Chronic Cough Patients Report a Miserable Existence
Troubles with incontinence and spouses moving out of the bedroom only start the list of common troubles for patients who suffer with chronic cough, according to a new report by Mayo Clinic pulmonology specialists. The findings from a survey of chronic coughers were presented as an abstract at the American College of Chest Physicians CHEST 2005 meeting in Montreal.

The top problems for chronic coughers when they were first evaluated at Mayo Clinic were the following:
• Interference with lifestyle and leisure
• Frequent physician visits and testing for cough
• Sleep disturbances
• Interference with social gatherings
• Other people’s reactions to the coughing
• Frustration, irritability, and anger

Smokeless Tobacco Poses Lower Risks
While still discouraging the use of tobacco in any form, University of Alabama at Birmingham (UAB) researchers say cancer risks may be much lower among smokeless tobacco (ST) users than cigarette smokers. “In contrast to the well-known deleterious effects of cigarette smoking, ST use does not substantially increase the risk for cancer incidence above that of non-tobacco users, particularly among males,” says UAB biostatistician Neil Accortt, PhD, and colleagues in the November issue of Cancer Causes and Control. Accortt calls for further studies to determine if cancer risk differs by ST type.

Cheek Cells Used to Identify Lung Cancer
A novel test for lung cancer uses inner cheek cells to identify the disease in high-risk patients. In a new study presented at CHEST 2005, the 71st Annual International Scientific Assembly of the American College of Chest Physicians, scientists found that buccal mucosa, or cells scraped from the inner part of the cheek, may contain information that separates patients with lung cancer from high-risk negatives, a finding that may support cheek cell analysis as a simple and inexpensive early screening method for patients at risk for lung cancer.

“Previous research has shown that cell nuclear changes can extend a significant distance from the site of a malignancy,” says lead researcher Bojana Turic, MD, director of clinical and regulatory affairs, Perceptronix Inc, Vancouver, BC, Canada. “We have already conducted a successful clinical trial for our sputum test for lung cancer. New data suggest that the effects of lung cancer can also be measured as far away as skin cells in the mouth. Although a clinical test based on buccal cells is still in development, the method of analyzing cheek cells to detect cancer is showing interesting results.”

Respiratory Fair Increases Insight Into Lung Health
More than 500 people took part in the 3rd Annual Respiratory Health Fair sponsored by Barlow Respiratory Hospital, Los Angeles, on Oct 22, 2005. Barlow staff, including respiratory therapists, pulmonologists, and nurses, volunteered to provide free health screenings and educational seminars for the general public. Respiratory experts led seminars on getting a handle on stress, exercises to improve breathing, managing asthma, and avoiding allergies. Attendees also had the opportunity to speak with RTs and take a spirometry test. “At Barlow, we deal with some of the most critical respiratory health cases,” says Margaret Crane, CEO, Barlow Respiratory Hospital. “This health fair is about education and prevention and is part of our commitment to help Southern California breathe easier.”

A correlation with higher asthma rates has also been noted in menopause and perimenopause, occurring prior to final menstrual cycle.


• Clinical Prediction Rule Developed to Determine Risk of Death Associated with Pulmonary Embolism
Investigators have developed a new clinical prediction rule that accurately classifies pulmonary embolism patients into five categories that show increasing risk of death or other adverse outcomes, according to a new study published in the October 15, 2005, issue of the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

The 11 patient factors independently associated with 30-day patient mortality from pulmonary embolism included: two demographic characteristics (age and male sex); three illnesses (cancer, heart failure, and chronic lung disease); and six clinical findings related to pulse, systolic blood pressure, respiratory rate, temperature, altered mental status (disorientation, lethargy, or stupor), and arterial oxygen saturation level. These readily available clinical parameters were assigned scores to correlate them with the patient’s potential for death. "To derive our prediction rule, we used clinical variables routinely available at presentation that were previously shown to be associated with mortality in patients with pulmonary embolism or other acute diseases," says Drahomir Aujesky, MD, MSc, of the Service de Médecine Interne at the University of Lausanne in Lausanne, Switzerland.

According to the authors, the rule identifies patients who are at either low or high risk of fatal and other adverse medical outcomes associated with pulmonary embolism. For example, the 30-day mortality rate for patients at a very low risk (class I) was 1.6% or less. For patients classified at low risk (class II), it was 3.5%. For those at a very high risk (class V), it ranged from 10% to 24.5%. "However, before this rule can be implemented into clinical practice, its clinical usefulness should be tested in a prospective study," says Aujesky.

• Neonatology Education Online
RTs can earn continuing education (CE) credits by participating in online lectures that feature experts in neonatology through NICUniversity’s Web-based medical education center. NICUniversity offers an e-learning environment Where RTs can explore the latest issues and findings in Neonatology, while earning CE credit. To find out more, visit www.NICUniversity.org.  (NICUniversity is supported by an unrestricted educational grant from Discovery Labs.)


