First Lady Introduces Asthma Program
First Lady Hillary Rodham Clinton has unveiled a $68 million asthma program that is the “first-ever comprehensive, administration-wide strategy” to fight the disease. The program will be part of the White House budget proposal.
Most of the money–nearly $50 million–would be used for competitive state grants to find and treat poor children with asthma who are served by Medicaid. The plan would also provide:

  • $8.4 million for schools to teach parents and children the importance of asthma medication and how to identify and avoid materials that trigger attacks. The administration estimates that this initiative will reach more than 2 million children.
  • $2 million for new research into the role chemicals, pesticides, and cigarette smoke play in the onset of asthma. An additional $1 million would be used by the Environmental Protection Agency to monitor air pollution in two communities to examine its relation to asthma.
  • $5.2 million for a public information campaign, including posters, flyers, and brochures, to reduce children’s exposure to tobacco smoke and other asthma triggers.

Increase in Childhood Asthma
Over the past 15 years, the number of children with asthma has doubled to approximately 6 million, with a 160 percent increase among children under 5 years of age. More than 100,000 children are hospitalized with the disease each year. While scientists have made huge strides in combating asthma, there is still a lot of work to be done.
“It’s still a huge problem,” said Dr Carolyn Kercsmar, a pediatric pulmonologist at Case Western Reserve University and Rainbow Babies & Children’s Hospital in Cleveland. She emphasizes that more attention should be paid to finding the children with the disease, then helping them and their families get proper nutrition, and changing environmental factors that may aggravate the disease.
While all children are at risk of contracting asthma, black children are at aslightly higher risk compared to other children, and are more than four times as likely to die from the disease. “Nobody should be dying of asthma, especially children,” Kercsmar said.

Health Groups Call for End to Misleading Tobacco Advertising
The American Lung Association and more than 20 national health organizations called on the Food and Drug Administration (FDA), working in cooperation with the Federal Trade Commission, to end misleading and deceptive advertising by the tobacco industry. The groups have filed a supplemental statement with the FDA to expand on a petition (FDA Docket #98P-0031) filed in January 1998, which outlined a national strategy for regulating tobacco advertising.
John R. Garrison, CEO of the American Lung Association, noted that the Food, Drug and Cosmetic Act, which gives the FDA its power, prohibits misleading and deceptive advertising practices. And the Supreme Court consistently has held that there can be no opposition to prohibiting or restricting commercial advertising that misleads and deceives.
The supplemental statement to the FDA addresses the need to halt the following:

  • “Lifestyle advertising” that promotes the use of cigarettes and smokeless tobacco products as having a positive effect on health, well-being, and social and economic status;
  • Advertising that implies low-tar, low-nicotine products are healthier or safer;
  • Advertising that omits critical health and safety information; and
  • Advertising and marketing strategies designed to downplay the hazards of tobacco use.

The groups are also urging the FDA to work with the Federal Trade Commission to launch a thorough investigation of the tobacco industry’s advertising and marketing techniques, including efforts to withhold health and safety information from the public.@News-Head:ALA/ATS International Conference to Convene in April
The 1999 American Lung Association (ALA)/American Thoracic Society (ATS) International Conference will take place April 23 through April 28 in San Diego. The conference is the largest scientific meeting in the world focusing on respiratory care and critical care medicine.
Nearly 15,000 health care professionals throughout the world are expected to attend. Researchers will present current findings on asthma, tuberculosis, genetics and lung disease, sleep disorders, cystic fibrosis, lung transplantation, lung volume reduction surgery, pulmonary hypertension, outcome management and managed care, and critical care.
Symposia and plenary sessions will focus on a variety of topics ranging from updates on the Sleep Heart Health Study to nutrition in lung function and disease.
Registration information can be obtained by faxing the ATS at (212) 315-6498, email to rschiller@lungusa.org, or writing to ALA/ATS International Conference, 1740 Broadway, New York, NY 10019-4374.

Severe Emphysema Patients Can Improve QOL
A new study was reported in the February issue of Chest, which found that patients with severe emphysema who undergo both pulmonary rehabilitation and bilateral lung volume reduction surgery (LVRS) can improve their quality of life in such areas as social functioning, vitality, role limitations due to physical problems, and physical functioning.
Drs Marilyn Moy, John Reily, Jr, and other researchers at Brigham and Women’s Hospital in Boston decided to determine whether and what kinds of quality of life improvements might take place in patients with severe emphysema after they undergo pulmonary rehabilitation and LVRS. The study showed that a combination of pulmonary rehabilitation and LVRS resulted in statistically significant progress in four of the eight areas measured. Investigators said that pulmonary rehabilitation accounted for more than 90 percent of the improvement in role limitation due to physical problems, while LVRS accounted for virtually all of the progress in physical functioning and vitality and for most of the gains in social functioning.

