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National Emphysema Foundation

Author: Frank Drescher MD 27.11.2008

Emphysema and Chronic Obstructive Pulmonary Disease (COPD) are related lung conditions that are caused by many years of cigarette smoking (‘smoker’s lung’). An estimated 3.1 million Americans have been diagnosed with emphysema; 11.2 million U.S. adults were estimated to have COPD. The disease is estimated to kill more than 120,000 Americans each year. Smoking is the major cause, but with ever increasing air pollution and other environmental factors that negatively affect pulmonary patients, those numbers are on the rise. There is no denying it, we must continue our work to reduce the suffering and the toll emphysema is taking.

The National Emphysema Foundation was founded in 1971; its mission is to improve the quality of life of patients with emphysema, chronic obstructive lung disease, asthma or related lung diseases with information and education for families. The National Emphysema Foundation supports research and works with many advisors who are involved in direct patient care.

The information presented here is from experienced professionals, they have written their expert opinions specifically for the website. Information is also presented from published literature. It is not a therapeutic recommendation or prescription. For specific information and advice, consult your own physician or other healthcare provider.


News on the Fight against Smoking

Author: Frank Drescher MD 27.11.2008

Smoking just a few cigarettes per day can be dangerous

Smoking just one to four cigarettes a day almost triples a person’s risk of dying of heart disease, according to Norwegian researchers. Their work suggests the health impact is stronger for women and that even “light” smokers face similar diseases to heavier smokers, including cancer.

The team tracked the health and death rates of almost 43,000 men and women from the mid 1970s up to 2002. Compared with those who had never smoked, the men and women who smoked between one and four cigarettes a day were almost three times as likely to die of coronary artery disease such as heart attacks. Among women, smoking one to four cigarettes daily increased the chance of dying from lung cancer almost five times. Men who smoked this amount were almost three times as likely to be killed by lung cancer.

Even occasional smokers get abnormal arteries

Scientists at the University of Georgia recruited 18 healthy college students, half of whom were nonsmokers. The other half were occasional smokers, puffing less than a pack a week, and had not smoked for at least two days before undergoing testing. The authors used ultrasound scans to measure blood flow in the arteries. They found that arteries of occasional smokers were 36 percent less responsive to changes in blood flow than nonsmokers. And, after the occasional smokers smoked two cigarettes arterial responsiveness dropped by another 24 percent, compared to before they smoked. Based on these findings the authors concluded that occasional cigarette smoking can impair artery function and contribute to heart disease.

Secondhand smoke

Secondhand smoke may cause the same problems as direct smoking, including lung cancer and emphysema, bronchitis and asthma. A study issued in 2002 by the International Agency for Research on Cancer of the World Health Organization concluded that non-smokers are exposed to the same carcinogens as active smokers. Some carcinogens may be present at higher concentrations in secondhand smoke than in mainstream smoke.
Scientific organizations confirming the harmful effects of secondhand smoke include the U.S. National Cancer Institute, the U.S. Centers for Disease Control, the U.S. National Institutes of Health, the United States Surgeon General, and the World Health Organization.

Smoking ban in the USA

In 1973, Arizona became the first state in the United States to restrict smoking in public places. California followed with a workplace smoking ban in 1994 and a complete smoking ban in enclosed spaces in 1998. Florida in 2002, Washington State in 2005 and the state of New York in 2003 followed with similar regulation. Ireland in 2004 was the first European country to establish a nationwide smoking ban in all workplaces; other European countries have introduced laws to that effect over the last years.

Smoking banned at Pennsylvania’s state-owned universities.

On August 11th Smoking at 14 of Pennsylvania’s state-owned universities has been banned anywhere on campus — even outdoors. This has prompted protests across the state by some of the 110,000 students in the State System of Higher Education, who received word of the ban only one day before a new state law took effect. While the move to make campuses system wide completely smoke-free is apparently unprecedented among state-owned Pennsylvania universities, the American Lung Association said more than 130 colleges and universities across the country have such policies.

Smoking rate in the USA dropped below 20%

The CDC in a press release from 11/13 reported that an estimated 19.8 percent of U.S. adults (43.4 million people), were current smokers in 2007, down from 20.8 percent in 2006, according to a study in CDC?s Morbidity and Mortality Weekly Report. However, based on the current rate of decline, it is unlikely that the national health objective of reducing the prevalence of adult cigarette smoking to 12 percent or lower will be met by 2010.
Quitting smoking is the most important step smokers can take to improve their health and protect the health of nonsmoking family members. Still too many US citizens smoke and more efforts need to be made to decrease the numbers of smokers in the USA.

