tag:theconversation.com,2011:/id/topics/copd-26872/articlesCOPD – The Conversation2023-10-26T01:12:15Ztag:theconversation.com,2011:article/2140652023-10-26T01:12:15Z2023-10-26T01:12:15Z3 ways to prepare for bushfire season if you have asthma or another lung condition<figure><img src="https://images.theconversation.com/files/555707/original/file-20231025-25-7t7ylm.jpg?ixlib=rb-1.1.0&rect=4%2C0%2C994%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sunlight-shining-through-smoke-haze-coloring-1605818323">Shutterstock</a></span></figcaption></figure><p>Australia’s bushfire season is officially <a href="https://www.nsw.gov.au/media-releases/fire-season-commences">under way</a> during an <a href="https://www.climatecouncil.org.au/resources/what-the-return-of-el-nino-means/">El Niño</a>. And after three wet years, and the <a href="https://www.afac.com.au/auxiliary/publications/newsletter/article/seasonal-bushfire-outlook-spring-2023#:%7E:text=For%20spring%202023%2C%20increased%20risk,bushfire%20this%20season%20are%20widespread">plant growth</a> that comes with it, there’s fuel to burn.</p>
<p>With the prospect of <a href="https://theconversation.com/its-official-australia-is-set-for-a-hot-dry-el-nino-heres-what-that-means-for-our-flammable-continent-209126">catastrophic bushfire</a> comes smoke. This not only affects people in bushfire regions, but those <a href="https://theconversation.com/bushfire-smoke-is-everywhere-in-our-cities-heres-exactly-what-you-are-inhaling-129772">in cities and towns</a> far away, as smoke travels. </p>
<p>People with a <a href="https://www.atsjournals.org/doi/10.1164/rccm.202012-4471LE">lung condition</a> are among those especially affected.</p>
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Read more:
<a href="https://theconversation.com/our-mood-usually-lifts-in-spring-but-after-early-heatwaves-and-bushfires-this-year-may-be-different-213643">Our mood usually lifts in spring. But after early heatwaves and bushfires, this year may be different</a>
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<h2>What’s so dangerous about bushfire smoke?</h2>
<p>Bushfire smoke <a href="https://www.health.nsw.gov.au/environment/air/Pages/common-air-pollutants.aspx">pollutes the air</a> we breathe by increasing the concentration of particulate matter (or PM).</p>
<p>Once inhaled, <a href="https://www.health.nsw.gov.au/environment/air/Pages/particulate-matter.aspx">small particles</a> (especially with a diameter of 2.5 micrometres or less, known as PM2.5) can get deep into the lungs and into the bloodstream. </p>
<p>Concentration of gases in the air – such as <a href="https://www.health.nsw.gov.au/environment/air/Pages/ozone.aspx">ozone</a>, <a href="https://www.health.nsw.gov.au/environment/air/Pages/nitrogen-dioxide.aspx">nitrogen dioxide</a> and <a href="https://www.health.nsw.gov.au/environment/air/Pages/sulphur-dioxide.aspx">sulfur dioxide</a> – also increase, to pollute the air.</p>
<p>All these cause the airway to <a href="https://www.alfredhealth.org.au/news/the-effects-of-bushfire-smoke-explained/">narrow and spasm</a>, making it hard to breathe. </p>
<p>This can be even worse for people with existing asthma or other respiratory conditions whose airways are already inflamed.</p>
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Read more:
<a href="https://theconversation.com/bushfire-smoke-is-everywhere-in-our-cities-heres-exactly-what-you-are-inhaling-129772">Bushfire smoke is everywhere in our cities. Here's exactly what you are inhaling</a>
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<p>Emergency department visits and hospital admissions for asthma-related symptoms <a href="https://www.sciencedirect.com/science/article/pii/S0013935119305742?dgcid=author">rise</a> <a href="https://pubmed.ncbi.nlm.nih.gov/33601224/">after exposure</a> to bushfire smoke.</p>
<p>Smoke from the bushfires in summer 2019/20 <a href="https://www.mja.com.au/system/files/issues/213_06/mja250545.pdf">resulted in</a> an estimated 400 deaths or more from any cause, more than 1,300 emergency department visits for asthma symptoms, and more than 2,000 hospital admissions for respiratory issues.</p>
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<p>Even if symptoms are not serious enough to warrant emergency medical attention, exposure to bushfire smoke <a href="https://www.qld.gov.au/health/staying-healthy/environmental/after-a-disaster/bushfires/bushfire-smoke-and-your-health#:%7E:text=Signs%20of%20smoke%20irritation%20include,throat%2C%20runny%20nose%20and%20coughing">can lead to</a> cough, nasal congestion, wheezing and asthma flares.</p>
<p>If you have <a href="https://theconversation.com/what-causes-asthma-what-we-know-dont-know-and-suspect-96409">asthma</a>, <a href="https://theconversation.com/explainer-what-is-chronic-obstructive-pulmonary-disease-25539">chronic obstructive pulmonary disease</a>, <a href="https://www.nhlbi.nih.gov/health/bronchiectasis#:%7E:text=Bronchiectasis%20is%20a%20condition%20that,These%20tubes%20are%20called%20airways.">bronchiectasis</a> or another lung condition, or you care for someone who has, here’s what you can do to prepare for the season ahead.</p>
<h2>1. Avoid smoke</h2>
<p>Monitor your local air quality by downloading one or both of these apps:</p>
<ul>
<li><p><a href="https://asthma.org.au/what-we-do/current-projects/airsmart/">AirSmart</a> from Asthma Australia has live air-quality information to help you plan and act</p></li>
<li><p><a href="https://airrater.org/">AirRater</a>, developed by Australian scientists, can be another useful app to monitor your environment, track your symptoms and help manage your health. </p></li>
</ul>
<p>During times of poor air quality and smoke stay indoors and avoid smoke exposure. Close windows and doors, and if you have one, use an air conditioner to recirculate the air. </p>
<p>Avoid unnecessary <a href="https://28bysamwood.com/blog/fitness/should-you-exercise-if-its-smoky-outside/">physical activity</a> which makes us breathe more to deliver more oxygen to the body, but also means we inhale more polluted air. Consider temporarily moving to a safer residence. </p>
<p>Well-fitting N95/P2 masks can reduce your exposure to fine smoke particles if you must travel. However they can make it more difficult to breathe if you are unwell. In that case, you may find a mask with a valve <a href="https://theconversation.com/how-to-protect-yourself-against-bushfire-smoke-this-summer-154720">more comfortable</a>.</p>
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<a href="https://images.theconversation.com/files/555709/original/file-20231025-17-n7pp9e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Person holding a N95/P2 respirator" src="https://images.theconversation.com/files/555709/original/file-20231025-17-n7pp9e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/555709/original/file-20231025-17-n7pp9e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/555709/original/file-20231025-17-n7pp9e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/555709/original/file-20231025-17-n7pp9e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/555709/original/file-20231025-17-n7pp9e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/555709/original/file-20231025-17-n7pp9e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/555709/original/file-20231025-17-n7pp9e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Well-fitting N95/P2 masks can help.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sydney-australia-20200105-trojan-p2-disposable-1608222889">Daria Nipot/Shutterstock</a></span>
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Read more:
<a href="https://theconversation.com/how-to-protect-yourself-against-bushfire-smoke-this-summer-154720">How to protect yourself against bushfire smoke this summer</a>
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<h2>2. Have an action plan</h2>
<p>Taking your regular preventer medication ensures your lung health is optimised before the danger period. </p>
<p>Ensure you have a <a href="https://www.nationalasthma.org.au/health-professionals/asthma-action-plans">written action plan</a>. This provides you with clear instructions on how to take early actions to prevent symptoms deteriorating or to reduce the severity of flare-ups. Review this plan with your GP, share it with a family member, pin it to the fridge.</p>
<p>Make sure you have emergency medication available, know when to call for help, and what medication to take while you wait. You may consider storing an emergency “reliever puffer” in your home or with a neighbour.</p>
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Read more:
<a href="https://theconversation.com/how-to-manage-your-essential-medicines-in-a-bushfire-or-other-emergency-127516">How to manage your essential medicines in a bushfire or other emergency</a>
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<h2>3. Have the right equipment</h2>
<p>High-efficiency particulate air (HEPA) filters <a href="https://www.phrp.com.au/issues/online-early/residential-indoor-air-quality-and-hepa-cleaner-use/">can reduce</a> smoke exposure inside the home during a fire event by 30-74%. These filters remove particulate matter from the air. </p>
<p>A spacer, which is a small chamber to contain inhaled medication, can help you take emergency medication if you are breathing quickly. You may want to have one to hand.</p>
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Read more:
<a href="https://theconversation.com/from-face-masks-to-air-purifiers-what-actually-works-to-protect-us-from-bushfire-smoke-128633">From face masks to air purifiers: what actually works to protect us from bushfire smoke?</a>
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<img src="https://counter.theconversation.com/content/214065/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People with a lung condition are among those particularly vulnerable to bushfire smoke. But you can prepare for the season ahead.Kazi Mizanur Rahman, Associate Professor of Healthcare Innovations, Faculty of Health Sciences and Medicine, Bond UniversityJoe Duncan, Clinical Associate Lecturer, Northern Clinical School and Lecturer, Internal Medicine. Rural Clinical School (Northern Rivers), University of SydneyJo Longman, Senior Research Fellow, The University Centre for Rural Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1887122022-09-14T19:21:29Z2022-09-14T19:21:29ZHow improving COPD treatment in primary care could reduce demand on hospitals and emergency departments<figure><img src="https://images.theconversation.com/files/484673/original/file-20220914-19-lq6phg.jpg?ixlib=rb-1.1.0&rect=0%2C22%2C4715%2C3295&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Because of the difficulty in managing their care, patients with COPD have hospitalization rates 63 per cent higher than the general population, as well as 85 per cent more emergency department visits and 48 per cent more ambulatory care visits.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>In Ontario, <a href="https://www.publichealthontario.ca/-/media/documents/c/2019/cdburden-report.pdf?sc_lang=en">nearly 900,000 people</a> live with chronic obstructive pulmonary disease (COPD). <a href="https://doi.org/10.1164/rccm.201211-2044OC">People with this condition account for 24 per cent of hospitalizations, 24 per cent of emergency department visits and 21 per cent of ambulatory care visits</a>. </p>
<p>Because of difficulty in managing care, patients with COPD have hospitalization rates that are <a href="https://doi.org/10.1164/rccm.201211-2044OC">63 per cent higher than the general population, as well as rates of emergency department and ambulatory care visits that are, respectively, 85 per cent and 48 per cent higher than the general population</a>, all of which contribute <a href="https://doi.org/10.1016/j.rmed.2007.10.010">significant financial costs</a> to Ontario’s health-care system. </p>
<p>Health-care sustainability has made headlines as emergency rooms around Ontario have closed due to <a href="https://www.cbc.ca/news/canada/toronto/ont-er-closures-1.6545119">staffing shortages, COVID-19 infections and burnout of frontline workers</a>. Ontario’s Health Minister Sylvia Jones has said that the province should <a href="https://toronto.citynews.ca/2022/08/11/ontario-health-minister-pushes-back-against-privatization/">embrace innovation</a> to help solve challenges within the health-care system. </p>
<p>Arguably, one of the most effective solutions would be to divert patients away from the emergency room and hospital in favour of more cost-effective primary care. Innovations in treatment of patients with COPD in primary care has the potential to alleviate a significant strain on the health system by reducing emergency department visits and hospitalizations.</p>
<p>Fortunately, there is an existing program in primary care, called Best Care, that has been demonstrated to be <a href="https://doi.org/10.1186/s12962-022-00377-w">cost-effective</a>, <a href="https://doi.org/10.1186/s12913-022-07785-x">improve patient and provider experience</a> and <a href="https://doi.org/10.2147/COPD.S338851">reduce emergency department visits and hospitalizations</a>.</p>
<h2>The opportunity for Best Care</h2>
<p>Best Care is an innovative integrated disease management program (IDM) for managing high-risk, exacerbation-prone patients with COPD in a primary care setting. It was designed by a collaborative team of frontline health-care providers and administrators, supported by Ontario Health.</p>
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<img alt="A young woman behind a desk in a white coat with stethoscope watching an older woman use an inhaler" src="https://images.theconversation.com/files/484703/original/file-20220914-9486-zb8574.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/484703/original/file-20220914-9486-zb8574.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/484703/original/file-20220914-9486-zb8574.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/484703/original/file-20220914-9486-zb8574.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/484703/original/file-20220914-9486-zb8574.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/484703/original/file-20220914-9486-zb8574.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/484703/original/file-20220914-9486-zb8574.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">People in the Best Care program become active partners in their care, taking back control over their lives.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>The <a href="https://doi.org/10.1038/s41533-019-0119-9">Best Care IDM program</a> involves <a href="https://www.argi.on.ca/copd-patient">embedding a certified respiratory educator</a>, who is also a case manager, within the primary care practice where the patient normally receives care. In collaboration with the patient’s primary care provider, the certified respiratory educator delivers or supports access to all 14 of <a href="https://www.hqontario.ca/Portals/0/documents/evidence/quality-standards/qs-chronic-obstructive-pulmonary-disease-quality-standard-en.pdf">Ontario Health’s COPD quality standards</a>, including diagnosis, assessment, care planning, patient education, medication management and specialized respiratory care.</p>
<p>People in the Best Care program become active partners in their care, taking back control over their lives. The efficacy of Best Care has been empirically <a href="https://doi.org/10.1038/s41533-019-0119-9">demonstrated to improve patients’ quality of life and to help avoid emergency department visits</a> and <a href="https://doi.org/10.2147/COPD.S338851">reduce hospitalizations</a>. </p>
<p>Over the past three years, 7,000 Ontarians affected by severe COPD have benefited from the program. Three Ontario health regions implementing Best Care have shown dramatic reductions in COPD-related emergency department visits and hospitalizations.</p>
<h2>Evaluating cost-effectiveness</h2>
<p>Recently, with a team of health economists from the University of Ottawa, we <a href="https://doi.org/10.1186/s12962-022-00377-w">evaluated the cost-effectiveness</a> of the Best Care integrated disease management program for high-risk, exacerbation-prone patients in a primary care setting. In this research we used data from our earlier clinical study and the best available evidence to evaluate if investment in the Best Care program was cost-effective from the perspective of the Ontario health system. </p>
<p>Our results show that Best Care is not just cost-effective, but is dominant in comparison to standard care in Ontario. Best Care integrated disease management program was cost-effective in 85.3 per cent of our simulations.</p>
<p>When evaluating programs in terms of health economics, a program is <a href="https://doi.org/10.1016%2Fj.jacc.2008.09.018">dominant</a> when it improves patient outcomes and costs less than the alternative standard of care: in other words, better care at a lower cost. </p>
<figure class="align-center ">
<img alt="A man breathing into a white tube through his mouth, with a blue nose clip on his nose." src="https://images.theconversation.com/files/484714/original/file-20220914-8999-jfq04p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/484714/original/file-20220914-8999-jfq04p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/484714/original/file-20220914-8999-jfq04p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/484714/original/file-20220914-8999-jfq04p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/484714/original/file-20220914-8999-jfq04p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/484714/original/file-20220914-8999-jfq04p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/484714/original/file-20220914-8999-jfq04p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">One of the ways COPD patients are assessed is spirometry, a test of lung function.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>With a modest up-front investment in primary care, the Best Care program is expected to dramatically reduce demand for acute health services. In fact, our modelling anticipates a 1.5-fold return on investment in the first year of implementation. Continued health system savings are expected for at least 10 years by reducing the number of urgent care and emergency room visits and the frequency of hospitalization.</p>
<p>We also ran several different scenarios to test the assumptions we made within our economic analysis. The results consistently demonstrated that Best Care integrated disease management program was cost-effective and dominant in comparison to the usual standard of care. When we assume that a patient’s quality of life should only improve with access to a certified respiratory educator/ case-manager (i.e., the patient’s quality of life should remain the same or increase, but not decrease), the probability that Best Care IDM is cost-effective increases to over 96 per cent. </p>
<h2>Sustainable health-care investment</h2>
<p>The <a href="https://www.ontario.ca/document/healthy-ontario-building-sustainable-health-care-system/chapter-2-vision-health-care-ontario">Ontario health system</a> seeks to invest in sustainable, innovative solutions that will maximize health-care capacity. This includes reducing avoidable hospitalizations and emergency department visits; improving patient, caregiver and provider experience; and enhancing patient outcomes while containing costs. </p>
<p><a href="https://doi.org/10.1038/s41533-019-0119-9">Prior peer-reviewed publications</a> and health system data have confirmed that the Best Care integrated disease management program improves patient outcomes as well as patient, caregiver and provider experience. Our robust health economic analysis confirms that Best Care is economically attractive compared to the current provincial care standard. </p>
<p>Best Care in COPD is a <a href="https://www.hqontario.ca/Portals/0/documents/health-quality/quality-matters-print-en.pdf">sustainable health-care investment</a> and delivers on all of the goals of the <a href="https://doi.org/10.1370%2Fafm.1713">quadruple aim approach to health care</a>: optimizing patient experience, improving health at the population level, reducing costs and supporting the well-being of health-care providers.</p>
<p><em>Madonna Ferrone, Director of Operations, Asthma Research Group Windsor-Essex County Inc., co-authored this article.</em></p><img src="https://counter.theconversation.com/content/188712/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew D. Scarffe (he/him) received funding from the Asthma Research Group Windsor-Essex County Inc. in the form of a doctoral student stipend. He also receives funding from Mitacs Inc. through the Mitacs e-Accelerate scholarship. Andrew is a two time recipient of the Queen Elizabeth II Graduate Scholarship for Science and Technology and is a one time recipient of the Ontario Graduate Scholarship. He also receives funding from the Telfer School of Management and the University of Ottawa in the form of a graduate student scholarship and excellence (admission) scholarship. Publication of this article was not contingent on approval and/or censorship from any of the funding sources listed above.</span></em></p><p class="fine-print"><em><span>Dr. Licskai has received salary support from Western University as Professor of Health System Innovation and is the Medical Director of the Best Care in Primary Care program related to this work. Outside of the submitted work Dr. Licskai reports personal fees and / or research grants from AstraZeneca, GlaxoSmithKline, Novartis, Teva, and Sanofi Genzyme.</span></em></p><p class="fine-print"><em><span>Doug Coyle, Kednapa Thavorn, and Kevin Peter Brand do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Innovation in primary care for COPD patients has the potential to alleviate a significant strain on the health system by reducing emergency department visits and hospitalizations.Andrew Scarffe, PhD Candidate in Management (concentration in Health Systems), L’Université d’Ottawa/University of OttawaChristopher Licskai, Associate Professor of Medicine, Professor of Health System Innovation, Division of Respiratory Medicine, Western UniversityDoug Coyle, Professor, School of Epidemiology and Public Health, L’Université d’Ottawa/University of OttawaKednapa Thavorn, Senior scientist, L’Université d’Ottawa/University of OttawaKevin Peter Brand, Associate professor, Health Systems, L’Université d’Ottawa/University of OttawaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1875152022-08-01T12:27:02Z2022-08-01T12:27:02ZHelping cells become better protein factories could improve gene therapies and other treatments – a new technique shows how<figure><img src="https://images.theconversation.com/files/476727/original/file-20220729-13650-l4tehb.jpg?ixlib=rb-1.1.0&rect=5%2C0%2C1991%2C1500&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Your genetic material instructs your cells to produce the proteins encoded in it.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/protein-synthesis-illustration-royalty-free-illustration/1296294290">Juan Gaertner/Science Photo Library via Getty Images</a></span></figcaption></figure><p>The cells in your body are <a href="https://www.ncbi.nlm.nih.gov/books/NBK26885/">not all the same</a>. Each of your organs has cells with very different functions. For example, liver cells are top-notch secretors, as their job requires them to make and export many of the proteins in your blood. By contrast, muscle cells are tasked with facilitating the contractions that allow you to move. </p>