Air Pollution Could Increase Mortality in Nonsmokers
A special 15-year study concluded that residents of three California air basins, working and residing in areas surrounded by high levels of air pollution for lengthy periods are associated with increased mortality. Inhaling particles less than 10 micrometers in diameter was associated with increased risk of death from natural causes and from lung cancer in males, as well as death from nonmalignant respiratory illness in men and women.
In the February issue of the American Journal of Respiratory and Critical Care Medicine, David E. Abbey, PhD, of the Center for Health Research, Loma Linda University, Loma Linda, Calif, along with six colleagues (several from the US Environmental Protection Agency), wrote about the studied relationship between air pollution and death rates in a group of 6,338 nonsmoking California Seventh-Day Adventists. Between 1977 and 1992, 989 females and 639 males died. Most of the participants had lived 10 years or more in one of the three major California air basins of San Francisco, South Coast (Los Angeles and eastward), or San Diego.
Investigators found that long-term ambient concentrations of ozone were verystrongly associated with death from lung cancer in males. Also, sulfur dioxide was independently associated with increased risk of death due to lung cancer in both men and women. The researchers said that other pollutants showed either weak or no association with mortality.
The researchers evaluated a large number of potentially effect-modifying factors such as medical history, diet, and other lifestyle components to make sure they did not affect the mortality estimates that resulted from pollutant levels.@News-Head:Why Infants Wheeze
British researchers recently found that diminished airway function in the first few weeks of life is an important predictor of subsequent wheezing before an infant’s first birthday. Carol Dezateux, MD, of the Department of Epidemiology and Public Health, Institute of Child Health, London, measured respiratory function in 101 Caucasian children between the ages of 1 and 3 months, prior to the development of any upper or lower respiratory symptoms.
According to the investigators, during their first year of life, 28 previously healthy infants were later diagnosed with wheezing, with 11 of the children having more than one episode. In the children who wheezed, airway conductance had been significantly reduced when tested at 1 to 3 months of age. Also, among the 27 infants with a family history of asthma, 14 had very reduced specific airway conductance and developed wheezing.
According to the researchers, diminished airway conductance reflects either small airways or some alteration in airway wall structure. They believe that sex difference is important since, relative to girls, boys have smaller airways and are more susceptible to respiratory illnesses during early childhood. Seventeen (16 percent) of the 28 infants who wheezed are boys. In addition, 20 (71 percent) of the infants who wheezed were born to mothers who smoked during pregnancy. The researchers called the adverse effects of smoking on the babies “potentially preventable.”

ACAAI Provides Asthma Screening Program
Hoping to prevent irreversible lung damage in children with undiagnosed anduntreated asthma, the nation’s allergists are increasing efforts to find children with breathing problems that might be caused by the disease. The campaign is part of the American College of Allergy, Asthma and Immunology (ACAAI) Nationwide Asthma Screening Program, now moving into its 3rd year. Allergists will screen adults and children forasthma in more than 200 communities beginning in May, which is National Asthma and Allergy Awareness Month. The screening program is funded by an educational grant from Astra Pharmaceuticals.
Nationally, between 14 million and 15 million people have asthma, and many do not know they have the disease or how to control it. Of these people, 5 million are children who might suffer from irreversible damage to their lungs if their asthma is not diagnosed and treated early. The damage known as “airway remodeling” results from the persistent inflammation that asthma causes in the lungs’ airways.
More than 11,000 adults and children have participated in the screening program since it was launched in 1997, and more than half arriving with breathing problems have had symptoms suggesting referral for a professional diagnosis. The free screenings will be performed at shopping malls, civic centers, health fairs, and other accessible locations throughout the country. Special outreach programs targeting children and parents at schools, activity centers, and toy stores will also be conducted.

A Possible Answer to Daytime Sleepiness
The American Lung Association published a study in the February issue of the American Journal of Respiratory and Critical Care Medicine, which found that as many as half of the middle-aged and older adult population may have irregular breathing during sleep that is associated with increased daytime sleepiness. Daniel J. Gottlieb, MD, MPH, assistant professor of medicine at Boston University School of Medicine, and collegues studied 1,824 adults participating in the Sleep Heart Health Study, a long-term investigation of the impact of sleep-related breathing disorders on heart health. The average age of the participants was 65. The study found that the more pronounced a person’s nighttime breathing disorder, the more sleepy they were during the day. Excessive daytimesleepiness was found even in people with the mildest sleep-disordered breathing. Overall, half of the study subjects experienced a level of sleep-disordered breathing that is associated with increased daytime sleepiness.@News-Head:New Guidelines Released for Treating Adult Sleep Apnea
New treatment guidelines were reported recently for one of the fastest growing areas of medicine–sleep disorders. The guidelines appeared in the March issue of Chest and focused on various forms of positive airway pressure (PAP) in the treatment of adult obstructive sleep apnea (OSA), the most common form of sleep apnea, which afflicts 20 million Americans.
The panel of experts that authored the guidelines said they wanted to provide a common sense and easily understood approach to the treatment of OSA with PAP. They said their recommendations were based on peer-reviewed studies and widely accepted clinical practice and should serve as an interim guide until results from research such as the Sleep Heart Health Study and various other evidence outcome studies could provide the data on which to develop more formal consensus recommendations.
The guidelines cover the following:

