person responds to and follows treatment.

Can emphysema be prevented?

Since most people who develop emphysema are smokers, the best way to prevent this lung disease is not to smoke.

SOURCES: The Cleveland Clinic. American Lung Association.