<p>The fact that cells are so specialized has implications for <a href="https://medlineplus.gov/genetics/understanding/therapy/procedures/">gene therapy</a>, a way to treat genetic diseases by correcting the source of the error in a patient’s DNA. Health providers use a harmless <a href="https://patienteducation.asgct.org/gene-therapy-101/vectors-101">viral or bacterial vector</a> to carry a corrective gene into a patient’s cells, where the gene then directs the cell to produce the proteins necessary to treat the disease. Muscle cells are a common target because gene therapies <a href="https://medlineplus.gov/genetics/understanding/therapy/procedures/">injected into the muscle</a> are more accessible than introduction into the body by other routes. But muscle cells may not produce the desired protein as efficiently as needed if the job the gene instructs it to do is very different from the one it specializes in.</p>
<p>We are <a href="https://scholar.google.com/citations?user=SPyKrnIAAAAJ&hl=en">cell biologists</a> and <a href="https://scholar.google.com/citations?user=PL6N9eoAAAAJ&hl=en">biophysicists</a> who study how healthy proteins are produced and maintained in cells. This field is called <a href="https://doi.org/10.1093%2Fgerona%2Fgln071">protein homeostasis, also known as proteostasis</a>. Our <a href="https://dx.doi.org/10.1073/pnas.2206103119">recently published study</a> details a way to make muscle cells behave more like liver cells by changing protein regulation networks, enhancing their ability to respond to gene therapy and treat genetic diseases.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/BxEoX6TkitY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Gene therapy involves replacing a defective gene with a functioning one that can direct cells to produce missing or dysfunctional proteins.</span></figcaption>
</figure>
<h2>Boosting protein factories</h2>
<p>One disease for which gene therapy has great potential is <a href="http://doi.org/10.1056/NEJMra1910234">alpha-1 antitrypsin (AAT) deficiency</a>, a condition in which liver cells are unable to make adequate amounts of the protein AAT. It results in a breakdown of lung tissue that can cause <a href="https://www.uncoveralpha1.com/what-is-alpha-1">serious respiratory problems</a>, including the development of severe lung diseases such as chronic obstructive pulmonary disease (COPD) or emphysema. </p>
<p>Patients are usually treated by <a href="https://www.nhlbi.nih.gov/health/alpha-1-antitrypsin-deficiency">receiving AAT via infusion</a>. But this requires patients to either make regular trips to the hospital or keep expensive equipment at home for the rest of their lives. Replacing the faulty gene that caused their AAT shortage in the first place could be a boon for patients. Current gene therapies inject the AAT-producing gene into muscle. One of our colleagues, <a href="https://scholar.google.com/citations?user=Sd6B6-UAAAAJ&hl=en">Terence Flotte</a>, developed a way to use a harmless version of an adeno-associated virus as a vehicle to deliver AAT gene therapies into the body via injection, allowing for <a href="https://doi.org/10.1016/j.ymthe.2017.03.029">sustained release of the protein</a> over several years.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/476729/original/file-20220729-13356-h2dp31.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Microscopy image of panlobular emphysema" src="https://images.theconversation.com/files/476729/original/file-20220729-13356-h2dp31.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/476729/original/file-20220729-13356-h2dp31.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=404&fit=crop&dpr=1 600w, https://images.theconversation.com/files/476729/original/file-20220729-13356-h2dp31.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=404&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/476729/original/file-20220729-13356-h2dp31.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=404&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/476729/original/file-20220729-13356-h2dp31.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=507&fit=crop&dpr=1 754w, https://images.theconversation.com/files/476729/original/file-20220729-13356-h2dp31.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=507&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/476729/original/file-20220729-13356-h2dp31.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=507&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Lung damage from alpha-1 antitrypsin deficiency can lead to emphysema.</span>
<span class="attribution"><a class="source" href="https://flic.kr/p/8TqvpQ">Atlas of Pulmonary Pathology/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>But muscle cells aren’t very good at producing the AAT proteins the gene instructs them to make. Flotte and his team found that AAT levels one to five years after gene therapy were <a href="https://doi.org/10.1016/j.ymthe.2017.03.029">only 2% to 2.5%</a> of the optimal concentration for therapeutic effect.</p>
<p>We wanted to find a way to turn muscle cells into better protein factories, like liver cells. We tested a number of different molecules on mice muscle cells to determine if they would boost AAT secretion. We found that adding a molecule called <a href="https://doi.org/10.1074/jbc.M112.404707">suberoylanilide hydroxamic acid, or SAHA</a>, helps muscle cells make AAT at a production level more like that of liver cells. It works because SAHA is a <a href="https://doi.org/10.7554%2FeLife.15550">proteostasis regulator</a> with the ability to boost the cell’s protein output.</p>
<p>Down the road, we believe that adding SAHA or similar proteostasis regulators to gene therapies could help increase the effectiveness of these treatments for many genetic diseases.</p>
<h2>Beyond gene therapy</h2>
<p>Our findings have implications beyond just gene therapies. The effectiveness of <a href="https://doi.org/10.1038/s41573-021-00283-5">mRNA vaccines</a>, for example, is also affected by how well each cell produces a particular type of protein. Because most mRNA vaccines are given through an injection to the muscle, they may also face the same limitations as gene therapies and produce a lower-than-desirable immune response. Increasing the protein production of muscle cells could potentially improve vaccine immunity.</p>
<p>Additionally, many drugs created by the biotech industry called <a href="https://www.fda.gov/about-fda/center-biologics-evaluation-and-research-cber/what-are-biologics-questions-and-answers">biologics</a> that are derived from natural sources rely heavily on a given cell’s <a href="https://doi.org/10.3389/fbioe.2019.00420">protein production capabilities</a>. But many of these drugs use <a href="https://weekly.biotechprimer.com/biomanufacturing-how-biologics-are-made/">cells that aren’t specialized to make large amounts of protein</a>. Adding a protein homeostasis enhancer to the cell could optimize protein yield and increase the effectiveness of the drug.</p>
<p>Protein homeostasis is a burgeoning field that goes beyond drug development. Many <a href="https://doi.org/10.1038/s41580-019-0101-y">neurodegenerative diseases</a> like Alzheimer’s and Parkinson’s are linked to abnormal protein regulation. The deterioration of a cell’s ability to manage protein production and use over time may contribute to age-related diseases. Further research on ways to improve the cellular machinery behind protein homeostasis could help delay aging and open many new doors for treating a wide range of diseases.</p><img src="https://counter.theconversation.com/content/187515/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Daniel N. Hebert receives funding from Alpha One Foundation and NIH/NIGMS. </span></em></p><p class="fine-print"><em><span>Lila Gierasch receives funding from NIH/NIGMS and the Alpha1 Foundation.</span></em></p>Gene therapies and vaccines are often injected into muscle cells that are inefficient at producing desired proteins. Making them work more like liver cells could lead to better treatment outcomes.Daniel N. Hebert, Professor of Biochemistry and Molecular Biology, UMass AmherstLila Gierasch, Distinguished Professor of Biochemistry and Molecular Biology, UMass AmherstLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1753012022-06-05T12:22:50Z2022-06-05T12:22:50ZListening to asthma and COPD: An AI-powered wearable could monitor respiratory health<figure><img src="https://images.theconversation.com/files/466825/original/file-20220602-14-yjybej.jpg?ixlib=rb-1.1.0&rect=858%2C0%2C3445%2C2832&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Even with optimal treatment, asthma and COPD patients encounter unpredictable flareups of their conditions, which can become life-threatening and need immediate medical attention.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>A neck patch that monitors respiratory sounds may help manage asthma and chronic obstructive pulmonary disease (COPD) by detecting symptom flareups in real time, without compromising patient privacy. </p>
<p>Asthma and COPD are two of the most common chronic respiratory diseases. In Europe, the <a href="https://www.erswhitebook.org/chapters/adult-asthma/epidemiology/">combined prevalence</a> is about <a href="https://www.erswhitebook.org/chapters/chronic-obstructive-pulmonary-disease/epidemiology/">10 per cent</a> of the general population. In Canada, an estimated <a href="https://health-infobase.canada.ca/datalab/asthma-blog.html">3.8 million</a> people experience asthma and <a href="https://health-infobase.canada.ca/datalab/copd-blog.html">two million people experience COPD</a>.</p>
<p>The chronic nature <a href="https://www.lung.org/blog/asthma-self-management-skills">of asthma</a> <a href="https://www.blf.org.uk/support-for-you/copd">and COPD</a> requires continuous disease monitoring and management. Patients with these conditions share many <a href="https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/diagnosing-treating-asthma/asthma-copd-overlap-syndrome">similar clinical symptoms</a> such as frequent coughing, wheezing and shortness of breath. These symptoms can worsen from time to time and situation to situation, such as exposure to smoke. </p>
<p>Even with optimal treatment, patients encounter unpredictable flareups or exacerbation of their conditions. These can become life-threatening and need immediate medical attention. Effective and predictive tools, which enable continuous remote monitoring and early detection of exacerbation, are crucial to prompt treatment and improved health. </p>
<p>An international collaboration between Canada and Germany with expertise in upper airway health, audio/acoustic engineering and wearable computing is developing a wearable device to monitor these respiratory symptoms. </p>
<h2>Privacy concerns</h2>
<p><a href="https://doi.org/10.1007/s11882-020-00927-3">Wearable technologies</a> have been widely applied for remote monitoring of asthma and COPD. Most of these devices have built-in microphones to collect audible clinical symptoms, such as coughs, from patients. However, such designs hamper patients’ full compliance because of privacy concerns about continuous monitoring of all sounds in their daily life encounters and home environment. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/466824/original/file-20220602-9413-j1rr0t.jpeg?ixlib=rb-1.1.0&rect=7%2C2%2C1564%2C1272&q=45&auto=format&w=1000&fit=clip"><img alt="Cropped image of a man in a gray T-shirt with a small round sensor patch on his neck just above the neckline of his shirt" src="https://images.theconversation.com/files/466824/original/file-20220602-9413-j1rr0t.jpeg?ixlib=rb-1.1.0&rect=7%2C2%2C1564%2C1272&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/466824/original/file-20220602-9413-j1rr0t.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=811&fit=crop&dpr=1 600w, https://images.theconversation.com/files/466824/original/file-20220602-9413-j1rr0t.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=811&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/466824/original/file-20220602-9413-j1rr0t.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=811&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/466824/original/file-20220602-9413-j1rr0t.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1019&fit=crop&dpr=1 754w, https://images.theconversation.com/files/466824/original/file-20220602-9413-j1rr0t.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1019&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/466824/original/file-20220602-9413-j1rr0t.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1019&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The sensor is placed on the skin of the neck.</span>
<span class="attribution"><span class="source">(Li-Jessen)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p><a href="https://www.wired.com/insights/2014/10/algorithms-wearable-tech-frontier/">Efficient and intelligent algorithms</a> are required for health wearables to meaningfully interpret data as soon as it’s fed into the system. Recent advances in <a href="https://www.ibm.com/topics/artificial-intelligence-medicine">artificial intelligence (AI)</a> have rapidly changed many fields of medical diagnosis and therapy monitoring. </p>
<p>However, the AI “black-box” problem also creates <a href="https://doi.org/10.1007/s43681-022-00141-z">ethical and transparency concerns in biomedicine</a>. Most AI tools only allow us to know the algorithm’s input and output (for example, turning an input X-ray image into a predicted diagnosis as output) but not the processes and workings in between. That means we don’t know how the AI tools do what they do.</p>
<p>Also, implementing real-time analytics in wearable devices is challenging due to constrained computational resources in these devices, but is essential for timely detection of airway symptoms. The development of trustworthy and cost-effective “<a href="https://www.wired.com/insights/2014/12/wearing-your-intelligence/">wearable AI</a>” is crucial to this project.</p>
<p>To address these unmet challenges, our AI-powered wearables will have the capacity to protect speech privacy and perform near-real-time data analysis to empower patients and clinicians to take informed actions without delay. </p>
<h2>Listening with protected speech privacy</h2>
<p>At McGill University, the Canadian team is developing a <a href="https://doi.org/10.3390%2Fapp10031192">wearable device</a>, similar in size to a Fitbit, to track and monitor the health status of the upper airway during daily activities. The device is based on mechano-acoustic sensing technology. </p>
<p>In a nutshell, a <a href="https://doi.org/10.3390%2Fapp9071505">small, patch-like skin accelerometer</a> is customized to be placed on the neck. When a person experiences upper airway symptoms such as cough, hoarse voice, etc., the characteristic body sounds of those symptoms create acoustic waves that spread across to the neck skin and turn into mechanical vibrations detectable by the skin accelerometer.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/466670/original/file-20220601-49109-frmmqn.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A small mechanical devices with a connection to a small remote controller, and a schematic diagram." src="https://images.theconversation.com/files/466670/original/file-20220601-49109-frmmqn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/466670/original/file-20220601-49109-frmmqn.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=473&fit=crop&dpr=1 600w, https://images.theconversation.com/files/466670/original/file-20220601-49109-frmmqn.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=473&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/466670/original/file-20220601-49109-frmmqn.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=473&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/466670/original/file-20220601-49109-frmmqn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=594&fit=crop&dpr=1 754w, https://images.theconversation.com/files/466670/original/file-20220601-49109-frmmqn.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=594&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/466670/original/file-20220601-49109-frmmqn.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=594&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A small, patch-like wearable device can be placed on the neck to detect when a person experiences upper airway symptoms such as cough, hoarse voice etc.</span>
<span class="attribution"><a class="source" href="https://doi.org/10.3390/app9071505">(Zhengdong Lei et al, 2019.)</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Most features of recognizable speech are within the high-frequency range (around six to eight kilohertz). Human neck tissues serve as a filter that only low-frequency components of a signal can pass through. That means identifiable speech information is detectable as sound by our sensors but inaudible by human ears, preserving users’ speech privacy. </p>
<p>We are now working to develop a smartphone application that will connect to the wearable device. This mobile app will generate a diary summary of upper airway health for patients. Also, with users’ consent, the report can also be sent to their primary healthcare providers for remote monitoring. </p>
<h2>Small and intelligent AI</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/466828/original/file-20220602-20-bo6abe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Closeup of a person's neck with a small round patch near the base of the neck with a white wire leading down from it" src="https://images.theconversation.com/files/466828/original/file-20220602-20-bo6abe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/466828/original/file-20220602-20-bo6abe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=441&fit=crop&dpr=1 600w, https://images.theconversation.com/files/466828/original/file-20220602-20-bo6abe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=441&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/466828/original/file-20220602-20-bo6abe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=441&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/466828/original/file-20220602-20-bo6abe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=554&fit=crop&dpr=1 754w, https://images.theconversation.com/files/466828/original/file-20220602-20-bo6abe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=554&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/466828/original/file-20220602-20-bo6abe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=554&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The device is currently capable of identifying cough, throat clearing and hoarse voice with over 80 per cent accuracy, which is important for accurately determining symptom severity.</span>
<span class="attribution"><span class="source">(Li-Jessen)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>At Friedrich-Alexander-Universität Erlangen-Nürnberg, the German team has developed <a href="https://doi.org/10.1038/nature14539">deep neural networks</a>, a specific subfield of AI, that are very lean and only need very small computational memory of less than 150 kilobytes. Also, continuous monitoring generates a large and complex data source. In a <a href="https://doi.org/10.1002/aisy.202100284">recent publication</a>, we reported that our algorithms are on par with state-of-the-art algorithms, even though they fit on a low-cost microcontroller. </p>
<p>Our current project will build upon these findings and expand these cost-effective AI algorithms to automate the analysis of mechanical acoustic signals. That information, together with other user-specific data (such as local air quality and reliever used), can be used to predict a patient’s risk of asthma/COPD symptom exacerbation. </p>
<p>At present, the device is at the testing stage. By looking at the magnitude and pattern of these neck surface vibration signals, our AI-based technology is currently capable of identifying symptoms related to airway health such as cough, throat clearing and hoarse voice with over 80 per cent accuracy, which is important for accurately determining severity. </p>
<p>Early detection of asthma and COPD flareups remains an unmet clinical need, but this technology may be useful for other conditions, too. For example, we anticipate that this application can be extended to monitor “<a href="https://www.bhf.org.uk/informationsupport/heart-matters-magazine/news/coronavirus-and-your-health/long-covid#Heading4">long COVID</a>” because some of its symptoms — such as shortness of breath and coughing — overlap with those of asthma and COPD. </p>
<p>With advances in wearable monitoring technology, we hope to empower and engage patients to take charge of their airway health.</p><img src="https://counter.theconversation.com/content/175301/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Li-Jessen receives funding from Canada Research Chair, Fonds de recherche du Québec–Santé, Canadian Institutes of Health Research, Social Sciences and Humanities Research Council, Natural Sciences and Engineering Research Council of Canada and National Institutes of Health. </span></em></p><p class="fine-print"><em><span>Andreas Kist receives funding from BayFOR (Bavarian Research Alliance)</span></em></p>Researchers are developing an AI-powered device to detect asthma and COPD symptoms in real-time for faster treatment. The ‘patch’ listens to airway sounds, but filters out speech to protect privacy.Nicole Y.K. Li-Jessen, Associate Professor of Communication Sciences and Disorders, McGill UniversityAndreas M. Kist, Assistant Professor, Artificial Intelligence in Communication Disorders, Friedrich–Alexander University Erlangen–Nürnberg (FAU)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1772382022-03-10T20:57:37Z2022-03-10T20:57:37ZShould public health measures like masking continue beyond the pandemic? Data on viral infections shows their benefits<figure><img src="https://images.theconversation.com/files/450321/original/file-20220307-84100-jira1v.jpg?ixlib=rb-1.1.0&rect=166%2C98%2C2717%2C1675&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A woman wears a face mask as she walks by the sculpture ‘The Illuminated Crowd’ on a street in Montréal. Vulnerable people may benefit from measures like face masks even after the COVID-19 pandemic.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span></figcaption></figure><p>Public health measures, such as masking and physical distancing, that have been a high-profile part of the COVID-19 response for the past two years <a href="https://www.cbc.ca/news/canada/edmonton/jason-kenney-copping-alta-covid-restrictions-lift-1.6368297">are now</a> <a href="https://www.cbc.ca/news/canada/toronto/covid19-ontario-march-9-mask-mandates-1.6378148">beginning to lift</a>. However, surprisingly little attention has been paid to the remarkable effects of these measures on other respiratory illnesses that are caused or exacerbated by viral infections.</p>
<p>These effects are a valuable research discovery from the pandemic. It’s a discovery that suggests that selective, non-mandated use of public health measures like masking, physical distancing and hand-washing may have a continued role as we enter the endemic phase of COVID-19. Collectively, these measures are known as non-pharmacologic public health interventions (NPIs).</p>
<h2>Decreases in acute care</h2>
<p>Following the onset of the pandemic in March 2020, many regions around the world reported a dramatic decrease in demand for <a href="https://doi.org/10.1371/journal.pone.0252441">acute health-care services</a>, including urgent care visits to emergency departments and inpatient hospital stays.</p>
<p>Early on, this was likely driven by stringent lockdown measures, patients avoiding health-care settings due to fears of contracting COVID-19 or the perception that hospitals were overwhelmed and unable to accommodate non-emergency cases. </p>
