European Smoking Cessation Guidelines 2013

Dear Respiratory friends we are happy to present new Smoking Cessation Guidelines!

The European Smoking Cessation Guidelines and Quality Standards are the main output of a project undertaken by ENSP to create a coherent and reliable set of guidelines for healthcare professionals working in the field of smoking cessation. The Guidelines form a complete range of tools to support smoking cessation strategies. The work was undertaken by the Editorial Board comprising seven eminent professors and the Board of Revisers from across the entire European continent and is the first of its kind. These guidelines are in accordance with Article 14 of the Framework Convention on Tobacco Control (FCTC), which states that:

Parties should develop and disseminate comprehensive tobacco dependence treatment guidelines based on the best available scientific evidence and best practices, taking into account national circumstances and priorities. These guidelines should include two major components: (1) a national cessation strategy, to promote tobacco cessation and provide tobacco dependence treatment, aimed principally at those responsible for funding and implementing policies and programs; and (2) national treatment guidelines aimed principally at those who will develop, manage and provide cessation support to tobacco users.

This project aims to support smoking cessation activities and strengthen their impact by:

• providing health professionals with a European template of smoking cessation guidelines and best practice;
• providing the tobacco control community with tools for monitoring and accreditation.

Five Things Chest Physicians and Respiratory Patients Should Question

Dear Respiratory friends we are re-posting interesting questions and answers from American College of Chest Physicians and American Thoracic Society!

1

Don’t perform computed tomography (CT) surveillance for evaluation of indeterminate pulmonary nodules at more frequent intervals or for a longer period of time than recommended by established guidelines.

Clinical practice guidelines for pulmonary nodule evaluation (such as those issued by the Fleischner Society or the American College of Chest Physicians) suggest that intensity of surveillance should be guided by the likelihood of malignancy. In patients with no prior history of cancer, solid nodules that have not grown over a 2-year period have an extremely low risk of malignancy (although longer follow-up is suggested for ground-glass nodules). Similarly, intensive surveillance (e.g., repeating CT scans every 3 months for 2 years or more) has not been shown to improve outcomes such as lung cancer mortality. Meanwhile, extended or intensive surveillance exposes patients to increased radiation and prolonged uncertainty.

2

Don’t routinely offer pharmacologic treatment with advanced vasoactive agents approved only for the management of pulmonary arterial hypertension to patients with pulmonary hypertension resulting from left heart disease or hypoxemic lung diseases (Groups II or III pulmonary hypertension).

Evidence and clinical practice guidelines have not established benefits of vasoactive agents (e.g., prostanoids, phosphodiesterase inhibitors, endothelin antagonists) for patients with pulmonary hypertension resulting from left heart disease or hypoxemic lung diseases. Moreover, the use of these agents may cause harm in certain situations and incurs substantial cost and resource utilization. Patients should be carefully assessed (including at a minimum right heart catheterization, echocardiography, chest CT, six minute walk test and pulmonary function testing) to confirm that they have symptomatic pulmonary arterial hypertension prior to having approved agents initiated.

3

For patients recently discharged on supplemental home oxygen following hospitalization for an acute illness, don’t renew the prescription without assessing the patient for ongoing hypoxemia.

Hypoxemia often resolves after recovery from an acute illness, and continued prescription of supplemental oxygen therapy incurs unnecessary cost and resource use. At the time that supplemental oxygen is initially prescribed, a plan should be established to re-assess the patient no later than 90 days after discharge. Medicare and evidence-based criteria should be followed to determine whether the patient meets criteria for supplemental oxygen.

4

Don’t perform chest computed tomography (CT angiography) to evaluate for possible pulmonary embolism in patients with a low clinical probability and negative results of a highly sensitive D-dimer assay.

Clinical practice guidelines for pulmonary embolism indicate that the cost and potential harms of CT angiography (including radiation exposure and the possibility of detecting and treating clinically insignificant pulmonary emboli with anticoagulation) outweigh the benefits for patients with a low pre-test probability of pulmonary embolism. In patients with a low clinical prediction score (e.g., Wells or Geneva score) followed by a negative D-dimer measured with a high sensitivity test (e.g., ELISA), pulmonary embolism is effectively excluded and no further imaging is indicated for pulmonary embolism evaluation.

