Lung Disease Often Missed in Long-term Smokers

June 30, 2015

Undiagnosed lung disease in smokers, the impact of guidelines for community-acquired pneumonia in children, and climate change and asthma attacks make headlines in the respiratory news.

As many as 35 million Americans who smoke or who are former smokers may have undiagnosed lung disease or impairment. On a more positive note, guidelines issued for childhood community-acquired pneumonia seem to have initiated an appropriate change in antibiotics. And a coalition of leading public health, disease advocacy, and medical organizations have listed the health effects of climate change, including asthma attacks, and are calling for more action by the federal government to limit them.

 

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Long-term Smokers May Have Undiagnosed Lung Disease

Current and former smokers who do not have airflow obstruction may assume that they are free of disease.

But millions of long-term smokers with normal spirometry results may have undiagnosed lung disease.

A cross-sectional, observational study included more than 9000 persons aged 45 to 80 years who had smoked at least 1 pack of cigarettes daily for 10 years.

Most smoked more than 1 pack per day; about half were considered disease-free based on their lung-function test results.

 

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Nearly Half of Smokers Have CT Evidence of Disease

One or more respiratory-related impairments were found in 54.1% of patients. This group had worse quality of life compared with never-smokers, as well as a shorter 6-minute walk distance.

In this group, 42.3% had CT evidence of emphysema or airway thickening.

Current smoking was associated with more respiratory symptoms, but former smokers had greater emphysema and gas trapping.

Advancing age was associated with smoking cessation and with more CT findings of disease.

 

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Unrecognized Disease in 35 Million Older Americans

Those with respiratory impairments were more likely to use respiratory medications, and the use of these medications was associated with worse disease.

Lung disease and impairments were common in smokers without spirometric chronic obstructive pulmonary disease.

The researchers projected that 35 million current and former smokers older than 55 years in the United States may have unrecognized disease or impairment.

 

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Guidelines for Community-Acquired Pneumonia in Children

The 2011 national guidelines for the management of childhood community-acquired pneumonia (CAP) recommended narrow-spectrum antibiotics (eg, ampicillin) for most children hospitalized with CAP.

Researchers assessed the guidelines’  impact on antibiotic prescribing at 3 children’s hospitals.

The study included 2121 children.

 

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Guidelines Lead to Changes in Antibiotics

During the pre-guideline period, 52.8% of children with CAP received third-generation cephalosporins compared with 2.7% who had received penicillin/ampicillin.

Nine months after the new guidelines were issued, third-generation cephalosporin use had declined by 12.4% and penicillin/ampicillin use had increased by 11.3%.

Changes were more apparent among institutions that proactively disseminated the guidelines.

The researchers suggest that targeted, hospital-based efforts are important for timely implementation of guideline recommendations.

 

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Climate Change Declared a Public Health Issue

A coalition of leading public health, disease advocacy, and medical organizations called for climate change to be seen as a public health issue.

The coalition issued a statement as part of the National Dialogue on Climate Change and Health at the White House.

The statement articulates a consensus on the health effects of climate change and the need for action to protect public health.

 

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Asthma Attacks and Other Health Effects of Climate Change

The statement notes that communities are experiencing the health effects of climate change, including:

-elevated ozone and particulate air pollution, linked to asthma attacks, cardiovascular disease, and premature death.

-extreme weather patterns, such as heat and severe storms, that cause droughts, wildfires, and flooding and destabilize communities, especially those least equipped to defend themselves.

-increased vector-borne diseases with expanding seasons and geographic ranges for ticks, mosquitoes, and other disease-carrying insects to roam.

The most vulnerable patients-including children, seniors, persons in low-income communities, and those with chronic disease-bear a disproportionate amount of the health effects of climate change.

Bold action is needed to clean up major sources of carbon pollution, including power plants, cars, trucks, and other mobile sources.

 

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Commendation to President Obama

The Climate Action Plan will help cut carbon pollution and other greenhouse gases.

The consensus group commended President Barak Obama for bringing greater awareness to the public health effects of climate change.

The group stated that they are united to protect the public from the risks of climate change.

 

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Take-home Messages:

The effect of chronic smoking on the lungs is substantially underestimated when spirometry is used alone.

After publication of national guidelines, third-generation cephalosporin use declined and penicillin/ampicillin use increased among children hospitalized with community-acquired pneumonia.

A declaration on climate change and health lists the adverse effects on health, such as elevated ozone and particulate air pollution leading to asthma attacks, and calls for more action.