<p>However, as public health measures were relaxed over the following months, there was a rapid rebound in health-care services for conditions such as heart disease and appendicitis. Meanwhile, the decrease persisted for respiratory illnesses attributed to <a href="http://doi.org/10.1007/s11739-022-02932-y">non-COVID-19 viruses</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A sign above a row of sinks shows an image of a man washing his hands with the message 'Clean hands keep you healthy. Wash your hands with soap and water for at least 20 seconds. Life is better with clean hands.'" src="https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Public health measures such as masking, hand-washing and physical distancing are collectively known as non-pharmacologic public health interventions (NPIs).</span>
<span class="attribution"><span class="source">(AP Photo/David Zalubowski)</span></span>
</figcaption>
</figure>
<p>In Canada, the usual annual surge in influenza infections has not occurred during the <a href="https://doi.org/10.1016/j.lana.2021.100015">two winters since the beginning of the pandemic</a>. </p>
<p>Our research group — all front-line health-care workers — analyzed nationwide admissions data. Our analysis revealed that hospital admissions for major respiratory illnesses dropped sharply in the year following the start of the first lockdown. </p>
<p>Specifically, flare-ups of chronic obstructive pulmonary disease (COPD), a severe lung disease related to long-term smoking, and community-acquired non-COVID-19 pneumonia decreased by nearly 40 per cent across Canada <a href="http://doi.org/10.1007/s11739-022-02932-y">following the implementation of NPIs like masking and physical distancing</a>. </p>
<p>These findings were supported by another study of 15,677 patients from nine countries. That study reported a 50 per cent reduction in the hospital admissions for COPD <a href="https://doi.org/10.1371/journal.pone.0255659">following the onset of the pandemic</a>. This is not entirely surprising as <a href="https://doi.org/10.1111/resp.12780">both COPD and non-COVID-19 pneumonia</a> are often triggered by <a href="https://doi.org/10.1007/s10741-017-9614-7">common cold viruses</a>. If you are like most Canadians, you have not caught a cold in nearly two years. </p>
<h2>Impact on vulnerable patients</h2>
<p>So, what’s the big fuss about a few runny noses and colds? While a viral infection such as the common cold or influenza is unlikely to significantly harm a healthy individual, it can be <a href="https://doi.org/10.1503/cmaj.201748">debilitating and sometimes deadly</a> for someone who is <a href="https://dx.doi.org/10.1016%2FS2213-2600(18)30496-X">elderly, immunocompromised or suffering from a lung disease</a>. It can result in the need for acute care in the hospital, or even the ICU in severe cases, and some patients do not survive. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two people in masks sitting on a park bench." src="https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=456&fit=crop&dpr=1 600w, https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=456&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=456&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=573&fit=crop&dpr=1 754w, https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=573&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=573&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A viral infection, such as the common cold or influenza, is unlikely to significantly harm a healthy individual, but it can be debilitating and sometimes deadly for someone who is elderly, immunocompromised or living with a lung disease.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span>
</figcaption>
</figure>
<p>In Canada, acute and chronic respiratory diseases are the third greatest cause of death, trailing behind only <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/201126/t001b-eng.htm">cancer and heart disease</a>. This also means virally linked respiratory illnesses place a substantial burden on limited health-care resources. </p>
<p>There were several periods during the pandemic when our <a href="https://cmajnews.com/2022/01/11/covid-update-beds-duong-1095984/">health-care systems</a> were <a href="https://www.cbc.ca/news/health/tam-omicron-more-restrictions-better-masks-1.6293347">over capacity</a>, and there was a fear that hospitals would need to <a href="https://www.theglobeandmail.com/canada/article-alberta-preps-critical-care-triage-plan-amid-surge-in-covid-19-cases/">triage resources</a> and deny ICU care to some critically ill patients. </p>
<p>Thankfully, this did not come to pass, and it seems that the likely reason was the significant additional capacity that became available due to hospitalizations avoided for other <a href="http://doi.org/10.1007/s11739-022-02932-y">virally linked respiratory illnesses</a>.</p>
<h2>Ending COVID-19 prevention measures</h2>
<p>As the pandemic drags on, people have become fatigued with ongoing public health restrictions. With <a href="https://ourworldindata.org/covid-vaccinations">vaccination rates in Canada among the highest in the world</a> and expected to reach even higher with the <a href="https://www.canada.ca/en/public-health/services/vaccination-children/making-decisions-5-11-years-age.html">approval of vaccinations for pediatric populations</a>, many are looking forward to a time when NPIs may no longer be needed. </p>
<p>However, before dispensing with the measures entirely, it is important to consider whether their demonstrated benefits warrant continued use. The fact that hospitalizations for non-COVID-19 respiratory illnesses have remained low, despite the relaxation of stringent lockdown measures, suggests that these benefits may be sustained with the use of masking and practices such as frequent hand-washing. </p>
<figure class="align-center ">
<img alt="Close-up image of a red social distancing circle on asphalt, with two shoe-prints and the message 'Please keep 2M distance'" src="https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=420&fit=crop&dpr=1 600w, https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=420&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=420&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=528&fit=crop&dpr=1 754w, https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=528&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=528&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There is no consensus on which specific NPIs may be most effective in preventing disease spread.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Jonathan Hayward</span></span>
</figcaption>
</figure>
<p>Even prior to the pandemic, <a href="https://www.asiapacific.ca/publication/great-mask-divide-lessons-asia">public masking was a common practice</a> in many Asian countries. With this now being the norm in Canada as well, continuing these practices may have significant merit and offer protection to the most vulnerable demographics of our society. </p>
<p>This will certainly be challenging given <a href="https://www.reuters.com/world/americas/canadian-cities-brace-more-anti-vaccine-mandate-protests-2022-02-05/">opposition from a vocal minority</a> and the lack of awareness among the general public about the benefits of continuing use of NPIs. Currently, most available evidence is largely observational, as no randomized trials have yet evaluated the efficacy of NPIs for reducing non-COVID-19 viral respiratory illnesses at a population level. </p>
<p>Additionally, there is no consensus on which specific NPIs may be most effective in preventing disease spread. It’s also unknown whether reductions in acute care use have translated into a reduction in mortality rates for specific conditions. </p>
<h2>Future prevention</h2>
<p>These limitations are currently being addressed in a large-scale Albertan study of over 500,000 patients. The preliminary results — which will be published in the proceedings of the 2022 American Thoracic Society International Conference — show that NPIs are an effective strategy for preventing both acute care visits and mortality related to respiratory illnesses. </p>
<p>However, in the interim, public policy-makers should consider this compelling evidence and weigh in on whether the continued use of masking and other NPI measures is warranted, especially for individuals at high-risk for serious illness from viral respiratory infections and those close to them. </p>
<p>Recommendations, policies or, if deemed necessary, mandates can be amended in the future as new evidence emerges. Until then, NPI use, even on an interim basis, may reduce the strain on our health-care system and help protect the most vulnerable members of our society.</p><img src="https://counter.theconversation.com/content/177238/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Decreases in respiratory infections during the pandemic suggest there may be a continued role for the selective, non-mandated use of measures like masks and social distancing even post-COVID-19.Rutvij A. Khanolkar, Medical Student, University of CalgaryEddy S. Lang, Professor, Cumming School of Medicine, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1416332020-11-25T13:22:07Z2020-11-25T13:22:07ZWith all the focus on coronavirus, let’s not forget the other respiratory viruses<figure><img src="https://images.theconversation.com/files/367207/original/file-20201103-15-1y9clyp.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C5472%2C3628&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sick-woman-buying-supermarket-coughing-into-1685691637">Drazen Zigic/Shutterstock</a></span></figcaption></figure><p>With coronaviruses taking over our news feeds – and lives – you may be fooled into thinking it’s the only virus affecting humans at the moment. But it’s important to remember that there are many viruses, especially respiratory viruses, that regularly infect us. These viruses range from the mildly annoying, such as those that cause the common cold, to the potentially deadly, such as influenza. </p>
<p>Despite the challenges posed by the pandemic, scientists around the world are still working hard on these viruses, to find treatments and vaccines to improve our quality of life. </p>
<h2>1. Rhinoviruses</h2>
<p>Rhinoviruses (from the Greek “rhinos” for “of the nose”) are usually associated with the common cold. They cause a nasal infection, resulting in congestion and a runny nose. But rhinoviruses have a more malevolent side. They have been linked to exacerbating lower respiratory tract diseases, such as asthma and <a href="https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/">COPD</a> (an obstructive lung disease that causes long-term breathing problems and poor airflow). </p>
<p>Rhinoviruses can spread all year round, and there is no vaccine against them as they are an incredibly diverse group of viruses. There is also no licensed antiviral medication against rhinoviruses, although scientists are working on this to help manage conditions such as asthma and COPD.</p>
<p>Interestingly, rhinoviruses have only been found in humans and are closely related to viruses that infect our guts.</p>
<h2>2. Adenoviruses</h2>
<p>Adenoviruses were first isolated from the adenoids – an area of the throat near the tonsils – hence the name. There are over 50 human adenoviruses, most of which cause respiratory disease. But some cause infections of the gastrointestinal tract, the eye (conjunctivitis), and the urinary tract (cystitis). In most healthy people these viruses only cause mild, short-lived disease, but they tend to spread quickly in densely populated areas.</p>
<p>There are no antiviral treatments for adenoviruses, although <a href="https://pubmed.ncbi.nlm.nih.gov/32842697/">some are in clinical trials</a>). But there are vaccines for two of the respiratory adenoviruses that cause regular outbreaks in crowded populations. These vaccines are <a href="https://pubmed.ncbi.nlm.nih.gov/32718082/">regularly used by armed forces</a>.</p>
<p>An <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6857090/#:%7E:text=Oncolytic%20adenoviruses%20provide%20a%20new,the%20anti%2Dtumor%20immune%20response.">exciting area of research</a> is using adenoviruses as anti-cancer therapies, as some strains can selectively infect and destroy cancer cells while leaving healthy cells untouched.</p>
<h2>3. Pneumoviruses</h2>
<p>Humans are infected with two kinds of pneumoviruses: respiratory syncytial virus (RSV) and metapneumovirus (MPV). All members of the pneumoviruses (“pneumo” being Greek for lung) are respiratory viruses, but they have a range of hosts they can infect. As well as humans, certain pneumoviruses can infect cows (bovine respiratory syncytial virus), mice (murine pneumonia virus) and birds (avian metaphneumovirus).</p>
<p>Most people will have had many human respiratory syncytial virus (HRSV) infections in their lifetime, <a href="https://jamanetwork.com/journals/jamapediatrics/article-abstract/512921">with over 80% of the population infected by the age of two years</a>. For most healthy people, HRSV causes a nasty cold, but this will resolve itself without the need for any treatment. In those with respiratory conditions such as asthma, however, the consequences can be severe. In 2015 alone, it is estimated that RSV caused <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5592248/">3.2 million hospitalisations and over 59,000 deaths in the under-fives</a>.</p>
<p>HRSV has been linked with the development of asthma, though this is a contentious area of science that is <a href="https://pubmed.ncbi.nlm.nih.gov/26766408/">still much debated and researched</a>.</p>
<h2>4. Parainfluenza viruses</h2>
<p>The <a href="https://www.cdc.gov/parainfluenza/index.html">parainfluenza viruses</a> (PIVs) are a sub-group of viruses known as paramyxoviruses and are closely related to other pathogens such as mumps and measles. They also infect our respiratory tract and are major causes of a lower respiratory tract disease called croup. People with croup often have a barking cough, like a seal.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/P7VGxsxnJYE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">What croup sounds like.</span></figcaption>
</figure>
<p>There are two distinct paramyxovirus groups of parainfluenza viruses, one called the respiroviruses (PIV1 and 3) and the other the rubulaviruses (PIV2 and 4). PIV1 and 3 have counterparts in other animal species, such as mice and cows, while PIV2 and 4 are relatively closely related to the mumps virus. </p>
<p>PIVs tend to spread in autumn and spring. There is no licensed vaccine or antivirals against PIVs, although researchers have made <a href="https://www.pnas.org/content/115/48/12265">significant progress on this</a>.</p>
<h2>5. Influenza viruses</h2>
<p><a href="https://www.cdc.gov/flu/about/viruses/index.htm">Influenza viruses</a> are perhaps the most worrying of respiratory viruses, given their capacity for causing pandemics, such as the 1918 flu pandemic. They are highly diverse viruses with four major types (A, B, C and D). All but influenza D virus infect humans, and A and B can cause significant lower respiratory tract disease and even death. Influenza B and C remain associated with humans while influenza A virus is really a virus of aquatic birds, although influenza A viruses circulate in humans, pigs and even bats. </p>
<p>Occasionally, avian flu A viruses jump species into humans and may even spread well and can cause pandemics. </p>
<p>Influenza viruses continuously circulate in humans because they are able to mutate and evade our immune responses. We have vaccines against influenza viruses, but they have to be updated each year to keep up with the mutations. </p>
<p>Antivirals, such as Tamiflu, when used early enough, can be <a href="https://www.nhs.uk/news/medication/effectiveness-of-tamiflu-and-relenza-questioned/">effective at reducing how long you are sick for</a>. Researchers are continuing to develop broader, long-lasting flu vaccines and more potent antivirals.</p>
<p>All the above respiratory viruses routinely infect humans. Most lack a vaccine and effective treatments – and many disproportionately affect the most vulnerable in society. Now that there is a raised scientific and public awareness on respiratory infections, we must take this opportunity now to make major advances against respiratory infections through research and increased preventative measures such as hand hygiene and social distancing.</p><img src="https://counter.theconversation.com/content/141633/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Connor Bamford receives funding from UKRI, SFI, DfE and Wellcome Trust.</span></em></p><p class="fine-print"><em><span>Grace C Roberts works at Queen's University, Belfast and receives funding from The Wellcome Trust.</span></em></p>Five respiratory viruses everyone should know about.Connor G G Bamford, Research Fellow, Virology, Queen's University BelfastGrace C Roberts, Research Fellow in Virology, Queen's University BelfastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1474092020-10-28T12:26:45Z2020-10-28T12:26:45ZCigarette smoke can reprogram cells in your airways, causing COPD to hang on after smoking ends<figure><img src="https://images.theconversation.com/files/362044/original/file-20201006-14-51yv5o.jpg?ixlib=rb-1.1.0&rect=1107%2C209%2C4036%2C2834&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Chronic obstructive pulmonary disease is the third leading cause of death in the United States.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/illustration-of-a-toxic-smoke-in-lung-cancer-or-royalty-free-image/1179207088">Pascal Kiszon via Getty Images</a></span></figcaption></figure><p>Smoking is the most common cause of chronic obstructive pulmonary disease, an often fatal respiratory condition that <a href="https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/learn-about-copd">afflicts millions</a> of Americans. But for many patients living with COPD, stopping smoking isn’t the end of the battle.</p>
<p>Cigarette smoke is a complex mixture of gases, chemicals and even bacteria. When it enters the lungs, it generates an inflammatory response much like pneumonia. </p>
<p>Inflammatory cells normally clear from the lungs when an infection ends or a patient quits smoking, but in patients with COPD, these cells may persist for years. Destructive enzymes produced by these cells – intended to destroy bacteria – cause progressive lung damage and respiratory failure characteristic of COPD.</p>
<p>It’s been a mystery why these cells continue triggering inflammation in the lungs after people stop smoking. Now, <a href="https://www.vumc.org/viiii/person/bradley-w-richmond-md-phd">research indicates</a> a defect in the immune system induced by cigarette smoke is to blame. Cigarette smoke <a href="https://pubmed.ncbi.nlm.nih.gov/25078120/">reprograms the cells lining the airways</a>, making the lungs of COPD patients who have quit smoking more susceptible to bacterial invasion.</p>
<h2>Good fences make good neighbors</h2>
<p>The lungs are continuously bombarded by inhaled bacteria and other irritants. At the same time, they are tasked with getting oxygen into the bloodstream, so they can’t have an impermeable physical barrier like skin. </p>
<p>To solve this dilemma, the lungs have developed a multi-pronged defense system. A key component of this system is an antibody called secretory IgA. These antibodies latch on to bacteria to prevent them from invading the lungs. Secretory IgA doesn’t directly kill microbes, but it prevents them from triggering a damaging immune response before they can be cleared by other mechanisms. </p>
<figure class="align-center ">
<img alt="Illustration of how SIgA operates in the lining of a person's airway." src="https://images.theconversation.com/files/361436/original/file-20201002-23-zfx5uq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/361436/original/file-20201002-23-zfx5uq.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=558&fit=crop&dpr=1 600w, https://images.theconversation.com/files/361436/original/file-20201002-23-zfx5uq.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=558&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/361436/original/file-20201002-23-zfx5uq.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=558&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/361436/original/file-20201002-23-zfx5uq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=701&fit=crop&dpr=1 754w, https://images.theconversation.com/files/361436/original/file-20201002-23-zfx5uq.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=701&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/361436/original/file-20201002-23-zfx5uq.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=701&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Our airways are lined with a layer of cells called the airway epithelium. When bacteria and other germs are inhaled, one way the airway epithelium protects itself is by transporting secretory immunoglobulin A (SIgA) to the airway surface. SIgA attaches to bacteria to prevent them from invading and causing inflammation. SIgA is made by plasma cells beneath the airway epithelium and transported by polymeric immunoglobulin receptors. People with COPD lack SIgA in their airways, which allows bacterial invasion, inflammation and lung damage.</span>
<span class="attribution"><span class="source">Dayana Espinoza/Vanderbilt University</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>In patients with COPD, lower levels of the <a href="https://pubmed.ncbi.nlm.nih.gov/25078120/">polymeric immunoglobulin receptor</a> and secretory IgA <a href="http://doi.org/10.1164/rccm.201604-0759OC">allow bacteria easier access to the airway surface</a>, triggering <a href="http://doi.org/10.1164/rccm.201612-2509ED">an inflammatory response</a> that persists after the patient quits smoking. </p>
<p>Mice that have been genetically manipulated to lack secretory IgA <a href="https://doi.org/10.1038/ncomms11240">also develop inflammation and a pattern of lung damage</a> resembling patients with COPD. Antibiotics can prevent them from developing lung disease, suggesting bacteria cause continued inflammation after smoking ends.</p>
<h2>The double-edged sword of anti-inflammatories</h2>
<p>Since inflammation is central to COPD, it makes sense that anti-inflammatory therapies might be beneficial. However, patients with COPD are also susceptible to lung infections, and anti-inflammatories run the risk of deactivating the body’s natural defenses against infection. The threat is more than theoretical: A <a href="http://doi.org/10.1183/09031936.00150208">clinical trial</a> studying an anti-inflammatory drug called rituximab was stopped early due to an increased rate of pulmonary infections.</p>
<p>Many antibiotics also have serious side effects when taken chronically, and prolonged use might encourage growth of bacteria resistant to these drugs.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/361994/original/file-20201006-14-1v4fjov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/361994/original/file-20201006-14-1v4fjov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=315&fit=crop&dpr=1 600w, https://images.theconversation.com/files/361994/original/file-20201006-14-1v4fjov.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=315&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/361994/original/file-20201006-14-1v4fjov.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=315&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/361994/original/file-20201006-14-1v4fjov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=396&fit=crop&dpr=1 754w, https://images.theconversation.com/files/361994/original/file-20201006-14-1v4fjov.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=396&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/361994/original/file-20201006-14-1v4fjov.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=396&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.nhlbi.nih.gov/health-topics/education-and-awareness/copd-learn-more-breathe-better">National Heart, Lung and Blood Institute</a></span>
