tag:theconversation.com,2011:/us/topics/lung-disease-1323/articlesLung disease – The Conversation2024-02-27T12:30:24Ztag:theconversation.com,2011:article/2229702024-02-27T12:30:24Z2024-02-27T12:30:24ZOmega-3 fatty acids are linked to better lung health, particularly in patients with pulmonary fibrosis<figure><img src="https://images.theconversation.com/files/577659/original/file-20240223-30-2mxmmk.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3840%2C2160&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Your diet may play a role in maintaining lung health.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/human-respiratory-system-lungs-anatomy-royalty-free-image/1249730889">magicmine/iStock via Getty Images</a></span></figcaption></figure><p>Omega-3 fatty acids have garnered significant interest among patients and clinicians for their potential <a href="https://doi.org/10.3945/an.111.000893">protective health effects</a>, including lung health. In our recently published research, my colleagues and I found that higher dietary intake of omega-3 fatty acids is linked to <a href="https://doi.org/10.1016/j.chest.2023.09.035">better lung function and longer survival</a> in patients with pulmonary fibrosis, a chronic respiratory disease.</p>
<p>Found in foods such as fish and nuts and in some supplements, <a href="https://chem.libretexts.org/Courses/Willamette_University/WU%3A_Chem_199_-_Better_Living_Through_Chemistry/01%3A_Chemicals_in_Food/1.04%3A_Macro-_and_Micronutrients/1.4.02%3A_Fats_and_Cholesterol">omega-3 fatty acids</a> are polyunsaturated fats that are essential nutrients for people. They serve several important functions in the body, such as providing structure to cells and regulating inflammation.</p>
<p>Researchers believe two omega-3 fatty acids, <a href="https://doi.org/10.1042/bst20160474">docosahexaenoic and eicosapentaenoic acids, or DHA and EPA</a>, are the most beneficial to overall health. When the body breaks them down, their byproducts have <a href="https://doi.org/10.1016/j.atherosclerosis.2020.11.018">anti-inflammatory effects</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/577668/original/file-20240223-26-i1nth6.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Chemical structure of EPA and DHA" src="https://images.theconversation.com/files/577668/original/file-20240223-26-i1nth6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/577668/original/file-20240223-26-i1nth6.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=507&fit=crop&dpr=1 600w, https://images.theconversation.com/files/577668/original/file-20240223-26-i1nth6.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=507&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/577668/original/file-20240223-26-i1nth6.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=507&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/577668/original/file-20240223-26-i1nth6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=637&fit=crop&dpr=1 754w, https://images.theconversation.com/files/577668/original/file-20240223-26-i1nth6.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=637&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/577668/original/file-20240223-26-i1nth6.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=637&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">EPA and DHA are two omega-3 fatty acids particularly linked to health benefits.</span>
<span class="attribution"><a class="source" href="https://med.libretexts.org/Courses/Allan_Hancock_College/Introduction_to_Nutrition_Science_(Bisson_et._al)/07%3A_Lipids/7.04%3A_Fatty_Acid_Types_and_Food_Sources">Minutemen/Wikimedia Commons via LibreTexts</a></span>
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<p>I <a href="https://scholar.google.com/citations?user=QeKA8ZoAAAAJ&hl=en">am a pulmonologist</a> at the University of Virginia School of Medicine, and my research team and I are working to identify risk factors that may contribute to the development of <a href="https://www.lung.org/lung-health-diseases/lung-disease-lookup/pulmonary-fibrosis/introduction#">pulmonary fibrosis</a>. In this disease, scarred lung tissue can lead to respiratory failure and death.</p>
<p>We examined whether higher levels of DHA and EPA in the blood of patients with pulmonary fibrosis in different groups of research participants in the U.S. were linked to disease progression. We found that patients with higher levels of omega-3 fatty acids in their blood had a <a href="https://doi.org/10.1016/j.chest.2023.09.035">slower decline in lung function and longer survival</a>. Notably, these findings persisted even after we accounted for other factors such as age and co-occurring diseases. </p>
<h2>Why it matters</h2>
<p>Currently, there are <a href="https://doi.org/10.1111/crj.13466">very few treatments</a> available for pulmonary fibrosis. Those that do exist have significant side effects. Our findings suggest that increasing omega-3 fatty acids in a patient’s diet may slow the progression of this devastating disease.</p>
<p>Researchers have investigated the role of nutrition in many other diseases, but it remains understudied in chronic lung diseases, including pulmonary fibrosis. Our study, along with other published research, suggests <a href="https://doi.org/10.1183/13993003.00262-2023">dietary modifications</a> may influence the trajectory of this disease and improve a patient’s ability to tolerate treatment.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/dQt4_KQUCnk?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Scarring in lung tissue makes it more difficult to breathe.</span></figcaption>
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<p>Furthermore, other studies using mice have shed light on how omega-3 fatty acids may <a href="https://doi.org/10.1186/1471-2466-14-64">protect against pulmonary fibrosis</a> by regulating the activity of inflammatory cells and slowing buildup of scar tissue in the lungs. </p>
<h2>What still isn’t known</h2>
<p>Since we were able to measure omega-3 fatty acid levels in the blood at only one point in time, we could not determine whether changing levels over time correlates with changes in pulmonary fibrosis. </p>
<p>Crucially, it remains unknown whether increasing omega-3 fatty acid levels in the blood will have a meaningful effect on the lives of patients with pulmonary fibrosis. Omega-3 fatty acids in the blood might not directly affect pulmonary fibrosis and may simply reflect healthier lifestyles and diets. </p>
<p>Clinical trials are necessary to actually determine whether omega-3 fatty acids are beneficial for patients with respiratory diseases.</p>
<h2>What’s next</h2>
<p>We plan to continue researching whether omega-3 fatty acids have a protective effect against pulmonary fibrosis. </p>
<p>Specifically, we hope to determine the mechanism by which omega-3-enriched interventions affect the lungs of patients with pulmonary fibrosis. </p>
<p>These will be important steps to identify patients who may be particularly responsive to omega-3 therapies and move these treatments toward clinical testing.</p><img src="https://counter.theconversation.com/content/222970/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Kim receives funding from the National Institute of Health and Chest Foundation. </span></em></p>Essential fats found in fish and nuts are tied to many protective health benefits. Researchers found they may also slow decline of lung function and prolong the lives of pulmonary fibrosis patients.John Kim, Assistant Professor of Medicine, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2177912023-11-16T06:19:20Z2023-11-16T06:19:20ZEngineered stone kills tradies. Bunnings and IKEA stopping its sales is a big win for public health<figure><img src="https://images.theconversation.com/files/559822/original/file-20231116-25-swoqzm.jpg?ixlib=rb-1.1.0&rect=0%2C12%2C4200%2C2345&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/launceston-australia-mar-2022-building-view-2134759163">haireena/Shutterstock</a></span></figcaption></figure><p>Major retailers Bunnings and IKEA have announced this week they will <a href="https://www.abc.net.au/news/2023-11-14/bunnings-to-stop-sale-of-engineered-stone/103104374">discontinue selling engineered stone</a>. While this might mean you have to rethink your plans for your new kitchen benchtops, it’s a positive step that will protect the health of tradespeople exposed to this dangerous product.</p>
<p>Engineered stone contains <a href="https://theconversation.com/renovating-your-kitchen-help-australias-tradies-avoid-silicosis-by-not-choosing-artificial-stone-156208">up to 95% crystalline silica dust</a>. This superfine dust is released into the atmosphere when workers cut, grind or drill engineered stone. </p>
<p>Breathing this dust into the lungs has been linked to serious <a href="https://theconversation.com/engineered-stone-benchtops-are-killing-our-tradies-heres-why-a-bans-the-only-answer-126489">long-term damage</a>, including breathing difficulties, lung cancer and silicosis (scarring of the lungs). </p>
<p>We got to this point through a concerted campaign backed by strong scientific evidence. Let’s take a look.</p>
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<h2>Silicosis is preventable</h2>
<p>In Australia, <a href="https://www.health.gov.au/ministers/the-hon-ged-kearney-mp/media/national-registry-to-fight-silicosis-and-protect-workers#:%7E:text=Nearly%20one%20in%20four%20engineered,in%20Australia%20is%20currently%20unknown">nearly one in four</a> engineered-stone workers employed in the industry before 2018 have already developed silicosis or other silica dust-related diseases as a result of their exposure.</p>
<p>Silicosis is caused by <a href="https://theconversation.com/explainer-what-is-silicosis-and-why-is-this-old-lung-disease-making-a-comeback-80465">breathing in silica dust</a> which becomes embedded in the lungs and causes scarring. This means the person’s lungs can no longer function to their full capacity. Silicosis is a progressive disease, and there’s no cure.</p>
<p>We’ve known about silicosis for many years. Although engineered stone is a particularly potent source of silica dust, it can come from other sources too, such as rock, sand and concrete. It was historically a disease of miners due to their exposure to high dust levels. </p>
<p>Until the past few years, we were seeing a decline in silicosis numbers in Australia and internationally. But we’re now seeing a significant resurgence, due in a large part to the <a href="https://onlinelibrary.wiley.com/doi/10.1111/all.14202">popularity of engineered stone</a>.</p>
<p>My colleagues and I released <a href="https://www.curtin.edu.au/about/wp-content/uploads/sites/5/2022/07/FEFreport_formatted.pdf">a report</a> last year which looked at how many Australian workers would develop silicosis and lung cancer as a result of their exposure to silica dust. We also looked at the effect of possible interventions to reduce or eliminate this exposure.</p>
<p>Our analysis found the lives of around <a href="https://theconversation.com/banning-artificial-stone-could-prevent-100-lung-cancers-and-1-000-cases-of-silicosis-where-dust-scars-the-lungs-182420">1,000 workers could be saved</a> from silicosis if a ban on engineered stone was implemented. In addition, around 100 lung cancers would also be prevented over the lifetime of these workers. </p>
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Read more:
<a href="https://theconversation.com/banning-artificial-stone-could-prevent-100-lung-cancers-and-1-000-cases-of-silicosis-where-dust-scars-the-lungs-182420">Banning artificial stone could prevent 100 lung cancers and 1,000 cases of silicosis, where dust scars the lungs</a>
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<p>While some lives could be saved by other measures, such as wearing well-fitted respirators and using water when cutting engineered stone to reduce the dust levels, we calculated that the impact of a ban was much greater. These control measures also rely on compliance to be effective.</p>
<h2>How did we get here?</h2>
<p>The move – first taken by Bunnings, and soon after by IKEA – follows a concerted effort led by the Australian Council of Trade Unions (ACTU) over the past few years. The ACTU formed a consortium of organisations all working towards <a href="https://beta.actu.org.au/media-release/calls-intensify-for-ban-on-lethal-engineered-stone/">a ban on engineered stone</a> to protect workers’ lives. </p>
<p>These organisations included the <a href="https://lungfoundation.com.au/">Lung Foundation</a>, the <a href="https://www.cancer.org.au/">Cancer Council</a>, the <a href="https://www.aioh.org.au/">Australian Institute of Occupational Hygienists</a> and the <a href="https://www.phaa.net.au/">Public Health Association of Australia</a>. Our report was used to inform the campaigning by these organisations.</p>
<p>Members of the Construction Forestry Mining and Energy Union (CFMEU) staged <a href="https://www.dailymail.co.uk/news/article-12656047/Workers-protests-Bunnings-killer-stone.html">protests at Bunnings stores</a> earlier this year to encourage them to stop the sale of engineered stone products in their stores. In addition, the CFMEU and the wider union movement have vowed to stop their members from using engineered stone <a href="https://www.australianunions.org.au/2023/10/24/unions-vote-to-ban-engineered-stone/">if a wider ban is not instituted</a>. </p>
<p>Alongside this effort, we’ve seen numerous stories of everyday Australians – people who have <a href="https://www.abc.net.au/news/2021-07-15/silicosis-workers-engineered-stone-dust-disease-taskforce-report/100295818">worked with engineered stone</a>, <a href="https://www.9news.com.au/national/silica-office-admin-worker-joanna-mcneill-contracts-silicosis/d64f8661-8bca-4b6f-b950-a1d64e13e421">quarry workers</a> and others – who have been diagnosed with silicosis. In many cases these have been young and otherwise healthy people.</p>
<h2>No safe level</h2>
<p>Our research added to evidence gathered by the Australian Institute of Occupational Hygienists that showed there was <a href="https://www.aioh.org.au/product/consultation-on-the-prohibition-on-the-use-of-engineered-stone/">no practical way</a> this product could be used safely. Based on the weight of this evidence, <a href="https://www.safeworkaustralia.gov.au/doc/decision-regulation-impact-statement-prohibition-use-engineered-stone">Safe Work Australia</a> recently recommended a complete ban on engineered stone. </p>
<p>State and territory ministers in the portfolio of work health and safety <a href="https://www.dewr.gov.au/work-health-and-safety/resources/work-health-and-safety-ministers-meeting-27-october-2023">met late last month</a> to discuss the possibility of a ban. So far, governments in <a href="https://greekherald.com.au/politics/nsw-set-to-ban-engineered-stone-benchtops-by-end-of-2023/">New South Wales</a> and <a href="https://www.abc.net.au/news/2023-11-12/act-government-to-ban-engineered-stone-one-way-or-another/103095626">the Australian Capital Territory</a> have indicated they will move towards a ban on engineered stone in the coming months if the federal government does not. It is thought that several other states would also support it.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/renovating-your-kitchen-help-australias-tradies-avoid-silicosis-by-not-choosing-artificial-stone-156208">Renovating your kitchen? Help Australia's tradies avoid silicosis by not choosing artificial stone</a>
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<p>There is clear momentum towards a ban on engineered stone, and we urge the federal government to implement this as soon as possible. This will ensure a unified, nationally consistent response. We would also encourage other businesses to follow the lead of Bunnings and IKEA.</p>
<p>While ministers deferred their decision on a ban when <a href="https://www.dewr.gov.au/work-health-and-safety/resources/work-health-and-safety-ministers-meeting-27-october-2023">they met last month</a>, we hope this issue will be resolved when they next meet in December. Continued use of engineered stone will only result in more illness and death among Australia’s tradies. There’s a real opportunity here to make a big difference to public health.</p><img src="https://counter.theconversation.com/content/217791/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Our report was commissioned by the Australian Council of Trade Unions (ACTU). </span></em></p>Engineered stone is a popular material often used for kitchen benches. But it carries serious health risks for the tradies who work with it.Renee Carey, Senior Research Fellow, School of Population Health, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag: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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<p>
<em>
<strong>
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>
<figure class="align-center zoomable">
<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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<p>
<em>
<strong>
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>
</strong>
</em>
</p>
<hr>
<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>
<hr>
<p>
<em>
<strong>
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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<hr>
<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>
<hr>
<p>
<em>
<strong>
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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</em>
</p>
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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/2113772023-08-27T05:40:55Z2023-08-27T05:40:55ZTB research shows a good diet can cut infections by nearly 50%<p>For centuries, we have known that tuberculosis is a social disease. It thrives on poverty and social factors such as malnutrition, poor housing, overcrowding, unsafe work environments and stigma.</p>
<p>Globally in 2021 an estimated 2.2 million cases of TB were <a href="https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022/uhc-tb-determinants/6-3-tb-determinants">attributable</a> to undernourishment, 0.86 million to HIV infection, 0.74 million to alcohol use disorders, 0.69 million to smoking and 0.37 million to diabetes.</p>
<p>But knowledge about social determinants alone does not always translate into tangible action and progress. A new trial in India, called <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01231-X/fulltext">RATIONS</a>, aimed to determine the effect of nutritional supplementation on new cases of tuberculosis in households of adults with pulmonary TB. The research found that providing food baskets to people with TB and their households could go a long way to prevent and mitigate the disease. </p>
<h2>No easy silver bullets</h2>
<p>The TB community has typically looked for biomedical solutions, or “silver bullets”, for a social pathology, and we are struggling to make progress.</p>
<p>Since the COVID pandemic, TB mortality and incidence have increased globally, putting TB back on top as the single most deadly infectious killer of humankind. </p>
<p>In 2021, 1.6 million people <a href="https://www.who.int/publications/i/item/9789240061729">died</a> of TB. In <a href="https://worldhealthorg.shinyapps.io/tb_profiles/?_inputs_&lan=%22EN%22&entity_type=%22group%22&group_code=%22AFR%22">Africa</a>, TB incidence is high (212 per 100,000 population) with a high case fatality rate because of the HIV epidemic. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tuberculosis-on-the-rise-for-first-time-in-decades-after-covid-19-interrupted-public-health-interventions-and-increased-inequality-207478">Tuberculosis on the rise for first time in decades after COVID-19 interrupted public health interventions and increased inequality</a>
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</em>
</p>
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<p><a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30792-1/fulltext">Undernutrition</a> is the most important cause of TB. This has been shown in studies in many countries, including <a href="http://www.scielo.org.za/pdf/hsa/v26/23.pdf">South Africa</a>, where researchers found poor levels of nutrition in patients admitted to a specialised TB hospital.</p>
<p>Malnutrition refers to all forms of deficiencies in nutrition, including over-nutrition and obesity. Undernutrition refers more specifically to a deficiency of nutrients. </p>
<p>While we know that many patients with TB have poor nutrition, the latest evidence is that undernutrition also plays a key role in TB within households. </p>
<p>The <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01231-X/fulltext">results</a> of the Reducing Activation of Tuberculosis by Improvement of Nutritional Status (RATIONS) trial show that improved nutrition in family members of patients with lung TB reduced all forms of TB by nearly 40%, and infectious TB by nearly 50%.</p>
<p>This trial recruited 10,345 household members of 2,800 patients with lung TB.</p>
<ul>
<li><p>All TB patients received a monthly 10kg food basket (rice, pulses, milk powder, oil) and multivitamins for six months. </p></li>
<li><p>In one group family members received 5kg rice and 1.5kg pulses per person per month, while the other group of family members did not get food baskets.</p></li>
</ul>
<p>Food worked like a vaccine in this trial, cutting the risk of household members developing TB. </p>
<p>Nutrition could also protect against other conditions such as anaemia, diarrhoea and respiratory infections, but these were not not the main focus of the trial.</p>
<p>An <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(23)00324-8/fulltext">accompanying paper</a>, based on the results of the RATIONS trial, showed that severe undernutrition was present in nearly half of all patients.</p>
