Children of Smokers May Suffer Effects From Second-Hand Smoke Later in Life
The negative effects of environmental tobacco smoke (ETS) on a child who lives with parents who smoke continue to linger after he or she has left home, suggests a new study from Ohio State University.

According to the research, which was recently published in the International Journal of Behavioral Medicine, college students who were exposed to high levels of ETS as children maintained higher levels of blood pressure, mean arterial pressure, and heart rate at rest and during psychological stress compared to students who grew up with low levels of ETS.

The study involved 78 male Ohio State students who were taking an introductory-level psychology course. The students reported little ETS exposure at that time in their lives. The students were divided into two groups–those from nonsmoking and smoking homes–and given tests designed to induce stress. Although the researchers discovered that both groups experienced equal increases in blood pressure, mean arterial pressure, and heart rate during stress tests, the smoking group consistently maintained all of these levels.

“Because these students have a higher blood pressure and heart rate, 20 to 30 years down the line they might be at risk for hypertension, which puts them at risk for heart disease,” says Lisa Manzi Lentino, psychology graduate student and coauthor of the study.

“The message is–if you’ve got kids, don’t smoke at home, because it will affect them later on,” says Catherine Stoney, associate professor of psychology and coauthor of the study.

Asthma Guidelines Pocket Reference Now Available
Arlen Medical Education Products, Los Angeles, offers the Asthma Guidelines Pocket Reference. Developed by Michael Arlen, president of Arlen Medical Education Products and chairman of the American Lung Association of Los Angeles, and Guy Soo Hoo, MD, the reference guide is a quick reference or training tool that contains information regarding drugs, dosages, delivery systems, and contraindications for children and adults. The information is based on the clinical practice guidelines for the diagnosis and management of asthma recommended by the National Institutes of Health.

A portion of the sales generated by the pocket references will be donated to the American Lung Association to support its asthma-related programs. For more information on the Asthma Guidelines Pocket Reference, call (800) 52-ARLEN, or visit www.Arlen1.com.

Hawaii Society for Respiratory Care Holds Meeting in September
The Hawaii Society for Respiratory Care will hold its 26th annual Respiratory Care Conference, “Partners in Excellence,” September 21-22, 1999, at the Ilikai Hotel Nikko Waikiki in Honolulu. For more information, contact Linda Miyasato-Castro at (808) 547-4396, or fax (808) 537-7830; or Jim Westgate at (808) 921-2054, fax (808) 921-2841, or email westgate@lava.net.

Poor Sleep Quality Associated With Noisy Intensive Care Units
Patients receiving intensive care may have difficulty achieving quality sleep, which may reveal that problems with sleep could be endemic to intensive care units (ICUs), suggested a study published in the April issue of the American Journal of Respiratory and Critical Care Medicine.

The study of sleep involved 203 medical, surgical, and cardiac intensive care patients who completed a questionnaire on the day they were discharged from the unit. The questionnaire determined the perceived effect of environmental stimuli on sleep disturbances in the ICU. Patients in the medical ICU perceived their sleep to be more disrupted by environmental factors, such as noise, than did patients in other units.

The researchers believe that poor quality of sleep and disrupted sleep–as well as being overcrowded–are common problems in all ICUs. They also said that various human interventions, such as the recording of vital signs, collecting of blood, and diagnostic testing, is as important to sleep disruption as is environmental noise. They also noted that future research should focus on methods for decreasing the interruptions of sleep in ICU patients, allowing them to achieve longer periods of consolidated sleep.

PhyMatrix Acquires Asthma and Allergy Research Associates
PhyMatrix Corp, Providence, RI, and its wholly owned subsidiary, Clinical Studies Ltd (CSL), has announced the acquisition of Asthma and Allergy Research Associates (AARA), Bloomington-Normal, Ill, with a satellite office in Decatur, Ill.

AARA is a premier asthma and allergy research site that participates in more than 120 clinical trials. During the past several years, AARA’s clinical research has involved asthma medications, antihistamine, decongestant preparations and nasal corticosteroids, and medications for migraines, hives, cardiovascular conditions, and heartburn.

“Building a high-quality, nationally recognized group of asthma and allergy sites is a priority within CSL. The acquisition of AARA represents a significant step in achieving this goal. AARA is well known and respected within the field of asthma and allergy,” says Michael Heffernan, president and co-CEO of PhyMatrix. “AARA’s clinical practice of more than 6,000 active patients and six full-time study coordinators currently involved with clinical research will provide a significant increase in CSL’s capacity to conduct asthma and allergy research. We will continue to actively pursue other sites known for their expertise in the field of asthma and allergy.”

AARA was founded by Drs Anjuli and Nicholas Nayak in 1987. Both physicians plan to continue their prospective roles, with Anjuli serving as the site’s principal investigator.