Tobacco companies manipulate menthol levels
to appeal younger smokers

A group of Harvard scientist in the American Journal of Public Health claimed that the tobacco industry has manipulated menthol levels in cigarettes to appeal youngsters, and maintain loyalty among smoking adults. Dr. Howard Koh, of the Harvard School of Public Health, and colleagues analyzed data from public tobacco industry documents, market research reports and a 2006 national health survey, and laboratory testing of menthol brands. The authors of the study accused the tobacco industry of pursuing “a very sophisticated strategy to lure in youth with lower menthol levels and then lock in adult customers who become acclimated to menthol and give them the higher levels they want.”
The study also showed that menthol was the predominant brand smoked by African-American teens, and they smoked it at higher rates than older African-Americans,”

When teen smokers realize they are addicted, it is too late to quit.

“Teen smokers often try to quit and seriously believe they can, only realizing they’re hooked when it’s too late,” according to a study published online Wednesday in the American Journal of Public Health. Researchers at the Université de Montreal tracked “319 students age[d] 12 or 13 who” began smoking “during the five years of the research.” At three-month intervals, “the group answered a questionnaire about their habits.” Investigators found that “[m]ore than 70 percent expressed a desire to quit, but only 19 percent managed to go smoke free for 12 months or more.” The data also showed that “a month and a half into smoking, teenagers will naively try and stop smoking completely,”. But, “by 21 months, they are no longer confident in their abilities to stop smoking, and are aware of the difficulty in quitting 32 months into the habit.”

Smoking and indoor pollution may claim more than 80 million Chinese lives over next
30-years.

More than 80 million Chinese may die in the next 25 years from complications related to smoking and indoor pollution from burning of biomass and coal, a Harvard University study says. If current levels of smoking and biomass and coal fuel use in Chinese homes continue, by 2033 there will be an estimated 65 million deaths from chronic obstructive pulmonary disease (COPD) and 18 million deaths from lung cancer. About half of Chinese men smoke, with an increasing number of women picking up the habit, and in more than 70 percent of homes fuels for cooking and heating come from wood, coal and crop residues.

WHO fights Smoking in Asia

700m Asians, mostly men, cannot get through the day without puffing on a cigarette. The habit is thought to kill around 2.3m Asians every year, almost half smoking’s global victims. Cases of cancer and other tobacco-related diseases are rising sharply.
The World Health Organization has urged the ministers to enact legislation to enforce smoke-free environments in indoor public places including offices, restaurants and bars. Health ministers from 11 South and Southeast Asian countries recently met in New Delhi for a four-day conference. They promised to promote policies to combat the use of tobacco, which claims more than one million lives in the region every year.

Nicotine gum may help pregnant women smoke less.

Cheryl Oncken, of the University of Connecticut School of Medicine, and colleagues, recruited 200 women who smoked an average of 18 cigarettes a day before pregnancy, and 10 a day in the week before beginning the study. The researchers found that subjects given nicotine gum cut back by five or six cigarettes each day, while those who were given placebos cut back by three or four cigarettes a day. The study also showed that “babies born to moms who chewed nicotine gum were less likely to need intensive care and had shorter hospital stays, although researchers say it’s possible that this could have been due to chance. About 85 percent of women in the study wanted to quit smoking, and they had tried to quit about three times.

Electronic cigarette not legitimate nicotine replacement therapy, WHO says.

“The electronic cigarette is not a proven nicotine replacement therapy,” said Dr Ala Alwan, WHO’s assistant director-general for noncommunicable diseases and mental health.
Developed in China in 2004, the electronic cigarette is sold there and in numerous other countries, including Brazil, Canada, Finland, Israel, Lebanon, the Netherlands, Sweden, Turkey and Britain. Marketers of the electronic cigarette typically describe it as a means to help smokers break their addictions to tobacco. Some have even gone so far as to imply that WHO views it as a legitimate nicotine replacement therapy like nicotine gum, lozenges and patches, according to the WHO statement.
In a WHO statement it was pointed out that there is no evidentiary basis for the marketers’ claim that the electronic cigarette helps people quit smoking, the statement said. “If the marketers of the electronic cigarette want to help smokers quit, then they need to conduct clinical studies and toxicity analyses and operate within the proper regulatory framework,” said Douglas Bettcher, head of WHO’s Tobacco Free Initiative.