<p>An early weight gain in the first two months was associated with 60% lower risk of TB mortality. The other benefits were higher treatment success and better weight gain. During the six-month follow-up period, a remarkable treatment success rate of 94% was achieved.</p>
<h2>Getting food to patients</h2>
<p>How expensive was the intervention? The cost of a food basket was US$13 per TB patient per month and US$4 per household member per month and could be delivered, even in rural areas, using field staff.</p>
<p>Even before the <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01231-X/fulltext">RATIONS</a> trial, the Indian government had recognised the need for nutrition support for people with TB, and in 2018 launched “Nikshay Poshan Yojana”, a <a href="https://tbcindia.gov.in/WriteReadData/l892s/6851513623Nutrition%20support%20DBT%20Scheme%20details.pdf">direct benefit transfer</a> scheme. Under this scheme, each TB patient receives a financial incentive of US$6 per month for the duration of the anti-TB treatment (typically, six months for people with drug-sensitive TB).</p>
<p>Emerging <a href="https://www.ijhpm.com/article_4192.html">data</a> suggests that while the scheme improves the treatment completion rates among patients with TB in India, they often receive their payments late. There is a need to improve the efficiency and provide timely payments.</p>
<p>The new <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01231-X/fulltext">RATIONS</a> trial suggests that directly providing food baskets may be another effective strategy. </p>
<p>Many countries, including India, have other social security programmes, <a href="https://nfsa.gov.in/portal/PDS_page">including public distribution systems </a> to provide food grains at subsidised prices. Using existing channels to provide extra food rations to people with TB, and expanding the menu to include proteins such as pulses and millets, is a strategy worth exploring. This could also have positive effects on other diseases such as diabetes.</p>
<h2>Implications for South Africa</h2>
<p>South Africa is one of the countries labelled by the World Health Organization as a <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00286-9/fulltext#:%7E:text=South%20Africa%20is%20among%20WHO's,notified%20tuberculosis%20in%20the%20world.&text=WHO%20global%20lists%20of%20high,2021%E2%80%932025%3A%20background%20document.">“high TB burden country</a>”. </p>
<p>What does this latest research mean for South Africa? Statistics South Africa <a href="https://www.statssa.gov.za/?p=16235">reported</a> that in 2021 2.6 million people had inadequate access to food and a further 1.1 million stated they had “severe” inadequate access to food. More than 683,000 children five years and younger experienced hunger. </p>
<p>This toxic mix requires prevention of TB by nutritional support, drugs to prevent TB infections and early diagnosis with molecular tests and treatment. </p>
<p>With high levels of food insecurity and undernutrition in South Africa, fuelled by the highest levels of <a href="https://www.imf.org/en/News/Articles/2020/01/29/na012820six-charts-on-south-africas-persistent-and-multi-faceted-inequality">inequality</a>, it is critical that South Africa includes social benefits for people with TB and those in their households to reduce the prevalence of TB in the country and to meet the <a href="https://www.who.int/data/gho/data/themes/topics/sdg-target-3_3-communicable-diseases">Sustainable Development Goals for 2030</a>.</p>
<p>Regardless of how social benefits are distributed, action must be based on evidence. We need better tests, cures and vaccines for TB, but they alone cannot end the epidemic.</p>
<p>TB patients must be provided with the social benefits that they need and deserve, as a basic human right.</p><img src="https://counter.theconversation.com/content/211377/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yogan Pillay is a director with the Bill and Melinda Gates Foundation </span></em></p><p class="fine-print"><em><span>Madhukar Pai reports that he has no financial or industry conflicts. He serves as an advisor to the following non-profit global health agencies; World Health Organization, Foundation for Innovative New Diagnostics, Geneva, Bill & Melinda Gates Foundation and Stop TB Partnership.</span></em></p>TB is the single most deadly infectious killer of humankind. New research shows food and proper nutrition work like a vaccine against the disease.Yogan Pillay, Extraordinary Professor in the Division of Health Systems and Public Health, Stellenbosch UniversityMadhukar Pai, Canada Research Chair of Epidemiology & Global Health, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1921982022-10-12T10:06:31Z2022-10-12T10:06:31ZFrom e-cigarettes to hookah pipes, South Africa aims to tighten tobacco laws<figure><img src="https://images.theconversation.com/files/489026/original/file-20221010-22-5b5ku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"> It's estimated that tobacco use kills half of it's consumers.</span> <span class="attribution"><span class="source">Alexander Joe/AFP via Getty Images</span></span></figcaption></figure><p><em>Tobacco is a <a href="https://www.afro.who.int/health-topics/tobacco-control">leading cause of disease</a>. It is estimated that it kills half of its consumers. Over a million additional deaths result from exposure to second hand smoke. Countries around the world are moving towards stricter regulation of tobacco products in compliance with their obligation to the World Health Organisation’s (WHO) <a href="https://fctc.who.int/who-fctc/overview">Framework Convention on Tobacco Control</a>. In <a href="https://www.afro.who.int/news/who-supports-south-africas-draft-bill-control-tobacco-products-and-electronic-delivery-systems">2018</a> South Africa published a tobacco control bill that sought to better regulate the sale of cigarettes and other tobacco products. It’s been revised as the <a href="https://www.youtube.com/watch?v=mXjRz9f2lts">Tobacco Products and Electronic Delivery Systems Control Bill 2021</a> and has been approved for submission to parliament. Ina Skosana speaks to Catherine Egbe, a lead researcher on <a href="https://www.samrc.ac.za/sites/default/files/attachments/2022-05-31/GATSFactsheet.pdf">South Africa’s Global Adult Smoking Survey</a>, about the latest developments.</em></p>
<hr>
<h2>Why has it taken so long to bring the bill before parliament?</h2>
<p>The bill was first released for public comments <a href="https://theconversation.com/how-south-africa-is-tightening-its-tobacco-rules-97382">in 2018</a>. After reviewing all the comments, the Department of Health had to do more consultations and update the 2018 version.</p>
<p>Under normal circumstances the process would not take this long. Introducing a law that is focused on protecting people’s health, and impacts on the big industries that make money off the products, will always be a challenge, no matter how harmful the products are.</p>
<p>Bills that have a wider impact on society usually take longer to pass because the consultation process takes time, but a delay of four years is not ideal. </p>
<p>We are happy that the bill is back on track. </p>
<h2>What are the major changes to the 2018 version of the bill?</h2>
<p>The first improvement is that it takes care of novel products – these now go beyond just e-cigarettes to include oral nicotine pouches, and other novel products related to tobacco or nicotine. It also includes future innovations that the industry may come up with.</p>
<p>The tobacco control landscape is very dynamic in terms of product types. One of the key problems we’re having today in South Africa is that the existing law doesn’t regulate electronic cigarettes or other novel products. </p>
<p>So you need a law that takes into account that there could be changes even tomorrow. The current bill, therefore, takes care of future innovations so that such products can fall within the tobacco regulatory framework in South Africa.</p>
<h2>What are the chances of this bill being passed?</h2>
<p>The administrative and political leadership of the Department of Health is committed to, and passionate about protecting South Africans from tobacco related harms. But it’s not in their hands anymore. They’ve done their part. It’s now left to the members of parliament and the public to make this bill become law. This is where citizens’ action will make impact. They must put pressure on parliament to pass this bill. The health of the nation should take precedence over profit from tobacco. </p>
<h2>Why is it important to update restrictions on tobacco use?</h2>
<p>South Africa introduced the very first <a href="https://www.gov.za/documents/tobacco-products-control-act#:%7E:text=The%20Tobacco%20Products%20Control%20Act,provide%20for%20matters%20connected%20therewith">Tobacco Control Act</a> in the 1990s. That law has been updated three times – in 1999, 2007, 2008. </p>
<p>The initial law came into place way before the WHO treaty and before many of these novel products were available. As a signatory to the WHO tobacco control framework, South Africa must make its laws align with the WHO treaty. </p>
<p>In the 1990s the country was a regional leader in tobacco control. It had some of the most stringent tobacco control laws. But the tobacco industry has since come up with new products and ways around the restrictions. South Africa has now fallen behind the rest of the world. As a result, South Africa has regressed and smoking prevalence has steadily increased over the past couple of years.</p>
<p>When the country first introduced tobacco control legislation, it had a smoking prevalence of over <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1758983/pdf/v001p00272.pdf">30%</a>. This subsequently fell to as low as 16% in 2010. But is has began to increase.</p>
<p>We’ve been monitoring the trends of tobacco use. One of the surveys I have been using is the <a href="https://hsrc.ac.za/special-projects/sasas/">South African Social Attitudes Survey</a>. </p>
<p>The global adult tobacco survey, which we conducted <a href="https://www.samrc.ac.za/sites/default/files/attachments/2022-05-31/GATSFactsheet.pdf">last year</a>, shows that 29.4% of South Africans use various tobacco products. And 25.8% smoke tobacco. This is proof that the current law is obsolete. It’s not doing what it’s supposed to do – which is to drive down the tobacco use prevalence. </p>
<h2>What are the main drivers of increase in smoking prevalence?</h2>
<p>The industry is using many tactics to get young people to start smoking. In the global adult tobacco survey, we found that the average age of initiation of smoking in South Africa was 17.6 years. About 74% of current smokers started when they were teenagers. So what does the industry do? It employs what I call the “catch them young” approach. It tries to target these young people to get them hooked on nicotine.</p>
<p>Nicotine is one of the most <a href="https://www.fda.gov/tobacco-products/health-effects-tobacco-use/nicotine-why-tobacco-products-are-addictive">addictive</a> drugs. Once hooked, the smoker keeps looking for the product. That’s why the industry targets young people by using celebrities on social media, and new products that contain exotic flavours. Exotic flavours <a href="https://tobaccocontrol.bmj.com/content/25/Suppl_2/ii32">appeal more</a> to children than adults. </p>
<p>Then electronic cigarettes came on board. Nicotine is one of the common components between electronic cigarettes and traditional tobacco products. </p>
<p><a href="https://tobacco.ucsf.edu/convincing-analysis-e-cigs-are-gateway-cigarette-smoking-studies-around-world">Studies </a> from around the world show that some people who may not have smoked, ended up smoking traditional products after starting with electronic cigarettes.</p>
<h2>What are the risks of not regulating tobacco products?</h2>
<p>Any delay in controlling tobacco will cause a lot of deaths from tobacco related diseases. Tobacco is one of the leading causes of noncommunicable diseases. These conditions are the leading cause of death in South Africa and in many parts of the world. If the legislation is delayed further, more young people are at risk of getting hooked on nicotine, with dire consequences.</p>
<p>In 2016, the healthcare <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822111/">cost</a> of tobacco use was R14.48 billion in South Africa. The tobacco industry only <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822111/">contributed</a> about R12 billion in taxes. So at the end of the day, who is benefiting more from tobacco?</p><img src="https://counter.theconversation.com/content/192198/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine O. Egbe, PhD has received research grant from the Campaign For Tobacco-Free Kids. </span></em></p>South Africa was once a leader in tobacco use control but has since fallen behind, and smoking prevalence has steadily increased.Catherine O. Egbe, PhD, Specialist Scientist, Alcohol Tobacco and Other Drug Research Unit, South African Medical Research CouncilLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1880412022-09-28T20:13:23Z2022-09-28T20:13:23ZWhy Viagra may be useful in treating lung diseases<figure><img src="https://images.theconversation.com/files/487160/original/file-20220928-6321-to39aq.jpg?ixlib=rb-1.1.0&rect=52%2C70%2C910%2C589&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The blood vessel dilation caused by sildenafil (Viagra) can be beneficial in lung diseases such as pulmonary arterial hypertension or idiopathic pulmonary fibrosis.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>You may be surprised to learn that the medication sildenafil — better known by its brand name Viagra — has other medical purposes aside from treating male erectile dysfunction. It can also be used to treat lung diseases that often have poor prognoses.</p>
<p>Sildenafil works by inhibiting an enzyme called phosphodiesterase. Through <a href="https://doi.org/10.1038/nrd2030">a complex pathway involving other molecules</a>, sildenafil ultimately helps smooth muscles relax and blood vessels dilate. The latter effect is known as vasodilation. Vasodilation results in more blood flow to organs — whether that organ is the penis or the lungs.</p>
<h2>Lung diseases</h2>
<p>The vasodilation caused by sildenafil can be beneficial in lung diseases such as pulmonary arterial hypertension (PAH) or idiopathic pulmonary fibrosis (IPF). People living with PAH and IPF experience progressive shortness of breath and chronic cough. In addition to lungs, PAH and IPF can affect many other organ systems. </p>
<p>PAH is a disease causing breathing difficulties and heart strain due to elevated pressure in the arteries of the lung, which were designed for much lower pressures. Thankfully, <a href="https://rarediseases.org/rare-diseases/pulmonary-arterial-hypertension/">it is a rare disease, affecting one or two individuals per 1,000,000 persons each year</a>. </p>
<p>IPF is a more common lung disease with between <a href="https://rarediseases.org/rare-diseases/idiopathic-pulmonary-fibrosis/">two and 29 people per 100,000 developing the condition per year</a>. It occurs due to repeated and chronic thickening, stiffening and scarring (fibrosis) of the lungs. </p>
<p>Both diseases often do not have a clear etiology, meaning that doctors and researchers do not fully understand why these diseases begin and progress. Both diseases are incurable, and frequently get worse over time despite our best treatment options. There are currently few effective treatments, and there is always interest in finding more. </p>
<h2>Evidence for sildenafil in PAH</h2>
<figure class="align-center ">
<img alt="Illustration of human respiratory system with lungs in red and yellow against a blue background" src="https://images.theconversation.com/files/487162/original/file-20220928-8992-z4f7qh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/487162/original/file-20220928-8992-z4f7qh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/487162/original/file-20220928-8992-z4f7qh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/487162/original/file-20220928-8992-z4f7qh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/487162/original/file-20220928-8992-z4f7qh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/487162/original/file-20220928-8992-z4f7qh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/487162/original/file-20220928-8992-z4f7qh.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">There are currently few effective treatments for pulmonary arterial hypertension or idiopathic pulmonary fibrosis.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>The use of sildenafil in PAH is already well established, effective and approved in Canada. There are several high quality randomized controlled trials that have demonstrated its efficacy to <a href="http://doi.org/10.1056/NEJMoa050010">improve exercise capacity and symptom burden</a>. Sildenafil is usually branded as Revatio in PAH (instead of Viagra for erectile dysfunction), although there is little difference between Viagra and Revatio except that patients typically take Revatio <a href="https://www.drugs.com/revatio.html">three times per day in smaller doses</a>. </p>
<p>Our recent publication <a href="http://doi.org/10.1183/16000617.0036-2022">synthesized the evidence for multiple PAH treatments</a>. We looked at combinations of sildenafil or another drug in the same class — such as tadalafil (brand name Cialis) or vardenafil (brand name Levitra) — with another commonly used PAH medication. </p>
<p>The results showed the number of clinical worsening events such as disease progression or hospitalization were reduced by 12.7 per cent compared to placebo. Markers of exercise capacity, measured by a six-minute walk test, were also improved by almost 50 meters. </p>
<h2>Evidence for sildenafil in IPF</h2>
<p>The use of sildenafil in IPF is much less certain, as there have been few randomized controlled trials, which are considered the gold standard of evidence. Just four trials have investigated its use in IPF. <a href="http://newzcap.com/does-viagra-reduce-mortality-in-pulmonary-fibrosis-does-viagra-reduce-mortality-in-pulmonary-fibrosis/">A meta-analysis of this small number approached statistical significance, which suggests that benefits would become evident if more trials were completed</a>.</p>
<p>The most recent <a href="https://www.thoracic.org/education-center/ild/pdf/ATS%20Pocket%20Guide_v1.pdf">European Respiratory Society / American Thoracic Society guidelines</a> addressing the question recommended against the use of sildenafil in IPF due to a lack of data. </p>
<p>However, recently a drug (treprostinil) that acts similarly to sildenafil showed promise in patients with combined interstitial lung disease (an umbrella term of lung diseases that includes IPF) and pulmonary hypertension. The <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2008470">greatest effect seen in patients with diagnosed interstitial lung disease</a>. </p>
<p>This further demonstrates the potential promise of drugs like sildenafil or similar vasodilation mechanisms in managing IPF.</p>
<h2>Why this matters</h2>
<p>For conditions like PAH or IPF that are incurable, re-purposing drugs like sildenafil has merit. For one thing, it is very expensive to develop new drugs. For another, there are more concerns about safety with new drugs; since Viagra is widely used, the side-effect profile is well known in the medical community. </p>
<p>For example, sildenafil is known to cause low blood pressure and should be avoided in people with conditions making them susceptible to hypotension or taking specific anti-high blood pressure medications. Other common side-effects include flushing, headaches and vision changes, among others. </p>
<p>While sildenafil may not be the magic pill for all lung diseases, it’s clear that it has promising uses that go beyond erectile dysfunction.</p><img src="https://counter.theconversation.com/content/188041/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dena Zeraatkar receives funding from the Banting postdoctoral scholarship. </span></em></p><p class="fine-print"><em><span>Jasmine Mah is an Internal Medicine resident with Nova Scotia Health and receives scholarships supporting her PhD research from the Department of Medicine at Dalhousie University, Dalhousie Medical Research Foundation, Dr. Patrick Madore Foundation, and the Pierre Elliott Trudeau Foundation. She is affiliated with the Canadian Consortium on Neurodegeneration in Aging (CCNA) Team 14, which investigates how multi-morbidity, frailty and social context modify risk of dementia and patterns of disease expression. The CCNA receives funding from the Canadian Institutes of Health Research (CNA-137794) and partner organizations (<a href="http://www.ccna-ccnv.ca">www.ccna-ccnv.ca</a>). The affiliations/funders had no input into any aspect of this subject or article.</span></em></p><p class="fine-print"><em><span>Tyler Pitre does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Sildenafil — better known as Viagra — may be helpful in treating lung diseases like pulmonary arterial hypertension and idiopathic pulmonary fibrosis, for which there are few effective treatments.Tyler Pitre, MD (Internal medicine physician), McMaster UniversityDena Zeraatkar, Assistant professor, Health Research Methods Evidence and Impact and Anesthesiology, McMaster UniversityJasmine Mah, MD (Internal Medicine Resident) & PhD candidate (Focus on Geriatrics), Dalhousie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1895162022-09-22T12:39:51Z2022-09-22T12:39:51ZCOVID-19 can cause lasting lung damage – 3 ways long COVID patients’ respiration can suffer<figure><img src="https://images.theconversation.com/files/485402/original/file-20220919-12-mtp5y0.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2944%2C2036&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Lung disease can manifest in a number of ways.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/lung-3d-rendering-imaging-royalty-free-image/1214718462">Mr. Suphachai Praserdumrongchai/iStock via Getty Images Plus</a></span></figcaption></figure><p>“I just can’t do what I used to anymore.” </p>
