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.

New 2013 Guidelines on Pulmonary Rehabilitation

A fresh guideline on pulmonary rehabilitation has been published this week, helping professionals, patients and the public understand what to expect from a pulmonary rehabilitation programme.

The new guideline, produced by the European Respiratory Society and the American Thoracic Society, supports the use of pulmonary rehabilitation as an essential part of the care offered to people with chronic obstructive pulmonary disease and other long-term lung conditions.

Link to 2013 Guidelines on Pulmonary Rehabilitation

For the first time, the European Lung Foundation has produced a patient version of this official ERS guideline. 

Link to this important Respiratory document

This document can be freely downloaded to help increase public understanding and awareness of pulmonary rehabilitation and what to expect from the programme.

Anti-Smoking Letter to President of European Parliament about Philip Morris

Dear friends we are reproducing and supporting Letter to President of European Parliament about Philip Morris lobbying activities on the Tobacco Products Directive 

Dear President Schulz,

We are writing to express our very deep concerns regarding the attempts by the tobacco industry lobby to derail vital public health legislation currently going through the Parliament.

As you will know, the EU is currently finalising the review of Tobacco Products Directive (TPD), a crucial piece of legislation for protecting the public from tobacco (the largest preventable cause of death and disease in the world). However, in recent weeks, European news media such as The Guardian, Der Spiegel and Le Parisien have reported extensively about leaked documents which outline the lobbying strategies and activities of tobacco giant Philip Morris International to influence the European Parliament’s decision-making on the TPD. There is widespread concern that the decision to delay the plenary vote on the TPD was a result of tobacco companies like Philip Morris International and others using their economic and political power to influence MEPs. The postponement of the vote is widely believed to be part of a tobacco industry strategy to delay, weaken or even derail the TPD. The leaked documents show that no less than 233 MEPs (almost one third of the Parliament) have been met by Philip Morris International lobbyists at least once. Several MEPs were listed as having had four or five such meetings.

This large number of meetings (which have taken place behind closed doors, without any transparency such as the publication of minutes from these meetings), constitutes a serious violation of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) Article 5.3 which is geared towards safeguarding public health policy-making from tobacco industry interference. FCTC Article 5.3 recognizes the fundamental and irreconcilable conflict of interest between the tobacco industry and public health policy-making. It also recognises that the tobacco industry has, for decades, been working tirelessly to delay, block, and weaken life-saving health measures, like those enshrined in the FCTC.

FCTC Article 5.3 requires all Parties, when deciding on their public health policies with respect to tobacco control to “. . . act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law”.

The WHO’s accompanying guidelines stipulate that decision-makers “should interact with the tobacco industry only when and to the extent strictly necessary to enable them to effectively regulate the tobacco industry and tobacco products.”

The guidelines state that “where interactions with the tobacco industry are necessary, Parties should ensure that such interactions are conducted transparently”.

We are deeply concerned about the astounding level of access to MEPs by tobacco lobbyists which has been exposed in the leaked Philip Morris International documents. As President of the European Parliament, we consider that it is your urgent responsibility to take determined action to ensure proper implementation of Article 5.3 of the FCTC, in order to assure that the Parliament protects its decision-making from tobacco lobby influence. This is crucial in order to protect public health and the interests of EU citizens in strong tobacco regulation and for the Parliament to fulfill its UN obligations.

Nobel Awards for Medicine 2013

Three researchers who studied how cells shuttle around essential molecules in tiny intracellular sacs have won this year’s Nobel Prize in physiology or medicine. James Rothman of Yale University; Randy Schekman of the University of California, Berkeley; and Thomas Südhof of Stanford University earned the award "for their discoveries of machinery regulating vesicle traffic, a major transport system in our cells," according to the announcement from the Nobel Assembly at Karolinska Institute in Stockholm.

The three researchers independently unraveled basic cellular mechanisms several decades ago—in Schekman's case, almost 40 years ago. Although mistakes in cellular transport systems can cause a variety of diseases—including diabetes and neurological and immunological disorders—their work has not yet led to any new drugs or therapies, but it has helped others develop diagnostic tests.

The Lung Health and Medicine Revolution in Respiratory Century

Over the past century we have become adept at suppressing the symptoms of respiratory diseases but we have made little progress in curing them. Respiratory diseases are responsible for over 650,000 deaths annually in the EU and the burden on health systems is increasing as the population ages. A revolutionary collaborative approach to research funding is providing new insights into the origins of chronic respiratory diseases. All stakeholders in respiratory medicine are pooling their knowledge and resources to focus on risk factors to find cures, formulate new vaccines and develop cutting-edge technologies to tackle the burden of chronic respiratory diseases.

The best 2013 Sleep Story Video

The American Sleep Medicine Foundation selected an effects-heavy YouTube video about the benefits of sleep as the grand-prize winner of the first-ever ASMF Sleep Story Video Contest. The video was created by Jasper Lown, a senior at Wheaton-Warrenville South High School, located near Chicago. His two-minute video uses creative visuals to provide simple tips to improve sleep habits. His sponsoring teacher was Tim Brylka.

Disparities in respiratory health

To address the global phenomenon of disparities in respiratory health, the American Thoracic Society and the European Respiratory Society have released an official policy statement in which each pledges its commitment to reducing health disparities between the lowest and highest socioeconomic groups by continuing or initiating work with leaders from governments, academia, and other organizations to promote scientific inquiry and training, disseminate medical information and best practices, and monitor and advocate for public respiratory health.

Klaus Rabe, MD, writing committee member and a past president of ERS, continued: "The effects of health disparities in Europe on respiratory disease are very pronounced. Individuals in lower social groups are not only more likely to have respiratory diseases, but, compared with other disorders, social inequality is associated with a larger proportion of deaths from these diseases."

The American Thoracic Society and European Respiratory Society pledge to frame their actions to reduce respiratory health disparities. The vision of the ATS and ERS is that all persons attain better and sustained respiratory health. They call on all their members and other societies to join in this commitment.