</figcaption>
</figure>
<h2>A new target for treating COPD?</h2>
<p>While studying mice lacking secretory IgA, our research team at Vanderbilt University Medical Center and colleagues at the University of Florida recently found these mice have increased numbers of a relatively uncommon type of cell called monocyte-derived dendritic cells, or moDCs, in the lungs.</p>
<p>Dendritic cells don’t directly destroy bacteria, but they ring the alarm that a bacterial infection is brewing and coordinate the subsequent immune response. Unlike typical dendritic cells, moDCs begin their lives as a different cell type, called a monocyte. But when chronic inflammation sets in, they can become a type of dendritic cell.</p>
<p>We showed that in mice genetically engineered to lack secretory IgA, <a href="https://doi.org/10.1038/s41385-020-00344-9">moDCs activate T lymphocytes</a> – white blood cells that fight off viruses and can destroy cells in the process – and those T lymphocytes in turn damage the lungs. These data implied that moDCs might also coordinate a pathologic immune response in patients with COPD who also lack secretory IgA in the airways. </p>
<p>Because moDCs weren’t known to exist in human lungs, we <a href="https://doi.org/10.1038/s41385-020-00344-9">used a cutting-edge technique called mass cytometry</a> to detect them. It allows us to distinguish moDCs from other cell types that appear very similar under a microscope.</p>
<p>Like secretory IgA-deficient mice, we found that human COPD patients lacking secretory IgA had increased numbers of moDCs in their lungs. Together, these data suggest that loss of secretory IgA makes the airways more susceptible to bacterial invasion, which activates moDCs to drive ongoing lung inflammation. Therefore, targeting moDCs through medical treatments might block inflammation and lung damage in patients with COPD.</p>
<h2>New drugs are urgently needed for COPD</h2>
<p>There are still many questions to answer, including how best to target moDCs. It also remains to be seen whether such a strategy would compromise the ability of COPD patients to defend against infection.</p>
<p>However, for a disease as common and debilitating as COPD, potential new drug targets come as a breath of fresh air.</p>
<p>COPD is the <a href="https://www.cdc.gov/nchs/fastats/copd.htm">fourth leading cause of death in the U.S.</a> and the <a href="https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death">third leading cause of death worldwide</a>. While many drugs are available to decrease symptoms and hospitalization rates in patients with COPD, none has been proven to prolong life.</p>
<p>Most patients with COPD don’t die from it, <a href="https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/learn-about-copd">but those who live with COPD</a> suffer from chronic breathlessness which negatively impacts their quality of life. The burden of COPD is felt not just by individual patients, but by families, workplaces and economies.</p>
<p>Though cigarette smoking rates are <a href="https://www.cdc.gov/media/releases/2019/p1114-smoking-low.html">declining in the United States</a>, they are <a href="https://www.who.int/gho/tobacco/use/en/">increasing in many other countries</a>, making COPD a global health issue.</p><img src="https://counter.theconversation.com/content/147409/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bradley Richmond receives funding from the U.S. Department of Veterans Affairs, the National Institutes of Health, and has an investigator-initiated grant from 4D Medical related to an investigational imaging technology not discussed here.</span></em></p>A new discovery offers hope for ways to treat a debilitating disease that has become a leading cause of death in the US..Bradley Richmond, Assistant Professor of Medicine, Vanderbilt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1447002020-08-20T13:24:18Z2020-08-20T13:24:18ZPotential new asthma treatment: protein linked to omega-3 fatty acids shows promise<figure><img src="https://images.theconversation.com/files/353849/original/file-20200820-18-q030x5.jpg?ixlib=rb-1.1.0&rect=17%2C17%2C5973%2C3970&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Omega-3 fatty acids can limit inflammation by stimulating free fatty acid receptor 4.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vitamin-d-source-fish-oil-capsules-785780302">1989studio/ Shutterstock</a></span></figcaption></figure><p>Though asthma affects almost <a href="https://www.who.int/news-room/q-a-detail/asthma">340 million people</a> worldwide, there is still no cure. The respiratory disease frequently develops in childhood, and can cause asthma “attacks” where the lungs become inflamed and the airways constricted, causing breathing difficulty and wheezing. These attacks are caused by a number of factors, including pollution, allergens, and smoking.</p>
<p>The condition is often treated by inhaling a bronchodilator drug called a <a href="https://www.drugbank.ca/drugs/DB00938">beta agonist</a>, such as ventolin. During an asthma attack, inhalers bring beta agonist into the airways. This causes the muscles in the airway to relax, allowing the patient to breathe more easily. But this type of medicine doesn’t work very well for everyone – and there are limited other options for medicines that can be used to treat acute asthma attacks.</p>
<p>But while researching the health benefits of eating “oily” fish such as salmon and mackerel, we found something surprising: omega-3 fatty acids (typically found in such fish in high levels), and more directly medicines that mimic some of the actions of omega-3 fatty acids, could potentially be used to <a href="https://stm.sciencemag.org/content/12/557/eaaw9009">help treat asthma</a>.</p>
<p>Omega-3 fatty acids have many health benefits, and generate them in a number of ways, including by limiting inflammation. This is because they interact with and stimulate a protein called “<a href="https://pubmed.ncbi.nlm.nih.gov/28887275/">free fatty acid receptor 4</a>”. This protein is present on the surface of certain cells that control the amount of sugar in the blood. As elevated blood sugar is often associated with diabetes, medicines that activate free fatty acid receptor 4 have been considered as a possible new treatment for <a href="https://pubmed.ncbi.nlm.nih.gov/32799609/">type 2 diabetes</a>.</p>
<p>One of the joys of being a research scientist is that chance observations can lead to new insights in completely different areas to those you were initially studying. Free fatty acid receptor 4 is typically located in the gut and on white fat cells. But when our team examined where else in the body it might be located, we were surprised to find large numbers of the receptor in the lungs of both mice and humans. We reasoned that if it was there, it must have a job to do. </p>
<h2>Asthma treatment</h2>
<p>Given the large numbers of free fatty acid 4 receptors in the lungs, we wondered if proto-medicines (synthetic chemicals that activate free fatty acid 4 receptor) would work just as well as beta agonists at opening up the airways and might also reduce inflammation in the lungs.</p>
<p>We first tested these chemicals on both living mice and in lung tissue samples. Initially, we found that activators of free fatty acid receptor 4 did indeed open up airways that had become constricted in the lungs of mice. However, in mice whose DNA we altered to lack free fatty acid receptor 4, these proto-medicines didn’t work.</p>
<p>We then wanted to know whether these compounds also worked effectively if we induced an asthma-like state in the mice. We did this by making them breathe the air-pollutant ozone, or making them inhale cigarette smoke. Both of these are known to induce asthma attacks in humans. Again, we saw that in the mice that had free fatty acid receptor 4, the proto-medicines opened up the airways. They had no effect in mice that did not have the receptor.</p>
<figure class="align-center ">
<img alt="Child using inhaler." src="https://images.theconversation.com/files/353850/original/file-20200820-16-tsj9az.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/353850/original/file-20200820-16-tsj9az.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/353850/original/file-20200820-16-tsj9az.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/353850/original/file-20200820-16-tsj9az.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/353850/original/file-20200820-16-tsj9az.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/353850/original/file-20200820-16-tsj9az.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/353850/original/file-20200820-16-tsj9az.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Inhalers work to reduce inflammation and open airways – which our proto-medicine was also able to do.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/child-using-inhaler-asthma-outside-park-1100000528">Lopolo/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Of course, mice are not humans – and if our initial observations are to have the potential to point towards a new treatment for asthma and other diseases that affect the airways such as chronic obstructive pulmonary disease, we needed to show that free fatty acid receptor 4 is also present in human lungs. </p>
<p>Using tissue samples from human lungs, we found that free fatty acid receptor 4 was also present – and that the proto-medicines which activate the receptor were able to relax the human lung and airways.</p>
<p>Now, we’ll need to show that such treatments are equally effective in airway tissue from patients suffering from asthma, chronic obstructive pulmonary disease, or other related diseases. We’ll need to show that we can produce improved versions of the proto-medicines that will be safe for use. It will also be necessary to demonstrate that they will be effective in alleviating the broncho-constriction than leaves people struggling for breath.</p>
<p>All interesting possibilities, considering we started out by wondering how eating a portion of salmon for dinner might be good for you.</p><img src="https://counter.theconversation.com/content/144700/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Graeme Milligan is a Director of Caldan Therapeutics. He receives funding from both the UK Medical Research Council and the Biotechnology and Biosciences Research Council</span></em></p><p class="fine-print"><em><span>Andrew Tobin receives funding from the Medical Research Council (MRC) and Biotechnology and Biological Sciences Research council (BBSRC).</span></em></p>Proto-medicines which activated “free fatty acid receptor 4” were able to relax the lungs and airways in both mice and human lung tissue samples.Graeme Milligan, Gardiner Professor of Biochemistry and Dean of reserach, College of Medical, Veterinary and Life Sciences, University of GlasgowAndrew Tobin, Professor of Molecular Pharmacology, University of GlasgowLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1285352019-12-18T10:37:39Z2019-12-18T10:37:39ZVaping makes lung bacteria more harmful and cause more inflammation<figure><img src="https://images.theconversation.com/files/306874/original/file-20191213-85376-vw5zop.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6000%2C3124&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">shutterstock</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vaping-pen-vape-devices-mods-electronic-625333358">Hazem.m.kamal/Shutterstock</a></span></figcaption></figure><p>Bacteria commonly found in the lungs become more harmful and cause more inflammation when they have been exposed to e-cigarette vapour, in a way that could lead to diseases such as <a href="https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/">COPD</a> and <a href="https://www.nhs.uk/conditions/asthma/">asthma</a>.</p>
<p>Chronic lung disease results from a complex interplay between infection and inflammation, which can be further complicated by the toxic effects of cigarette smoke. We know that cigarettes are bad for us and, as a result, many smokers have switched to vaping instead. </p>
<p>But is vaping less harmful than smoking? This question has divided specialists in the field. Some, including Public Health England, maintain that vaping is less harmful and a <a href="https://www.gov.uk/government/news/e-cigarettes-around-95-less-harmful-than-tobacco-estimates-landmark-review">useful way to help people stop smoking</a>. But others, including the European Respiratory Society, argue that the evidence suggests that rather than helping, e-cigarettes are undermining <a href="https://www.ersnet.org/advocacy/eu-affairs/ers-position-paper-on-tobacco-harm-reduction-2019">people’s attempts to give up smoking</a>. </p>
<p>The number of people vaping has increased dramatically in recent years. Figures from the World Health Organization show a rise from 7 million in 2011 to 41 million in 2018. And this increase isn’t solely accounted for by people switching from smoking to vaping. According to a recent US study, around 27% of high school students now vape, many of <a href="https://jamanetwork.com/journals/jama/fullarticle/2755265">whom aren’t smokers</a>. </p>
<p>The huge variety of flavours, sleek vaping devices and a social media presence contribute to making vaping more socially acceptable among young people. For this large group of vapers but non-smokers, safety comparisons between smoking and vaping are irrelevant – what they need is more information about the direct effects of vaping.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/307414/original/file-20191217-58311-1jnx69p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/307414/original/file-20191217-58311-1jnx69p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/307414/original/file-20191217-58311-1jnx69p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/307414/original/file-20191217-58311-1jnx69p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/307414/original/file-20191217-58311-1jnx69p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/307414/original/file-20191217-58311-1jnx69p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/307414/original/file-20191217-58311-1jnx69p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">About 27% of US high school students vape.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vape-lgbt-teenagers-bisexual-lesbian-young-1535887688">Aleksandr Yu/Shutterstock</a></span>
</figcaption>
</figure>
<h2>More virulent</h2>
<p>Bacteria play a role in the development of smoking-related lung diseases, such as bronchitis and pneumonia. Our research looked at the usual suspects in lung infection (<em>Haemophilus influenzae</em>, <em>Streptococcus pneumoniae</em>, <em>Staphylococcus aureus</em> and <em>Pseudomonas aeruginosa</em>) and investigated the bacterial responses that had the potential to increase harm and cause long-term infection. Bacteria, grown in the laboratory, were exposed to either cigarette smoke or vape.</p>
<p>In chronic infections, bacteria are often found in large aggregates, called biofilms. Biofilms represent a real challenge when it comes to getting rid of infection: they are physically hard to remove, more resistant to antibiotics and harder for the body’s immune system to tackle. We found that exposure to either cigarette smoke or vape resulted in an increase in biofilm formation. </p>
<p>Also, when these bacteria were exposed to smoke and vape, it increased the inflammation in lung cells. In some cases, the effect following vaping exposure exceeded that of cigarette smoke exposure. </p>
<p>We also compared the survival of <em>Galleria mellonella</em> (wax moth larvae) following infection with vaped, smoked and unexposed bacteria. This is a well-established model that uses wax moth larvae to measure whether bacteria are likely to cause harm. Exposing bacteria to vape or smoke made the bacteria more virulent in the larvae.</p>
<h2>Not quite real life, but still…</h2>
<p>As with all studies, ours had limitations. Although our lab-based experimental procedures aimed to mimic smoking and vaping as closely as possible, it probably doesn’t exactly capture how people smoke and vape in real life. </p>
<p>We used a basic flavourless nicotine-containing vape and a commonly used e-cigarette. But in reality, there is a wide range of devices and thousands of e-cigarette flavours. Indeed, some flavours have been particularly associated with <a href="https://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.2003904">lung damage</a>. </p>
<p>Also, we only “vaped” or “smoked” bacteria once and didn’t measure the effect of long-term exposure. Vapers take deeper puffs than smokers and so we probably didn’t expose our bacteria to high enough levels of vape, so it’s possible that the effects of vape might be greater in the lungs.</p>
<p>So what does this study tell us about vaping safety? Exposing bacteria to vape is likely to make already harmful bacteria more dangerous and carry the same risk as exposure to cigarette smoke. </p>
<p>We urgently need to know more about what the long-term effect of vaping is, not just directly on the lungs but on the bacteria that might contribute to the development of diseases, such as COPD and asthma, so that the public can make an informed choice about whether to vape.</p><img src="https://counter.theconversation.com/content/128535/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>More evidence that vaping may be harmful to your health.Deirdre Gilpin, Lecturer, School of Pharmacy, Queen's University BelfastMichael Tunney, Professor of Clinical Pharmacy, Queen's University BelfastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1230552019-09-23T14:58:44Z2019-09-23T14:58:44ZAn increasing number of countries are banning e-cigarettes – here’s why<figure><img src="https://images.theconversation.com/files/293382/original/file-20190920-135122-163ywwl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/girl-soars-on-black-background-vape-557796589?src=jpJQoRC2TNDaTpP35K6Egg-1-3">Svetov Dmitrii/Shutterstock</a></span></figcaption></figure><p>The White House recently announced plans to ban flavoured e-cigarettes – except for tobacco-flavoured products – because of a rise in the number of middle and high school students using these products.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1171846192210350080"}"></div></p>
<p>A few days later, India’s cabinet <a href="https://www.bbc.co.uk/news/world-asia-india-49738381">approved an emergency order</a> banning the production, import and sale of e-cigarettes.</p>
<p>To date, <a href="https://uk.reuters.com/article/us-india-ecigarettes-factbox/factbox-india-south-korea-latest-to-take-steps-on-e-cigarettes-idUKKBN1W51DI">over 20 countries</a>, mostly in South America, the Middle East and South-East Asia, have banned the sale of e-cigarette products. Some countries have also banned possession of these products. Thailand has the strictest laws, while countries such as Australia, Canada and Norway have introduced many restrictions. </p>
<p>Research suggests that e-cigarettes may help smokers <a href="https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntz114/5531618?redirectedFrom=fulltext">quit regular cigarettes</a> benefiting their long-term health. But young people who have never smoked traditional cigarettes are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6355139/pdf/nihms-981901.pdf">taking up e-cigarettes</a>, which are available in over 1,500 flavours, including bubble gum and candy floss. In a <a href="https://jamanetwork.com/journals/jama/fullarticle/2464690">survey of US youths aged 12-17</a>, 81% of e-cigarette users reported that the first product they ever used was flavoured and that they use e-cigarettes because “they come in flavors I like”. </p>
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Read more:
<a href="https://theconversation.com/vaping-could-be-a-trojan-horse-for-real-cigarettes-21776">Vaping could be a trojan horse for real cigarettes</a>
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<p>According to the US Centers for Disease Control and Prevention (CDC) over <a href="https://www.cdc.gov/mmwr/volumes/68/wr/mm6806e1.htm?s_cid=osh-vs-mmwr-full-001">3.6m children in the US use e-cigarettes</a>, with a jump of 78% (from 11.7% to 20.8%) of US high school students reporting e-cigarette use from 2017 to 2018. And <a href="https://ash.org.uk/wp-content/uploads/2019/06/ASH-Factsheet-Youth-E-cigarette-Use-2019.pdf">in the UK</a>, 1.6% of those aged 11-18 use e-cigarettes more than once a week, compared with 0.5% in 2015.</p>
<p>Because of the highly addictive nature of nicotine, there is a risk that young e-cigarette users might switch to using traditional cigarettes. Indeed, some healthcare professionals refer to e-cigarettes as a “gateway drug”.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/293383/original/file-20190920-135078-10y2i4m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/293383/original/file-20190920-135078-10y2i4m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/293383/original/file-20190920-135078-10y2i4m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/293383/original/file-20190920-135078-10y2i4m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/293383/original/file-20190920-135078-10y2i4m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/293383/original/file-20190920-135078-10y2i4m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/293383/original/file-20190920-135078-10y2i4m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There are over 1,500 e-cigarette flavours. Many of which appeal to children.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/689826262?src=KMRvzG7iL6pFhoikwDiCcg-1-0&size=medium_jpg">Ulf Wittrock/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Harmful enzymes</h2>
<p>E-cigarettes create an aerosol by heating a complex solution of chemicals, comprising oils, flavouring and nicotine. The fine particles released in the vapour are similar in size and concentration to tobacco smoke and so can reach <a href="https://www.ncbi.nlm.nih.gov/pubmed/23042984">deep into the lungs</a>. Several of these chemicals are <a href="https://www.medigraphic.com/pdfs/revinvcli/nn-2019/nn191c.pdf">toxic to cells</a>, but what makes research into their safety difficult is that each product is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4376316/pdf/nihms672695.pdf">very different</a> with the final composition of chemicals being determined by the temperature at which the vaping device heats them.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/29053025">Researchers</a> have found that vaping irritates and inflames the airways, leading to the production of a greater amount of mucus and an increase in tissue-degrading enzymes called proteases. High levels of proteases can destroy sensitive lung tissue and reduce the ability of our lungs to function. The resulting damage to the lungs is irreversible and over time can lead to severe lung conditions, including emphysema which is commonly found in chronic obstructive pulmonary disease (<a href="https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/">COPD</a>). For those who already have a chronic lung disease, such as COPD or asthma, vaping has been linked to an increase <a href="https://link.springer.com/article/10.1007%2Fs11606-017-4150-7">in the severity of symptoms</a>.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/fake-e-cigarette-liquid-is-putting-vapers-at-risk-heres-how-we-can-tackle-the-fraud-100916">Fake e-cigarette liquid is putting vapers at risk – here's how we can tackle the fraud</a>
</strong>
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<p>Another <a href="https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-016-0368-x">study</a> found that proteases are stimulated by e-cigarette vapour. The vapour was prepared from different e-cigarette brands and then used to treat isolated white blood cells in the lab. Levels of the enzymes were found to be similar to or more than when the cells were exposed to an extract prepared from cigarette smoke. The increase in enzyme levels was also found with nicotine-free e-cigarette products suggesting that other components in the e-cigarette vapour were responsible.</p>