<p>As <a href="https://uvahealth.com/findadoctor/profile/jeffrey-m-sturek">pulmonologists and</a> <a href="https://uvahealth.com/findadoctor/profile/alexandra-kadl">critical care doctors</a> treating patients with lung disease, we have heard many of our patients recovering from COVID-19 tell us this even months after their initial diagnosis. Though they may have survived the most life-threatening phase of their illness, they have yet to return to their pre-COVID-19 baseline, struggling with activities ranging from strenuous exercise to doing laundry. </p>
<p>These lingering effects, called <a href="https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html">long COVID</a>, have affected as many as <a href="https://www.statnews.com/2022/07/06/understanding-long-covid-estimates/">1 in 5 American adults diagnosed with COVID-19</a>. Long COVID includes a <a href="https://doi.org/10.1038/s41591-022-01909-w">wide range of symptoms</a> such as brain fog, fatigue, cough and shortness of breath. These symptoms can result from damage to or malfunctioning of <a href="https://doi.org/10.1038/s41591-021-01283-z">multiple organ systems</a>, and understanding the causes of long COVID is a special research focus of the <a href="https://www.hhs.gov/about/news/2022/08/03/biden-harris-administration-releases-two-new-reports-long-covid-support-patients-further-research.html">Biden-Harris administration</a>.</p>
<p>Not all breathing problems are related to the lungs, but in many cases the <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/what-coronavirus-does-to-the-lungs">lungs are affected</a>. Looking at the lungs’ basic functions and how they can be affected by disease may help clarify what is on the horizon for some patients after a COVID-19 infection.</p>
<h2>Normal lung function</h2>
<p>The <a href="https://www.ncbi.nlm.nih.gov/books/NBK539907/">main function of the lungs</a> is to bring oxygen-rich air into the body and expel carbon dioxide. When air flows into the lungs, it is brought into close proximity with the blood, where oxygen diffuses into the body and carbon dioxide diffuses out. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/WIAoGZPw0zE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The lungs bring oxygen into and carbon dioxide out of the body.</span></figcaption>
</figure>
<p>This process, as simple as it sounds, requires an extraordinary coordination of air flow, or ventilation, and blood flow, or perfusion. There are <a href="https://www.ncbi.nlm.nih.gov/books/NBK537353/">over 20 divisions</a> in your airway, starting at the main windpipe, or the trachea, all the way out to the little balloons at the end of the airway, called alveoli, that are in close contact with your blood vessels. </p>
<p>By the time a molecule of oxygen gets down to the end of the airway, there are about <a href="https://doi.org/10.1164/rccm.200308-1107OC">300 million</a> of these little alveoli it could end up in, with a total surface area of <a href="https://www.healthline.com/health/alveoli-function#alveoli-structure">over 1,000 square feet (100 square meters)</a> where gas exchange occurs.</p>
<p>Matching ventilation and perfusion rates is critical for basic lung function, and damage anywhere along the airway can lead to difficulty breathing in a number of ways.</p>
<h2>Obstruction – decreased airflow</h2>
<p>One form of lung disease is obstruction of airflow in and out of the body.</p>
<p><a href="https://doi.org/10.1016/j.jaci.2010.01.003">Two common causes</a> of impairments like these are chronic obstructive pulmonary disease and asthma. In these diseases, the airways become narrowed because of either damage from smoking, as is common in COPD, or allergic inflammation, as is common in asthma. In either case, patients experience difficulty blowing air out of their lungs. </p>
<p>Researchers have observed ongoing airflow obstruction in <a href="https://doi.org/10.1148/radiol.212170">some patients who have recovered from COVID-19</a>. This condition is typically treated with inhalers that deliver <a href="https://doi.org/10.1016%2Fj.rmed.2021.106401">medications that open up the airways</a>. Such treatments may also be helpful while recovering from COVID-19.</p>
<h2>Restriction – reduced lung volume</h2>
<p>Another form of lung disease is referred to as <a href="https://www.ncbi.nlm.nih.gov/books/NBK560880/">restriction</a>, or difficulty expanding the lungs. Restriction decreases the volume of the lungs and, subsequently, the amount of air they can take in. Restriction often results from the formation of scar tissue, also called <a href="https://www.mayoclinic.org/diseases-conditions/pulmonary-fibrosis/symptoms-causes/syc-20353690">fibrosis</a>, in the lungs due to injury. </p>
<p>Fibrosis thickens the walls of the alveoli, which makes gas exchange with the blood more difficult. This type of scarring can occur in chronic lung diseases, such as <a href="https://www.nhlbi.nih.gov/health/idiopathic-pulmonary-fibrosis">idiopathic pulmonary fibrosis</a>, or as a result of severe lung damage in a condition called <a href="https://www.nhlbi.nih.gov/health/ards">acute respiratory distress syndrome</a>, or ARDS. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/485406/original/file-20220919-8366-ys0duh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Health care provider tests a ventilation helmet on a patient." src="https://images.theconversation.com/files/485406/original/file-20220919-8366-ys0duh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/485406/original/file-20220919-8366-ys0duh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/485406/original/file-20220919-8366-ys0duh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/485406/original/file-20220919-8366-ys0duh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/485406/original/file-20220919-8366-ys0duh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/485406/original/file-20220919-8366-ys0duh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/485406/original/file-20220919-8366-ys0duh.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"></a>
<figcaption>
<span class="caption">Patients with acute respiratory distress syndrome due to COVID-19 may be treated with a helmet that provides oxygen, reducing the need for intubation.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/health-workers-test-a-helmet-that-allows-injecting-oxygen-news-photo/1297081646">Guillermo Legaria/Stringer via Getty Images News</a></span>
</figcaption>
</figure>
<p>ARDS can be caused by injuries originating in the lungs, like pneumonia, or severe disease in other organs, like pancreatitis. Around <a href="https://advances.massgeneral.org/research-and-innovation/article.aspx?id=1238">25% of patients</a> who recover from ARDS go on to develop restrictive lung disease. </p>
<p>Researchers have also found that patients who have <a href="https://doi.org/10.1038/s41591-021-01283-z">recovered from COVID-19</a>, especially those who had <a href="https://doi.org/10.1016%2Fj.chest.2021.02.062">severe disease</a>, can later develop restrictive lung disease. COVID-19 patients who require a ventilator may also have recovery rates similar to those who require a ventilator for <a href="https://doi.org/10.1164/rccm.202110-2335oc">other conditions</a>. Long-term recovery of lung function in these patients is still unknown. Drugs treating fibrotic lung disease after COVID-19 are currently undergoing <a href="https://clinicaltrials.gov/ct2/show/NCT04856111">clinical trials</a>.</p>
<h2>Impaired perfusion – decreased blood flow</h2>
<p>Finally, even when air flow and lung volume are unaffected, the lungs cannot complete their function if blood flow to the alveoli, where gas exchange occurs, is impaired. </p>
<p>COVID-19 is associated with an <a href="https://doi.org/10.1001/jama.2022.13072">increased risk for blood clots</a>. If blood clots travel to the lungs, they can cause a life-threatening <a href="https://www.healthline.com/health/pulmonary-embolus">pulmonary embolism</a> that restricts blood flow to the lungs. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/485407/original/file-20220919-6421-eq9toa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Diagram of alveolus and gas exchange, where oxygen diffuses into the bloodstream and carbon dioxide diffuses out" src="https://images.theconversation.com/files/485407/original/file-20220919-6421-eq9toa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/485407/original/file-20220919-6421-eq9toa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=408&fit=crop&dpr=1 600w, https://images.theconversation.com/files/485407/original/file-20220919-6421-eq9toa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=408&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/485407/original/file-20220919-6421-eq9toa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=408&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/485407/original/file-20220919-6421-eq9toa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=513&fit=crop&dpr=1 754w, https://images.theconversation.com/files/485407/original/file-20220919-6421-eq9toa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=513&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/485407/original/file-20220919-6421-eq9toa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=513&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 alveoli of the lungs are where oxygen diffuses into the bloodstream and carbon dioxide diffuses out.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/alveolus-gas-exchange-royalty-free-illustration/530484347">ttsz/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<p>In the long term, blood clots can also cause chronic problems with blood flow to the lungs, a condition called <a href="https://foundation.chestnet.org/lung-health-a-z/chronic-thromboembolic-pulmonary-hypertension-cteph/">chronic thromboembolic pulmonary hypertension</a>, or CTEPH. Only <a href="https://doi.org/10.1183/13993003.01792-2016">0.5% to 3% of patients</a> who develop a pulmonary embolism for reasons other than COVID-19 go on to develop this chronic problem. However, there is evidence that severe COVID-19 infections can <a href="https://doi.org/10.1056/NEJMoa2015432">damage the blood vessels of the lung</a> directly and <a href="https://doi.org/10.1111/resp.14101">impair blood flow</a> during recovery.</p>
<h2>What’s next?</h2>
<p>Lungs can work less optimally in these three general ways, and COVID-19 can lead to all of them. Researchers and clinicians are still figuring out ways to best treat the long-term lung damage seen in long COVID. </p>
<p>For clinicians, closely following up with patients who have recovered from COVID-19, particularly those with persistent symptoms, can lead to quicker diagnoses of long COVID. Severe cases of COVID-19 are associated with <a href="https://www.ncbi.nlm.nih.gov/books/NBK570608/">higher rates of long COVID</a>. <a href="https://doi.org/10.1016/j.cell.2022.01.014">Other risk factors</a> for development of long COVID include preexisting Type 2 diabetes, presence of virus particles in the blood after the initial infection and certain types of abnormal immune function.</p>
<p>For researchers, long COVID is an opportunity to study <a href="https://theconversation.com/long-covid-19-and-other-chronic-respiratory-conditions-after-viral-infections-may-stem-from-an-overactive-immune-response-in-the-lungs-186970">the underlying mechanisms</a> of how different types of lung-related conditions that result from COVID-19 infection develop. Uncovering these mechanisms would allow researchers to develop targeted treatments to speed recovery and get more patients feeling and breathing like their pre-pandemic selves once again.</p>
<p>In the meantime, everyone can <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html">stay up to date on recommended vaccinations</a> and use <a href="https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html">preventive measures</a> such as good hand hygiene and masking when appropriate.</p><img src="https://counter.theconversation.com/content/189516/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jeffrey M. Sturek has received funding from the National Institutes of Health. </span></em></p><p class="fine-print"><em><span>Alexandra Kadl does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Understanding how injury and disease, including COVID-19, can impair lung function can help researchers and clinicians better help patients who are experiencing chronic conditionsJeffrey M. Sturek, Assistant Professor of Medicine, University of VirginiaAlexandra Kadl, Assistant Professor of Medicine and Pharmacology, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1874222022-08-29T12:39:49Z2022-08-29T12:39:49ZExtreme heat and air pollution can be deadly, with the health risk together worse than either alone<figure><img src="https://images.theconversation.com/files/481425/original/file-20220828-7442-4j6f2d.jpg?ixlib=rb-1.1.0&rect=37%2C37%2C3551%2C2355&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bad air pollution and extreme heat each raise health risks, but they're worse combined.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/los-angeles-resident-carmen-green-jumps-rope-at-a-closed-news-photo/1228565250">Brian van der Brug/Los Angeles Times via Getty Images</a></span></figcaption></figure><p>Heat waves and air pollution from wildfire smoke and other sources are <a href="https://doi.org/10.1001/jama.2017.17923">each problematic</a> for <a href="https://doi.org/10.1016/S0140-6736(21)01208-3">human health</a>, particularly for vulnerable populations such as older adults. But what happens when they hit at the same time?</p>
<p>We examined over 1.5 million deaths from 2014 to 2020 registered in California – a state prone to summer heat waves and air pollution from wildfires – to find out.</p>
<h2>Deaths spike when both risks are high</h2>
<p>The number of deaths rose both on hot days and on days with high levels of fine particulate air pollution, <a href="https://www.health.ny.gov/environmental/indoors/air/pmq_a.htm">known as PM2.5</a>. But on days when an area was hit with a double whammy of both high heat and high air pollution, the effects were much higher than for each condition alone.</p>
<p>The risk of death on those extra-hot and polluted days was about <a href="https://doi.org/10.1164/rccm.202204-0657OC">three times greater</a> than the effect of either high heat or high air pollution alone.</p>
<p>The more extreme the temperatures and pollution, the <a href="https://doi.org/10.1164/rccm.202204-0657OC">higher the risk</a>. During the top 10% of hottest and most polluted days, the risk of death increased by 4% compared to days without extremes. During the top 1%, it increased by 21%; and among older adults over age 75, the risk of death increased by more than a third on those days.</p>
<p><iframe id="2f0eY" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/2f0eY/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Why risks are higher when both hit at once</h2>
<p>There are several ways the combined exposure to extreme heat and particulate air pollution can harm human health.</p>
<p>Oxidative stress is the most common biological pathway linked with particulate air pollution and heat exposure. <a href="https://doi.org/10.1038/s41573-021-00233-1">Oxidative stress</a> is an imbalance between production of highly reactive molecules known as reactive oxygen species, or ROS, and the body’s ability to remove them. It’s been linked with <a href="https://link.springer.com/chapter/10.1007/978-981-32-9366-3_5">lung diseases</a>, among other illnesses. </p>
<p>Antioxidants help clean up these molecules, but particulate air pollution and heat disrupt this balance through excessive metabolic ROS production and lowered antioxidant activity.</p>
<p>Our research also showed that the effects of particulate air pollution and heat extremes were <a href="https://doi.org/10.1164/rccm.202204-0657OC">larger when high nighttime temperature and pollution occurred together</a>. High nighttime temperatures can <a href="https://doi.org/10.1016/S2542-5196(22)00139-5">interfere with normal sleep</a> and potentially contribute to chronic health conditions such as <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/215006">heart disease</a> and <a href="https://www.pnas.org/doi/full/10.1073/pnas.1216951110">obesity</a>, and disrupt how the body regulates temperature.</p>
<p>Older adults may be more susceptible to effects of extreme heat and air pollution exposure, in part because this stress comes on top of age-related chronic health conditions like heart disease, high blood pressure, diabetes or chronic lung disease. <a href="https://www.ncbi.nlm.nih.gov/books/NBK507838/">Impaired body temperature regulation</a> in response to heat can also occur with aging. And older adults may be less mobile and therefore less able to get to cooling centers or to medical care and be less able to afford air conditioning. </p>
<h2>A future of high temperatures and air pollution</h2>
<p>This isn’t just a California problem. Climate change will increase exposure to high heat and air pollution in many parts of the country. </p>
<p>Yearly average temperatures in the U.S. are already more than 1.8 degrees Fahrenheit (1 degree Celsius) warmer than at the beginning of the 1900s. By the end of this century, global temperatures are on pace to be <a href="https://www.unep.org/resources/emissions-gap-report-2021">nearly 5 F (2.7 C) warmer</a>. Dangerous extreme heat waves, currently rare, will <a href="https://science2017.globalchange.gov/chapter/6/">become more common</a>. </p>
<p>Changing climate is also <a href="http://doi.org/10.1016/j.amepre.2008.08.025">affecting levels</a> of outdoor fine particulate pollution – for example, through weather changes such as air stagnation events, wind and dust storms, and drier and warmer conditions that <a href="https://nca2018.globalchange.gov/chapter/13/">contribute to increasingly frequent and intense wildfires</a>.</p>
<h2>What to do to stay safe</h2>
<p>Further research is needed to better understand these effects, such as the full impact of wildfire smoke exposure. However, enough is known that people should take measures to reduce their risk of harm during periods of extreme heat or air pollution.</p>
<p>That means staying <a href="https://www.cdc.gov/disasters/extremeheat/heattips.html">well hydrated and keeping cool</a>. Shopping malls and other air-conditioned public spaces can provide a refuge from heat. Home air conditioning, especially during nighttime, can reduce mortality. A portable air filter in the bedroom can <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/ina.12753">markedly reduce particle pollution levels</a>.</p>
<p>People with <a href="https://www.cdc.gov/disasters/extremeheat/warning.html">symptoms of heat stress</a>, such as headache, nausea, dizziness or confusion, especially the elderly, should seek medical care. </p>
<p>Many county and state health departments already provide alerts about extreme heat and extreme air pollution. Developing a special category of alert during co-occurring extremes may be beneficial to public health.</p>
<p>Governments also need to take steps now to avoid the worst future climate change scenarios. Some best practices for cities include creating cooling shade cover and green space that will also reduce particle pollution.</p><img src="https://counter.theconversation.com/content/187422/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Erika Garcia receives support from Southern California Environmental Health Sciences Center, National Institute of Environmental Health Sciences grant P30ES007048, and the University of Southern California Office of Research Strategic Development of Research Award.</span></em></p><p class="fine-print"><em><span>Rob Scot McConnell receives funding from the National Institute of Environmental Health Sciences</span></em></p><p class="fine-print"><em><span>Md Mostafijur Rahman does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The worst effects are during high nighttime temperatures, something happening more often with climate change. Wildfire smoke adds to the risk.Erika Garcia, Assistant Professor of Population and Public Health Sciences, University of Southern CaliforniaMd Mostafijur Rahman, Postdoctoral Scholar and Research Associate in Environmental Health, University of Southern CaliforniaRob Scot McConnell, Professor of Population and Public Health Sciences, University of Southern CaliforniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1871302022-08-16T15:59:14Z2022-08-16T15:59:14ZWellness vapes: what you need to know about vaping vitamins and other supplements<figure><img src="https://images.theconversation.com/files/476067/original/file-20220726-10345-jpynrf.jpg?ixlib=rb-1.1.0&rect=5%2C0%2C3849%2C2566&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Disposable vapes, for illustration purposes only and not necessarily representative of 'wellness vapes'.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/disposable-ecigarettes-different-flavors-pink-concept-2066722790">Master_foto/Shutterstock</a></span></figcaption></figure><p>So-called wellness vapes are <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2792671">growing in popularity</a>. Unlike regular vapes (e-cigarettes) that contain nicotine, these products contain vitamins, hormones or essential oils. But they have caught <a href="https://www.fda.gov/consumers/consumer-updates/beware-vaping-products-unproven-health-claims">the attention of the US Food and Drug Administration</a> (FDA) because of the unproven health claims made by many of the companies that sell them.</p>