Gender Differences in Smoking
Men are more likely than women to smoke if they are angry, anxious, sad, or tired, indicating possible gender differences in the effect of nicotine on the central nervous system, possibly caused by different interactions with hormones, according to a study conducted at the University of California, Irvine.

The study included 25 women and 35 men ages 18 to 42, who made three diary entries an hour, for up to 48 hours, recording their mood and smoking behavior. The urge to smoke was more strongly associated with anger, anxiety, and alertness in men than in women, and feelings of sadness or fatigue were linked with the urge to smoke in men only. Smoking was associated with decreasing feelings of anger and sadness in men only, and feelings of happiness in women only.

“The commonly held belief before this study was that women smoked more for emotional reasons, but this does not appear to be the case in the real-life settings measured in this study,” says researcher Ralph Delfino, MD, PhD. “The results are consistent with the hypothesis that women are smoking less for mood control than men, and that social interactions may play a more important role in why women smoke. Ongoing research using similar diary techniques in adolescents may reveal targets for early preventive interventions.”

The findings suggest that smoking prevention and cessation programs offering different approaches for males and females, as well as personality profiles, may be more effective.

Anti-Inflammatory Agents Underutilized in CF Patients
A nationwide survey of 67 cystic fibrosis (CF) centers revealed that anti-inflammatory medications are underutilized by physicians when treating children and adults with CF in the United States, according to an article published in the April issue of Chest. In addition, when physicians order an anti-inflammatory medication, they twice as often prescribe inhaled corticosteroids (which have the fewest clinical safety studies) than oral corticosteroids or ibuprofen.

Christopher M. Oermann, MD, Department of Pediatrics, Baylor College of Medicine, Houston, along with two associates, concluded that approximately 25 percent of 8,803 CF patients in the survey routinely used anti-inflammatory drugs. However, only 41 percent to 45 percent of the 70 physicians in the survey prescribed specific anti-inflammatory agents. Nearly 12 percent of the patients were taking inhaled corticosteroids.

“In contrast to the greater use of inhaled corticosteroids in CF patients, we found that lack of efficacy data was the most common reason given by physicians not to prescribe the drug for routine control of CF lung disease,” Oermann says. “The limited use of oral corticosteroids is likely due to concerns over adverse affects and long-term safety also. However, one must question whether these risks outweigh the benefits of improved lung function for selected patients in a fatal disease whose primary cause of death is respiratory failure.”

In studies with CF patients, anti-inflammatory medications, including oral corticosteroids and ibuprofen, have been shown to be effective in reducing chronic inflammation connected with ongoing infection, which plays a dominant role in CF lung disease.

However, the authors also point out the lack of use of anti-inflammatory agents in patients less than 5 years of age. Clinical trials for oral corticosteroids and ibuprofen did not include younger patients because of an inability to perform pulmonary function testing on these patients. The authors suggest that future research efforts should focus on younger patients since excessive inflammation often occurs before the age of 5 years old.

ATS To Split From The ALA
The American Thoracic Society (ATS), the medical section of the American Lung Association (ALA), has announced it will become an independent incorporated organization as of January 1, 2000. The board of directors of the ALA/ATS approved the decision at the International Conference held in April in San Diego.

Terms of the agreement include $11.1 million to be paid by the ATS to the ALA over 15 years, which will give the following: ATS ownership of its name; the ALA/ATS International Conference; two journals (American Journal of Respiratory and Critical Care Medicine and the American Journal of Respiratory Cell and Molecular Biology); membership lists; subscription fees; and depreciated physical assets. The ATS plans to lease the office space it currently occupies in the ALA headquarters in New York. Each organization has agreed to continue representing the other on its board of directors, and each will have two representatives on the other’s board sharing a single vote.

“The ATS remains dedicated to fighting lung disease through research, education, patient care, and advocacy, and these goals are still consistent with those of the American Lung Association,” says Jeff Glassroth, MD, president of the ATS. “However, the ATS has grown and evolved through the years and has become the premier international society for respiratory and critical care medicine, with more than 25 percent of our members coming from outside the United States. This growth has created the necessity for autonomy to pursue global partnerships and ventures. We will continue to work hand-in-hand with the ALA on many fronts, but now we are also empowered to explore alliances and opportunities.”

The new ATS will continue to offer its 13,500 members the same benefits of membership, which include subscriptions to its two peer-reviewed journals, continuing medical education opportunities, and timely statements and position papers on topics relevant to lung health and disease and related issues.

Editorial Advisory Board Member Selected for New Position
Walter O’Donohue, Jr, MD, has recently been selected as the associate dean for graduate medical education at Creighton University School of Medicine, Omaha, Neb. O’Donohue will continue serving as chief of pulmonary and critical care medicine at the school.

O’Donohue’s new position entails preparing the medical school’s programs as well as the overall institution for accreditation from the Accreditation Counsel for Graduate Medical Education (ACGME), which takes place at various times of the year. O’Donohue will also prepare for future visits fromthe ACGME by correcting past problems and conducting internal reviews. In addition, he oversees the residency and fellowship programs within the medical school, and deals with numerous administrative functions.