  • Which patients should undergo such diagnostic techniques as polysomnography, the continuous recording of a number of physiological functions and events during sleep, which could range from 3 to 6 hours;
  • What criteria should be met to appropriately define apnea (cessation of breathing) and hypoxia (oxygen deficiency);
  • What conditions warrant treatment for which PAP therapy, and what efforts should be undertaken to help patients adhere to their treatment.

First American Double Lung Transplant Patient is Honored
On March 26, Patsy Ruff was honored for her lifetime achievement and contributions as the longest living double lung transplant patient in the world. Her surgery was performed by Dr Joel Cooper in July 1987. At the time of surgery, she was severely handicapped with emphysema due to smoking for 22 years. She was using oxygen 24 hours a day, and weighed a mere 75 pounds. She is the first American and fourth person in the world to undergo this type of organ transplantation.
At the tribute luncheon, Ruff received a key to the City of Prattville, Ala, from Mayor David Whetstone, a proclamation of Patsy Ruff Appreciation Day from Governor Don Siegelman, and certificates from the Alabama Department of Public Health, the Alabama Organ Donor Center, the American Lung Association of Alabama, and the Coalition for a Tobacco-free Alabama.
Ruff is a longtime advocate for statewide clean indoor air legislation, and demonstrates the benefits of organ donation to help people live longer and healthier lives. She has been instrumental in passing many local clean indoor air ordinances as well as conducting smoking cessation clinics for adults. In addition, she speaks to schoolchildren about the health hazards of smoking.

Overweight Males Are Loudest Snorers
A 14-year study reported in the March issue of Chest confirmed that men snore louder than women. The study also confirmed that the heavier a person is, the louder he/she snores. Twelve percent of 1,139 study participants snored loud enough to exceed the maximum acceptable levels for nighttime noises set by a pollution control agency.
Kent Wilson, MD, department of otolaryncology, University of Minnesota, St Paul, along with six associates, conducted the research and reported data from their systematic investigation of snoring sound levels during sleep testing. The researchers also explored the relationship between snoring sound intensity and a variety of demographic and clinical factors.
In their results, the investigators point out that the regulations of the Minnesota Pollution Control Agency limit the maximum acceptable outdoor nighttime noise level to 55 decibels, a level that was exceeded by more than 12 percent of the snorers during this research. Additional study results showed that almost 85 percent of the snorers exceeded 38 decibels of sound, which is the equivalent to the noise of light highway traffic.

Respiratory School Profile
Victor Valley College, Respiratory Therapy Program
18422 Bear Valley Road, Victorville, CA 92393-5849; (760) 245-4271 x2339; www.vvcconline.com

Victor Valley College is a 2-year educational institution. As part of the Allied Health family, it offers an Associate Degree Respiratory Therapy Program that is fully accredited by the Committee on Accreditation for Respiratory Care. Courses include lectures, computer-aided instruction, clinical simulations, and practice of respiratory procedures/techniques in a laboratory setting on campus before entering a clinical environment. Physician lectures are provided by two full-time medical directors both credentialed in pulmonary medicine. More than 1,000 hours of clinical experience are gained at seven area hospitals. Upon successful completion of the program, the student is eligible to take the licensure examination for the State of California and to obtain the CRTT credential, and is qualified to sit for the national RRT examination. Classes begin in the fall. Current projections through the year 2006 show a 53.8%ncrease in demand for RCPs in the service area.
Program name: Respiratory Therapy
Program director: Robert Flome, MA, MEd, RRT
Director of clinical education: Larry Boutcher, PhD, RRT
Approximate cost: $3,200 for California residents
Faculty size: 2 full-time; 7 adjunct
Spaces available: 30 full-time
Special features: In addition to standard floor therapy and adult ICU activities, each student completes clinical practice objectives in a sleep lab, rehabilitation, subacute care, hyperbaric oxygenation, intubation, and NICU rotations. All students complete Neonatal Advanced Life Support (NALS), Pediatric Advanced Life Support (PALS), and Advanced Cardiac Life Support (ACLS) classes before graduation. An Advanced Standing Program is available for any CRTT/RCP currently employed in respiratory care. Graduate pass rates far exceed the state average for the RCP/CRTT examination and are significantly higher than the national average for the RRT examination.