<p>Wellness vapes – also known as “nutritional supplement diffusers” – cover a range of products that find a common origin in e-cigarettes. E-cigarettes deliver nicotine to the lungs without the need for combustion or tobacco. This removes some harmful components, such as tobacco tar. Instead of combustion, e-cigarettes use energy from a battery to heat e-liquid, which forms a vapour that can be inhaled.</p>
<p>A new wave of products aims to use this same inhaled delivery system for a wide range of non-nicotine products, including vitamins (B12 and C are particularly popular), milk thistle, melatonin (a hormone), green tea and a variety of essential oils. Wellness vape companies make claims that different combinations of these additives can help you focus better, promote sleep and even help you lose weight. </p>
<p>Inhaling rather than swallowing these compounds results in faster absorption into the bloodstream, so, theoretically, the vitamins and supplements could act faster when inhaled. </p>
<p>Many of these additives will be individually familiar as supplements that are rated as safe for ingestion. But the vast majority lack inhalation safety testing, particularly of potential long-term harms. Because wellness vapes don’t contain nicotine, they evade the regulators.</p>
<p>The incidence of <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1915314">e-cigarette-related acute lung injury (Evali) in the US</a> in 2019 highlights the importance of testing the route of intake. In the 60 deaths from Evali initially reported, vitamin E acetate was identified as a key agent that caused lung damage in these people. Vitamin E is a common food additive, so this clearly highlights how even well-known substances can have very serious health consequences when inhaled. </p>
<p>These devices are quite new to the market, so there is little research on their safety. However, we can consider the specific components to look for potential effects, whether beneficial or harmful. </p>
<h2>E-liquid components</h2>
<p>Many benign or beneficial compounds can become harmful if given in an untested way or given to the wrong patient group. For example, the benefits of vitamin C are universally known, yet the use of high-dose vitamin C has been shown to increase the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2200644#:%7E:text=In%20contrast%2C%20in%20a%20randomized,than%20those%20who%20received%20placebo.">risk of death in people with sepsis</a>.</p>
<p>Vitamin B12 is also a popular additive for these devices. In people who are deficient in the vitamin, a B12 injection is very effective in restoring levels. Yet there is a distinct lack of supporting evidence for any benefits to people with normal B12 levels. Also, we lack evidence on the safety or effectiveness of inhaled B12.</p>
<p><a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2141.1967.tb08696.x">One study carried out in 1967</a> showed no benefit to inhaling vitamin B12 over supplementation by injection. But even in 1967, the researchers were careful to point out the potential for lung damage. </p>
<p>We can also look at information from shared components with e-cigarettes to look for potential effects. Some products deliver vitamin B12 dissolved in a common e-liquid component, vegetable glycerine. Other products use propylene glycol or a mixture of both liquids. When heated, these <a href="https://pubmed.ncbi.nlm.nih.gov/28076380/">components break down into harmful chemicals</a>, termed reactive carbonyl species, such as formaldehyde. </p>
<p>These chemicals have been <a href="https://thorax.bmj.com/content/73/12/1161">shown to harm alveolar macrophages</a>, important immune cells in the lung, in a way not dependent on the presence of nicotine. Similar findings have also been shown in other <a href="https://journals.physiology.org/doi/full/10.1152/ajplung.00081.2021?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org">important airway and immune cells</a>. </p>
<p>Wellness vapes delivering essential oils may also suffer from the same concerns. They contain compounds called terpenes and a mixture of other chemicals similar to e-liquids. </p>
<p>Terpenes have been reported to have a range of benefits including <a href="https://www.sciencedirect.com/science/article/pii/S2590157522000153">anticancer, antiallergy and antimicrobial properties</a>, suggesting the potential benefits of taking these essential oils. However, terpenes are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623941/">degraded by heat</a> so may be broken down by vaping into harmful compounds that can <a href="https://www.nature.com/articles/s41598-022-14236-4.pdf?proof=t2017-5-22">irritate the airways and may be toxic</a> to cells at higher doses and longer exposure. </p>
<h2>Increased scrutiny</h2>
<p>Given the similarities between e-cigarettes and wellness vapes, these companies are now facing increased scrutiny from public health bodies. The FDA has warned that wellness vapes are <a href="https://www.fda.gov/consumers/consumer-updates/beware-vaping-products-unproven-health-claims">“unsafe”, “ineffective” and “unproven”</a>.</p>
<p>We must carefully weigh the benefits and risks of use. Many of the supplements in these devices may help improve our lifestyles, but there is no evidence to support the benefits of inhalation over traditional methods of delivery. </p>
<p>While wellness vapes have not been around long enough for researchers to know for certain the long-term consequences of their use. We know that short-term exposure to their components can harm the lungs, so prolonged use may pose a very serious risk – one that tips the scales of evidence firmly against the use of “wellness vapes”.</p><img src="https://counter.theconversation.com/content/187130/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aaron Scott receives funding from Asthma + Lung UK (MCFPHD20F\2), the NIHR Health technology assessment (NIHR129593), NIHR EME programme (NIHR131600) and Medical Research Council (MR/L002736/1). </span></em></p><p class="fine-print"><em><span>Alice Jasper does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Wellness vapes are marketed as healthy lifestyle supplements, but the claims of their beneficial effects are not supported by evidence.Aaron Scott, Asscoiate Professor in Respiratory Science, University of BirminghamAlice Jasper, Postdoctoral Research Fellow, Inflammation and Ageing, University of BirminghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1824202022-07-11T20:03:51Z2022-07-11T20:03:51ZBanning artificial stone could prevent 100 lung cancers and 1,000 cases of silicosis, where dust scars the lungs<figure><img src="https://images.theconversation.com/files/473304/original/file-20220711-14-dgmvla.jpg?ixlib=rb-1.1.0&rect=20%2C31%2C3473%2C2294&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/man-work-clothes-gloves-polishes-marble-1202772427">Shutterstock</a></span></figcaption></figure><p>Silica dust is a very fine dust produced when products such as bricks, concrete and pavers are cut or drilled. Artificial stone, which is used mainly for kitchen benchtops, is a <a href="https://theconversation.com/renovating-your-kitchen-help-australias-tradies-avoid-silicosis-by-not-choosing-artificial-stone-156208">particularly potent source</a> of silica dust. </p>
<p>Breathing this dust into the lungs can cause severe long-term damage. This can <a href="https://theconversation.com/engineered-stone-benchtops-are-killing-out-tradies-heres-why-a-bans-the-only-answer-126489">result in</a> breathing difficulties, scarring of the lungs (silicosis) and lung cancer.</p>
<p>In our <a href="https://about.curtin.edu.au/wp-content/uploads/sites/5/2022/07/FEFreport_formatted.pdf">recently published report</a>, we estimate that without action, Australian workers would develop more than 10,000 future lung cancers and almost 104,000 silicosis cases during their lifetime due to their exposure to silica dust. This is around 1% of all future lung cancers in the Australian adult population. </p>
<p>However, banning artificial stone would reduce silica exposure and could prevent 100 lung cancers and almost 1,000 silicosis cases over the lifetime of these workers. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-silicosis-and-why-is-this-old-lung-disease-making-a-comeback-80465">Explainer: what is silicosis and why is this old lung disease making a comeback?</a>
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</p>
<hr>
<h2>Re-emergence of an old disease</h2>
<p>Silica dust is a serious hazard in Australian workplaces. Around <a href="https://pubmed.ncbi.nlm.nih.gov/26888888/">7% of Australian workers</a> are at risk of breathing it in. Exposure is most common in miners and construction workers. </p>
<p>For the last 60 years, silicosis was very rare in Australia. Due to the increased use of artificial stone, we are now <a href="https://theconversation.com/explainer-what-is-silicosis-and-why-is-this-old-lung-disease-making-a-comeback-80465">seeing a re-emergence</a> of this terrible disease.</p>
<p>In response to the resurgence of silicosis, the Australian government set up a <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/ohp-nat-dust-disease-taskforce.htm">taskforce</a> to improve the health and safety of those working with silica dust. Its final report, from June 2021, recommended further analysis on how best to protect artificial stone workers. </p>
<p>This is now under way, with Safe Work Australia releasing a regulatory impact statement for <a href="https://engage.swa.gov.au/cris-managing-the-risks-of-respirable-crystalline-silica">consultation</a>. This statement looks at a number of options to reduce exposure to silica and the cost of these over the next ten years. </p>
<p>Safe Work Australia concluded these measures would only need to save about five people a year from silicosis in order for these options to be cost effective. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1538702320120102912"}"></div></p>
<p>While this is a good start, there’s scope to do much more. Banning artificial stone is among the recommendations suggested by the taskforce but <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/ohp-dust-occupational-disease.htm">not currently supported by government</a> and <a href="https://ehq-production-australia.s3.ap-southeast-2.amazonaws.com/194bd57754dab582a564c67315a2ee37112572d1/original/1656545533/5c2b36be2733fdd1a02881939d9e95bd_consultation-RIS-managing-risks-crystalline-silica-at_work.pdf?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Credential=AKIAIBJCUKKD4ZO4WUUA%2F20220711%2Fap-southeast-2%2Fs3%2Faws4_request&X-Amz-Date=20220711T052238Z&X-Amz-Expires=300&X-Amz-SignedHeaders=host&X-Amz-Signature=a386cd6e0d10be6cd4814c972521923d99d9a969e94c32d90eb2cd23e914b9d7">not being considered by Safe Work Australia</a>. </p>
<h2>Assessing the harm</h2>
<p>To estimate the harm caused by silica dust at work, we used <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3066-1">a method</a> which calculates how many additional disease cases would occur in workers exposed to silica dust in one year – in this case, the year 2016. </p>
<p>We used <a href="https://oem.bmj.com/content/71/1/55.short">past exposure surveys</a> and recent reports from <a href="https://www.nsw.gov.au/sites/default/files/2021-08/case-finding-study-respirable-crystalline-silica-exposure-nsw-manufactured-stone-industry.pdf">New South Wales</a> and <a href="https://www.worksafe.vic.gov.au/resources/silica-associated-lung-disease-health-screening-research-project-phase-two-final-report">Victoria</a> to estimate how many workers were exposed to silica dust nationwide. </p>
<p>Then we modelled how many lung cancers and silicosis cases would occur during the lifetimes of these workers. </p>
<p>We then looked at possible ways to reduce exposure to silica dust, including wet cutting, reducing worker access to dusty areas, using good quality and well-fitted respirators, as well as banning artificial stone. </p>
<p>While this modelling isn’t yet published in a peer-reviewed journal, it has been peer-reviewed by others in the field. </p>
<h2>Reducing the harm</h2>
<p>We found banning artificial stone could prevent 100 lung cancers and almost 1,000 silicosis cases. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/engineered-stone-benchtops-are-killing-our-tradies-heres-why-a-bans-the-only-answer-126489">Engineered stone benchtops are killing our tradies. Here's why a ban's the only answer</a>
</strong>
</em>
</p>
<hr>
<p>We also looked at other control measures which could be implemented in the interim. </p>
<p>Setting up exclusion zones around areas where artificial stone is cut, using well-fitted respirators, wetting artificial stone while cutting it, and using on-tool dust extraction while cutting artificial stone could prevent cases of lung cancer and silicosis, but not as many as a complete ban.</p>
<figure class="align-center ">
<img alt="Man cuts stone." src="https://images.theconversation.com/files/473320/original/file-20220711-18-jtohev.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/473320/original/file-20220711-18-jtohev.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/473320/original/file-20220711-18-jtohev.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/473320/original/file-20220711-18-jtohev.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/473320/original/file-20220711-18-jtohev.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/473320/original/file-20220711-18-jtohev.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/473320/original/file-20220711-18-jtohev.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">Well-fitting respirators can reduce the risk.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woodworking-carpenter-furniture-hand-cuting-skills-2136009577">Shutterstock</a></span>
</figcaption>
</figure>
<p>Unfortunately, a ban on silica dust in other industries such as mining isn’t possible. However, exposure can be reduced. Stopping workers from entering areas near crushers on mine sites would prevent 750 lung cancers and almost 7,500 silicosis cases. </p>
<p>If we were able to reduce exposure in the mining industry to that experienced by the general population, we could save more than 2,300 lung cancers and over 20,000 silicosis cases. </p>
<h2>Reducing silica dust would save lives</h2>
<p>Overall, ensuring compliance with engineering controls and respiratory equipment could prevent more than 400 workers from developing two terrible diseases. </p>
<p>These cases can only be prevented if there is 100% compliance with control measures. This is a level of compliance <a href="https://www.nsw.gov.au/sites/default/files/2021-08/case-finding-study-respirable-crystalline-silica-exposure-nsw-manufactured-stone-industry.pdf">much higher</a> than what we’re currently seeing in Australian workplaces. </p>
<p>A <a href="https://www.worksafe.vic.gov.au/engineered-stone-licence">licensing system</a> for artificial stone businesses such as that underway in Victoria might go some way to improving compliance, but the effects of this remain to be seen. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/renovating-your-kitchen-help-australias-tradies-avoid-silicosis-by-not-choosing-artificial-stone-156208">Renovating your kitchen? Help Australia's tradies avoid silicosis by not choosing artificial stone</a>
</strong>
</em>
</p>
<hr>
<p>However, if we banned artificial stone, we could save up to 700 more young workers from developing these diseases. If we tried to eliminate silica dust exposure in other industries, we could prevent even more disease. </p>
<p>Clearly, much more needs to be done to protect our workers from these ultimately preventable lung diseases.</p><img src="https://counter.theconversation.com/content/182420/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This report was commissioned by the Australian Council of Trade Unions (ACTU). </span></em></p><p class="fine-print"><em><span>Lin Fritschi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Artificial stone, which is used mainly for kitchen benchtops, is a potent source of silica dust, which can scar the lung and cause lung cancer. Banning artificial stone could save lives.Renee Carey, Senior Research Fellow, Curtin UniversityLin Fritschi, Professor of Epidemiology, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1824352022-05-09T01:25:00Z2022-05-09T01:25:00ZThe US FDA has moved to ban menthol cigarettes. Australia should do that and more<figure><img src="https://images.theconversation.com/files/461725/original/file-20220506-22-bccw5d.jpg?ixlib=rb-1.1.0&rect=17%2C8%2C5947%2C3961&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/closeup-many-cigarette-butts-ash-600w-1727470504.jpg">Shutterstock</a></span></figcaption></figure><p>Menthol is the minty cigarette ingredient that conjures up images of beaches, snow-covered ski slopes and glamorous yacht parties, all crisp white and fresh green. Menthol as a deadly additive is under threat at last.</p>
<p>Several countries, including <a href="https://tobaccotactics.org/wiki/flavoured-and-menthol-tobacco/">Canada, Ethiopia, Turkey, Chile, the European Union and the United Kingdom</a>, have <a href="https://tobaccocontrol.bmj.com/content/30/4/373">banned the use of menthol</a> and other flavours in tobacco products.</p>
<p>Late to regulating menthol in tobacco products, the <a href="https://www.theguardian.com/us-news/2022/apr/28/us-fda-menthol-cigarettes-flavored-cigars-ban-rules#:%7E:text=The%20US%20Food%20and%20Drug,dent%20sales%20at%20tobacco%20companies.">US Food and Drug Administration has also announced a ban</a>. </p>
<p>In Australia, we have done little to change what’s inside cigarettes and other smoking products. So we lag even further behind the many other countries that have banned menthol.</p>
<h2>For ‘timid’ ladies</h2>
<p>The marketing of menthol by the tobacco industry in Australia has long been targeted at supposedly sophisticated smokers. In Melbourne in the 1990s, tobacco giant Philip Morris – in its <a href="https://www.industrydocuments.ucsf.edu/tobacco/docs/#id=xqkm0112">personality analysis</a> of smokers of its Alpine menthol brand – found the “Alpine Gal is a physically timid lady”, so the packaging had to be “gentle”, not “dare devil”.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/461730/original/file-20220506-21-8dt8zt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="cigarette advert images with mountain images" src="https://images.theconversation.com/files/461730/original/file-20220506-21-8dt8zt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/461730/original/file-20220506-21-8dt8zt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=350&fit=crop&dpr=1 600w, https://images.theconversation.com/files/461730/original/file-20220506-21-8dt8zt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=350&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/461730/original/file-20220506-21-8dt8zt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=350&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/461730/original/file-20220506-21-8dt8zt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=440&fit=crop&dpr=1 754w, https://images.theconversation.com/files/461730/original/file-20220506-21-8dt8zt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=440&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/461730/original/file-20220506-21-8dt8zt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=440&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 classic ‘fresh’ look of menthol cigarette advertising.</span>
<span class="attribution"><a class="source" href="https://live.staticflickr.com/65535/52005982483_4e4d71a066_c.jpg">Flickr/Keijo Knutas</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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</figure>
<p>More recently, the industry <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-021-01297-2">added menthol</a> “crush balls” or capsules in filters in Australian cigarettes, so users get a burst of menthol by biting on the filter. Once again, women and children are the target market. A <a href="https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntac040/6545999">study from Wales</a> showed the fact that:</p>
<blockquote>
<p>[…] three in five 11–16 year-old smokers reported using menthol cigarettes in the past 30 days highlights how appealing these products are to young people, particularly capsule cigarettes, used by 70% of menthol smokers.</p>
</blockquote>
<p>A search of <a href="https://tobaccocontrol.bmj.com/content/20/Suppl_2/ii12?ijkey=7fae4fee8eca39ec8baeb0ea9e7272a313fd682e&keytype2=tf_ipsecsha">millions of tobacco industry documents</a> confirms menthol is <a href="https://truthinitiative.org/research-resources/traditional-tobacco-products/menthol-facts-stats-and-regulations">designed to attract new young smokers</a>, who <a href="https://www.mdpi.com/1660-4601/18/11/5501">incorrectly believe</a> it makes cigarettes somehow less harmful.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/461728/original/file-20220506-16-8t7psr.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="opened up cigarette filter shows blue capsule inside" src="https://images.theconversation.com/files/461728/original/file-20220506-16-8t7psr.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/461728/original/file-20220506-16-8t7psr.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/461728/original/file-20220506-16-8t7psr.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/461728/original/file-20220506-16-8t7psr.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/461728/original/file-20220506-16-8t7psr.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/461728/original/file-20220506-16-8t7psr.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/461728/original/file-20220506-16-8t7psr.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">These days, menthol capsules are used inside cigarette filters.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>In 2012, Australia’s then health minister and Attorney-General Nicola Roxon <a href="https://www.abc.net.au/news/2012-08-27/nicola-roxon-on-australian-story/4225972">regulated</a> the outside of cigarette packets, introducing plain packaging with graphic health warnings. Although significant, the packaging change did nothing to alter what was inside the product.</p>