<p>A recent <a href="https://www.atsjournals.org/doi/abs/10.1164/rccm.201903-0615OC">US study</a>, published in the American Journal of Respiratory and Critical Care Medicine, investigated the effect of chronic e-cigarette use on markers of lung injury in the airways of vapers. Proteases linked to tissue damage were increased in both smokers and vapers, compared with non-smokers. </p>
<h2>Difficult to research</h2>
<p>The problem with <a href="https://www.atsjournals.org/doi/abs/10.1164/rccm.201908-1605ED#readcube-epdf">investigating the potential harm</a> of e-cigarettes is that there is such a vast array of products, devices and flavourings that it’s impossible to create a “standardised exposure”. </p>
<p>According to a <a href="https://e-cigarettes.surgeongeneral.gov/documents/2016_sgr_full_report_non-508.pdf">report by the US Surgeon General</a>, 97% of young vapers used a flavoured product in the previous 30 days. Individual e-cigarette products are reported to have over six flavouring chemicals with the sweetest flavours having a <a href="https://www.ncbi.nlm.nih.gov/pubmed/31025300">significantly higher number</a> of compounds. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/31025300">Tests of 166 e-cigarette products</a> showed that one in five (21%) contains flavouring chemicals (benzyl alcohol, benzaldehyde, vanillin) that can be toxic to the airways. Several other toxic chemicals were also found and measurable levels of tobacco-specific nitrosamines (TSNAs), an important group of carcinogens in tobacco products, were in <a href="https://www.ncbi.nlm.nih.gov/pubmed/31025300">70% of the products tested</a>. The effect of inhaling these complex mixtures of chemicals will be very difficult to determine.</p>
<p>The <a href="https://edition.cnn.com/2019/09/10/health/vaping-outbreak-2019-explainer/index.html">recent reports</a> of deaths in the US associated with vaping fans further concerns on safety. The <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html">CDC has reported</a> a rising number of cases (530 across 38 states) of a mysterious “lipoid” (presence of fat in the lung) pneumonia, most of which have occurred in young men who vape, and which has been linked to <a href="https://www.independent.co.uk/news/health/vaping-death-lung-illness-mystery-missouri-a9114451.html">eight deaths</a>. But it is worth noting that some who have developed lipoid pneumonia admitted that they vape THC (the active ingredient in cannabis), although others have insisted that they only used nicotine products with their e-cigarettes. </p>
<p>One substance called vitamin E acetate has been identified in all the samples tested by New York state health officials, but there isn’t enough evidence to say if this is the cause of disease. And so far, no cases of lipoid pneumonia have been reported outside the US. </p>
<p>The evidence to date suggests that vaping is not a safe alternative to smoking tobacco. This, coupled with the worrying trend of young, previous non-smokers being attracted to vaping, raises fears of yet another generation suffering from chronic lung disease. Indeed, a <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31694-5/fulltext">recent study</a> in The Lancet estimates that in 2040, COPD will be the only disease in the top ten leading causes of death that will still be increasing. Although how much will be driven by vaping remains to be seen.</p><img src="https://counter.theconversation.com/content/123055/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>More than 20 countries have banned e-cigarettes.Lorraine Martin, Professor of Biomolecular Science, Queen's University BelfastJames Reihill, Senior Research Fellow, Queen's University BelfastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1066692019-03-01T11:40:11Z2019-03-01T11:40:11ZYour lungs are really amazing. An anatomy professor explains why<figure><img src="https://images.theconversation.com/files/244828/original/file-20181109-116820-1oqq38v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A 3D image of lungs.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/3d-illustration-lungs-part-human-organic-417318079?src=KjqZGrlNVZp4XYjszzMEuA-1-2">MDGRPHC/Shutterstock.com</a></span></figcaption></figure><p>Lungs are remarkable organs that continuously achieve amazing feats, which they do so well that we take them for granted, except when their function is diminished. It all happens in a space inside your chest, divided in two and reduced by the presence of the heart, the great vessels and the esophagus.</p>
<p>With Supreme Court Justice Ruth Bader Ginsburg having <a href="https://www.apnews.com/0248a100a932418fac5c1ea7d287a355">recently returned</a> to the court after surgery for lung cancer, I have been asked a lot of questions about the lungs, as I am a professor of anatomy. </p>
<p>Many lung cancers are not operable, but to treat some types of lung disease, such as early stages of lung cancer, a surgical treatment called a lobectomy may be performed. In this operation, a lobe of a lung (your right lung has three lobes, your left lung has two) is removed. Afterward, the other lobes expand to adapt and compensate for the missing tissue, allowing the lungs to work as well or better than they did before.</p>
<p>In addition to being highly efficient organs, the lungs are beautifully complex in their structure. I can’t help but wonder: If we appreciated them more, would we be more proactive in taking care of them? </p>
<h2>Breath of life</h2>
<p>The primary function of the respiratory system is to bring oxygen into our lungs. There it is exchanged for a waste product, carbon dioxide, which is then removed from the body.</p>
<p>Several weeks following conception, the work of the lungs is performed by the <a href="https://www.medicalnewstoday.com/articles/318993.php">placenta</a>, a structure outside our fetal bodies where our blood exchanges carbon dioxide and oxygen with the maternal blood of the uterus. </p>
<p>Before birth, we just practice respiratory movements, moving <a href="https://www.medicalnewstoday.com/articles/307082.php">amniotic fluid</a> instead of air in and out of the lungs.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/256175/original/file-20190129-42594-9grp28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/256175/original/file-20190129-42594-9grp28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/256175/original/file-20190129-42594-9grp28.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/256175/original/file-20190129-42594-9grp28.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/256175/original/file-20190129-42594-9grp28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/256175/original/file-20190129-42594-9grp28.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/256175/original/file-20190129-42594-9grp28.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A newborn and mother. After birth, a baby gasps because of a buildup of CO2 and takes its first breath to take in oxygen.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-african-mother-pink-lace-dress-630663665?src=k2KnKNT9g-KxuiSvzXkMSA-3-25">Anneka/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Within seconds after the umbilical cord is cut, a buildup of carbon dioxide causes <a href="https://medlineplus.gov/ency/article/002395.htm">newborns to gasp for breath</a> to exchange it for oxygen, an activity that will continue until our death. The average person breathes some 13 million cubic feet of air during their lifetime.</p>
<p>During quiet activity, such as bed rest or sitting, we take eight to 16 breaths per minute, each breath inhaling about a pint of air containing 21 percent oxygen and a small amount of carbon dioxide for about two seconds. Then for three seconds, we exhale the same amount of air, but it now contains 16 percent oxygen and a 100-fold increase in carbon dioxide. In other words, you spend about 40 percent of your life drawing air in, and 60 percent of your life expelling it.</p>
<h2>Your lungs, by the numbers</h2>
<p>Each day, 5,000 gallons of air are transported through airways leading into and extending throughout the lungs. The airways branch and diminish in size 22 times. Almost of all this occurs within our lungs, with these airways reaching a combined length of 14,900 miles. </p>
<p>About 2,600 gallons of the transported air are delivered into and removed from 300 million tiny, thin-walled, hollow sacs, or <a href="https://www.britannica.com/science/pulmonary-alveolus">alveoli</a>, that provide an enormous surface for the exchange of oxygen, required by all our cells, for carbon dioxide, a waste product from them. This is an area varying in size between half and most of a regulation tennis court. </p>
<p>This immense area is contained within two lungs, each only somewhat smaller than three, 1-liter bottles. The left lung is 10 percent smaller than the right, due to the left-sided position of the heart. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/256176/original/file-20190129-108355-up6ry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/256176/original/file-20190129-108355-up6ry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/256176/original/file-20190129-108355-up6ry.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/256176/original/file-20190129-108355-up6ry.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/256176/original/file-20190129-108355-up6ry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/256176/original/file-20190129-108355-up6ry.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/256176/original/file-20190129-108355-up6ry.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A 3-D illustration of alveoli.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/digital-illustration-alveoli-colour-background-236439439?src=4jGDr1QwqRUug8d1HzCPkg-1-19">RAJ CREATIONZS/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>The alveoli are tightly surrounded by blood vessels, or capillaries, so small that red blood cells continuously pass through them squeezed into a single row as they exchange carbon dioxide for oxygen. </p>
<p>The capillaries of the lung receive an immense blood supply, equal to that distributed to all other parts of the entire body. The alveoli expand and contract 15,000 times a day. During activity, the rate of respiration doubles – and in extreme activities triples – and the amount of air reaching the alveoli increases three to five times. Breathing deeper and faster uses lung capacity that’s held in reserve while at rest. Stress can also result in deeper and faster respiration.</p>
<h2>Your lungs at work</h2>
<p>The air we breathe is far from clean, however, and one of the primary jobs of the respiratory system is to “condition” the air before it reaches the air sacs deep inside your lungs. </p>
<p>Indoor air pollutants can have <a href="https://www.epa.gov/iaq-schools/why-indoor-air-quality-important-schools">two to five times more pollutants than outdoor air</a>. (Have you observed and changed filters on your heating/AC system recently?) </p>
<p>The respiratory system “conditions” the air in several ways. First, it raises the temperature of cool air to body temperature, or it cools hot air to body temperature. Second, it moisturizes the air to 100 percent humidity to prevent dehydration of alveolar membranes. Last, it cleans the air. </p>
<p>Foreign and possibly harmful substances are filtered from in-flowing air and removed by several means, including nasal hairs and sticky mucus lining the airways that is produced at a rate of about a quart a day. It contains antimicrobial agents that help to neutralize harmful germs and many viruses. </p>
<p>Importantly, hair-like projections on cells lining the airways, called cilia, move the soiled mucus out of the lungs and air passages to the throat to be swallowed and destroyed by stomach acid. </p>
<p>Pollutants reaching the alveolar gas-exchanging membranes are removed by specialized cells called phagocytes and macrophages that ingest particles to move most to be carried away via lymph vessels and nodes. However, much of the black carbon is merely moved to non-exchanging portions of the lung. </p>
<p>In addition to conditioning air for the alveoli, ventilation of the lungs helps to cool the body down when it is overheated. About 7 percent of body heat is removed via evaporation from airways inside and outside the lungs. Eleven ounces of water per day are lost as water vapor. Three percent of body heat is lost by heating air below body temperature as the lungs are ventilated.</p>
<p>Other amazing functions of the lungs include controlling the acid-base balance (pH) of the body as a whole by selectively retaining or eliminating carbon dioxide. In order to be ventilated for gas exchange, the lungs act as bellows. The propulsion of air from the lungs enables the larynx to serve as a “voice box,” vibrating the vocal cords to produce the tone that is modified by the tongue, teeth and lips to produce our voice for interpersonal communication and for singing. This air output also allows us to blow up balloons or play wind instruments.</p>
<p>Air drawn in by expansion of the lungs passes over the olfactory areas of the nose, enabling our sense of smell. The lungs also act as “packing foam” inside the rib cage, supporting and protecting the vital heart that delivers half of its output to the lungs, and the other half to the rest of the body.</p>
<h2>The dark side of the lungs, and of their care</h2>
<p>While the lungs were a pristine pink at birth, our lungs gradually darken to a gray and mottled appearance due to these carbon particles, much of which remains in place, usually with no detrimental effect. Larger, irritating particles are commonly “blasted” away by reflexive coughing and sneezing. This air conditioning system is compromised in smokers, whose airways lose cilia and their directional coordination, and so must revert to coughing as a major means of pollutant removal. </p>
<p>Smokers’ lungs darken faster, becoming more mottled, and take on an orange tone due to nicotine and brown tars. Prolonged exposure to these carcinogens causes chronic bronchitis, emphysema and cancer in many parts of the body, but especially around airways just inside the entrance to the lungs. In emphysema, the alveolar structure of the lungs collapses, especially in the upper lung, making it difficult to fully exhale.</p>
<p>Take a deep breath and consider all the miraculous activities your incredible lungs are performing.</p><img src="https://counter.theconversation.com/content/106669/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arthur Dalley authors and edits anatomical textbooks and atlases for, and consults with, Wolters Kluwer Health, LLC, a publisher for health care students and professionals.</span></em></p>As organs go, lungs do not receive a lot of attention, and diseases associated with them, such as lung cancer, historically have been underfunded. Here’s a look at how your amazing lungs function.Arthur Dalley, Professor of Anatomy, Vanderbilt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1095962019-01-11T13:34:22Z2019-01-11T13:34:22ZTreat vitamin D deficiency to prevent attacks of chronic obstructive pulmonary disease<figure><img src="https://images.theconversation.com/files/253068/original/file-20190109-32121-1is2m59.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/129311027?src=YROHv3J8TOqmH2DONmrqHQ-1-14&size=medium_jpg">R_Szatkowski/Shutterstock</a></span></figcaption></figure><p>Correcting vitamin D deficiency nearly halves the risk of potentially fatal lung attacks in patients with chronic obstructive pulmonary disease (COPD), our <a href="https://thorax.bmj.com/content/early/2019/01/10/thoraxjnl-2018-212092">latest study</a> has found.</p>
<p><a href="https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/">COPD</a> describes several lung conditions, including emphysema and chronic bronchitis, where a person’s airways become inflamed, making it harder to breathe. Almost all COPD deaths are due to lung attacks (termed “exacerbations”) in which symptoms worsen sharply. These are often triggered by viral upper respiratory infections – the type that cause the common cold. </p>
<p>Vitamin D – “the sunshine vitamin” – is best known for its effects on bone, but it also boosts immunity to viral infections. Our previous research at Queen Mary, University of London, has shown that vitamin D supplements <a href="https://www.ncbi.nlm.nih.gov/pubmed/28986128">protect against</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/27595415">asthma attacks</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/28202713">acute respiratory infections</a>, such as colds and flu, in people who have low vitamin D levels to start with.</p>
<p>A number of clinical trials have tested whether vitamin D supplementation might have a role in reducing the risk of COPD attacks, but they have yielded conflicting results. Some show a benefit, others do not. </p>
<p>One way to get a handle on the reason for their different findings is to pool the data from the various studies into a single database and then run analyses to determine whether vitamin D might have stronger protective effects against lung attacks in certain groups of COPD patients compared with others. This approach is known as “individual participant data meta-analysis”.</p>
<p>Our latest study, published in the journal Thorax, reports the findings of such an analysis. We pooled data from 469 patients who took part in one of three clinical trials of vitamin D that were conducted in the UK, Belgium and the Netherlands.</p>
<h2>Cheap, safe solution</h2>
<p>We found that giving vitamin D supplements led to a 45% reduction in the rate of lung attacks in COPD patients with low vitamin D levels (less than 25 nanomoles per litre of blood or 10 nanograms per millilitre of blood, which is the standard cut-off used by the UK Department of Health to define vitamin D deficiency). We didn’t observe any benefit in patients with higher vitamin D levels.</p>
<p>Doses of vitamin D investigated in the original trials ranged from 30 micrograms daily to 2,500 micrograms, monthly. For comparison, Public Health England and the Scientific Advisory Committee on Nutrition advise a daily intake of 10 micrograms of vitamin D. Supplementation at the higher doses given in the clinical trials did not influence the proportion of participants experiencing serious side effects, indicating that they were safe.</p>
<p>Given this excellent safety profile, and the fact that vitamin D supplements cost just a few pence per year, offering them to patients with COPD is a potentially highly cost-effective treatment that could be targeted at those who have low vitamin D levels following routine testing.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/253385/original/file-20190111-43532-1j77ahr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/253385/original/file-20190111-43532-1j77ahr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=442&fit=crop&dpr=1 600w, https://images.theconversation.com/files/253385/original/file-20190111-43532-1j77ahr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=442&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/253385/original/file-20190111-43532-1j77ahr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=442&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/253385/original/file-20190111-43532-1j77ahr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=556&fit=crop&dpr=1 754w, https://images.theconversation.com/files/253385/original/file-20190111-43532-1j77ahr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=556&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/253385/original/file-20190111-43532-1j77ahr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=556&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">COPD is a common condition that includes emphysema and chronic bronchitis.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/588313340?src=hSpyzyCANGQXAtiDBJXwZQ-1-8&size=medium_jpg">pathdoc/Shutterstock</a></span>
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<p>Around one-fifth of COPD patients in the UK – about 240,000 people – have low levels of vitamin D. Reducing risk of attacks in such a large group would have major benefits for patients and for health services, since many attacks require costly hospital admission. (COPD costs the NHS <a href="https://www.nice.org.uk/guidance/ng115/documents/draft-scope">£800m</a> per year.)</p>
<p>Our study provides the strongest evidence yet of a benefit of giving vitamin D supplements to patients with COPD who have low vitamin D levels. But it is important to recognise that the data contributing to this analysis come from a relatively small number of trials, so our findings should be interpreted with caution. </p>
<p>Another clinical trial of vitamin D, focused just on COPD patients with low baseline vitamin D levels, is underway in the Netherlands. Results are expected in 2020.</p><img src="https://counter.theconversation.com/content/109596/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This research was supported by a grant from National Institute for Health Research (NIHR) under its Health Technology Assessment (HTA) Program (Reference Number 13/03/25, to Adrian Martineau). The views expressed are those of Professor Martineau and not necessarily those of the National Health Service, the NIHR or the Department of Health.</span></em></p>Vitamin D shows promise in treating COPD in people who are deficient in the vitamin.Adrian Martineau, Professor of Respiratory Infection and Immunity, Queen Mary University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/990062018-10-01T10:38:57Z2018-10-01T10:38:57ZCan ‘persuasive technology’ change behavior and help people better manage chronic diseases?<figure><img src="https://images.theconversation.com/files/236259/original/file-20180913-177950-1lxu1cc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Could a timely text or a friendly reminder be the difference between good health and chronic disease?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/delhi-india-08042018-apple-iphone-watch-1149372197?src=4rVDydyGTm_yT7wyHztozQ-5-0">anuje/Shutterstock.com</a></span></figcaption></figure><p>It was March 2014 when I received a phone call as I was working in my office. The person on the other end introduced herself as Dr. Linda Houston-Feenstra, chief cardiac nurse of Loma Linda University SACHS Heart Clinic. She said that she has heard about my work on <a href="http://doi.org/10.1197/jamia.M2859">persuasive technology</a>, in particular how it can influence attitude or behavior change in people. She wanted me to assist her with her heart-failure patients. </p>
<p>These patients failed to comply with the regimens of self-management such as exercise, diet and measuring blood glucose daily, and an increasing number of them came back to the hospital within 30 days of discharge, which is known as 30-day hospital readmission. </p>
<p>Thus began a long and fruitful collaboration which has since resulted in three dissertations, several new technologies, numerous research publications, grants and a startup company. </p>
<p>I have been heavily involved in several health care information technology projects before in which we have been utilizing existing theories to implement systems such as texting, medical apps or services to help patients. My <a href="http://www.idea-labs.net/">IDEA lab</a> at Claremont was already focusing on prevention and behavior change. The call from Dr. Houston-Feenstra was a key step in helping my lab uncover the potential and pitfalls of using digital technologies to improve chronic disease management. </p>