5

Don’t perform CT screening for lung cancer among patients at low risk for lung cancer.

Low dose chest CT screening for lung cancer has the potential to reduce lung cancer death in patients at high risk (i.e., individuals aged 55-74 with at least a 30-pack year history of tobacco use, who are either still smoking or quit within the past 15 years). However, CT screening for lung cancer also has the potential to cause a number of adverse effects (e.g., radiation exposure, high false positive rate, harms related to downstream evaluation of pulmonary nodules, overdiagnosis of indolent tumors). Thus, screening should be reserved for patients at high risk of lung cancer and should not be offered to individuals at low risk of lung cancer.

Master Studies in Interventional Pneumology at Firenze, Italy, 2014

Dear Respiratory Doctors,

We are happy to invite you in 2014 at Firenze, Italy for Master Studies in Interventional Pneumology, which is organized by great friend of Respiratory Decade Professor Lorenzo CORBETTA.
Please find links with program of Master Studies!

Cari Colleghi,
sono aperte le iscrizioni alla 5° edizione del Master di II livello in Pneumologia Interventistica, A.A. 2013-2014 collegandosi on-line al sito: http://ammissioni.polobiotec.unifi.it/turul. Le iscrizioni chiuderanno alle ore 13 del 15 Gennaio 2014. Per informazioni sui contenuti del Master potete collegarvi al sito http://master.pneumologia-interventistica.it o visualizzare il video informativo al seguente indirizzo: http://www.youtube.com/watch?v=0x0MsBfbEcY.

Il Master che avrà inizio il 25 Febbraio 2014 avrà un durata di 10 mesi.
La sede del Master è provvista di 3 manichini permanenti e di un simulatore per le prove pratiche. L'obiettivo principale è quello di fornire un valido aggiornamento nel settore della broncoscopia diagnostica e operativa, della toracoscopia e della gestione delle vie aeree artificiali e si avvale sia di metodologie didattiche tradizionali di tipo frontale o seminariale sia di metodologie innovative che prevedono l'uso di manichini, simulatori, collegamenti in "real time" con le sale endoscopiche, sessioni di e-learning e videoconferenze.
Il Master prevede, inoltre, uno stage formativo della durata di 3 settimane in uno dei Centri italiani di Pneumologia convenzionati.

L'insegnamento, affidato a docenti dell'Ateneo fiorentino e dei principali Centri italiani di Pneumologia Interventistica, è diretto principalmente a medici Specialisti in Malattie dell'Apparato Respiratorio e ad altri Specialisti che hanno interesse ad acquisire professionalità in questo settore.
Per ulteriori informazioni: Segreteria master polo biomedico
Tel: 055 4598 031-769-775-773
Fax: 055 7946699 master@polobiomedico.unifi.it

Segreteria organizzativa:
Tel: 055 4271462
Fax: 055 4271464 segreteria.master@pneumologia-interventistica.it

Ufficio supporto organizzativo:
Mob: +39 331 5664435
Tel: +39 0532 974077 mailto:margherita.franzoni@unife.it convegni@unife.it

COMITATO ORDINATORE:
Lorenzo Corbetta
Raffaele De Gaudio
Stefano Gasparin
Carlo Mereu
Marco Patelli
Massimo Pistolesi

Sito Web: http://master.pneumologia-interventistica.it

Waterpipe tobacco smoking: it is so dangerous as smoking or no?

Many medical students and young people are asking me about effects of waterpipe tobacco smoking or narghila. it is so dangerous as smoking or no?

Waterpipe tobacco smoking is a centuries-old tobacco use method with an ambiguous origin and links to the countries of southwest Asia and north Africa. Although known by many different names (eg, hookah, narghile, shisha), the term waterpipe has been used for the last 2 decades in the English language scientific literature to refer to any of a variety of instruments that involve passing tobacco smoke through water before inhalation. Contrary to popular belief that waterpipe tobacco smoking is less lethal than cigarette smoking, emerging research indicates that both involve comparable health risks including nicotine/tobacco dependence.