<p>Nor have subsequent governments.</p>
<p>In other words, we have not yet regulated the most damaging aspects of cigarette design that increase and maintain addiction.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/next-step-for-tobacco-control-make-cigarettes-less-palatable-42549">Next step for tobacco control? Make cigarettes less palatable</a>
</strong>
</em>
</p>
<hr>
<h2>Not really ‘light’ - just dangerous</h2>
<p>Menthol is associated with so-called “light” cigarettes, which the Australian Competition and Consumer Commission (ACCC) has <a href="https://www.accc.gov.au/media-release/accc-resolves-light-and-mild-cigarette-investigation-with-imperial-tobacco">found misleading and deceptive</a> and banned the use of the term. The ACCC did not ban the content or engineering of cigarettes.</p>
<p>It is not just additives in cigarettes, and the smoke emissions, that are harmful. The “<a href="https://theconversation.com/filters-a-cigarette-engineering-hoax-that-harms-both-smokers-and-the-environment-85393">engineering hoax</a>” of filters – which don’t make smoking any safer – <a href="https://theconversation.com/next-step-for-tobacco-control-make-cigarettes-less-palatable-42549">is an even more dangerous</a> <a href="https://tobaccocontrol.bmj.com/content/early/2021/04/26/tobaccocontrol-2020-056245.abstract">fraud</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/filters-a-cigarette-engineering-hoax-that-harms-both-smokers-and-the-environment-85393">Filters: a cigarette engineering hoax that harms both smokers and the environment</a>
</strong>
</em>
</p>
<hr>
<h2>A new era of additives</h2>
<p>Australia’s new <a href="https://consultations.health.gov.au/atodb/national-tobacco-strategy-2022-2030/">National Tobacco Strategy Consultation Draft</a> says it will “explore” regulation of filters, additives – including menthol – and nicotine content, but offers little certainty.</p>
<p>In the UK, <a href="https://www.mirror.co.uk/money/menthol-cigarettes-banned-uk-illegal-22050817">the ban on menthol cigarettes</a> not only triggered a switch to menthol vapes, but also prompted the tobacco industry to <a href="https://blogs.bmj.com/tc/2021/05/05/menthol-tobacco-companies-are-exploiting-loopholes-in-the-uks-characterising-flavours-ban/">invent new products</a> to exploit <a href="https://www.occrp.org/en/investigations/japan-tobacco-international-making-a-mint-by-circumventing-menthol-cigarette-ban">loopholes in the law</a>. </p>
<p>Late last year, the Organised Crime and Corruption Reporting Project – a network of investigative journalists – <a href="https://www.occrp.org/en/investigations/japan-tobacco-international-making-a-mint-by-circumventing-menthol-cigarette-ban">found</a>: </p>
<blockquote>
<p>A key goal of Big Tobacco was to get menthol defined as vaguely as possible.</p>
</blockquote>
<p>So, any attempts at legislative control must be tightly worded. <a href="https://tobaccotactics.org/wiki/promotion-newer-products-uk-menthol-ban/">Big tobacco</a> will drive its legal trucks through anything vague.</p>
<h2>The effects of bans are mixed</h2>
<p><a href="https://tobaccocontrol.bmj.com/content/early/2021/03/31/tobaccocontrol-2020-056259?int_source=trendmd&int_medium=cpc&int_campaign=usage-042019">Canadian research</a> showed a fall in smoking rates followed their menthol ban.</p>
<p><a href="https://www.sciencedirect.com/science/article/abs/pii/S037687162030555X">Other research</a> suggested targeting menthol in cigarettes might cause a switch to vaping, as in the UK. We know that vaping is a <a href="https://www.nature.com/articles/s41533-022-00277-9">global public health problem</a> and that flavourings drive uptake in adolescents. The FDA will not immediately ban menthol in e-cigarettes.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/461729/original/file-20220506-24-8t7psr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="hand with e-cigarette and vapour" src="https://images.theconversation.com/files/461729/original/file-20220506-24-8t7psr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/461729/original/file-20220506-24-8t7psr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=417&fit=crop&dpr=1 600w, https://images.theconversation.com/files/461729/original/file-20220506-24-8t7psr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=417&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/461729/original/file-20220506-24-8t7psr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=417&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/461729/original/file-20220506-24-8t7psr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=525&fit=crop&dpr=1 754w, https://images.theconversation.com/files/461729/original/file-20220506-24-8t7psr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=525&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/461729/original/file-20220506-24-8t7psr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=525&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In some places, menthol cigarette bans have seen a switch to vaping.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/london-uk-sept-8-2019-600w-1498869299.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<p>Vaping causes <a href="https://pubmed.ncbi.nlm.nih.gov/32726146/">lung damage</a> and <a href="https://newsnetwork.mayoclinic.org/discussion/e-cigarette-users-who-test-positive-for-covid-19-are-more-likely-to-experience-covid-19-symptoms/">exacerbates COVID symptoms</a>. </p>
<p>The sale of heat-not-burn products should <a href="https://www.news.com.au/national/victoria/politics/experts-warn-of-public-health-crisis-for-kids-as-state-leaders-urged-to-ban-illicit-vape-sales/news-story/7c64de9acf72b0a0bc3449b86fec39f4">remain banned</a> in Australia. The current arrangement that permits <a href="https://www.tga.gov.au/nicotine-vaping-products-information-prescribers#:%7E:text=Medical%20practitioners%20do%20not%20need,through%20the%20Personal%20Importation%20Scheme.">non TGA-approved</a> vape products to be <a href="https://adf.org.au/talking-about-drugs/parenting/vaping-youth/vaping-australia/">prescribed</a> by medical practitioners, ostensibly for quitting purposes is <a href="https://www.anu.edu.au/news/all-news/e-cigarettes-are-harmful-and-addicting-youth-report">problematic</a>. <a href="https://tobaccocontrol.bmj.com/content/30/1/108.abstract">Flavours should be regulated</a> or eliminated.</p>
<p><a href="https://www.stuff.co.nz/science/127803331/low-nicotine-cigarettes-could-cut-smoking-significantly">New Zealand</a> has moved to reduce nicotine content, the principal addictive drug in tobacco. But NZ has dropped the ball on e-cigarettes by separating its regulatory framework from other tobacco products. The country is experiencing high rates of <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.13169">teenage vaping uptake</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-damning-review-of-e-cigarettes-shows-vaping-leads-to-smoking-the-opposite-of-what-supporters-claim-180675">A damning review of e-cigarettes shows vaping leads to smoking, the opposite of what supporters claim</a>
</strong>
</em>
</p>
<hr>
<h2>Smoking kills</h2>
<p>There are three million smokers in Australia. <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0281-z">Two-thirds will die</a> from smoking-related diseases. </p>
<p>Most will have health problems, and <a href="https://www.phrp.com.au/issues/july-2016-volume-26-issue-3/tobacco-smoking-by-adult-emergency-department-patients-in-australia-a-point-prevalence-study/">our hospital emergency departments</a> and <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1467-842X.2002.tb00678.x">wards</a> deal with much higher rates of smokers being admitted than the general population. </p>
<p>The crushing burden on the health system and the <a href="https://ndri.curtin.edu.au/NDRI/media/documents/publications/T273.pdf">associated economic cost</a> could be effectively reduced with comprehensive regulatory measures on tobacco.</p>
<h2>Endgame</h2>
<p>The four endgame initiatives that will reduce smoking and vaping to a minimum in Australia are:</p>
<ol>
<li><p>a ban on sales of both combustible and vape tobacco products to <a href="https://tobaccocontrol.bmj.com/content/22/suppl_1/i22">anyone born after the year</a> 2004</p></li>
<li><p>regulation to eliminate flavours (including, but not limited to, menthol) in combustible, vape and emerging tobacco products</p></li>
<li><p>staged <a href="https://www.tobaccoinaustralia.org.au/chapter-18-harm-reduction/18-4-low-nicotine">reduction in nicotine content</a></p></li>
<li><p>a ban on <a href="https://academic.oup.com/jnci/article/109/12/djx075/3836090?login=false">filter ventilation</a> engineering in cigarettes.</p></li>
</ol>
<p>Banning menthol as a standalone reform would make a modest contribution to reducing smoking and vaping rates in Australia. </p>
<p>However, substantive reduction in smoking rates will only occur with a comprehensive suite of measures, already strongly <a href="https://tobaccocontrol.bmj.com/content/early/2022/05/02/tobaccocontrol-2021-057122">supported in the community</a>. These include <a href="https://insightplus.mja.com.au/2020/19/exit-strategy-we-can-do-it-for-covid-19-why-not-tobacco/">phasing out the sale</a> of tobacco products completely.</p>
<hr>
<p><em>Correction: This article has been edited to clarify that vape products containing nicotine are banned in Australia but available via prescription.</em></p><img src="https://counter.theconversation.com/content/182435/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathryn Barnsley is co-convenor of SmokeFree Tasmania.</span></em></p>Traditionally marketed to women, banning menthol tobacco flavouring would make a moderate impact on smoking harms. Australia is behind many other countries.Kathryn Barnsley, Adjunct researcher, University of TasmaniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1787462022-03-09T19:15:44Z2022-03-09T19:15:44ZLungs have their own microbiome – and these microbes affect the success of bone marrow transplants in kids<figure><img src="https://images.theconversation.com/files/450791/original/file-20220308-27-1aqy8qb.jpeg?ixlib=rb-1.1.0&rect=0%2C0%2C1841%2C1625&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">While the gut microbiome has gotten much of the spotlight, the microbes in the lungs also play an important role in health.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/bacteria-and-viruses-on-human-lungs-royalty-free-illustration/1283819612">sorbetto/DigitalVision Vectors via Getty Images</a></span></figcaption></figure><p>The microorganisms deep in your lungs may play an important role in your overall lung health. And for children undergoing bone marrow transplants, measuring the microbes in their lungs could help predict treatment outcomes, according to a <a href="https://science.org/doi/10.1126/scitranslmed.abm8646">recent study</a> my research team and I published.</p>
<h2>What is the lung microbiome?</h2>
<p>The <a href="https://www.genome.gov/genetics-glossary/Microbiome">microbiome</a> comprises all the microorganisms in the human body, including bacteria, viruses and fungi. The more well-known and commonly studied microbiome is that of the gut.</p>
<p>But recent studies show that the <a href="https://doi.org/10.1038/mi.2016.108">lungs</a> also have a complex and dynamic collection of microbes in combination with the mouth, nose and stomach. Healthy lungs have a baseline level of microorganisms that train them how to mount an immune response against their harmful counterparts. Imbalances in the lung microbiome, or <a href="https://doi.org/10.1186/s12931-019-1246-0">dysbiosis</a>, are associated with poor lung health in children and adults, as well as a variety of diseases that include cystic fibrosis, asthma and chronic obstructive pulmonary disease.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/1Qfmkd6C8u8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">For someone with a blood cancer, replacing their bone marrow with that of a healthy donor could help flush malignant cells out.</span></figcaption>
</figure>
<h2>Lung microbes and bone marrow transplants</h2>
<p>Optimal lung health is especially important for children about to undergo a bone marrow transplant to treat incurable blood diseases such as leukemia. Also called a <a href="https://bethematch.org/transplant-basics/">hematopoietic cell transplant (HCT)</a>, this procedure offers a “hard reset” that uses chemotherapy to wipe out all the patient’s blood cells before replacing them with a new set of donor blood cells.</p>
<p>The problem is that HCT puts a lot of stress on the entire body, and about <a href="https://doi.org/10.1016/j.bbmt.2019.06.004">12%</a> to <a href="https://doi.org/10.1016/j.bbmt.2009.03.019">39%</a> of patients develop <a href="https://doi.org/10.1016/j.bbmt.2019.09.027">life-threatening infections and organ dysfunction</a>, often affecting the <a href="https://doi.org/10.1016/j.bbmt.2009.03.019">lungs</a>. Pulmonary disease accounts for <a href="https://doi.org/10.1016/j.bbmt.2019.06.004">16% of deaths</a> after this procedure in kids. Therefore, making sure the lungs are as healthy as possible before the procedure is important to ensuring success.</p>
<p>My research team <a href="https://scholar.google.com/citations?user=r7qW4jwAAAAJ&hl=en">and I</a> were interested in discovering how the pulmonary microbiome might relate to lung health in children preparing to undergo this kind of transplant. To do this, we had 104 children <a href="https://www.thoracic.org/patients/patient-resources/resources/pulmonary-function-testing-children.pdf">breathe into a machine</a> to test their lung function. Then, we measured the composition of their lung microbiome through a <a href="https://doi.org/10.1182/blood.2020009246">bronchoalveolar lavage</a>. This process circulates a saline solution through the lungs of a patient under sedation. We then examine the fluid under a microscope and sequence the genomes of any microbes it contains to identify what types of microorganisms are present.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/Ur8Lrep1voU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Bronchoalveolar lavage is commonly used to diagnose pulmonary diseases.</span></figcaption>
</figure>
<p>We found that patients with lungs depleted of their normal bacteria had higher amounts of potentially harmful bacteria that aren’t usually present in healthy lungs. Patients with depleted lung microbiomes also had worse lung function, including signs of scarring, trouble absorbing oxygen and damage at the cellular level.</p>
<p>This study also confirms our <a href="https://doi.org/10.1182/blood.2020009246">previous finding</a> that children with depleted lung microbiomes are two to three times more likely to die from bone marrow transplantation than children without depleted microbiomes. Knowing the composition of the lung microbiome allowed us to <a href="https://science.org/doi/10.1126/scitranslmed.abm8646">more accurately predict</a> who would survive the treatment procedure better than lung function tests alone.</p>
<p>We don’t yet know whether microbiome depletion causes or results from lung disease. But our study suggests that the lung microbiome may be important in predicting bone marrow transplant outcomes. Ultimately, we hope to use this information to develop treatments that restore or strengthen the lungs of high-risk children before they undergo transplantation.</p>
<p>[<em>Get fascinating science, health and technology news.</em> <a href="https://memberservices.theconversation.com/newsletters/?nl=science&source=inline-science-fascinating">Sign up for The Conversation’s weekly science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/178746/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matt Zinter receives funding from the National Institutes of Health (K23HL146936, K12HD000850), the American Thoracic Society, the Pediatric Blood and Marrow Transplant Consortium, and the National Marrow Donor Program Amy Strelzer Manasevit Fund.</span></em></p>Disruptions to the lung microbiome are linked to a number of respiratory conditions in both children and adults.Matt Zinter, Assistant Professor of Pediatrics, University of California, San FranciscoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1653032021-08-08T21:03:08Z2021-08-08T21:03:08ZTuberculosis, the forgotten pandemic relying on a 100-year-old vaccine<figure><img src="https://images.theconversation.com/files/414927/original/file-20210806-19-w40utz.jpg?ixlib=rb-1.1.0&rect=1%2C1%2C997%2C664&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/adult-child-hands-holding-lung-world-1653122248">from www.shutterstock.com</a></span></figcaption></figure><p>By some estimates, <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002152">2 billion people</a> are now infected worldwide, and in 2019, around <a href="https://www.who.int/publications/i/item/9789240013131">1.4 million people</a> died from it.</p>
<p>It’s a pandemic infection, spread through the air — but it’s not COVID. It’s tuberculosis (or TB). Yet we’re not in lockdown for it. And we’re not queuing up for a vaccine.</p>
<p>Some people call TB “<a href="https://www.the-scientist.com/features/tuberculosis-the-forgotten-pandemic-68894">the forgotten pandemic</a>”. But our knowledge of one pandemic is helping us manage the other.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-tb-and-am-i-at-risk-of-getting-it-in-australia-75290">Explainer: what is TB and am I at risk of getting it in Australia?</a>
</strong>
</em>
</p>
<hr>
<h2>They’re similar in some ways …</h2>
<p>TB is caused by the bacterium <em><a href="https://theconversation.com/explainer-what-is-tb-and-am-i-at-risk-of-getting-it-in-australia-75290">Mycobacterium tuberculosis</a></em>. And COVID is caused by SARS-CoV-2, a virus. They’re quite different microorganisms. But it’s easy for them to overlap in people’s minds. </p>
<p>Both TB and COVID are infectious diseases that generally affect the lungs. Both are passed between people mainly by aerosols, when infected people cough, sing or otherwise release them into the surrounding air.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/414928/original/file-20210806-25-1o0xxea.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Mycoplasma tuberculosis" src="https://images.theconversation.com/files/414928/original/file-20210806-25-1o0xxea.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/414928/original/file-20210806-25-1o0xxea.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/414928/original/file-20210806-25-1o0xxea.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/414928/original/file-20210806-25-1o0xxea.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/414928/original/file-20210806-25-1o0xxea.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=471&fit=crop&dpr=1 754w, https://images.theconversation.com/files/414928/original/file-20210806-25-1o0xxea.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=471&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/414928/original/file-20210806-25-1o0xxea.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=471&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">TB is caused by <em>Mycobacterium tuberculosis</em>.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/bacteria-mycobacterium-tuberculosis-causative-agent-3d-1013219203">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>So some of the things we’re used to doing for COVID-19 – like wearing masks and good ventilation – also work for preventing the spread of TB. </p>
<p>However, there are some important differences between them, which mean our public health responses can look quite different.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/kissing-can-be-dangerous-how-old-advice-for-tb-seems-strangely-familiar-today-140172">'Kissing can be dangerous': how old advice for TB seems strangely familiar today</a>
</strong>
</em>
</p>
<hr>
<h2>… but not in others</h2>
<p>We are all so familiar with COVID. So when I’m talking with people about TB, I’ve started highlighting three key differences between the infections.</p>
<p><strong>1. TB is less infectious</strong></p>
<p>TB is much less infectious. While COVID (especially strains like the <a href="https://science.sciencemag.org/content/372/6549/1375.summary">Delta variant</a>) may be transmitted after brief or “fleeting” contact, this is rare for TB. </p>
<p>As a rule of thumb, <a href="https://www.thermh.org.au/tb">TB programs</a> around the world often suggest you need to be in close contact with an infectious person for more than eight hours before that risk builds up to the point where you need to be tested for it.</p>
<p>This means people are more likely to spread the infection within their household or immediate family rather than at the shops. </p>
<p><strong>2. TB symptoms take longer to show up</strong></p>
<p>With TB, the “window” between being exposed and becoming unwell, known as the incubation period, is much longer.</p>