<h2>What is persuasive technology?</h2>
<p>Persuasive technologies can be any form of information and communication technology that interacts with people to change their attitude and/or behavior. After several meetings with Dr. Houston-Feenstra’s staff, we had a good understanding of the problem: namely, the barriers to compliance with self-management and why an increasing number of patients came back to ICU within 30 days. We were then able to design a remote home monitoring system including a free app called <a href="http://doi.org/10.1109/HealthCom.2014.7001860">MyHeart</a>. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/236975/original/file-20180918-158237-e2oc8c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/236975/original/file-20180918-158237-e2oc8c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/236975/original/file-20180918-158237-e2oc8c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=942&fit=crop&dpr=1 600w, https://images.theconversation.com/files/236975/original/file-20180918-158237-e2oc8c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=942&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/236975/original/file-20180918-158237-e2oc8c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=942&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/236975/original/file-20180918-158237-e2oc8c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1184&fit=crop&dpr=1 754w, https://images.theconversation.com/files/236975/original/file-20180918-158237-e2oc8c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1184&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/236975/original/file-20180918-158237-e2oc8c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1184&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Main home page of the MyHeart app.</span>
<span class="attribution"><span class="source">Samir Chatterjee</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/236976/original/file-20180918-158228-8tbvle.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/236976/original/file-20180918-158228-8tbvle.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=860&fit=crop&dpr=1 600w, https://images.theconversation.com/files/236976/original/file-20180918-158228-8tbvle.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=860&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/236976/original/file-20180918-158228-8tbvle.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=860&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/236976/original/file-20180918-158228-8tbvle.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1081&fit=crop&dpr=1 754w, https://images.theconversation.com/files/236976/original/file-20180918-158228-8tbvle.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1081&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/236976/original/file-20180918-158228-8tbvle.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1081&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Symptoms capture page.</span>
<span class="attribution"><span class="source">Samir Chatterjee</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/236978/original/file-20180918-158228-rk7ig5.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/236978/original/file-20180918-158228-rk7ig5.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/236978/original/file-20180918-158228-rk7ig5.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1003&fit=crop&dpr=1 600w, https://images.theconversation.com/files/236978/original/file-20180918-158228-rk7ig5.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1003&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/236978/original/file-20180918-158228-rk7ig5.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1003&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/236978/original/file-20180918-158228-rk7ig5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1261&fit=crop&dpr=1 754w, https://images.theconversation.com/files/236978/original/file-20180918-158228-rk7ig5.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1261&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/236978/original/file-20180918-158228-rk7ig5.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1261&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Alerts and motivational messages tab.</span>
<span class="attribution"><span class="source">Samir Chatterjee</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
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<p>As patients left the clinic, they were given a Bluetooth-enabled weight scale, a blood pressure cuff, blood glucose meter and MyHeart installed on their smartphone. The patient would measure vitals daily and log their symptoms in the app. The system collected daily data such as weight, blood pressure, blood glucose and activity (steps) along with answers to five questions about their symptoms, which they rated on a scale of 1-10 based on guidelines from American Heart Association. The MyHeart app provided motivational messages along with reminders for any missing vital data. </p>
<p>All the data were channeled and displayed through a dashboard to Dr. Houston-Feenstra’s staff. Moreover, each incoming vital data or symptom was directed through a rule filter which helps classify each patient as high, medium or low risk for hospital readmission. Nurses can then make a call for high-risk patients and intervene to help them stay at home through medication changes, diet recommendations or providing suggestions on exercises. </p>
<p>I have been fascinated by this area since 2008 and have developed an active research agenda in my lab where we have designed several persuasive technologies. When one considers chronic diseases, it often comes down to certain behaviors. Let’s take obesity and diabetes as an example. Research shows that these are often caused by improper diets, lack of exercise, forgetting to take medication, etc. </p>
<p>Persuasive apps can remind people, provide motivations, and help them reach their goals. It can be done with something as simple as daily text messages or using a fancy app with Bluetooth-enabled interfacing or virtual avatars. </p>
<h2>Why do we need external motivators?</h2>
<p>Why don’t we do what is needed to be done? This aspect of human psychology is important to understand for designing technologies that can act only as support tools. There are many well-known theories of behavior change that can apply here. Theories such as the <a href="https://en.wikipedia.org/wiki/Health_belief_model">health-belief model</a>, <a href="http://www.swaycraft.com/two-sided-messages/">counter-agumentation theory</a>, <a href="https://www.utwente.nl/en/bms/communication-theories/sorted-by-cluster/Health%20Communication/theory_planned_behavior/">theory of planned behavior</a> and <a href="https://en.wikipedia.org/wiki/Transtheoretical_model">trans-theoretical stages of change</a> theory all help us to understand the nuances of human behavior. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/236256/original/file-20180913-177965-1ngs9kt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/236256/original/file-20180913-177965-1ngs9kt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/236256/original/file-20180913-177965-1ngs9kt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/236256/original/file-20180913-177965-1ngs9kt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/236256/original/file-20180913-177965-1ngs9kt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/236256/original/file-20180913-177965-1ngs9kt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/236256/original/file-20180913-177965-1ngs9kt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Alerts reminding patients to adhere.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/close-shot-reminder-app-icon-notifications-1176571054?src=ecqQDJCzf4rUFkmbFICIDw-1-70">ninefotostudio/Shutterstock.com</a></span>
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<p>Let’s take a simple case. John is obese but loves to drink calorie-rich sodas. The counter-argumentation theory says that it is not enough to say to John, “Don’t drink Coke.” We have to provide an alternative, such as, “Drink lots of vitamin water.” What happens then is that in John’s mind, there is a period of conflict where he grapples with both the statements. He weighs the pros and cons and finally arrives at a decision. </p>
<p>Behavioral psychologist <a href="https://www.behaviormodel.org/">B.J. Fogg</a> has described behavior change as a mathematical relationship that depends on motivation, ability and trigger. Motivation levels can be high or low; our ability to perform or do something can be high or low; but a trigger, an external stimulus, can often provide that vital nudge to make us act and perform the needed action or behavior. </p>
<p>Presenting tailored information can help increase motivation and ability. In my lab’s research, my colleagues and I have found that triggers on which the user can act, called “actionable triggers,” can influence behavior change. We are increasingly seeing that such persuasive technology can be tailored based on racial disparity, cultural aspects and even language issues. Students from my lab along with few undergraduate students from USC are currently working with Cigna Corporation to test tailored text messaging and its impact on diabetes self-management. </p>
<p>We have also found in our studies that in spite of nudges and reminders, we might get short-term changes in behaviors but after a while relapse. How can we achieve sustainable behavior change into something that becomes a habit? </p>
<h2>Transforming short-term changes into long-term habits</h2>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/236263/original/file-20180913-177938-gujjc0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/236263/original/file-20180913-177938-gujjc0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=796&fit=crop&dpr=1 600w, https://images.theconversation.com/files/236263/original/file-20180913-177938-gujjc0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=796&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/236263/original/file-20180913-177938-gujjc0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=796&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/236263/original/file-20180913-177938-gujjc0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1000&fit=crop&dpr=1 754w, https://images.theconversation.com/files/236263/original/file-20180913-177938-gujjc0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1000&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/236263/original/file-20180913-177938-gujjc0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1000&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Friendly reminders are often just what a patient needs to take their medicines.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/pill-medicine-cartoon-character-678718978">siridhata/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>My graduate student, Ala Alluhaidan, my colleague, <a href="https://www.cgu.edu/people/david-drew/">David Drew</a>, and I studied this problem and recently came out with a <a href="https://www.springer.com/gb/book/9783319789774">theory of empowerment</a>. We concluded that patients need to feel empowered, and things such as messages aligned with their goals, and social and community support, can play an important role in helping achieve their desired outcome. The challenge is to program these constructs into software implementations. </p>
<p>The heart-failure study at Loma Linda led to <a href="http://doi.org/10.2196/humanfactors.6481">a small pilot trial</a> with eight patients where we saw a remarkable result: Not one patient was readmitted back in 30 days. Their quality of life also improved. Since then we have conducted other trials by spinning off a startup company called <a href="http://dclhealth.com/">DCL Health</a> that works with clinics and cardiac physicians to provide their patients with remote home-monitoring technologies. </p>
<p>Today we are developing an artificial intelligence system that can learn from the remote home-monitoring data and, based on certain combinations of vital and symptoms variables, can predict the risk of hospital readmission or likelihood of severe chest pain. We are now entering an exciting phase of digital health technologies where we can predict with certain levels of accuracy what might be happening to a patient and then take precautions and plan interventions ahead of time. </p>
<p>The technology behind MyHeart is now finding its way to other chronic diseases such as diabetes and chronic obstructive pulmonary disease. Each disease requires specific vitals and symptoms to be measured and has different rules to filter them but can be applied to help patients. </p>
<p>Digital technologies in this space are emerging. Risks can include battery malfunction, network transmission issues and sustainable usage of such technology. I believe those things will improve with time, but for now, these digital health tools are actually saving lives.</p><img src="https://counter.theconversation.com/content/99006/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Samir Chatterjee is founder and Chief-Scientist at DCL Health and is also Professor and Fletcher Jones Chair at Claremont Graduate University. He has received a seed grant from LLU SACHS clinic to get this work started. </span></em></p>Sometimes the difference between intending to do something and doing it is a little nudge. Now researchers are designing apps that nudge patients with chronic diseases to change their behavior.Samir Chatterjee, Professor of Technology Design & Management , Claremont Graduate UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/951882018-04-18T10:43:44Z2018-04-18T10:43:44ZBarbara Bush may have suffered from a chronic lung disease called COPD – a doctor explains<figure><img src="https://images.theconversation.com/files/215255/original/file-20180417-163998-xs6zxq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Barbara Bush and her husband, George H.W. Bush, at his Houston campaign headquarters June 4, 1964. </span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Barbara-Bush-Marriage/51e0c5f4323444c7b7d3d6a02a0409f7/1/0">AP Photo/Ed Kolenovsky/file</a></span></figcaption></figure><p>Former First Lady Barbara Bush died on April 17, 2018, two days after spokespeople said that she had <a href="https://www.nytimes.com/2018/04/15/us/politics/barbara-bush-ill.html">decided not to seek</a> additional medical treatment. <a href="https://www.cnn.com/2018/04/15/politics/barbara-bush-health/index.html">CNN had reported</a> that Barbara Bush had COPD. </p>
<p>I am a respiratory disease physician and professor at the University of Pittsburgh School of Medicine, and I direct the COPD clinical and research programs. My research has been inspired by real clinical problems when facing my lung disease patients whom I have worked with over the past 30 years.</p>
<p><a href="https://www.nhlbi.nih.gov/health-topics/education-and-awareness/COPD-national-action-plan">COPD</a> is a chronic respiratory condition that results in cough and shortness of breath. It often gets worse. It affects up to <a href="https://www.cdc.gov/copd/index.html">16 million people and is the third-leading cause of death</a> in the United States behind heart disease and stroke. It further results in 6 percent of all deaths worldwide.</p>
<p>The disease is most commonly caused by <a href="https://www.cdc.gov/tobacco/campaign/tips/diseases/copd.html">tobacco smoking</a> and is thus often preventable. <a href="https://www.goodhousekeeping.com/health/a19829613/did-barbara-bush-smoke-copd/">Mrs. Bush smoked cigarettes for decades</a>, she wrote in her biography, but quit in 1968. One-fourth of cases occur in nonsmokers, in part due to other environmental exposures. COPD is often undiagnosed because of its slow onset. Also, people often assume that their coughing is “smokers’ cough,” or old age. Women are more likely than men to be diagnosed with COPD.</p>
<p>COPD includes several different conditions, including emphysema and chronic bronchitis. They can occur separately or together. </p>
<p>Normal lungs have bronchial tubes that branch like a tree into smaller and smaller tubes, which end in tiny elastic air sacs called <a href="https://www.britannica.com/science/pulmonary-alveolus">alveoli</a>. These fill up as we breathe in and snap back empty when we exhale. </p>
<p>In COPD, the airway tubes narrow due to inflammation, increased mucous production and, eventually, scarring, which is known as chronic bronchitis. Further, the walls of the alveoli can break down, as do small bubbles coalesce to form larger bubbles. This is known as emphysema. As a result, they do not snap back as easily when a person exhales. They have less ability to transfer oxygen into, and remove carbon dioxide from, the blood.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/215263/original/file-20180417-163962-xbe4x9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/215263/original/file-20180417-163962-xbe4x9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=498&fit=crop&dpr=1 600w, https://images.theconversation.com/files/215263/original/file-20180417-163962-xbe4x9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=498&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/215263/original/file-20180417-163962-xbe4x9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=498&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/215263/original/file-20180417-163962-xbe4x9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=626&fit=crop&dpr=1 754w, https://images.theconversation.com/files/215263/original/file-20180417-163962-xbe4x9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=626&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/215263/original/file-20180417-163962-xbe4x9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=626&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Chronic bronchitis and emphysema are forms of COPD.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/chronic-obstructive-pulmonary-disease-90181153?src=fdsCdfgPj2Zdp1I6XOZF4w-1-74">Ailia Medical Media/Shutterstock.com</a></span>
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<p>These different processes result in a prolonged and incomplete exhalation, and air remains trapped in the lungs when the next breath begins. As the condition progresses, it becomes increasingly hard to breathe. This results in more fatigue, a decreasing ability to exercise, declining activity and a lower quality of life. </p>
<p>Many COPD patients develop recurrent chest colds, often requiring hospitalization and rising medical bills. Patients susceptible with COPD are also at greater risk of other chronic conditions such as heart disease, which can complicate the diagnosis and management. For example, Mrs. Bush was reported to have had <a href="https://www.medicinenet.com/congestive_heart_failure_chf_overview/article.htm">congestive heart failure</a>. </p>
<p>Due to differences in genetics, <a href="https://www.cdc.gov/copd/index.html">not all people who smoke get COPD</a>, and not all patients have the same symptoms or progress at the same rate. It is thus critical that people who have a prolonged cough or shortness of breath undergo lung function testing, particularly if they are smokers or former smokers.</p>
<p>The most important treatment for COPD is to stop smoking, but vaccinations, pulmonary rehabilitation, use of long-acting inhalers and other surgical advances have led to improved quality of life, decreased hospitalizations and better survival for many patients with COPD.</p><img src="https://counter.theconversation.com/content/95188/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Frank Sciurba has received funding from the National Institutes of Health, Department of Defense, Commonwealth of Pennsylvania, COPD Foundation and several pharmaceutical companies including GlaxoSmithKline and AstraZeneca Pharmaceuticals. He has served on the advisory boards of GSK, Boehringer-Ingelheim Pharmaceuticals, Inc., and Circassia.</span></em></p>The former first lady was reported to have a condition that makes breathing hard and often occurs in smokers. COPD is a condition that affects almost 16 million Americans.Frank Sciurba, Professor of Medicine and Education, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/893472017-12-21T11:11:35Z2017-12-21T11:11:35ZWho forced the cigarette companies to run those anti-smoking ads?<figure><img src="https://images.theconversation.com/files/200212/original/file-20171220-4980-1rir4e5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Judge Gladys Kessler's ruling in 2006 was the basis for tobacco companies' corrective statements now airing on TV and placed in newspapers.</span> <span class="attribution"><a class="source" href="https://www.tobaccofreekids.org/assets/images/content/kessler-horizontal.jpg">Tobacco Free Kids</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>You may have seen ads run by the big cigarette companies listing the dangers of smoking and that they manipulated cigarettes to make them more addictive.</p>
<p>The path to the advertisements the big cigarette companies are now running in newspapers, radio, and television began in New York’s Plaza Hotel in December, 1953.</p>
<p>That’s when the heads of America’s tobacco companies, their lawyers, and the <a href="https://en.wikipedia.org/wiki/Hill%2BKnowlton_Strategies">Hill and Knowlton public relations</a> company gathered to craft the tobacco industry’s response to growing public concern about the emerging evidence that smoking caused cancer. They decided that rather than accepting the fact that smoking caused disease, they would create an “independent” research organization, the Tobacco Industry Research Committee, to fund research to get to the bottom of the “smoking and health controversy.” They announced the creation of the TIRC in full page ads in newspapers and magazines all over the country assuring smokers and policymakers that the companies “<a href="https://publishing.cdlib.org/ucpressebooks/view?docId=ft8489p25j&chunk.id=d0e1439&toc.depth=1&toc.id=d0e1439&brand=ucpress">accept an interest in people’s health as a basic responsibility, paramount to every other consideration in our business.”</a></p>
<p>The tobacco companies did no such thing.</p>
<p>I have spent decades studying and doing battle with the tobacco industry. There’s a backstory about why you are seeing these ads now.</p>
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<h2>Not independent</h2>
<p>Far from being “independent,” <a href="https://publishing.cdlib.org/ucpressebooks/view?docId=ft8489p25j&chunk.id=d0e10912&toc.depth=1&toc.id=d0e10912&brand=ucpress">industry lawyers and executives controlled the TIRC</a> (later renamed the Council for Tobacco Research) and other subsequent industry-wide organizations. These people used these organizations to funnel money to individuals and organizations that would contest the science linking smoking – and later secondhand smoke – with disease and death. Why? They needed support for the tobacco companies’ legal and political efforts to keep people smoking as much as possible and as long as possible so the companies could make as much money as possible.</p>
<p>And while contesting the evidence that smoking caused disease and that nicotine was the addictive drug in cigarettes, the cigarette companies secretly accepted these facts since the 1950s (<a href="https://publishing.cdlib.org/ucpressebooks/view?docId=ft8489p25j&chunk.id=d0e1246&toc.depth=1&toc.id=d0e1246&brand=ucpress">cancer</a>) and 1960s (<a href="https://publishing.cdlib.org/ucpressebooks/view?docId=ft8489p25j&chunk.id=d0e2507&toc.depth=1&toc.id=d0e2507&brand=ucpress">addiction</a>). Indeed, while denying that nicotine was addictive, the companies used their sophisticated understanding of nicotine as an addictive drug to design more addictive cigarettes.</p>
