HEADLINES

• Nicotine replacement therapy targets proposed for QOF
• Does smoking compound other MS risk factors?
• New test could identify smokers at risk of emphysema
• Survey shows residents want children protected from smoking in park
• USA: States not using new tobacco tax for prevention

• Nicotine replacement therapy targets proposed for QOF

  QOF targets on smoking cessation should be ditched in favour of indicators for prescribing smoking cessation drugs, a leading GP researcher has said.

  
  Indicators that reward GPs for prescribing nicotine replacement therapy to smokers would be 'more logical', an analysis of evidence concluded.
  
  The study - by Dr Tim Coleman, a researcher at the University of Nottingham and a GP in the city - suggested that after the QOF was introduced, the likelihood of a patient having their smoking status recorded almost doubled and the likelihood of receiving smoking cessation advice tripled.

  But there was no consistent change in prescriptions of smoking cessation drugs and no acceleration in prescriptions in any cohort.

  Source: Pulse, 07 April 2010
  Link: http://bit.ly/dyztWn

• Does smoking compound other MS risk factors?

  A new study shows that smoking may increase the risk of multiple sclerosis (MS) in people who also have specific established risk factors for MS. The research is found in the April 7, 2010, online issue of Neurology®, the medical journal of the American Academy of Neurology.

  The research involved 442 people with MS and 865 people without the disease from three studies: the Nurses' Health Study I/Nurses' Health Study II, the Tasmanian MS Study and the Swedish MS Study. Researchers first determined whether participants had known risk factors for MS, including having a high level of antibody in the blood to the Epstein-Barr virus (a common herpes virus that infects most people but is associated with MS in a small fraction of those infected), or having an immune-system-related gene called the HLA-DR15 gene (which is present in 20% of the population at large but 60% of patients with MS).

  The study found that among those with high levels of the antibody to the Epstein-Barr virus, smokers were twice as likely to have MS as those who had never smoked. The same association was not seen in those with low antibody levels. The risk of MS associated with smoking was not different in people with and without the HLA-DR15 gene.

  "The consistency of an association between MS, smoking and the body's immune response to the Epstein-Barr virus based on these three distinct, geographically diverse studies suggests this finding is not due to chance," said study author Claire Simon, ScD, with Harvard School of Public Health in Boston. "This relationship may provide clues as to why certain individuals develop MS while others do not."

  In the United States, the average lifetime risk of developing MS is approximately one in 200 for women and one in 600 for men. Among those with high antibody levels to the Epstein-barr virus, smokers may have up to a twofold increase in MS risk compared to non-smokers.

  MS is the most common non-traumatic disabling neurologic disease in the US among young adults.

  Source: Medical News Today, 08 April 2010
  Link: http://bit.ly/cHkfPu

• New test could identify smokers at risk of emphysema

  Using CT scans to measure blood flow in the lungs of people who smoke may offer a way to identify which smokers are most at risk of emphysema before the disease damages and eventually destroys areas of the lungs, according to a University of Iowa study.

  The study found that smokers who have very subtle signs of emphysema, but still have normal lung function, have very different blood flow patterns in their lungs compared to non-smokers and smokers without signs of emphysema.

  This difference could be used to identify smokers at increased risk of emphysema and allow for early intervention. The findings appear this week in the Early Edition of the Proceedings of the National Academy of Sciences.

  "We have developed a new tool to detect early emphysema-related changes that occur in smokers who are susceptible to the disease," said lead study author Eric Hoffman, Ph.D., UI professor of radiology, internal medicine and biomedical engineering. "Our discovery may also help researchers understand the underlying causes of this disease and help distinguish this type of emphysema from other forms of chronic obstructive pulmonary disease. This type of CT scan could even be a tool to test the effectiveness of new therapies by looking at the changes in lung blood flow."

  As many as 24 million Americans have chronic obstructive pulmonary disease (COPD) - a group of serious lung diseases that includes emphysema - and COPD is the fourth leading cause of death nationwide. Because COPD is a group of different diseases, identifying more effective treatments may hinge on distinguishing between these diseases and targeting them separately.