<p>Infections can stay dormant (or “latent”) in the body for many months or years before people become unwell. But almost everyone who becomes unwell with COVID has been infected within the past two weeks.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1397504069917319170"}"></div></p>
<p>We don’t ask contacts of TB to isolate at home as we can’t predict when they might become unwell. It certainly wouldn’t be ethical or realistic to isolate people for months or years, just in case. Fortunately, people who have dormant TB cannot pass infection on to others in the meantime.</p>
<p><strong>3. We have TB treatments to help curb the spread</strong></p>
<p>As we’re uncertain about how long it takes between someone becoming infected and becoming unwell with TB, you’d think that would be a big problem.</p>
<p>But we have effective treatments to give people with dormant TB. These help prevent them developing active disease.</p>
<p>These treatments, particularly antibiotics such as <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1714283">isoniazid or rifampicin</a>, can greatly reduce the risk of contacts becoming sick.</p>
<p>For COVID, we don’t yet have any treatments for people who are infected but who are not showing symptoms (known as post-exposure treatments) to minimise the chance of them spreading the virus. </p>
<p>Some have been tried, but so far none have convincingly been shown <a href="https://www.covid19treatmentguidelines.nih.gov/overview/prevention-of-sars-cov-2/">to be effective</a>.</p>
<h2>How about vaccines?</h2>
<p>Perhaps the biggest difference in our response to these pandemics is we have a variety of effective vaccines against COVID.</p>
<p>For TB, we are relying on a <a href="https://www.the-scientist.com/features/tuberculosis-the-forgotten-pandemic-68894">100-year-old vaccine, known as BCG</a> (short for Bacille Calmette-Guerin), which is still one of the <a href="https://www.who.int/teams/health-product-policy-and-standards/standards-and-specifications/vaccines-quality/bcg">most widely used</a> vaccines globally.</p>
<p>While it <a href="https://www.sciencedirect.com/science/article/pii/S0140673606685073?casa_token=COyGuPY0ZQUAAAAA:JHAoRMZxvaZPO-hlHPKZiqSRsaLPXtcZzYZwrnDR5H6MtmJbA9mliwX0NbTKXZwUFzARGRAQlp9a">protects young children</a> from the most severe forms of TB, the vaccine seems to give <a href="https://academic.oup.com/jid/article-abstract/221/1/146/5556484">much less protection for adults</a>. </p>
<p>The BCG vaccine, unlike COVID vaccines, is a live vaccine, meaning it contains live (but weakened) bacteria. So it can’t be given safely to people with immune suppressing conditions, like HIV, because they could get infected from it. This means its use is limited in some people who most need protection.</p>
<h2>TB vaccine may protect against COVID</h2>
<p>Perhaps the BCG vaccine and COVID will come full circle. The <a href="https://www.mcri.edu.au/brace">BRACE trial</a>, launched from Melbourne’s Murdoch Children’s Research Institute, is studying whether the BCG vaccine might protect against COVID infection. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1243299284243509248"}"></div></p>
<p>This investigation has been prompted by a long history of research showing the vaccine also <a href="https://www.sciencedirect.com/science/article/pii/S1198743X19301971">improves our immune responses to other conditions</a> such as viral infections.</p>
<p>We don’t know yet whether this will work, as the study is ongoing. Almost 7,000 health-care workers around the world at risk of COVID exposure have been recruited to the trial.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/could-bcg-a-100-year-old-vaccine-for-tuberculosis-protect-against-coronavirus-138006">Could BCG, a 100-year-old vaccine for tuberculosis, protect against coronavirus?</a>
</strong>
</em>
</p>
<hr>
<p>Whether or not BCG turns out to prevent COVID, there’s no question we need new and more effective vaccines for TB.</p>
<p>While we have an increasing number of <a href="https://www.tbvi.eu/what-we-do/pipeline-of-vaccines/">potential vaccine candidates</a>, right now there is still no alternative to our 100-year-old BCG. </p>
<p>The massive amount of activity globally in developing COVID vaccines has also stimulated calls for <a href="https://theunion.org/news/bcg-100th-anniversary-statement-close-the-funding-gap">greater efforts and funding</a> to develop new TB vaccines. </p>
<p>We hope these will lead to more effective and safer options, and be powerful tools for eliminating TB. Let’s hope we’re not left waiting another 100 years.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/tuberculosis-kills-as-many-people-each-year-as-covid-19-its-time-we-found-a-better-vaccine-151590">Tuberculosis kills as many people each year as COVID-19. It's time we found a better vaccine</a>
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<img src="https://counter.theconversation.com/content/165303/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Justin Denholm is the Medical Director of the Victorian Tuberculosis Program.</span></em></p>COVID has shown us we can develop a range of safe and effective vaccines. Now we need to do the same for TB.Justin Denholm, Associate Professor, Melbourne HealthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1562082021-03-19T05:15:53Z2021-03-19T05:15:53ZRenovating your kitchen? Help Australia’s tradies avoid silicosis by not choosing artificial stone<figure><img src="https://images.theconversation.com/files/390511/original/file-20210318-21-w6kx4.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6006%2C3998&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>In 2012 my wife and I renovated our house — a two-storey extension with a brand new kitchen. Inspired by various renovation-themed TV shows and magazines, we chose a sleek stone island bench as the focal point for the kitchen. </p>
<p>I knew the benchtop material was some form of stone. You could choose almost any colour and it cost a lot less than marble. But I didn’t know much else and I didn’t ask any questions. As a respiratory physician who has diagnosed numerous workers with silicosis over the past four years, I regret my ignorance. </p>
<p>Like <a href="https://s23.q4cdn.com/225400014/files/doc_presentations/Investor-presentation-Sept-2018-Final-Version.pdf">many Australians</a> who have renovated or built homes since the early 2000s, the material we chose was artificial stone (also known as engineered or reconstituted stone, or quartz).</p>
<p>In 2015, after the first Australian stone benchtop industry worker was reported to have <a href="https://erj.ersjournals.com/content/46/suppl_59/PA1144">severe silicosis</a>, I was astonished to discover artificial stone contains <a href="https://theconversation.com/engineered-stone-benchtops-are-killing-our-tradies-heres-why-a-bans-the-only-answer-126489">up to 95%</a> crystalline silica.</p>
<p>Inhalation of crystalline silica dust is one of the best-known causes of lung disease, including silicosis and lung cancer. The adverse health effects of silica exposure <a href="https://theconversation.com/explainer-what-is-silicosis-and-why-is-this-old-lung-disease-making-a-comeback-80465">were established</a> while there was still debate about the harm of cigarettes and asbestos. But Australians’ affinity for artificial stone benchtops has seen silicosis make a major comeback in recent years.</p>
<p>New research <a href="https://www.worksafe.vic.gov.au/resources/silica-associated-lung-disease-health-screening-research-phase-one-final-report">in Victoria</a> shows the extent of silicosis among workers in the stone benchtop industry.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-silicosis-and-why-is-this-old-lung-disease-making-a-comeback-80465">Explainer: what is silicosis and why is this old lung disease making a comeback?</a>
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<h2>What is silicosis?</h2>
<p>Silicosis is <a href="https://theconversation.com/explainer-what-is-silicosis-and-why-is-this-old-lung-disease-making-a-comeback-80465">a preventable disease</a> characterised by scarring on the lungs, called <a href="https://pubmed.ncbi.nlm.nih.gov/31989662/">pulmonary fibrosis</a>. </p>
<p>Over time, inhalation of tiny silica dust particles triggers an inflammatory response that causes small growths called nodules to build up on the lungs. These nodules can grow and cluster together, causing the lungs to become stiffer and impeding the transfer of oxygen into the blood. </p>
<p>In the early stages of the disease, a person may be well. Symptoms of silicosis can include a cough, breathlessness and tiredness. Generally, the more widespread the disease becomes in the lungs, the more trouble a person will have with breathing.</p>
<p>There’s not currently a cure. In severe cases, a lung transplant may be the only option, and the disease <a href="https://www.abc.net.au/news/2019-03-13/silicosis-victim-dies-from-disease/10895774">can be fatal</a>.</p>
<p>Brisbane researchers, however, recently demonstrated <a href="https://www.9news.com.au/national/queensland-researchers-develop-world-first-treatment-for-deadly-lung-disease-silicosis-killing-tradies/2f5fc92f-d8a5-46f4-b6d3-2f0a6beb083a">early but promising results</a> from <a href="https://pubmed.ncbi.nlm.nih.gov/33626187/">a trial</a> in which they washed silica out of a small number of silicosis patients’ lungs.</p>
<figure class="align-center ">
<img alt="Two women drinking wine at a kitchen island bench." src="https://images.theconversation.com/files/390540/original/file-20210319-19-177rfrb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/390540/original/file-20210319-19-177rfrb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/390540/original/file-20210319-19-177rfrb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/390540/original/file-20210319-19-177rfrb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/390540/original/file-20210319-19-177rfrb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/390540/original/file-20210319-19-177rfrb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/390540/original/file-20210319-19-177rfrb.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">Many modern kitchens have benches made from artificial stone.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>The road to reform</h2>
<p>Tradesmen in the stone benchtop industry cut slabs of stone to size and use hand-held power saws and grinders to form holes for sinks and stove tops. This generates crystalline silica dust from the stone which may be released into the air. </p>
<p>Using water in this process can <a href="https://pubmed.ncbi.nlm.nih.gov/25326187/">suppress the generation of dust</a> significantly, but until recently dry processing of artificial stone has been ubiquitous in the industry. Almost <a href="https://www.worksafe.vic.gov.au/resources/silica-associated-lung-disease-health-screening-research-phase-one-final-report">70% of workers</a> with silicosis in Victoria indicated they spent more than half their time at work in an environment where dry processing was occurring.</p>
<p>Stone benchtop workers suffering silicosis <a href="https://www.abc.net.au/7.30/spike-in-silicosis-cases-from-dust-created-when/10361776">have called out</a> poor work conditions over recent years, including being made to perform dry cutting with inadequate protections such as effective ventilation and appropriate respirators. </p>
<p>Queensland was the first state to <a href="https://www.worksafe.qld.gov.au/news-and-events/alerts/workplace-health-and-safety-alerts/2018/prevent-exposure-to-silica-for-engineered-stone-benchtop-workers">ban dry cutting</a> in 2018. Victoria followed <a href="https://www.worksafe.vic.gov.au/news/2019-08/uncontrolled-dry-cutting-engineered-stone-banned">in 2019</a>, and <a href="https://www.smh.com.au/business/workplace/nsw-to-ban-dry-cutting-of-stone-products-to-combat-deadly-silicosis-20200220-p542qr.html">New South Wales</a> in 2020.</p>
<p>It’s too early to assess whether these changes have affected the prevalence of silicosis, but hopefully they will make a difference.</p>
<h2>Our research</h2>
<p>Around the time the Victorian government introduced the ban, it launched <a href="https://www.premier.vic.gov.au/protecting-victorian-workers-deadly-silica-dust">an enforcement blitz</a> in high-risk workplaces, while WorkSafe Victoria implemented a free screening program for the estimated 1,400 workers in the stone benchtop industry across the state. </p>
<p>The Monash Centre for Occupational and Environmental Health recently released <a href="https://www.worksafe.vic.gov.au/resources/silica-associated-lung-disease-health-screening-research-phase-one-final-report">a report</a> detailing the findings from the first year of the screening program. Some 18% of initial 324 workers who completed the assessments were diagnosed with silicosis.</p>
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<img alt="A doctor looks at an x-ray of lungs." src="https://images.theconversation.com/files/390544/original/file-20210319-23-1877npt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/390544/original/file-20210319-23-1877npt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/390544/original/file-20210319-23-1877npt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/390544/original/file-20210319-23-1877npt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/390544/original/file-20210319-23-1877npt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/390544/original/file-20210319-23-1877npt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/390544/original/file-20210319-23-1877npt.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">We found almost one in five workers in Victoria’s stone benchtop industry have silicosis.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>We’ve seen similar results <a href="https://www.worksafe.qld.gov.au/claims-and-insurance/work-related-injuries/types-of-injury-or-illness/work-related-respiratory-diseases/silicosis">in Queensland</a>, where as of February 2021 the government had screened 1,053 stonemasons exposed to crystalline silica dust from artificial stone. Some 223 (or 21%) were diagnosed with silicosis, including 32 with the most severe form, called progressive massive fibrosis.</p>
<p>The Monash report indicates workers in Victoria are diagnosed with silicosis at an average age of just 41. The average time spent working in the stone benchtop industry when diagnosed was 14 years, and the shortest was just three years, reflecting an extremely high level of silica dust exposure. </p>
<p>We published some earlier results of this research project in <a href="https://pubmed.ncbi.nlm.nih.gov/33115923/">Occupational and Environmental Medicine</a> late last year. But this latest data hasn’t yet been published in a peer-reviewed journal, meaning it hasn’t been subject to the same level of scrutiny as other published research.</p>
<h2>A broader problem</h2>
<p>Failure to protect workers from silica exposure <a href="https://www.9news.com.au/national/silica-office-admin-worker-joanna-mcneill-contracts-silicosis/d64f8661-8bca-4b6f-b950-a1d64e13e421">goes well beyond</a> the stone benchtop industry. </p>
<p>Around <a href="https://pubmed.ncbi.nlm.nih.gov/26888888/">3.7% of Australian workers</a> are estimated to be highly exposed to silica at work, and we see workers in other industries, such as quarry work, with silicosis too.</p>
<p>Some <a href="https://www.britannica.com/science/silica">59% of Earth’s crust</a> is silica, so in certain workplaces such as mines and quarries, eliminating silica is not feasible.</p>
<p>In these circumstances, exposure must be identified and tightly controlled with measures to prevent dust generation, isolation of workers from the dust, and effective ventilation. If silica cannot be eliminated from a workplace, constant vigilance and evaluation of control strategies are essential.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/engineered-stone-benchtops-are-killing-our-tradies-heres-why-a-bans-the-only-answer-126489">Engineered stone benchtops are killing our tradies. Here's why a ban's the only answer</a>
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</em>
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<hr>
<p>But when it comes to the choice of material for your kitchen benchtop, it’s hard to argue elimination of high-silica artificial stone isn’t feasible. There are many other materials suitable for benchtops that contain little or no silica, such as wood, laminate, steel or marble.</p>
<p>Compared with other countries, Australian consumers have developed a particular fondness for artificial stone, which accounts for <a href="https://s23.q4cdn.com/225400014/files/doc_presentations/Investor-presentation-Sept-2018-Final-Version.pdf">45% of the benchtop market here</a>, but just 14% in the United States.</p>
<p>Workers’ lung health may seem like a strange thing to contemplate when designing a kitchen. But increased awareness of this issue is crucial to drive change.</p><img src="https://counter.theconversation.com/content/156208/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ryan Hoy receives funding from WorkSafe Victoria. </span></em></p>New data shows 18% of workers in Victoria’s stone benchtop industry have silicosis. Ignorance and complacency around the risks of working with artificial stone are seeing tradies paying a high price.Ryan Hoy, Respiratory Physician. Senior Research Fellow. Monash Centre for Occupational and Environmental Health, Monash UniversityLicensed 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/1429562020-08-31T19:33:07Z2020-08-31T19:33:07ZWhy sign language is vital for all deaf babies, regardless of cochlear implant plans<figure><img src="https://images.theconversation.com/files/353720/original/file-20200819-25043-r3r9zy.jpg?ixlib=rb-1.1.0&rect=0%2C14%2C4590%2C3529&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Learning how to say 'more.'</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/african-american-mother-playing-with-baby-boy-royalty-free-image/138307713">JGI/Jamie Grill via Getty Images</a></span></figcaption></figure><p>When their newborn failed a hearing test, Quinn and Kai were distraught. Their pediatrician reassured them their baby was a candidate for a <a href="https://www.fda.gov/medical-devices/cochlear-implants/what-cochlear-implant#a">cochlear implant</a> – an electronic device consisting of an external part worn behind the ear and an internal part surgically placed under the skin – that could <a href="https://www3.gallaudet.edu/clerc-center/our-resources/cochlear-implant-education-center/navigating-a-forest-of-information/what-is-a-cochlear-implant.html">partially restore hearing</a> through electrical stimulation of the auditory nerve. </p>
<p>“We were told Casey would go to a mainstream school and learn to hear and talk just like any other kid,” Quinn told us. “The doctors said to speak to him as if he were hearing and not to learn sign language, because it would inhibit his spoken language development.” A few years later, Casey could speak some words but fell short of language milestones. Quinn and Kai’s story is one that is all too familiar to <a href="https://doi.org/10.1017/jse.2014.19">parents of deaf children</a>. </p>
<p>As <a href="https://scholar.google.com/citations?hl=en&user=S_q9BKsAAAAJ">researchers of language and literacy</a> in <a href="https://scholar.google.com/citations?user=BaAF_MEAAAAJ&hl=en&oi=ao">deaf education</a>, we regularly see implanted deaf children like Casey arrive at school with limited language and reasoning skills.</p>
<p>September is International Deaf Awareness Month. We want to debunk common misconceptions that can – and often do – harm deaf children.</p>
<h2>Cochlear implant ‘success’</h2>
<p>Cochlear implants are not a proven substitute for natural hearing. After surgery, children must undergo ongoing, intensive therapy to train the brain to make meaning of the sound it hears. Implant users’ understanding of speech is highly variable and <a href="https://doi.org/10.1146/annurev-neuro-080317-061513">declines substantially when talking or other environmental noise is present</a>. </p>
<p>Research shows cochlear implant success is uneven. Although children implanted at younger ages have higher speech and language scores than those implanted at older ages, the majority still <a href="https://doi.org/10.3389/fpsyg.2020.01407">perform “below” to “well below” average</a>. In a 2020 study of 136 children with cochlear implants in grades 3-6, teachers reported <a href="https://siwi.utk.edu/wp-content/uploads/Summary-Demographic-Data-Year-1-3.pdf">half had difficulty expressing “many to most” concepts in spoken English, and 13% did not speak English at all</a>.</p>
<h2>Sign language and speech development</h2>
<p>It is a misconception that learning sign language hinders spoken language development for implanted children. <a href="https://doi.org/10.1017/S0022215112001909">Research shows the opposite to be true</a>. Deaf children of deaf parents, whose first language is sign language, end up having better spoken language skills once they are implanted than deaf children of hearing parents <a href="https://doi.org/10.1093/deafed/ent045">who did not learn sign language</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/352998/original/file-20200814-16-l2nthd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A twelve year old girl dressed in a red top and an nine year old girl dressed in a lilac top communicate with sign language. The younger girl is fitted with a cochlear implant and the older girl wears a voice amplifier." src="https://images.theconversation.com/files/352998/original/file-20200814-16-l2nthd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/352998/original/file-20200814-16-l2nthd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/352998/original/file-20200814-16-l2nthd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/352998/original/file-20200814-16-l2nthd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/352998/original/file-20200814-16-l2nthd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/352998/original/file-20200814-16-l2nthd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/352998/original/file-20200814-16-l2nthd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cochlear implants are most successful for children who learn sign language at an early age.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/deaf-children-with-hearing-aids-in-a-school-class-royalty-free-image/1094646216">Brian Mitchell/Corbis Documentary via Getty Images</a></span>