<p>These activities, marketing that tricked smokers into thinking that “light” and “mild” cigarettes are safer (they aren’t), as well as marketing to kids led many state attorneys general to sue the tobacco companies for fraud under state laws in the early 1990s. These lawsuits culminated in the companies agreeing to some limits on marketing (which is why there are no more tobacco billboards and only very limited sports sponsorship) and the multi-billion dollar <a href="https://en.wikipedia.org/wiki/Tobacco_Master_Settlement_Agreement">Master Settlement Agreement</a> with the states in 1998.</p>
<p>Based on this groundwork, in <a href="https://www.tobaccofreekids.org/what-we-do/industry-watch/doj/timeline">September 1999</a>, the U.S. Department of Justice filed a civil lawsuit against the big tobacco companies and their scientific and trade organizations for defrauding the public to keep them smoking. </p>
<p>The Department of Justice accused the defendants of violating the <a href="https://en.wikipedia.org/wiki/Racketeer_Influenced_and_Corrupt_Organizations_Act">Racketeer Influenced and Corrupt Organization Act</a> (RICO) because they created an “enterprise” that crossed state lines that engaged in illegal activity. </p>
<p>RICO is the same law used to prosecute organized crime networks. </p>
<p>After many <a href="https://secure.apha.org/imis/ItemDetail?iProductCode=978-087553-0178&CATEGORY=BK">twists and turns</a>, in August 2006, Federal Judge Gladys Kessler found that the <a href="https://www.tobaccofreekids.org/content/what_we_do/industry_watch/doj/FinalOpinion.pdf">companies’ coordinated efforts violated RICO</a>. She <a href="https://www.tobaccofreekids.org/assets/content/what_we_do/industry_watch/doj/JudgmentOrder.pdf">ordered them</a> to end the conspiracy and not recreate it. </p>
<p>She prohibited them from contesting the dangers of smoking and secondhand smoke or denying that nicotine was addictive. She broke up their coordinated efforts, including the Council for Tobacco Research and similar organizations and prohibited the companies from working together to create new organizations.</p>
<p>She also ordered the companies to continue to make <a href="https://www.industrydocumentslibrary.ucsf.edu/tobacco/">millions of pages of previously secret internal documents public</a>. These documents, which will continue to be produced until 2021, have formed the basis for <a href="https://www.industrydocumentslibrary.ucsf.edu/tobacco/biblio/#q=*%3A*&subsite=tobacco&cache=true&count=964">over 1,000 publications and reports</a> that have changed the landscape of tobacco control policymaking.</p>
<p>And, after the industry’s appeals of the overall verdict were rebuffed, in 2012 the judge ordered the companies to publish <a href="https://www.tobaccofreekids.org/assets/content/what_we_do/industry_watch/doj/2012_11_27_Order.pdf">“corrective statements”</a> setting the record straight about the industry’s past behavior and the truth about tobacco.</p>
<h2>Delaying the corrective statements for years</h2>
<p>And yet, the industry continued to fight the corrective statements in court for five more years, particularly <a href="https://www.usatoday.com/story/news/nation/2012/11/27/judge-smoking-cigarettes-tobacco-lied/1730305/">Judge Kessler’s order</a> that the statements be preceded with “A Federal Court has ruled that Altria, R.J. Reynolds Tobacco, Lorillard, and Philip Morris USA deliberately deceived the American public about the health effects of smoking, and has ordered those companies to make this statement. Here is the truth.”</p>
<p>In the end, the industry succeeded in avoiding the statements that they “deceived” the public about the “truth.” The <a href="https://www.tobaccofreekids.org/assets/content/what_we_do/industry_watch/doj/corrective_statements/2017_10_corrective_statements.pdf">statements that were first published beginning on Nov. 26, 2017</a>, are prefaced by the less damning (and less informative) “A Federal Court has ordered Altria, R.J. Reynolds Tobacco, Lorillard, and Philip Morris USA to make this statement.”</p>
<h2>Still relevant, but not the end of the fight</h2>
<p>People ask, after all this time, are these <a href="http://www.adweek.com/agencies/marketers-say-big-tobaccos-court-mandated-anti-smoking-ads-are-too-little-too-late/#/">bland </a>statements still relevant. After all, they doesn’t everyone know smoking is bad?</p>
<p>The reality is that, while most people have a vague appreciation that smoking is “bad,” they do not appreciate just how bad it is. In addition, the corrective statements address a wide range of issues, such as nicotine addiction and the fact that light and mild cigarettes are a fraud. These are issues that most people have likely never thought about.</p>
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<span class="caption">Photo of ad in USA Today.</span>
<span class="attribution"><span class="source">Campaign for Tobacco Free Kids</span></span>
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<p>Are these statements the end of the fight? No. Big tobacco is still doing everything it can to prey on its “customers” and protect its profits. The most recent entry into this field is Philip Morris International’s <a href="https://theconversation.com/philip-morris-hides-data-in-plain-sight-on-dangers-of-new-heat-not-burn-product-87636">IQOS</a>, a product that delivers nicotine by heating tobacco without burning it. Like “light” and “mild” Philip Morris International is promoting IQOS as safer than conventional cigarettes even though its own research shows that they are <a href="https://theconversation.com/philip-morris-hides-data-in-plain-sight-on-dangers-of-new-heat-not-burn-product-87636">not detectably different in terms of 24 health measures</a>.</p>
<p>And Philip Morris recently launched the <a href="https://www.smokefreeworld.org/">Foundation for a Smoke-Free World</a>, which, <a href="http://blogs.bmj.com/tc/2017/09/19/a-frank-statement-for-the-21st-century/">like the TIRC of 60 years ago</a>, claims to care about health and be independent of Philip Morris.</p>
<p>Today we know better.</p>
<p><em>All the corrective statements that the tobacco companies have to make are available<a href="https://www.tobaccofreekids.org/assets/content/what_we_do/industry_watch/doj/corrective_statements/2017_10_corrective_statements.pdf"> here.</a></em></p><img src="https://counter.theconversation.com/content/89347/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stanton Glantz receives funding from the National Institutes of Health, the Truth Initiative, and other foundations that work against smoking among youth people.</span></em></p>The journey to the ads that cigarettes companies started running Nov. 26, 2017 about the dangers of smoking and their bad behavior started 64 years ago .Stanton Glantz, Professor of Medicine, University of California, San FranciscoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/887662017-12-08T03:39:08Z2017-12-08T03:39:08ZPeople with mental illness still die a decade earlier than those without<figure><img src="https://images.theconversation.com/files/198114/original/file-20171207-28927-ri9v3a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The largest differences in early death between those with and without mental disorders were for respiratory diseases and alcohol misuse.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/oQ-Y9OvEVBo">Jake Oates</a></span></figcaption></figure><p>Men who are diagnosed with a mental health condition can expect to live 10.2 years less than those who aren’t, according to our new research, published this week in <a href="http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(17)30429-7/fulltext">The Lancet Psychiatry</a>. The life expectancy gap for women with mental illness is 7.3 years earlier those without.</p>
<p>Despite efforts to address the issue, the gap has remained consistent over two decades. However the causes of death have changed: deaths from injury and suicide have decreased, while premature deaths from cancer and heart disease have doubled.</p>
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Read more:
<a href="https://theconversation.com/mental-health-report-card-its-time-to-address-quality-of-life-11001">Mental health report card: it's time to address quality of life</a>
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<p>My colleagues and I analysed medical and hospital data from Denmark over two decades to 2014. While our new study only looked at Danes, past research from Australia found <a href="http://www.bmj.com/content/346/bmj.f2539">supportive results</a>. In 2005, Australian men with a mental illness could expect to live 15.9 years less than men without mental illness. The gap was 12 years for Australian women.</p>
<p>Our new study used a new mathematical approach to calculate life expectancy and life years lost, with more precision than previous research. This allowed us to examine the changes in the cause of death.</p>
<p>The largest differences in early death between those with and without mental disorders were found for respiratory diseases, such as <a href="https://theconversation.com/explainer-what-is-chronic-obstructive-pulmonary-disease-25539">chronic obstructive pulmonary disorders</a> (known as “smoker’s lung”), and alcohol misuse. Deaths involving alcohol still account for the major share of the excess life years lost among people with mental disorders over the past two decades. </p>
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Read more:
<a href="https://theconversation.com/explainer-what-is-chronic-obstructive-pulmonary-disease-25539">Explainer: what is chronic obstructive pulmonary disease?</a>
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<p>Deaths due to suicide and accidents such as car crashes decreased slightly among people with mental illnesses over the past 20 years. These are, however, still major contributors to the life expectancy gap. This is partially related to the mental health disorders themselves, but also to less healthy lifestyles, which might involve high-risk behaviours, such as being under the influence of alcohol or other substances. </p>
<p>Chronic diseases – such as cancer, diabetes and heart disease – are now playing a bigger role in the early death of people with mental health disorders. These people live longer than they used to and are therefore exposed to the risks of developing other age- and lifestyle-related disorders. </p>
<p>People with mental disorders tend to live less healthy lives – in terms of diet, smoking, alcohol consumption, and physical exercise – than the rest of the population. <a href="https://www.sane.org/mental-health-and-illness/facts-and-guides/antipsychotic-medication">Side-effects of anti-psychotic medication</a>, such as weight gain, blurred vision and muscle spasms, can also have a significant impact on the lives of people with severe mental disorders. </p>
<p><a href="http://www.sciencedirect.com/science/article/pii/S0022395610001378?via%3Dihub">Physical conditions are sometimes overlooked</a> in people with mental disorders and tend to be detected later than for other people. People with schizophrenia, for instance, are less likely to be treated for and more likely to die from heart disease. </p>
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Read more:
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<p>Clinicians rightly focus on the mental well-being of people with mental disorders, but more attention needs to directed toward their physical well-being. One way to ensure this occurs is to implement routine screening programs for chronic health conditions in mental health clinics and during admissions to mental health wards. </p>
<p>We need to address the life expectancy gap by approaching mental illness more holistically, and consider the person’s whole health profile, including their lifestyle and the support they need. The health system can no longer simply prescribe medication and send the patient on their way.</p><img src="https://counter.theconversation.com/content/88766/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Annette Erlangsen receives funding from governmental boards and the Dansih Tryg Foundation. </span></em></p>Despite efforts to address the issue, the life expectancy gap between those with and without mental illness has remained consistent over two decades. However the causes of death have changed.Annette Erlangsen, Visiting Fellow, Centre for Mental Health Research, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/734502017-05-04T20:11:04Z2017-05-04T20:11:04ZFood as medicine: how what you eat shapes the health of your lungs<figure><img src="https://images.theconversation.com/files/161268/original/image-20170317-14625-1ooynhw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Shifting your diet away from processed foods and towards fruits and vegetables can reduce symptoms of asthma. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-cute-white-male-kid-black-228411865?src=i0AApem71Mquh8bY8C2_4Q-1-2">from www.shutterstock.com </a></span></figcaption></figure><p><em>This article is part of a three-part package “<a href="https://theconversation.com/au/topics/food-as-medicine-37809">food as medicine</a>”, exploring how food prevents and cures disease. Read other articles in the series <a href="https://theconversation.com/au/topics/food-as-medicine-37809">here</a>.</em></p>
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<p>We all understand that eating too much of the wrong foods – those that are high in energy and low in nutrients, such as fast foods, processed foods and takeaways – causes weight gain and can lead to obesity. These foods are often high in saturated fat, refined carbohydrates (or sugars) and sodium, which increase the risk of developing diabetes, heart disease and some cancers. </p>
<p>But eating poorly has other, somewhat more surprising ramifications. Recently we have come to understand that unhealthy eating patterns can affect our lungs. Switching your diet to one rich in fruit and vegetables could help you breathe easier. </p>
<h2>Healthy diets and healthy lungs</h2>
<p>Most of the epidemiological evidence linking diet with lung function has focused on chronic obstructive pulmonary disease (COPD). Linked to smoking, COPD causes progressive lung deterioration and asthma. </p>
<p>Several large studies have observed people over time, and found that an <a href="http://www.bmj.com/content/350/bmj.h286">unhealthy eating pattern</a> (including refined grains, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2117325/">cured and red meats, desserts and French fries</a>) increases the risk of lung function decline and COPD onset, compared to a <a href="http://ajcn.nutrition.org/content/86/2/488.long">healthy eating pattern</a> (including fruit, vegetables, fish and wholegrains). </p>
<p>A <a href="http://thorax.bmj.com/content/early/2017/01/03/thoraxjnl-2015-207851.long">recent study</a> followed more than 40,000 men for 13 years, and found a high fruit and vegetable intake was associated with reduced risk of COPD. Current and ex-smokers eating five or more serves a day of fruit and vegetables were 30 to 40% less likely to develop COPD compared to those eating fewer than two serves per day. </p>
<p>A <a href="http://erj.ersjournals.com/content/36/4/774.long">three year study</a> in patients with existing COPD revealed those consuming a high fruit and vegetable diet had an improvement in lung function.</p>
<p>In asthma, there is evidence westernised diets, fast foods and processed foods <a href="http://erj.ersjournals.com/content/33/1/33.long">increase the risk of asthma attacks</a>, <a href="http://ajcn.nutrition.org/content/92/2/408.long">lung function decline</a>, <a href="http://www.resmedjournal.com/article/S0954-6111(08)00056-5/abstract">wheeze and breathlessness</a>. </p>
<p>We have tested the effect of a high fruit and vegetable diet in asthma sufferers over three months. We found people consuming seven or more servings of fruit and vegetables per day had a <a href="http://ajcn.nutrition.org/content/96/3/534.long">reduced risk of asthma attacks</a>, compared to people who consumed a low fruit and vegetable diet (fewer than three servings per day).</p>
<p><a href="http://erj.ersjournals.com.content/47/1/122">Another intervention study in asthma</a> used a diet originally designed to reduce high blood pressure – the Dietary Approaches to Stop Hypertension (DASH) diet – for six months. One of the DASH dietary goals was to consume seven to 12 servings of fruit and vegetables, as well as two to four servings of low-fat/fat-free dairy products, and limiting daily fat and sodium intake. This led to improvements in asthma control and quality of life.</p>
<h2>How do fruit and vegetables improve lung health?</h2>
<p>People with respiratory diseases such as COPD and asthma typically suffer from inflamed airways. The airway tissue becomes swollen and hypersensitive, excess mucus is produced and the breathing tubes become damaged, sometimes irreversibly. The resulting narrowing of the airways makes it difficult for air to pass in and out of the lungs. </p>
<p>Failure to breathe freely can very quickly become life threatening. Restricted airflow can also have a debilitating effect on day-to-day activities, causing symptoms such as coughing, wheezing, breathlessness and chest tightness in people with asthma and COPD. </p>
<p>Fruit and vegetables are a rich source of several nutrients, in particular soluble fibre and antioxidants, that have been shown to reduce inflammation in the airways.</p>
<h2>Dietary fibre reduces lung inflammation</h2>
<p>Dietary fibre exists in soluble and insoluble forms. Soluble fibre is fermented by gut bacteria to produce short chain fatty acids. These can <a href="http://www.nature.com/nature/journal/v461/n7268/full/nature08530.html">bind to specific receptors on the surface of immune cells</a>, which <a href="http://www.nature.com/nm/journal/v20/n2/full/nm.3444.html">suppress airway inflammation</a>. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5295101/">We have shown</a> a single dose of soluble fibre activates these receptors and reduces inflammation in human airways within just four hours. </p>
<p>Short chain fatty acids can also inhibit expression of the genes that cause airway inflammation, through a process known as <a href="http://www.nature.com/articles/ncomms8320">epigenetic modification</a>. So a high soluble-fibre intake has the potential to protect against airway inflammation through both activation of anti-inflammatory immune receptors, and inhibition of genes controlling inflammation.</p>
<h2>Antioxidants are also anti-inflammatory</h2>
<p>Antioxidants present in fruit and vegetables – such as vitamin C, carotenoids and flavonoids – are also beneficial, as they can protect against the <a href="http://erj.ersjournals.com/content/21/1/177.long">damaging effects of free radicals</a>, which are highly reactive molecules produced by activated inflammatory cells that can damage asthmatic airways. <a href="http://www.sciencedirect.com/science/article/pii/S0163725809000734">Many observational studies</a> have linked antioxidants with lung health. </p>
<p>However, data from antioxidant supplementation trials in asthma are <a href="http://www.sciencedirect.com/science/article/pii/S0163725809000734">not convincing</a>. Few studies show a beneficial effect, likely due to the use of individual nutrients. Multiple antioxidants exist together in fruit and vegetables, which have interdependent roles that are likely to be critical for their protective effects. So dietary modifications using whole fruit and vegetables is a better strategy.</p>
<p>Sometimes we can become overwhelmed by the nutrition messages in the media, which tell us to eat this and not eat that. Sometimes the advice seems contradictory and confusing. So here is a very simple and focused message for people with respiratory disease - eat more fruit and vegetables! </p>
<p>There’s really nothing to lose and everything to gain. As well as helping to maintain or achieve a healthy weight and reducing the risk of <a href="https://www.nhmrc.gov.au/guidelines-publications/n55">heart disease, diabetes and cancer</a>, you will also be improving your lung health.</p>
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<p><em>Further reading:</em></p>
<p><em><a href="http://theconversation.com/food-as-medicine-why-do-we-need-to-eat-so-many-vegetables-and-what-does-a-serve-actually-look-like-76149">Food as medicine: why do we need to eat so many vegetables and what does a serve actually look like?</a></em></p>
<p><em><a href="http://theconversation.com/food-as-medicine-your-brain-really-does-want-you-to-eat-more-veggies-74685">Food as Medicine: your brain really does want you to eat more veggies</a></em></p><img src="https://counter.theconversation.com/content/73450/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lisa Wood receives funding from the National Health and Medical Research Council of Australia. </span></em></p>Upping your intake of vegetables and fruits can do more than just reduce your risk of heart disease, diabetes and cancer – it could also help you breathe easier.Lisa Wood, Professor, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/624972016-07-18T05:38:35Z2016-07-18T05:38:35ZPhilip Morris speaks at and promotes an obscure conference on lung disease<figure><img src="https://images.theconversation.com/files/130835/original/image-20160718-2147-16b9p2b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Chronic obstructive pulmonary disease (COPD) is one of the most wretched tobacco-caused illnesses.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-203490043/stock-photo-respiratory-oxygen-nasal-catheter-to-the-elder-patient.html?src=5MC0Db60Lun72JPF7GaD5w-1-38">Chris Singshinsuk/Shutterstock</a></span></figcaption></figure><p>Over the past decade, every researcher’s email inbox has been crammed daily with junk from what have come to be known as predatory journals and conferences. Last week I had 21 offers to send my non-existent research to open-access journals from everything from plant biology, metallurgy and human resource management, plus four conferences offering splendid opportunities to showcase my yet-to-be-started work in drug discovery and transplantation. </p>
<p>These emails want you to part with big money to have them publish your paper, sometimes within days, or attend a world conference that sounds like the real deal if you came down in a recent shower. I block and then delete them all, but they change addresses and keep pouring in, often with inane opening lines like “<a href="https://twitter.com/SimonChapman6/status/748114548838653952">refreshing greetings</a>!”</p>
<p>This week my attention was drawn to a Philip Morris International <a href="https://www.pmiscience.com/events/3rd-international-conference-chronic-obstructive-pulmonary-disease">website</a> promoting the 3rd International Conference on Chronic Obstructive Pulmonary Disease being held in Brisbane over two days this week. The <a href="http://copd.conferenceseries.com/scientific-program/">program</a> for the meeting showed just 19 speakers talking across two days, with a bonus of three posters I could look at as well.</p>
<p>This packed program was punctuated by a “group photo”, lunches, an awards ceremony as well as a closing ceremony for those who can’t get too many ceremonies. Exhausted delegates would be set free to “network” and have a refreshment break on at 3.30pm on day two.</p>
<p>Philip Morris International had a staff member on the program flying in all the way from Switzerland to talk in the coveted opening session about “Physiological measures and novel sputum biomarkers to distinguish subjects with mild to moderate COPD from asymptomatic current smokers, former smokers and never smokers.” He was also on the <a href="http://copd.conferenceseries.com/organizing-committee.php">organising committee</a>.</p>