College Scholarships Attract Athletes With Asthma
The 1999 “Will to Win” Asthma Athlete Scholarship Program, which is sponsored by Schering/KEY, has generated nearly 4,000 application requests from around the country–and many more are expected by the April 15, 1999 filing deadline.
Celebrating its 15th year, the “Will to Win” program honors 10 high school seniors who have achieved both academic and athletic excellence in spite of the challenge of having asthma. Scholarships, including the top $10,000 award, will be presented at a press conference and banquet to be held this summer in New York City.
With the new millennium and the 2000 Olympic Games rapidly approaching, the 1999 event will enlist the support of top Olympic athletes past, present, and future–all of whom have overcome asthma to achieve athletic success.
Information and applications for the Asthma Athlete Scholarship Program may be obtained by calling the “Will to Win” hotline at (800) 558-7305.

AARC’s Educational Broadcast Series Now Approved
The American Association for Respiratory Care (AARC) “Professor’s Rounds” series is now approved for Nursing CEU and Respiratory Therapist CRCE credits. The series offers a unique educational opportunity for anyone involved in the treatment of respiratory diseases. The “Professor’s Rounds” is a professionally produced, educational broadcast series that presents timely topics medical professionals have requested. The AARC has chosen renowned experts to speak on each topic, so the information is up-to-date and relevant to today’s health care system.
Live programs, or optional teleconference (with videotapes), make it easy for medical staff to acquire the continuing education credits they need while learning about the topics they have most often requested. Single programs cost $245 each for nonmembers and $215 for AARC members (cost are per facility and there is no limit on number of attendees). Call the AARC at (972) 243-2272 to register.

Patients Prefer Straight Talk
According to a study done by Press, Ganey Associates Inc, South Bend, Ind, patient satisfaction data reveal that talking with patients about life support and organ donation actually increases satisfaction.
The firm recently compiled data from a quarter of a million patients in 476 hospitals. An average of 525 patients per hospital completed the surveys. The questionnaire asked the patient if the hospital provided information on organ donation and on the options and choices available for continuing life. “The mere thought of giving up control can be worrisome, adding to other anxieties that already exist about entering the hospital. The good news is that based on our research, discussing life and death issues is not an addition of negative stress, instead it creates an environment that contributes to patient satisfaction,” said Rodney F. Ganey, chief executive officer of Press, Ganey Associates.
These issues are not easy ones to address when someone is entering the hospital. Reminding patients that they are mortal and they might not leave the hospital cured appears to be a strike against the goal of the facility, namely, to make things better or to give hope. Some health care workers agree that, in theory, patients should be told about options in case of bad outcomes, but they resist giving the information because the message implied is gloomy. “When we look at the satisfaction of patients who tell us they received information of this sort, it is clear that their assessment of the health care experience does not diminish. Instead, patients who report receiving information are significantly more satisfied than those who did not,” said Irwin Press, PhD, president.
This research clearly shows that by addressing these questions the facility has informed patients that they are ultimately in control, even when they are placing the care of their bodies in the hands of others. This communication becomes the first step in caring for the patient, and often takes place before more traditional health care even begins. “Patients can handle the truth,” Press concluded.

Erratum
In the February/March issue of RT, “ALA Unveils Asthma Awareness,” page 16, was actually launched by the San Diego Chapter of the American Lung Association, not Los Angeles.

ARCF Announces Its Third Annual Silent/Live Auction
The American Respiratory Care Foundation recently announced its Third Annual Silent/Live Auction, scheduled for December 13-16, 1999, to be held in conjunction with the American Association for Respiratory Care (AARC) 45th International Respiratory Conference in Las Vegas.
The ARCF auction is critical to the ongoing success of the Foundation. Past sponsors have donated such items as medical equipment, travel packages, jewelry, sports memorabilia, and dining certificates. These generous acts of support provide funding for the Foundation’s various programs, furthering the advancement of the respiratory care profession and ultimately leading to quality patient care.
A few examples of the Foundation’s activities include:

  • Education Recognition Awards–proceeds from the auction help provide funding for students and therapists in pursuit of higher education;
  • International Fellowships–allow health care professionals from around the world to visit two US cities and observe respiratory care practice in this country before attending the AARC International Respiratory Conference;
  • International Job Analysis Project–identifies the respiratory therapist’s scope of practice in Latin America and other countries in an effort to enhance the development of educational opportunities in those countries, eventually leading to an appropriate credentialing examination;
  • Literary Awards–abstracts submitted by health care professionals that address new technologies and applications in the respiratory care arena receive monetary awards.
    All donors and sponsors of the ARCF silent auction will be recognized in AARC publications, press releases, the on-site auction catalog, and future brochures. For more information, contact Norma Hernandez at (972) 243-2272. r