Long-Term Smoking Associated with Dulled Thinking, Lower IQ
Smokers often say that smoking a cigarette helps them concentrate and feel more alert. But years of tobacco use may have the opposite effect, dimming the speed and accuracy of a person’s thinking ability and bringing down their IQ, according to a new study led by University of Michigan (UM) researchers.

The new findings, released online before publication by the journal Drug and Alcohol Dependence, were made by a team from UM Medical School’s Addiction Research Center, or UMARC, and their colleagues at the VA Ann Arbor Healthcare System and Michigan State University.

While the researchers confirmed previous findings that alcoholism is associated with thinking problems and lower IQ, their analysis also revealed that long-term smoking is too. "We can’t say that we’ve found a cause-and-effect relationship between smoking and decreased thinking ability, or neurocognitive proficiency,’ says lead author Jennifer Glass, PhD, a research assistant professor in the UM Department of Psychiatry. "But we hope our findings of an association will lead to further examination of this important issue. Perhaps it will help give smokers one more reason to quit, and encourage quitting smoking among those who are also trying to control their drinking."

Whooping Cough Vaccine Recommended for Adults
Researchers at Saint Louis University have demonstrated that immunization with a new vaccine could potentially prevent more than a million cases of pertussis (whooping cough) each year in adolescents and adults. Most children are protected from pertussis by a series of vaccines in early childhood. But the vaccine protection wanes after a decade or so, leaving adolescents and adults susceptible to the bacterial infection.

‘It’s a misconception that you’re protected from pertussis for life if you’ve been vaccinated as a child,’ says Stephen J. Barenkamp, MD, professor of pediatrics and one of the study’s clinical investigators. He also is director of the Pediatric Research Institute at the Saint Louis University School of Medicine. "The study demonstrated that an estimated one in 300 adolescents and adults contracts the illness each year. The results also demonstrate that an effective vaccine is now available for this population and its use should be strongly encouraged." Study results were published in the October 13, 2005 issue of the New England Journal of Medicine.


Medical News Briefs from Chest 2005
News briefs from CHEST 2005 highlight new medical data related to COPD, asthma, and SARS.


Daily Nasal Spray Controls Asthma, Saves Money
(Poster 174, November 2, 2005, 12:30 pm -2:00 pm)
Using daily nasal steroids and HT1 blockers for asthma can dramatically improve asthma symptoms, while reducing cost and the amount of medications needed. In a review of Blue Shield Puerto Rico records for claims paid in 2004, researchers from the Asthma Management Center, Puerto Rico, looked at 358 patients who were referred to an asthma management center and compared them to a control group of 12,070 asthmatics treated elsewhere. Patients were given daily nasal steroids, instructions in the use of peak expiratory flow and logging, inhaled bronchial medication, and emergency albuterol inhalations. Of the patients taking daily nasal steroids and HT1 blockers, there was a significant decrease in peak-flow readings, use of controller medications, dollars spent on medications, and an 88% drop in number of hospital admissions for asthma.


Psychiatric Disorders Common in Women with COPD
(Poster 101, November 2, 2005, 12:30 pm -2:00 pm)
A new study out of Sacré-Coeur Hospital (Montréal), the Montréal Heart Institute, and the University of Québec at Montréal found that psychiatric disorders are at least three times higher in patients with COPD than in those without the disease, and the rates are three times higher for women than men. Researchers screened a total of 116 patients with COPD (54 men and 62 women) for psychiatric disorders. They found that 57% of the women and 35% of the men were classified as having one or more anxiety disorders, the most common being panic disorder; 31% of the women and 14% of the men were classified as having one or more mood disorders, the most common being major depression. While women and men had similar dyspnea scores and no difference in exacerbation rates or lung function, women showed significantly greater psychological distress, worse perceived control of symptoms, and worse disease-related quality of life.


Sepsis Risk Higher for Patients with COPD
(Poster 604, November 2, 2005, 12:30 pm-2:00 pm)
With data from 15,586 patients included in the Atherosclerosis Risk in Communities study (ARIC), as well as up to 11 years of follow-up data, researchers identified patients with COPD, pneumonia, and sepsis. The analysis shows that patients with COPD are more likely to get sepsis, but the risk was dramatically reduced after controlling for pneumonia. Researchers from the University of Kentucky conclude that pneumonia is a very strong predictor of sepsis in patients with COPD.


Long-term Health Effects of SARS
(October 31, 2005, 2:30 pm-4:00 pm)
SARS has harmful long-term effects on survivors’ pulmonary function, exercise capacity, and health-related quality of life, according to a study of 86 survivors of SARS (27 men and 59 women) at the Chinese University of Hong Kong; 18 months after first acquiring the illness, the exercise capacity and health status of patients with SARS were much lower than normal, and 27.9% of patients had suffered from significant impairment in diffusing capacity. In addition, while 6-minute walk distance times had improved from 3 months to 12 months, no additional improvements were seen after 18 months.