<p>COPD specialists attending no doubt would have been fascinated to learn of Philip Morris’ research dedication to measuring and classifying people with COPD, since <a href="http://www.healthline.com/health/copd/smoking">90%</a> of those with the disease are or have been smokers. The WHO’s <a href="http://www.who.int/respiratory/copd/GOLD_WR_06.pdf">Global Initiative for Chronic Obstructive Lung Disease</a> states that:</p>
<blockquote>
<p>Cigarette smoking is by far the most commonly encountered risk factor for COPD. </p>
</blockquote>
<p>And that:</p>
<blockquote>
<p>In most countries, consultations for COPD greatly outnumbered consultations for asthma, pneumonia, lung and tracheal cancer, and tuberculosis.</p>
</blockquote>
<p>Philip Morris is second only to the Chinese National Tobacco Company in selling the most cigarettes. So over the decades, uncounted millions of some of its best customers have acquired COPD from their addiction to its products.</p>
<p>People living with advanced COPD find their quality of life is often severely reduced, with ordinary tasks such as walking across a room or up a few steps being very difficult. The disease slowly suffocates people to death, sometime over long drawn-out months. It is the most wretched of tobacco-caused diseases.</p>
<p>This “international conference” was organised by conferenceseries.com which is owned by OMICS, one of the most criticised of all predatory conference organisers. If you Google “OMICS predatory” you are deluged with pages of information such as <a href="https://scholarlyoa.com/?s=OMIC">this</a>, <a href="http://cabbagesofdoom.blogspot.com.au/2013/07/omics-group-conferences-sham-or-scam.html">this</a> and <a href="https://en.wikipedia.org/wiki/OMICS_Publishing_Group">this</a>. Reading through such pages you learn of the tiny attendances, the hidden charges (including a paper withdrawal charge if you change you mind), the use of unauthorised names to promote events and much more besides. You read many angry comments from people who have engaged with them.</p>
<p>A year or so ago, when I received an invitation to a junk conference in China, I noticed a colleague’s name and photo on the conference organising page and smelled a rat. He confirmed to me he knew nothing of the conference and that his name and photo had been used without permission.</p>
<p>A delegate to the Brisbane meeting told me:</p>
<blockquote>
<p>yes, it was predatory and they phoned me frequently for me to pay the registration. They asked me to write letters of invitation for other speakers from overseas on my letterhead. I was invited so I got some concessions, and I was invited to give a talk a another local meeting in Brisbane so it all worked out for me – otherwise I wouldn’t have gone and likely won’t go again. There were probably 40-50 people.</p>
</blockquote>
<p>I tweeted news of Philip Morris’ attendance and the European COPD Coalition <a href="https://twitter.com/EU_COPD/status/753203378457575424">replied</a> saying:</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"753203378457575424"}"></div></p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"753203775763013634"}"></div></p>
<p>A tobacco company speaking at a lung disease conference is a bit like a gun lobbyist speaking at a gunshot surgery forum.</p>
<p>The outstanding question for me in all this, is what on earth is Philip Morris trying to achieve by helping organise, attend, speak at and publicise a gnat-sized “conference” on COPD?</p>
<p>Tobacco companies have long sought to bring <a href="http://tobaccocontrol.bmj.com/content/12/suppl_3/iii31.full.pdf+html">scientists into their web</a> through unrestricted slush grants, consultancies, travel, lab support and speaking tours. By helping support scientific conferences such as that in Brisbane, it might hope that opportunities to “network” with potential recruits might arise.</p>
<p>Tobacco companies have run decades-long public narratives about how “more research is needed” and their hand-on-heart desire to develop <a href="http://jech.bmj.com/content/57/8/571.full">reduced-risk products</a> while they continue to do all they can to promote their staple standard products. Conferences like this may be a small brick in that wall.</p>
<p><em>If you’re a researcher and have found yourself at conferences like this, share your experiences below.</em></p><img src="https://counter.theconversation.com/content/62497/count.gif" alt="The Conversation" width="1" height="1" />
Over the past decade, every researcher’s email inbox has been crammed daily with junk from what have come to be known as predatory journals and conferences. Last week I had 21 offers to send my non-existent…Simon Chapman, Emeritus Professor in Public Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/589262016-06-08T20:09:47Z2016-06-08T20:09:47ZHow Australians Die: cause #4 – chronic lower respiratory diseases<figure><img src="https://images.theconversation.com/files/123510/original/image-20160523-9565-qwyae1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Chronic obstructive pulmonary disease (COPD) is responsible for the majority of deaths from chronic lower respiratory diseases.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p><em>This is the fourth in the <a href="https://theconversation.com/au/topics/how-australians-die">How Australians Die</a> series that focuses on the country’s top five causes of death and how we can drive down rates of these illnesses. Tomorrow’s piece will explore the fifth leading cause of death: diabetes. You can read yesterday’s piece on dementia <a href="https://theconversation.com/how-australians-die-cause-3-dementia-alzheimers-57341">here</a>.</em></p>
<hr>
<p>Chronic lower respiratory diseases are a group of conditions affecting the lungs. The group is <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0%7E2014%7EMain%20Features%7ELeading%20Causes%20of%20Death%7E10001">the fourth leading cause of death</a> in Australia. </p>
<p>The three main contributors to the death rate from chronic respiratory diseases are: chronic obstructive pulmonary disease (COPD), asthma and bronchiectasis or permanent damage to the airways. </p>
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<figure><figcaption>The How Australians Die series has combined all cancer deaths to make them the second leading cause of death after heart diseases and stroke. Alzheimer’s is number 3, respiratory diseases number 4 and diabetes number 5.</figcaption></figure>
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<h2>Lung basics</h2>
<p>The lung is like an upside-down tree where the wind pipe (trachea) is the trunk and the bronchi are the branches that get smaller as they branch out deep into the lung. Chronic lower respiratory diseases affect the branches.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/123507/original/image-20160523-9562-1it1w96.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/123507/original/image-20160523-9562-1it1w96.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/123507/original/image-20160523-9562-1it1w96.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/123507/original/image-20160523-9562-1it1w96.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/123507/original/image-20160523-9562-1it1w96.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/123507/original/image-20160523-9562-1it1w96.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/123507/original/image-20160523-9562-1it1w96.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The lung is like an upside-down tree.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Damage to these from toxins, chronic infection or inflammation affects the function of the whole lung. Millions of tiny air sacs (alveoli) are like the leaves surrounded by a network of tiny blood vessels (capillaries). These transport oxygen from the lung to the body via the circulatory system.</p>
<p>If air can’t reach the alveolar air sacs, oxygen can’t be absorbed, body tissues can’t be fuelled and waste gases can’t be expelled efficiently. As compensation, the brain sends signals to increase our breathing, which we experience as feeling short of breath.</p>
<h2>Chronic obstructive pulmonary disease (COPD)</h2>
<p>Chronic obstructive pulmonary disease (COPD) is responsible for the majority of deaths from chronic lower respiratory diseases. In 2014, nearly 7,000 deaths were attributable to COPD and emphysema combined, compared to 411 from asthma. Around 7.5% of people over 40 are <a href="http://www.ncbi.nlm.nih.gov/pubmed/23418694">estimated to have COPD</a> in Australia.</p>
<p>Although factors like pollution can influence the development of COPD, in Australia, <a href="https://theconversation.com/explainer-what-is-chronic-obstructive-pulmonary-disease-25539">cigarette smoke is the largest contributor</a> and it is often thought of as smoker’s lung disease. </p>
<p>COPD is characterised by irreversible narrowing of the bronchi. Chronic inflammation scars and thickens the bronchial walls, obstructing the air flow in and out of the lung. Emphysema is technically a description of the destruction of the alveolar sacs, while COPD is the name given to the disease as a whole, which includes both the bronchial narrowing and the emphysema.</p>
<p>The majority of people with COPD will actually die <a href="http://www.ncbi.nlm.nih.gov/pubmed/16236937">from heart disease</a> – which is the biggest killer in Australia as a whole and is particularly common in people with COPD. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16807258">COPD as cause of death</a> is also likely to be under-reported. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=192&fit=crop&dpr=1 600w, https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=192&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=192&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=241&fit=crop&dpr=1 754w, https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=241&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/123909/original/image-20160525-25231-7yojbi.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=241&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Even with the under-reporting, the rate of death from COPD is increasing, as opposed to the rate of death from heart disease, which <a href="http://theconversation.com/how-australians-die-cause-1-heart-diseases-and-stroke-57423">has decreased</a> over the last few decades. In 2014, <a href="http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3303.02014?OpenDocument">COPD accounted for</a> 4.5% of all deaths, compared to 3.7% in 2005.</p>
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<p>This is mainly due to COPD being associated with ageing, so it’s expected death rates will increase as our population ages. But the <a href="http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs/2013/tobacco/">main preventable risk</a> factor for COPD is cigarette smoking. And while levels in Australia are at a record low, there is a long lag effect, which means we are still seeing results of past high smoking rates coming through. </p>
<p>Lastly, we still have no effective treatments that decrease death from COPD, just those that help with symptoms. The only intervention shown conclusively to reduce death from COPD is quitting smoking. Thankfully, this intervention also reduces the risk of death from other diseases such as heart disease and stroke – which will help people with COPD live longer.</p>
<h2>Asthma</h2>
<p>Compared to COPD, the death rate due to asthma is very low. Asthma is also a disease of the bronchi characterised by acute episodes or “attacks” of bronchial narrowing and obstruction of air flow. </p>
<p>About <a href="http://www.aihw.gov.au/asthma/prevalence/">10% of Australians</a>, or around 2.3 million people, suffer from asthma. Long-standing asthma – which usually begins in childhood – can lead to permanent or irreversible narrowing of the bronchi, particularly if inadequately treated. It may then begin to resemble COPD.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/125308/original/image-20160606-25980-534m03.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/125308/original/image-20160606-25980-534m03.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/125308/original/image-20160606-25980-534m03.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=702&fit=crop&dpr=1 600w, https://images.theconversation.com/files/125308/original/image-20160606-25980-534m03.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=702&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/125308/original/image-20160606-25980-534m03.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=702&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/125308/original/image-20160606-25980-534m03.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=882&fit=crop&dpr=1 754w, https://images.theconversation.com/files/125308/original/image-20160606-25980-534m03.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=882&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/125308/original/image-20160606-25980-534m03.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=882&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Preventer puffers are the main line of treatment for chronic asthma.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>While the rate of asthma cases has increased over the last few decades, the <a href="http://www.ncbi.nlm.nih.gov/pubmed/18827152">rate of death</a> from asthma has decreased. Preventer puffers containing steroid medication are the main line of treatment for chronic asthma. They decrease inflammation inside the asthmatic lung and have been <a href="http://www.ncbi.nlm.nih.gov/pubmed/10922423">shown to prevent</a> death from asthma, as well as improve symptoms and maintain normal lung function. </p>
<p>Death from asthma in Australia now accounts for less than 0.3% of all deaths, or only 1.5 deaths per 100,000 people in 2014. This represents a success story in the management of chronic lower respiratory diseases.</p>
<h2>Bronchiectasis</h2>
<p>Bronchiectasis (from the Greek <em>ektasis</em>, or stretching) is different to bronchitis, which is just inflammation of the bronchi commonly caused by viruses. Brochiectasis occurs when damage to supporting tissue structures of the bronchi make the walls go floppy and enlarge, instead of maintaining their small tubular structure. Dilated bronchi operate inefficiently as mucus collects inside them rather than being expelled, creating an ideal environment for infections. </p>
<p>The disease is characterised by chronic moist cough with phlegm, recurrent infections and breathlessness. Death is often due to complications of the disease, such as infection or major bleeding from the lungs.</p>
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<p>In the general Australian community, bronchiectasis accounts for only 0.2% of all deaths, or 1.3 deaths per 100,000 people. In the Aboriginal and Torres Strait Islander population, the death rate is <a href="http://www.thoracic.org.au/">around six times</a> that of non-indigenous Australians. </p>
<p>Early respiratory infection in Aboriginal and Torres Strait Islanders probably explains its higher prevalence there; partly as a result of bacterial accumulation in the nasal passage from living in close quarters, general social disadvantage and poor access to health care.</p>
<h2>Can we drive down the death rate?</h2>
<p>Finding effective treatments is essential if we want to decrease the death rate from COPD. Until then, prevention – mainly by reducing smoking rates – remains the only hope. </p>
<p>Continuing our success in driving down the asthma death rate relies on encouraging people with asthma to take their prescribed treatments, which are proven to be effective at reducing death, and by addressing the disease’s underlying causes.</p>
<p>Finally, addressing the disparity in death due to bronchiectasis between our Indigenous and non-Indigenous communities by improving living standards and access to health care must be a high priority.</p><img src="https://counter.theconversation.com/content/58926/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Milne receives funding from the National Health and Medical Research Council</span></em></p>The lung is like an upside-down tree where the wind pipe is the trunk and the bronchi are the branches. Chronic lower respiratory diseases affect these branches.Stephen Milne, Respiratory and Sleep Medicine Physician, Researcher, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/572282016-04-26T09:27:04Z2016-04-26T09:27:04ZYour lungs are full of microorganisms … and that’s a good thing<figure><img src="https://images.theconversation.com/files/120063/original/image-20160425-22352-155prtx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The types of bugs that may be calling your lungs home</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-214336648/stock-photo-growth-of-pathogenic-bacteria-populations-populations-from-commercial-toilet-in-petri-dish.html?src=m1iaLRV6vRDo-nk7WcUnlw-1-34">www.shutterstock.com</a></span></figcaption></figure><p>When we’re born, our lungs are thought to be sterile. But from the moment we take our first breath, our pristine lungs are exposed to all the bugs that are in the air. It has become clear in the last 10 years that the lungs rapidly acquire a population of many different microorganisms (mostly bacteria and viruses) that colonise the lungs and remain with us for the rest of our lives. This population of bugs is called the lung microbiome.</p>
<p>We now know more about the lung microbiome thanks to genetics. In the past, identifying the types of bugs present in the lungs depended on being able to grow them in a laboratory, and for many types of bug this was difficult. The big change that happened recently is our ability to recognise both the different bug species, and their relative abundance, by using <a href="https://www.genome.gov/10001177/dna-sequencing-fact-sheet/">DNA sequencing</a>. This can be done either from a sample taken from the lungs or from sputum (the mucus we cough up when we have an infection).</p>
<h2>Is the lung microbiome a good or a bad thing?</h2>
<p>We all know that bacteria in the lungs can be harmful. When harmful bacteria multiply, they cause <a href="http://www.nhs.uk/conditions/pneumonia/Pages/Introduction.aspx">pneumonia</a> which, despite the existence of antibiotics, can still be deadly. However, it seems that the lung microbiome usually exists in a balanced state, such that harmful types of bugs do not increase in number sufficiently to cause pneumonia. In fact, it’s possible that the very presence of such a diverse range of bugs in the lungs is one of the reasons it’s quite difficult for harmful bugs to multiply and cause disease.</p>
<p>There are a number of reasons why the lung microbiome is important. It can alter when we have underlying chest diseases, especially those in which there are marked structural changes in the lungs. A good example is <a href="http://www.nhs.uk/conditions/Cystic-fibrosis/pages/introduction.aspx">cystic fibrosis</a>. In this disorder, a fault in a gene changes a protein that regulates the movement of salt in and out of cells. It results in sticky sputum and infections, which in turn can cause structural damage to the airways – a condition called <a href="http://www.nhs.uk/Conditions/Bronchiectasis/Pages/Introduction.aspx">bronchiectasis</a>. </p>
<p>This makes it easier for some kinds of bacteria – especially <em><a href="https://www.blf.org.uk/support-for-you/pseudomonas">Pseudomonas</a></em> – to grow in the lungs, and it becomes very difficult to get rid of these bacteria. The continuing inflammation in the lungs leads to more damage and the chest disease worsens. Treatment is therefore aimed at trying to eradicate these damaging bacteria, but it’s very difficult to eradicate infection once it has become established.</p>
<p>The difficulties of treating infection in patients with cystic fibrosis have been known for a long time. Recently, attention has been focused on trying to identify if changes in the lung microbiome are present in other more common chest diseases, <a href="http://www.ncbi.nlm.nih.gov/pubmed/27078029">such as asthma</a> or <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+26917613">chronic obstructive pulmonary disease</a> (COPD). Recent work has suggested that the bugs grown from airways in patients with these conditions can be different from bugs grown in healthy people. This raises the intriguing possibility that the different bugs present may, in part, be responsible for either the development of these diseases, or for altering the severity of disease once it develops. </p>
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<img alt="" src="https://images.theconversation.com/files/119641/original/image-20160421-26976-1xeigbi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/119641/original/image-20160421-26976-1xeigbi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/119641/original/image-20160421-26976-1xeigbi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/119641/original/image-20160421-26976-1xeigbi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/119641/original/image-20160421-26976-1xeigbi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/119641/original/image-20160421-26976-1xeigbi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/119641/original/image-20160421-26976-1xeigbi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">COPD symptoms include an ongoing cough that produces a lot of mucus.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-174190997/stock-photo-auscultation-elderly-person.html?src=gEZjH2gL5CnAiGy7z55jIQ-1-2">Image Point Fr</a></span>
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<p>If it does prove to be the case that the different types of bugs in our lungs are in part responsible for development of chest disease, it follows that altering the lung microbiome might be a useful treatment. Directly altering the lung microbiome by administering “friendly” bacteria into the gut or lungs has mostly been <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+26548605">tested in animals</a> to date. There are, however, examples of this approach working in other kinds of disease, particularly for conditions affecting the gut, for example for the <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=PMID%3A+25780308">treatment of irritable bowel syndrome</a>.</p>
<h2>Altering the lung microbiome</h2>
<p>I think the most important question about the lung microbiome is whether or not altering it could be helpful in treating or preventing chest disease. A good example is asthma. It’s well recognised that asthma seems to be more common in countries where early childhood exposure to infection is low. It has also been suggested that this increase in risk is due to lack of exposure to bugs in early life (an idea called the <a href="https://theconversation.com/infants-with-siblings-and-pets-less-likely-to-develop-allergies-9523">hygiene hypothesis</a>. </p>
<p>Some work has suggested that asthma risk could be reduced by encouraging early exposure to bugs, for example by spending more time in dirtier environments such as farms. Whether or not this approach works in the long term remains unclear, but if it does, it seems likely that changes in the lung microbiome may in part be responsible for the beneficial effects.</p><img src="https://counter.theconversation.com/content/57228/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span> I have research grants on asthma and COPD although none are related to work on the lung microbiome.</span></em></p>Understanding the bugs in our lungs could help treat certain diseases, including asthma.Ian Hall, Dean of the Faculty of Medicine and Health Sciences, University of NottinghamLicensed as Creative Commons – attribution, no derivatives.