</figcaption>
</figure>
<p>Research also shows <a href="https://siwi.utk.edu/wp-content/uploads/Summary-Demographic-Data-Year-1-3.pdf">a relationship between sign language and spoken English in school-aged children with cochlear implants</a>: The children who scored highly in sign language were the same ones who scored highly in English. And the children with weak sign language skills also struggled with spoken English.</p>
<p>In fact, sign language is so good for the developing brain some <a href="https://www.babysignlanguage.com/">hearing parents teach it to their hearing children</a> to boost brain development and jump-start communication before speech. </p>
<h2>The window of opportunity for language development</h2>
<p>The idea that sign language can be introduced later, if a cochlear implant is not successful, ignores the basic facts of language development.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/352994/original/file-20200814-14-7y7y43.jpg?ixlib=rb-1.1.0&rect=8%2C25%2C5565%2C3707&q=45&auto=format&w=1000&fit=clip"><img alt="A white mother signing to her attentive baby who is mimicking the hand gesture" src="https://images.theconversation.com/files/352994/original/file-20200814-14-7y7y43.jpg?ixlib=rb-1.1.0&rect=8%2C25%2C5565%2C3707&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/352994/original/file-20200814-14-7y7y43.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/352994/original/file-20200814-14-7y7y43.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/352994/original/file-20200814-14-7y7y43.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/352994/original/file-20200814-14-7y7y43.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/352994/original/file-20200814-14-7y7y43.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/352994/original/file-20200814-14-7y7y43.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">Babies’ brains need language to develop properly.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-signing-the-word-dad-in-american-sign-royalty-free-image/89839900">Huntstock via Getty Images</a></span>
</figcaption>
</figure>
<p>In the first years of life, children absorb language like sponges, as long as social interactions are accessible. The longer a child waits for meaningful language input, the greater the <a href="https://doi.org/10.1017/S0142716407070294">risk of never fully acquiring language</a>. The first five years are a critical period for acquisition.</p>
<p>Research shows that deaf children exposed to sign language later – after unsuccessfully developing spoken language – demonstrate <a href="https://doi.org/10.1017/S1366728917000724">rapid word learning but stop short of attaining complex grammatical structures</a>. </p>
<p>The long-term implications of language deprivation are quite serious. A wide range of <a href="https://doi.org/10.1016/j.amepre.2019.04.001">adverse childhood experiences</a> are known to be associated with adult disease and health problems. Communication exclusion and neglect experienced by deaf children create toxic stress that can trigger physiological and psychological responses. </p>
<p>Limited access to communication in childhood is <a href="https://doi.org/10.1016/j.amepre.2020.04.016">linked to heart problems, lung disease, diabetes, hypertension, depression and anxiety disorders</a> as well as <a href="https://doi.org/10.1093/deafed/enj042">chronic mental illness</a>. </p>
<p>In severe cases, individuals may be institutionalized with language deprivation syndrome. They struggle with <a href="https://doi.org/10.1007/s00127-017-1351-7">social and emotional skills, memory, problem solving and judgment</a>, all of which can impact their ability to live independently.</p>
<h2>Audism in the medical community</h2>
<p>Just as racism is at the root of structural inequalities towards Black, Indigenous and other people of color, <a href="https://doi.org/10.1177/0160597613481731">audism</a> is institutionalized discrimination against deaf people. The medical community is steeped in <a href="https://doi.org/10.1007/s10995-020-02989-1">hearing-at-all-costs attitudes and beliefs</a> that can <a href="https://doi.org/10.1007/s10995-017-2287-y">lead to language deprivation</a> in deaf children. </p>
<p>Doctors are trained to treat and remedy specific physical ailments. Unfortunately, their <a href="https://doi.org/10.1007/s40670-014-0073-7">training is unlikely to include</a> topics of early language acquisition and sign language. </p>
<p>When a deaf baby is born, parents receive the bulk of their <a href="https://doi.org/10.1093/deafed/enq004">information and advice from the medical community</a> – audiologists, ENTs and pediatricians. These doctors too often <a href="https://doi.org/10.1177/0162243913512538">discourage sign language</a>, suggesting it impedes speech development. As a result, deaf children risk growing up without a solid foundation in any language, which is <a href="https://www.routledge.com/Language-Deprivation-and-Deaf-Mental-Health/Glickman-Hall/p/book/9781138735392">dehumanizing and reduces their quality of life</a>. </p>
<h2>The way forward</h2>
<p>We believe the medical community must be educated about <a href="https://doi.org/10.1007/s10995-017-2287-y">deaf children’s need for sign language education</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/3o8Z2lzS764?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A two-year-old deaf girl chatting with her mother in British Sign Language.</span></figcaption>
</figure>
<p>Families can learn sign language along with their babies. It takes two years to acquire conversational skills and five to seven years to develop language fluency, which perfectly matches a child’s language development timeline. </p>
<p>Free services are available to families, including home visits, sign language classes and deaf mentorship. <a href="https://www.ceasd.org/administrative-educational-members/">Schools for the deaf</a> are a great resource, as are civil rights organizations like the <a href="https://www.nad.org/">National Association of the Deaf</a>. For deaf children and their families, taking part in the deaf community can deepen their understanding and appreciation of the deaf experience and increase their linguistic role models, which in turn <a href="https://doi.org/10.1353/sls.2015.0006">provides a long-term educational advantage</a>.</p>
<p>The catastrophe of language deprivation is entirely preventable with early sign language exposure. Lack of awareness is all that stands in the way.</p>
<p>[<em>Understand new developments in science, health and technology, each week.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-understand">Subscribe to The Conversation’s science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/142956/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The research reported here was supported by the Institute of Education Sciences, U.S. Department of Education, through Grant R324A170086 to the University of Tennessee. The opinions expressed are those of the authors and do not represent views of the Institute or the U.S. Department of Education.</span></em></p><p class="fine-print"><em><span>Kristina Bernhardt and Leala Holcomb do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Teaching deaf babies sign language improves the success of cochlear implants – and also safeguards their long-term physical and mental health.Kimberly A. Wolbers, Professor of Deaf Education, University of TennesseeLeala Holcomb, Postdoctoral Researcher of Language and Literacy, University of TennesseeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1399572020-06-25T12:21:24Z2020-06-25T12:21:24ZDays with both extreme heat and extreme air pollution are becoming more common – which can’t be a good thing for global health<figure><img src="https://images.theconversation.com/files/341891/original/file-20200615-65916-uthnry.jpg?ixlib=rb-1.1.0&rect=14%2C21%2C4796%2C2798&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Much of India experiences both extreme heat and extreme air pollution, as seen in this photo of the Akshardham Hindu temple. Days with both are going to increase. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/general-view-of-the-akshardham-hindu-temple-under-heavy-news-photo/1182232711?adppopup=true">Sajjad Hussain/AFP via Getty Images</a></span></figcaption></figure><p><em>The Research Brief is a short take on interesting academic work.</em></p>
<h2>The big idea</h2>
<p>Days of extreme high heat and extreme air pollution are both increasing worldwide. In November 2019, New Delhi experienced a week of the worst air pollution in human history. <a href="https://www.cnn.com/2019/11/04/india/delhi-india-smog-pollution-intl-hnk/index.html">The entire city shut down</a> and <a href="https://weather.com/science/environment/news/2019-11-04-hazardous-smog-new-delhi-india-air-quality-index">planes couldn’t see well enough to land</a>. Not long before that, Western Europe was slammed with two record-breaking heatwaves that <a href="https://en.wikipedia.org/wiki/July_2019_European_heat_wave">caused the deaths of nearly 1,500 people</a>. </p>
<p>Days of extreme heat and extreme pollution do not often overlap, but our two teams at Texas A&M wanted to see if the <a href="https://scholar.google.com/citations?hl=en&user=vFWm-10AAAAJ">number of these double extreme days was increasing</a> and explore what the <a href="https://scholar.google.com/citations?hl=en&user=hRARGzgAAAAJ">health risks of that might be</a>.</p>
<p>To test this, we used a computer model to look at the <a href="https://doi.org/10.1029/2019AV000103">co-occurrence of extreme heat and extreme air pollution in South Asia</a>. The model incorporated trends in greenhouse gas and air pollution emissions from industrial and residential sources, population growth, migration trends and even how air pollution is affected by weather, terrain and nearby oceans. </p>
<p>We predict that the frequency of days with both extreme heat and pollution – and the number of people that will be affected by those days – could massively increase by 2050.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/343835/original/file-20200624-132955-1opo8fo.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/343835/original/file-20200624-132955-1opo8fo.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/343835/original/file-20200624-132955-1opo8fo.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=599&fit=crop&dpr=1 600w, https://images.theconversation.com/files/343835/original/file-20200624-132955-1opo8fo.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=599&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/343835/original/file-20200624-132955-1opo8fo.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=599&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/343835/original/file-20200624-132955-1opo8fo.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=753&fit=crop&dpr=1 754w, https://images.theconversation.com/files/343835/original/file-20200624-132955-1opo8fo.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=753&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/343835/original/file-20200624-132955-1opo8fo.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=753&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Increases in heat and air pollution could cause huge areas of South Asia to experience these double extreme days.</span>
<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>We focused on South Asia because it’s already a climate change hot spot and its population is projected to increase from <a href="https://iopscience.iop.org/article/10.1088/1748-9326/11/8/084003/meta">1.5 billion today to 2 billion by 2050</a>. Under a <a href="https://www.theatlantic.com/science/archive/2019/01/rcp-85-the-climate-change-disaster-scenario/579700/">worst-case climate change scenario</a> and with little reduction in CO2 and other pollutants, days with both extreme heat and extreme pollution would <a href="https://doi.org/10.1029/2019AV000103">increase in frequency by 175% in the region</a>, resulting in roughly 78 days a year with those double whammy conditions. </p>
<p>Additionally, the amount of land that would experience this double threat for 60 days or more a year would increase tenfold from 2000 to 2050 – from 2% to more than 25% of all of South Asia. This will also lead to more than 52% of the population being exposed to more than 60 days of this double hazard.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/341892/original/file-20200615-65942-1qcvqf4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/341892/original/file-20200615-65942-1qcvqf4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/341892/original/file-20200615-65942-1qcvqf4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/341892/original/file-20200615-65942-1qcvqf4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/341892/original/file-20200615-65942-1qcvqf4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/341892/original/file-20200615-65942-1qcvqf4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/341892/original/file-20200615-65942-1qcvqf4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/341892/original/file-20200615-65942-1qcvqf4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Both extreme heat and extreme air pollution pose serious health risks and the evidence, though minimal, shows experiencing both at once is even more dangerous.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/the-first-plane-of-a-putting-sun-hiding-between-royalty-free-image/608220672?adppopup=true">Jose A. Bernat Bacete/Moment via Getty Images</a></span>
</figcaption>
</figure>
<h2>Why it matters</h2>
<p>Both extreme heat and air pollution have severe negative effects on the human body.</p>
<p>Extreme heat increases the likelihood of <a href="https://doi.org/10.1177/1010539510391644">heat exhaustion and heat stroke</a>, but can also worsen <a href="https://doi.org/10.1016/j.ejim.2010.03.001">chronic ailments such as heart disease</a>. As part of an effort to better understand how extreme heat affects mortality rates, we are currently studying the <a href="https://innovation.tamu.edu/Innovation-X-Program-Results-(1)/Heat-Extremes">health effects of heat extremes here in Texas</a>. </p>
<p>Air pollution is known to lead to <a href="https://doi.org/10.1016/j.acap.2019.03.010">asthma</a>, <a href="https://doi.org/10.1016/j.envpol.2007.06.012">heart disease</a>, <a href="https://doi.org/10.1016/j.envres.2014.08.002">pregnancy complications</a> and other severe health effects.</p>
<p>So what happens when a person experiences both at the same time?</p>
<p>Scientists know that when a person experiences air pollution in addition to another simultaneous stressor, they become more susceptible to both. This has been shown for combinations such as <a href="https://doi.org/10.1164/rccm.201106-1011OC">air pollution and smoking</a>, as well as <a href="https://www.iass-potsdam.de/en/blog/2020/05/lack-clean-cooking-energy-aggravates-coronavirus-impact-africa">air pollution and COVID-19</a>. </p>
<p>It is hard to say exactly what effect a prolonged exposure to the double threats of heat and air pollution would have on human health as there have only been a few cases studies looking at the <a href="https://doi.org/10.1007/s10584-010-9852-3">combined effects of both</a>. The results, though sparse, <a href="https://doi.org/10.1097/EDE.0000000000000090">do suggest that more people die</a> when the two conditions co-occur.</p>
<h2>What still isn’t known</h2>
<p>The full health effects from a combination of extreme heat and extreme pollution are largely unknown, especially in many developing nations where studies haven’t been done and the extremes are expected to get more severe. Billions of people are expected to experience these conditions in the coming decades, but researchers know little about what the risks are.</p>
<p>Which populations – both demographically and in terms of chronic diseases – are most at risk? Just how dangerous are these double extreme days to human health? Where are the most at-risk populations?</p>
<p>It is thus important to develop an empirical understanding of the relationship between health outcomes and multiple environmental stressors like heat and air quality.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/341893/original/file-20200615-65934-10jl1w5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/341893/original/file-20200615-65934-10jl1w5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/341893/original/file-20200615-65934-10jl1w5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/341893/original/file-20200615-65934-10jl1w5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/341893/original/file-20200615-65934-10jl1w5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/341893/original/file-20200615-65934-10jl1w5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/341893/original/file-20200615-65934-10jl1w5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/341893/original/file-20200615-65934-10jl1w5.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">A transition to greener energy and practices can improve both climate and air quality.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/windmills-in-zhoushan-royalty-free-image/1125840430?adppopup=true">Jia Yu/Moment via Getty Images</a></span>
</figcaption>
</figure>
<h2>What’s next</h2>
<p>Learning who is most at risk is important, but taking preventative measures, everyone together, should also be considered.</p>
<p>Using our models, we found that reducing carbon dioxide and non-CO2 air pollutant emissions – even by a moderate amount far less than what would be required to meet the <a href="https://www.unenvironment.org/resources/emissions-gap-report-2019">2 degrees Celsius target in the Paris agreement</a> – would prevent the most severe outcomes. </p>
<p>Even under a very moderate emission reduction scenario called RCP6.0 – <a href="https://doi.org/10.1007/s10584-011-0148-z">where emissions peak in 2060</a> – the frequency of double extreme days would increase by only 58% by 2050, compared to the 175% we are headed for. The population and land area to experience extended exposure to this hazard would be less than half of what was projected in the business-as-usual scenario.</p>
<p>These increases are still nothing to look forward to, but they show that mitigation efforts can make a big difference. In our view, the world needs to act swiftly and, for example, seize the opportunity of current economic recovery to <a href="https://doi.org/10.1038/d41586-020-01682-1">invest in greener energy</a>. Our future generations do not deserve a dirty, hot future.</p>
<p>[<em>Get our best science, health and technology stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-best">Sign up for The Conversation’s science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/139957/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yangyang Xu receives funding from National Science Foundation. </span></em></p><p class="fine-print"><em><span>Xiaohui Xu does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In South Asia, days with both extreme heat and extreme pollution are expected to increase 175% by 2050. Separately, the health effects are bad; together they will likely be worse.Yangyang Xu, Assistant Professor of Atmospheric Sciences, Texas A&M UniversityXiaohui Xu, Associate Professor of Epidemiology and Biostatistics, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1365812020-05-05T12:19:03Z2020-05-05T12:19:03ZCoronavirus is giving smokers incentive to quit, and social distancing could help them do it<figure><img src="https://images.theconversation.com/files/331156/original/file-20200428-110785-29m6g0.jpg?ixlib=rb-1.1.0&rect=3%2C7%2C2349%2C1469&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Research shows smoking or vaping can make coronavirus illnesses worse.</span> <span class="attribution"><a class="source" href="http://gettyimages.com">krisanapong detraphiphat via Getty Images</a></span></figcaption></figure><p>The coronavirus pandemic is giving smokers more reasons to give up the habit, and it’s creating a unique window of opportunity to do so.</p>
<p><a href="https://theconversation.com/profiles/amy-harrington-1036181">As a medical doctor</a> working in addiction psychiatry, I work with a lot of patients who smoke or vape. I’ve been hearing from many of them that the coronavirus pandemic is the extra motivation that they need to finally quit.</p>
<p>Some have told me they want to eliminate that trip to the corner store to buy cigarettes because they’re worried about catching or spreading the virus. Others have lost jobs or have fewer work hours now and need to eliminate the expense.</p>
<p>Many of them tell me that they want their lungs to be as healthy as possible in case they become infected with the coronavirus. </p>
<p>The medical research coming in about coronavirus and smoking backs up those fears. </p>
<h2>Why smoking can make COVID-19 worse</h2>