“I enjoy working with the residents and fellows,” O’Donohue says. “Overall, I’m looking forward to the new job as well as being a pulmonary doctor,” he notes.

O’Donohue served 11 years as chairman of the Department of Medicine and 15 years as the program director of internal medicine at Creighton University. O’Donohue is currently a member of the Editorial Advisory Board for RT.

Oxygen Consensus Conference to Convene in September
The Fifth Oxygen Consensus Conference will take place September 20-22, 1999, in Washington, DC. Topics to be discussed include: developing a standard of care for long-term home oxygen therapy (LTOT); protocols for the administration of LTOT in the home; and educating physicians and patients about the basic principles and practices of LTOT. For information, write to LTOT Solutions Conference, Robert McCoy, RRT, 3953 West 143rd St, Savage, MN 55378, or call (612) 808-9881, fax (612) 808-9882, or email at info@inspiredrc.com.

Women Smoking Menthol CigarettesMay Have Greater Nicotine Exposure
Women who smoke menthol cigarettes may be more likely to inhale deeper, potentially taking in more nicotine, than do smokers of nonmenthol cigarettes, according to a study conducted at Ohio State University’s Comprehensive Cancer Center, Columbus. The study is especially significant for African-American women smokers since the majority of them–more than 65 percent–smoke menthol cigarettes, compared to 25 percent to 30 percent of white women smokers.

The study, which was published in a recent issue of Addictive Behaviors, revealed that users of menthol cigarettes tend to smoke their first cigarette of the day sooner than users of nonmenthol cigarettes (the sooner a person smokes his or her first cigarette of the day may indicate level of nicotine dependence). The finding suggests that a link may exist between menthol and nicotine dependence.

The study also concluded that although African-American women in both groups smoked fewer cigarettes per day than did Caucasian women, they had higher blood levels of cotinine, the breakdown product of nicotine. Researchers are not sure why this occurs.

“There is no safe cigarette,” says Karen Ahijevych, associate professor of nursing at Ohio State University and a researcher at the Comprehensive Cancer Center, who conducted the study. “These results are particularly important for African-American women because the majority of African-Americans who smoke choose menthol cigarettes. Black women also have a higher rate of smoking-related morbidity and mortality than do white women.”

The study involved 95 female smokers: 48 African-Americans and 47 Caucasians (of these, 27 African-American women and 22 Caucasian women smoked menthol cigarettes). The women were an average age of 35, and had smoked on average 17 cigarettes per day for 15 years. Nicotine and carbon monoxide levels were measured before and after each of the women smoked a single cigarette. Other measures included volume of smoke inhaled (puff volume) in milliliters (ml), and blood level of cotinine (in nanograms per milliliter [ng/ml]).

These findings suggest that clinicians should not use number of cigarettes per day as their only estimate of a patient’s nicotine dependence. “Asking smokers how soon after getting out of bed they have their first cigarette of the day also has important implications for treatment,” Ahijevych says.

Frost & Sullivan Issues new Ventilator Strategy Market Study
Frost & Sullivan, Mountain View, Calif, has produced a new strategic market engineering study, US Medical Ventilator Markets, which identifies the challenges and opportunities for companies competing for market share.

US Medical Ventilator Markets provides detailed market forecasts of pricing, unit shipments, and revenues for adult and pediatric ventilators, neonatal ventilators, and noninvasive ventilators across hospital, subacute, and home care settings. In 1998, revenues from the sale of all respiratory ventilators generated $258.7 million. The hospital setting currently represents the largest component of the market at 61.3 percent; however, home care is expected to grow to just over 40 percent by the end of the 2005 forecast period.

However, Frost & Sullivan warns that in order to succeed in the post-acute care segment, manufacturers must understand the impact of Medicare reforms under the Balanced Budget Act of 1997. A few of the Medicare policies raising concerns in the post-acute care environment include: the financial and administrative impact that the new payment system will have on facilities; the adequacy of payment levels under the Resource Utilization Group, Third Edition (RUGS III), payment system and the lack of adequate data used by the Health Care Financing Administration in developing the rate structure; and lack of reimbursement for higher acuity patients inherent in the 44-category RUG payment methodology.

For more information, visit Frost & Sullivan’s Web site at www.frost.com.

Lung Transplant Outcomes May Be Linked to Gender
A significant risk has been associated with transplanting lungs from male donors into female recipients, according to a study presented at the American Lung Association/American Thoracic Society International Conference. Researchers at the University of Wisconsin-Madison studied 116 lung transplantations, 19 of which involved male donor organs transplanted into female recipients. Researchers found that the rate of graft survival with good function was 29 percent at 24 months after transplantation for the male to female combination. The overall 24-month rate for all other patients was 69 percent. Additional research into male to female lung transplants is necessary to conclude these results.