Smoking warning for HIV patients

As new HIV therapies prolong the lives and improve the health of sufferers, patients have been urged to consider long-term health factors.

Patients with HIV are twice as likely to smoke and also more susceptible to the detrimental effects of smoking due to a swifter decline in lung function, new research shows.

"Early in the epidemic, HIV was a different disease - with few effective drugs, the best that an HIV-positive patient could hope for was a relatively painless death after a brief period," said Syed Kadri of Ohio State University medical centre.

"The long-term effects of HIV were therefore fairly obvious: death. But with the advent of a new class of anti-retroviral drugs called 'highly active anti-retroviral therapy,' or HAART, the clinical picture of HIV has changed. The disease has gone from being an automatic death sentence to a chronic condition, and like all chronic conditions, it brings with it other complications that can seriously affect the lives of those who have it."

Today's study evaluated declines in lung function among HIV-positive patients.

Patients involved in the study, mostly men in their 40s, half of whom were smokers, were assessed at baseline for two measures of respiratory status, FEV1 and DLCO, and had been followed for two years at the time of reporting. FEV1 is a measure of expiratory flow in one second, a standard gauge of lung capacity, whereas DLCO is a measurement of diffusing capacity of the lungs and is decreased in patients with emphysema.

At the end of two years, the 63 patients displayed marked declines in lung function, going from an average FEV1 of 88 per cent predicted to 83.2 per cent and a DLCO of 77.6 to 70.0.

"This is the type of decline you might expect to see in elderly individuals who have a long history of smoking," said Mr Kadri.

"These results indicate that HIV-positive patients are more susceptible to lung-related problems than HIV-negative individuals and that HIV-positive smokers are even more susceptible to developing early emphysema. We don't know when these differences begin to manifest in HIV-positive individuals who smoke, but the severity is likely a function of the time that they have lived with the disease."

Source: View London, 18 May 2009
Link: http://tinyurl.com/p55uv8

USA: Study links cigarette changes to rising lung risk

It may be riskier on the lungs to smoke cigarettes today than it was a few decades ago according to new research which blames changes in cigarette design for fueling a certain type of lung cancer.

Dr. David Burns of the University of California, San Diego, told a recent meeting of tobacco researchers that up to half of the nation's lung cancer cases may be due to those changes,

It's not the first time that scientists have concluded the 1960s movement for lower-tar cigarettes brought some unexpected consequences. But this study, while preliminary, is among the most in-depth looks. And intriguingly it found the increase in a kind of lung tumor called adenocarcinoma was higher in the U.S. than in Australia even though both countries switched to so-called milder cigarettes at the same time.

Burns said, "The most likely explanation for it is a change in the cigarette. Cigarettes sold in Australia contain lower levels of nitrosamines, a known carcinogen, than those sold in the U.S."

That's circumstantial evidence that requires more research, he acknowledged.

But anti-smoking advocates are citing the study as Congress considers whether the Food and Drug Administration should regulate tobacco, legislation that would give the agency power to decide such things as whether to set caps on certain chemicals in tobacco smoke.

Smokers once tended to get lung cancer in larger air tubes, particularly a type named "squamous cell carcinoma." Then doctors noticed a jump in adenocarcinoma, which grows in small air sacs far deeper in the lung. Initial studies blamed introduction of filtered, lower-tar cigarettes. When smokers switched, they began inhaling more deeply to get their nicotine jolt, pushing cancer-causing smoke deeper than before.

Burns' study, presented at a meeting of the Society for Research on Nicotine and Tobacco, took a closer look. He compared smoking behaviours of different age groups over four decades — how much they smoked, when they started, when they quit and how cancer-risk changed.

The risk of squamous cell carcinoma stayed about the same over those years, Burns found. But adenocarcinoma rose. It makes up 65 percent to 70 percent of newly occurring U.S. lung cancer cases, but no more than 40 percent of Australia's lung cancer, he said.