Smoking cessation

Smoking cessation is of benefit for your health not matter how old you are. Over the last years new medications have been developed that can help smokers to quit their deadly habit.
Doctors recommend that smoking cessation is supported by providing a combination of behavioral treatment and medication therapy. Behavioral intervention often starts with counseling provided by the physician, but can also include group counseling offered by health and voluntary organization as well as the patient’s own social network.
A variety of medication has been approved by the FDA for the cessation of smoking. Chantix (Varenicline) has been shown in studies to be particularly beneficial for smoking cessation. Alternatives include Zyban (Bupropion ) and a variety of different nicotine replacements such as chewing gums and nicotine patches. Any of these treatments may be associated with significant costs and side effects and should only be taken under the supervision of a physician.
If you want to quit smoking
today consult your physician and get more information about smoking cessation at
this website:

http://www.surgeongeneral.gov/tobacco/


Oxygen levels decrease with high altitude. Commercial airplanes fly at such a high altitude that passenger cabins need to be pressurized in order to maintain adequate oxygen levels. The Federal Aviation Administration (FAA) requires airlines to keep the cabin pressure inside of airplanes to an equivalent pressure of 8000 feet or less. This means that oxygen levels on most commercial airplanes are equal to standing on top of a mountain that is 8000 feet high. Oxygen levels at this altitude are around 25% lower than at ground level. This may not cause any problems in healthy people, patients with lung diseases however may struggle with low oxygen levels inside commercial airplanes. For travelers with lung diseases such as chronic obstructive lung disease (COPD) and emphysema it is often necessary to have low oxygen simulation tests prior to air travel in order to determine the need for oxygen supplements onboard an airplane. Patients with heart and lung conditions should consult their clinician and contact their airline well in advance to the desired air travel in order to make arrangements for oxygen supplements on board. Unfortunately commercial air carriers have variable policies in regards to portable oxygen devices leading to confusion and frustration among passengers that have to rely on oxygen supplements during air travel.

New Regulations protects Passengers Using Oxygen Devices on Airplanes

A new ruling was instituted by the U.S. Department of Transportation (DOT) in May this year requiring airlines to accept certain approved portable oxygen concentrators (POC’s) aboard flights. The DOT will give airlines time to implement these changes until May 13, 2009. This rule will apply to U.S. air carriers worldwide and to foreign air carriers whose flights begin or end in the U.S. The Department of Transportation has not yet decided whether to require airlines to provide free in-flight medical oxygen to passengers.

Always check with your airline when booking travel to understand how and when these rules are being implemented. The Airline Oxygen Council of American web site (www.airlineoxygencouncil.org) lists various airlines’ policies regarding in-flight oxygen use and equipment.

Communication between Airlines and Patients about the use of POC’s

According to the DOT ruling, passengers are expected to inform the air carrier about the intended use of POC’s on board while making the flight reservation. Airlines in return are required to give passengers who declare their intention to use a POC aboard the following information:

1. Any requirements for advance check-in. Airlines may require travelers to notify the airline up to 48 hours in advance if the traveler wishes to use a device.
2. Any weight or size limits for devices to ensure they can be accommodated in the aircraft cabin.
3. Any labeling requirements to permit use on board. (In the future the FAA may require device manufacturers to label devices if they are FAA approved.)
4. Airlines may also require one hour advance check-in for flights. However, airlines may not deny boarding on a connecting flight because of this additional hour requirement.
5. Any requirements about contacting the airline regarding the maximum flight duration and battery capacity requirements.
6. The airline may require travelers to provide a statement from a physician stating that the passenger requires the use of a POC.
7. In the event the travel has connecting or codesharing flights, airlines must also inform travelers of any requirements of the other airlines or direct the passenger to contact that airline directly.
Batteries for POC’s

The new DOT regulation contains specific directions in regards to batteries that are needed for POCs.

1. The airlines may require travelers to carry enough fully charged batteries required to operate their POC for at least 150 percent of the expected maximum flight duration. This includes the total duration of the flight from arrival at the gate including any possible delays that may occur during a flight.
2. If oxygen is provided by the air carrier the passenger is not required to carry batteries.
3. Boarding may be denied by the airline if the passenger does not carry enough, properly packed batteries. The airline must provide a written statement on why the airline refused to provide transportation within 10 days of the incident.
4. Airlines are not required to provide priority seating nor are they obliged to provide an opportunity for passengers to plug in their device. The DOT, however, encourages airlines to permit passengers to plug in their devices.

POC’s approved by the FAA

AirSep FreeStyle
AirSep LifeStyle
Inogen One
Respironics EverGo
Sequal Eclipse

Oxygen during Air Travel – More Information

Official document published by the Department of Transportation (DOT)

www.regulations.gov, docket number DOT-OST-2004-19482-1300 page 27629

Department of Transportation
www.safetravel.dot.gov

Federal Aviation Association
www.faa.gov

American Lung Association
www.lungusa.org

Alpha-1 Foundation
www.alphaone.org

Airline Oxygen Council of America
www.airlineoxygencouncil.org

American Association for Respiratory Care
www.aarc.org

National Home Oxygen Patients Association
www.homeoxygen.org/airtrav.html

Transportation Security Administration
www.tsa.dhs.gov/travelers/airtravel/specialneeds/editorial_1374.shtm#2

Frank Drescher 9.27.2008