  The team used multi-detector row CT imaging to measure blood flow patterns in the lungs of 41 study participants - 17 non-smokers and 24 smokers. All the participants had normal lung function, but 12 of the smokers had very subtle signs of emphysema. The CT scans showed that these 12 individuals had the most disrupted patterns of blood flow compared to the other participants.

  The findings also support the idea that abnormal blood flow occurs before emphysema develops.

  "Although the underlying causes of emphysema are not well understood, smoking increases the risk of developing the disease," Hoffman said. 
  
  "Our study suggests that some smokers have an abnormal response to inflammation in their lungs; instead of sending more blood to the inflamed areas to help repair the damage, blood flow is turned off and the inflamed areas deteriorate."

  The cellular pathway that turns off blood flow is helpful when an area of the lung has become permanently blocked and cannot be rescued. In that case, the lung "optimizes gas exchange" and stops supplying the area with blood. However, lung inflammation caused by smoking can be resolved and resultant damage repaired by increased blood flow, which brings oxygen and helpful cellular components to the site of injury.

  This study suggests that the ability to distinguish when to turn off or when to ramp up blood flow is defective in some people - probably due to genetic differences. If this genetic difference is coupled with smoking, which increases lung inflammation, that could increase the risk of developing emphysema.

  Source: Science Daily, 07 April 2010
  Link: http://bit.ly/aG68HP

• Survey shows residents want children protected from smoking in park

  A survey showed residents would like to see measures brought in to protect children from second hand smoke in the play area at Phoenix Park, Runcorn.

  The study was conducted jointly by NHS Halton and St Helens’ Health Improvement Team and Halton Borough Council’s Environmental Health Department .

  More than three quarters (76%) agreed they would be in favour of a voluntary code of not smoking within the fenced playground area, while 62% said they would want to see smoking banned within 10m of it.

  Halton Borough Council environmental health officer Mark Clayton said: “Smokers themselves are all too aware of the damaging effects of second hand smoke and are very supportive of the measures to protect children’s health.

  “Our aim is to increase awareness about the risks associated with second hand smoke.”

  Source: icCheshireOnline, 08 April 2010
  Link: http://bit.ly/b2ssps

• USA: States not using new tobacco tax for prevention

  Higher cigarette taxes can substantially curb smoking but states can make an even bigger dent by investing the new funds in programs to help people quit, the U.S. Centers for Disease Control and Prevention said.

  "None of the 15 states dedicated any of the new excise tax revenue by statute to tobacco control," lead author Karen Debrot of the CDC's Office on Smoking and Health wrote.

  Tobacco use is the leading cause of preventable death in the United States, causing nearly one in five deaths per year, according to the CDC.

  All 50 states and Washington, D.C., have cigarettes taxes.

  The national average state cigarette tax rose from $1.18 per pack in 2008 to $1.34 per pack in 2009, the CDC said in its weekly report on death and disease.

  "A 10 percent increase in the price of cigarettes can reduce consumption by nearly 4 percent among adults and can have an even greater effect among youths and other price-sensitive groups," the CDC wrote in a commentary.

  When combined with other tobacco control measures, "cigarette excise tax increases can be even more effective in reducing tobacco-related death and disease," the report said.

  State cigarette taxes range from a high of $3.46 per pack in Rhode Island to 7 cents per pack in South Carolina, the CDC said.

  American Heart Association CEO Nancy Brown urged all states to boost their tobacco taxes.

  "Legislators can multiply the positive impact of a tax increase on both public health and their state's fiscal health by dedicating a portion of the money to implementing tobacco prevention programs that have, in some cases, reduced youth smoking by up to 40 percent," Brown said in a statement.

  A separate report released by the CDC said imposing minimum price laws in states with low cigarette taxes could help control tobacco use and counter discounts offered by cigarette makers.

  "Additional laws might be necessary to prohibit all retail price promotions (e.g., coupons or two-for-one offers) that can decrease cigarette retail prices to consumers," the CDC said in a commentary.

  Source: Reuters News, 08 April 2010
  Link: http://bit.ly/cmyWzB