While the nation's total lung cancer cases have inched down as the number of smokers has dropped in recent years, the study suggests an individual smoker's risk of getting cancer is higher.

It's well known that cigarettes differ from country to country, because of different tobacco crops grown locally and smokers' varying tastes. Nitrosamines are a byproduct of tobacco processing and levels vary for several reasons, including differences in curing practices.

Australian cigarettes contain about 20 percent of the nitrosamine content of U.S. cigarettes, making the chemical a prime suspect, concluded Burns, who has been scientific editor of several surgeon general reports on tobacco.

That doesn't rule out a role for deeper inhaling, cautioned Dr. Michael Thun of the American Cancer Society: "There's several strong suspects in the lineup. They may have acted in combination."

Philip Morris USA spokesman David Sutton called the study speculative and hard to evaluate until it's published in a medical journal, something Burns plans to do.

Still, Philip Morris, which supports FDA tobacco regulation, began taking steps with its growers in 2000 that have yielded "significantly lower" nitrosamine levels in recent years' supplies, Sutton said.

Be careful in assuming lower-nitrosamine cigarettes are less lethal, said Dr. Neal Benowitz of the University of California, San Francisco, a well-known tobacco expert. Lung cancer is only one of tobacco's many risks — it causes heart disease and other killer diseases, too.

"If you reduce someone's (lung cancer) risk by 10 percent, that's not really meaningful for an individual," he said. "The goal still is to get them to stop."

Source: Associated Press, 18 May 2009
Link: http://tinyurl.com/ppb5v7

Bulgaria votes for smoking ban in public places

Bulgarian lawmakers have voted to ban smoking in all public spaces from June 2010, ignoring protests from tobacco producers and the tourist industry.

The Black Sea country has already banned smoking in hospitals, taxis and offices and requires restaurant and bar owners to designate non-smoking areas, but the measures have been widely ignored.

Bulgaria ranks second after Greece in the European Union in terms of number of regular smokers as a percentage of the population, according to a recent Eurobarometer survey.

More than half of its men and more than a third of women in the European Union newcomer of 7.6 million people smoke.

In January, the EU Employment and Social Affairs Commissioner Vladimir Spidla backed a ban on smoking in all workplaces across the 27-member bloc, including in bars and restaurants.

Many European countries have already imposed national bans but the level of exemptions varies widely.

More than five million people die of smoking related illnesses each year, the World Health Organisation says.

Source: Reuters News, 15 May 2009
Link: http://tinyurl.com/rb24ry

South Koreans spend over US$6 Billion on cigarettes

South Koreans spent a record 8.16 trillion won ($6.46 billion) on cigarettes in 2008 despite efforts by the government and social groups to get people to cut down on smoking, a report by the central bank said.

The Bank of Korea said the figure represents a 3.9 percent gain from the 7.85 trillion won tallied the year before.

The total is equivalent to 25.2 percent of what the nation spends on medical and health care, 32.37 trillion won, and reflects a steady increase in cigarette purchasing.

Outlays on cigarettes reached 5.35 trillion won in 2000 before surpassing the 7-trillion won mark for the first time in 2005, and topped 7.49 trillion won in 2006.

Combined sales of cigarettes and alcoholic beverages reached 14.07 trillion won in 2008, up 4.7 percent from the previous year. The figure is equal to 43.5 percent of the country's medical and health care spending.

The report, however, said sales of both cigarettes and alcoholic beverages were somewhat affected by the poor economic conditions, with sales falling to a 2.1 percent annual gain in the fourth quarter, the lowest since minus 3.5 percent growth recorded for the fourth quarter of 2005.

On a quarterly basis, domestic sales of the two commodities rose 4.1 percent in the first quarter of 2008 and moved up 5.0 percent from April through June before dipping to 4.0 percent year-on-year growth in the third quarter.

Source: The Korean Times, 17 May 2009
Link: http://tinyurl.com/ol5c9y