One more argument was published last days in Chest journal: Laboratory and Clinical Acute Effects of Active and Passive Indoor group Water-Pipe (Narghile) Smoking.
One session of indoor group active waterpipe smoking resulted in significant increases in COHb and serum nicotine levels (8- and 18-fold, respectively), and was associated with adverse cardio-respiratory health effects. The minor effects found in passive smokers suggest that they too may be affected adversely by exposure to waterpipe smoking.

We are for Global ban of Waterpipe tobacco smoking!!!

New study on COPD Surveillance in United States, 1999-2011

New study on COPD Surveillance in United States, 1999-2011 was published in Chest!!

COPD is a serious public health problem in the United States. In 2008, chronic lower respiratory diseases, of which COPD represents the principal component, became the third leading cause of mortality. Because smoking is the dominant risk factor for COPD and contributed to about 80% of COPD deaths in 2000 to 2004, much of this disease is potentially preventable. People with COPD experience worse health-related quality of life, more disabilities, and higher rates of comorbidities than people without COPD.

This report updates surveillance results for COPD in the United States. For 1999 to 2011, data from national data systems for adults aged ≥ 25 years were analyzed. In 2011, 6.5% of adults (approximately 13.7 million) reported having been diagnosed with COPD.

New Guidelines of Treatment of Multidrug-Resistant Tuberculosis

Dear Respiratory we are happy to present New Guidelines of Treatment of Multidrug-Resistant Tuberculosis!

It can be a Revolution in treatment of Multidrug-Resistant Tuberculosis!

Multidrug-resistant tuberculosis (MDR TB) is caused by Mycobacterium tuberculosis that is resistant to at least isoniazid and rifampin, the two most effective of the four first-line TB drugs (the other two drugs being ethambutol and pyrazinamide). MDR TB includes the subcategory of extensively drug-resistant TB (XDR TB), which is MDR TB with additional resistance to any fluoroquinolone and to at least one of three injectable anti-TB drugs (i.e., kanamycin, capreomycin, or amikacin). MDR TB is difficult to cure, requiring 18–24 months of treatment after sputum culture conversion with a regimen that consists of four to six medications with toxic side effects, and carries a mortality risk greater than that of drug-susceptible TB.

Bedaquiline fumarate (Sirturo or bedaquiline) is an oral diarylquinoline. On December 28, 2012, on the basis of data from two Phase IIb trials (i.e., well-controlled trials to evaluate the efficacy and safety of drugs in patients with a disease or condition to be treated, diagnosed, or prevented), the Food and Drug Administration (FDA) approved use of bedaquiline under the provisions of the accelerated approval regulations for "serious or life-threatening illnesses" (21CFR314.500) (Cox EM. FDA accelerated approval letter to Janssen Research and Development.

European Parliament Written Declaration on recognising the burden of allergic disease

Dear Respiratory Friends now you can sign European Parliament Written Declaration on Recognizing the Burden of Allergic Disease!

 

Allergic diseases affect over 150 million Europeans, of whom some are affected by severe, debilitating diseases, but these are neglected as a public health concern.
Members of the European Parliament now have an opportunity to call on the European Commission and EU Member States to take action by signing a Written Declaration on Recognising the Burden of Allergic Disease, which opened for signatures in October 21st and will remain open until January 21, 2014.

1. More than 150 million EU citizens suffer from chronic allergic diseases, half of whom are undiagnosed due to a lack of awareness and shortage of medical specialists;

2. More than 100 million Europeans suffer from allergic rhinitis and 70 million from asthma,the most common non-communicable diseases in children and the main cause of children’s emergency room visits and hospital admissions;

3. More than 17 million Europeans suffer from food allergies or severe allergies implying a risk of acute attacks or anaphylaxis with life-threatening potential;

4. Allergies are an underestimated cause of unhealthy ageing and have a severe impact on social, professional and educational performance, especially in children, causing socioeconomic inequalities;

5. The Commission is therefore called upon to encourage cooperation and coordinationbetween Member States to promote: national allergyprogrammes to reduce the disease burden and health inequalities; training in allergies and multidisciplinary care plans to

improve disease management; use of preventive and tolerance-inducing approaches toallergy treatment; and scientific research into direct and indirect allergy risk factors,including pollution;

6. This declaration, together with the names of the signatories, is forwarded to the Commission.