<p>A study in China looked at the differences between early <a href="https://doi.org/10.1056/NEJMoa2002032">COVID-19 patients who were smokers and nonsmokers</a> and found a higher percentage of smokers had severe COVID-19 illnesses compared to non-severe symptoms. It also found that of the people who were put on a ventilator or died, a higher percentage of smokers were in this group compared with the percentage of people who smoke in general. </p>
<p>There are many reasons why smoking or vaping nicotine or other products might make coronavirus illnesses worse. (There are a lot of people who vape non-nicotine products, thinking it’s healthier. It’s not.) </p>
<p>People who smoke are more likely to have heart disease and chronic lung conditions like COPD, and these conditions make the prognosis for the infection worse. <a href="https://theconversation.com/chronic-conditions-worsen-coronavirus-risk-heres-how-to-manage-them-amid-the-pandemic-136037">People with chronic illnesses are more vulnerable</a> to the effects of a type of inflammation caused by COVID-19 called a cytokine storm, which can damage blood vessels and lead to blood clots.</p>
<p>Simply the fact that smokers bring their hands to their faces, often touching or coming close to touching their face, can also increase the likelihood of infection. </p>
<p>European doctors who reviewed the data and research on connections between smoking and COVID-19 severity suggested that <a href="https://doi.org/10.1093/ntr/ntaa059">smoking may cause direct biochemical changes</a> to the lung cells that can cause smokers to develop more severe illnesses from coronavirus infections.</p>
<p>Occasionally over the past few months, people have tried to promote tobacco use in the context of COVID-19. <a href="https://doi.org/10.32388/WPP19W.3">One study at a hospital in France</a> found that a smaller percentage of COVID-19 patients were smokers as compared with the country’s general population. That drew attention, but the study, published without peer review, has several weaknesses, including a small sample size that excluded the sickest patients – those in ICU – and probably underestimated the number of smokers who were hospitalized. </p>
<h2>A unique opportunity to quit</h2>
<p>Quitting is hard, even under normal circumstances. Many people say that smoking or vaping is a way they deal with stress, and these are stressful times. </p>
<p>On the other hand, smoking is often a social activity. With offices and factories closed and people away from friends and colleagues, old social patterns of smoking with friends and in certain places at certain times of day are disrupted. Social distancing can effectively take away the social aspect of smoking, particularly if no one else in the home smokes.</p>
<p>With less social pressure, smokers have a window of opportunity to work on quitting.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/331061/original/file-20200428-110770-1c0xuya.jpg?ixlib=rb-1.1.0&rect=0%2C21%2C2020%2C1215&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/331061/original/file-20200428-110770-1c0xuya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/331061/original/file-20200428-110770-1c0xuya.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/331061/original/file-20200428-110770-1c0xuya.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/331061/original/file-20200428-110770-1c0xuya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/331061/original/file-20200428-110770-1c0xuya.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/331061/original/file-20200428-110770-1c0xuya.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">Smokers are more likely to have heart disease and chronic lung conditions that increase the likelihood of developing severe COVID-19 symptoms.</span>
<span class="attribution"><a class="source" href="http://gettyimages.com">Kena Betancur/AFP/Getty Images</a></span>
</figcaption>
</figure>
<p>There are many online resources to support people who are trying to quit smoking, and taking advantage of these can be an opportunity to connect socially and develop a new support system during these times. </p>
<p><a href="http://nicotine-anonymous.org/">Nicotine Anonymous</a> offers telephone meetings for people trying to quit smoking that follow the 12-step format, similar to the one used by Alcoholics Anonymous. Their website also has links to internet-based meetings and support lines. </p>
<p>There are also several <a href="https://smokefree.gov/">apps for quitting smoking</a> on the National Institutes of Heath website smokefree.gov that can be downloaded to a smartphone. </p>
<p><a href="https://mylifemyquit.com/">Teens in certain states</a>, including Massachusetts, can get smoking cessation support through text or live chat through the website MyLifeMyQuit.com. The Massachusetts Department of Public Health operates the <a href="http://quitworks.makesmokinghistory.org/">Quitworks program</a>, which begins with either a phone call or an online referral and offers support.</p>
<h2>Medications and telemedicine can help</h2>
<p>Doctors can also prescribe different types of medication to help people quit smoking. </p>
<p>Nicotine patches are just one form of medication that can help someone to quit smoking. These patches are in the category of nicotine replacement therapy, which also includes nicotine gum and nicotine lozenges. Nicotine replacement therapy helps to reduce cravings by providing nicotine through a safer route. </p>
<p>Other medications affect the areas of the brain that make nicotine rewarding, so smokers are left with just the unpleasant effects of tobacco. These medications include varenicline, which binds to the nicotine receptor and activates it to reduce cravings. Another is bupropion, which reduces cravings for nicotine and may also help prevent the minor weight gain some people experience when they quit smoking.</p>
<p>Many doctors have added telemedicine to their practices during the coronavirus pandemic. Telemedicine provides a safe platform to develop a smoking cessation strategy with your doctor without leaving your home. </p>
<h2>A few more tips</h2>
<p>Once smokers and their doctors have decided on a strategy, there are some basic things they can do to increase their likelihood of success in quitting smoking.</p>
<p>Start by getting rid of the things that might trigger the urge to smoke, like lighters or ashtrays. </p>
<p>Tell friends and family that you are quitting so they can hold you accountable. </p>
<p>Finally, remember that quitting smoking is one of the most important things that you can do to stay safer during the coronavirus pandemic.</p>
<p>[<em>Get facts about coronavirus and the latest research.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=upper-coronavirus-facts">Sign up for The Conversation’s newsletter.</a>]</p><img src="https://counter.theconversation.com/content/136581/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Harrington does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>An addiction psychiatrist explains why smoking raises the risks from COVID-19 and how to quit.Amy Harrington, Assistant Professor of Psychiatry, UMass Chan Medical SchoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1360372020-04-22T11:56:45Z2020-04-22T11:56:45ZChronic conditions worsen coronavirus risk – here’s how to manage them amid the pandemic<figure><img src="https://images.theconversation.com/files/328975/original/file-20200420-152558-1hof1e4.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2117%2C1383&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">To avoid the high risk COVID-19 poses to older adults with chronic illnesses, many doctors have shifted appointments to telemedicine. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com">BSIP/Universal Images Group via Getty Images</a></span></figcaption></figure><p>Amid the stress and confusion of coronavirus shutdowns and social distancing orders, it can seem to older patients as though everything is on pause. Clinics have postponed regular office visits. Patients worry about going to pharmacies and grocery stores. There’s even <a href="https://www.washingtonpost.com/health/patients-with-heart-attacks-strokes-and-even-appendicitis-vanish-from-hospitals/2020/04/19/9ca3ef24-7eb4-11ea-9040-68981f488eed_story.html">anecdotal evidence</a> that people with <a href="http://www.onlinejacc.org/content/accj/early/2020/04/07/j.jacc.2020.04.011.full.pdf">serious issues such as chest pain</a> are avoiding emergency rooms.</p>
<p>One important fact must not get overlooked amid this pandemic: Chronic health conditions still need attention. </p>
<p>If you had diabetes before the pandemic, you still have diabetes and should be monitoring your blood sugar levels. If you were advised to follow a low-salt diet before the pandemic to control your blood pressure, you still need to follow a low-salt diet during what my spouse calls “the duration.” If you had to check in with your doctor if your weight increased from underlying congestive heart failure, you still need to check your weight daily and call your doctor.</p>
<p>As <a href="https://theconversation.com/profiles/laurie-archbald-pannone-894205">I remind my geriatric patients</a>, taking care of chronic conditions is even more critical right now as the new coronavirus raises the risk for people with underlying medical problems.</p>
<h2>Lungs, heart and even kidneys</h2>
<p>If you have chronic medical conditions and you become infected with the coronavirus, you’ll likely face an increased risk of developing severe symptoms. </p>
<p>The Centers for Disease Control and Prevention looked at a sample of U.S. patients with COVID-19 and found that
<a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm?s_cid=mm6915e3_w#contribAff">89% of those hospitalized in March had underlying conditions</a>. The percentage rose to 94% for patients age 65 and older.</p>
<p><iframe id="iJVja" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/iJVja/9/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>COVID-19 primarily affects the lungs, and people with lung diseases, such as COPD, have less “pulmonary reserve,” which is like having a backup generator waiting to kick in if the power goes out. So, what might have been a mild infection for someone else can develop into a severe infection for someone with lung problems.</p>
<p>Beyond the lungs, doctors and scientists are starting to see signs that COVID-19 may have <a href="https://doi.org/10.1016/j.kint.2020.04.003">devastating effects on the kidneys</a> and heart. An extreme immune system response known as a <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/797584">cytokine storm</a> can damage organs, and <a href="https://doi.org/10.1111/jth.14830">mini blood clots</a> have developed in some patients. </p>
<p>High blood pressure, congestive heart failure or diabetes can also increase the risk of developing severe symptoms from COVID-19. In the <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm?s_cid=mm6915e3_w#contribAff">CDC sample</a>, 73% of older patients hospitalized with COVID-19 also had hypertension, about a third had diabetes and just over half had cardiovascular disease.</p>
<h2>How to keep seeing your doctor</h2>
<p>Managing chronic conditions amid a pandemic is not easy. It requires adjusting daily routines and dealing with new obstacles. </p>
<p>One of the challenges is medical appointments. During the pandemic, most geriatric clinics have postponed in-person visits for routine check-ups to avoid exposing patients or staff to the coronavirus. But that doesn’t mean your doctor isn’t there for you. </p>
<p>My clinic, for example, has transitioned most patient appointments to telehealth. This allows us to keep in touch with our patients and their symptoms and to adjust treatment plans in real time. </p>
<p>Online portals with “virtual waiting rooms” allow for video visits between patient and doctor. For patients who don’t have access to the internet or aren’t as comfortable with the technology, the telephone works, too. Patients can send photos of injuries. Over 90% of my clinic visits with my geriatric patients are now by telephone. We schedule time for the clinic appointment, the clinic staff registers the patient, and then I call the patient for the check-up. </p>
<p>I was in the middle of one of these visits recently when a patient asked me if I thought they should try telehealth. I was surprised by the question, and the patient was surprised by my answer – we were in the middle of a telehealth visit. I realized that the common picture of telehealth conveys a complex process, perhaps similar to calling a customer service line.</p>
<p>Telehealth is typically arranged with your own doctor – same doctor, same relationship – just a different physical connection. </p>
<h2>What about prescription refills?</h2>
<p>Even if a clinic no longer has routine patient appointments, the office is probably still staffed. Patients can call the clinic and may also be able to request medication refills online. </p>
<p>Patients should check if their insurance company will allow 90-day supplies rather the usual 30 days so they can limit trips to the pharmacy. Some pharmacies are also providing <a href="https://theconversation.com/older-americans-are-risking-coronavirus-exposure-to-get-their-medications-135899">medication delivery or curbside pickup</a> now so high-risk patients don’t have to walk inside the store. </p>
<h2>Staying on a diet</h2>
<p>Diet is often one of the toughest adjustments needed for controlling chronic medical conditions.</p>
<p>Watching what we eat can be even more challenging during a pandemic. Following a low-carb diet for diabetes, following a low-salt diet for congestive heart failure or following a low-cholesterol diet for heart disease isn’t simple when people are sitting at home with stocked pantries and unable to get to the grocery store for fresh produce. </p>
<p>To avoid snacking out of boredom, try creating a daily meal and snack schedule. </p>
<p>Staying hydrated can also help. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682932/#R1%20(PMID:%2023702406)">Hormones that tell us when we need to drink something don’t respond as well</a> as we age, so our bodies may need water rather than an unhealthy snack. </p>
<p>If getting to the grocery store is a challenge, check if the store has senior-only hours, delivery or curbside pickup. A friend, neighbor or family member might be able to go grocery shopping for you. Many people are eager to help and just need to be asked.</p>
<h2>Staying out of the hospital</h2>
<p>Even if you don’t get COVID-19, it is still critically important that you continue to manage your chronic medical conditions. </p>
<p>When chronic conditions aren’t managed, patients run a higher risk of ending up in the emergency room and hospital – places where COVID-19 patients are likely also being treated and that have <a href="https://www.washingtonpost.com/graphics/2020/investigations/coronavirus-hospitals-data/">become overburdened</a> amid the pandemic.</p>
<p>One of the best ways to help them is to take care of yourself. Stay home. Stay well. Stay connected. </p>
<p>[<em>Get facts about coronavirus and the latest research.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=upper-coronavirus-facts">Sign up for The Conversation’s newsletter.</a>]</p><img src="https://counter.theconversation.com/content/136037/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laurie Archbald-Pannone does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While COVID-19 raises the risk for people with underlying medical conditions such as diabetes, high blood pressure and COPD, social distancing can make it harder to keep up diets and medication.Laurie Archbald-Pannone, Associate Professor Medicine, Geriatrics, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1344672020-04-13T14:12:52Z2020-04-13T14:12:52ZMore young people vaping, despite growing evidence of risks<figure><img src="https://images.theconversation.com/files/324628/original/file-20200401-23115-191rb8g.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2967%2C2020&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many young people are unaware of the health risks of e-cigarettes.</span> <span class="attribution"><span class="source">(AP Photo/Kin Cheung)</span></span></figcaption></figure><p>Vaping use is on the rise in young people, with as many as <a href="https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey/2018-2019-summary.html">one in five junior and secondary school students reporting use of vaping products in 2019</a>. </p>
<p>Vaping has been associated with <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html">severe respiratory health injuries and untimely deaths</a>, and there is now the <a href="https://www.cps.ca/en/blog-blogue/covid-youth-and-substance-use-critical-messages-for-youth-and-families">possibility that vaping may increase the risk of severe symptoms and complications in people infected with SARS-CoV-2, the virus that causes COVID-19</a>. These emerging risks raise serious concerns that vaping’s real consequences — either to individuals or broader society — are not yet known. </p>
<p>As public health researchers at the University of Saskatchewan, we have been tracking the use of vaping products since 2014 using the <a href="https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey/2018-2019-summary.html">Canadian Student Tobacco, Alcohol and Drugs Survey</a> (CSTADS). As negative consequences emerge, more work must be done to prevent the growing use of vaping products.</p>
<h2>Vaping use continues to increase among youth</h2>
<p>The <a href="https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey/2014-2015-supplementary-tables.html">first collection of data about e-cigarette use among Canadian youth in 2014</a> showed that six per cent of students in grades 6 through 12 reported they had used e-cigarettes in the previous 30 days. By 2017, <a href="https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey/2016-2017-summary.html">in the same national survey</a>, that number had climbed to 10 per cent.</p>
<p>By 2019, e-cigarette use among youth had <a href="https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey/2018-2019-summary.html">doubled compared to 2017</a>. In the 2019 survey, 20 per cent of young people had used an e-cigarette in the previous 30 days, and 40 per cent of that group reported daily or nearly daily use of the products.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/324181/original/file-20200331-65509-1ec8n1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/324181/original/file-20200331-65509-1ec8n1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=828&fit=crop&dpr=1 600w, https://images.theconversation.com/files/324181/original/file-20200331-65509-1ec8n1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=828&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/324181/original/file-20200331-65509-1ec8n1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=828&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/324181/original/file-20200331-65509-1ec8n1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1041&fit=crop&dpr=1 754w, https://images.theconversation.com/files/324181/original/file-20200331-65509-1ec8n1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1041&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/324181/original/file-20200331-65509-1ec8n1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1041&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A selection of e-cigarettes.</span>
<span class="attribution"><span class="source">(AP Photo/Ben Margot)</span></span>
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</figure>
<p>Although the popularity and the use of e-cigarettes have increased, the perceived risk of harm remains low. On the 2018-19 CSTADS, only 42 per cent of Canadian youth reported that they believe regular use of e-cigarettes containing nicotine posed a “great risk of harm,” and only 14 per cent believed e-cigarettes without nicotine posed such a risk. </p>
<p>With the <a href="https://www.justice.gc.ca/eng/cj-jp/cannabis/">legalization of marijuana</a> use in Canada in October 2018, there is a concern that we have yet to see how new behaviours like e-cigarette use, and their consequences, will become entrenched among youth.</p>
<h2>Initial intention backfires</h2>
<p>E-cigarettes were initially invented with the goal of creating a more effective smoking cessation tool to <a href="https://dx.doi.org/10.3978%2Fj.issn.2072-1439.2015.07.37">assist individuals experiencing challenges quitting tobacco smoking</a>. Despite this intention, <a href="https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey/2018-2019-summary.html">42 per cent of e-cigarette users indicated that they had never smoked a cigarette, not even a drag</a>. </p>
<p>The device has the potential to normalize smoking behaviour among youth rather than provide an incentive for smokers to quit.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/324182/original/file-20200331-65537-py3rnd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/324182/original/file-20200331-65537-py3rnd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/324182/original/file-20200331-65537-py3rnd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/324182/original/file-20200331-65537-py3rnd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/324182/original/file-20200331-65537-py3rnd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/324182/original/file-20200331-65537-py3rnd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/324182/original/file-20200331-65537-py3rnd.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">A vape kit, available for authorized retailers, is displayed at the Ontario Cannabis Store in Toronto in January 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Tijana Martin</span></span>
</figcaption>
</figure>
<p>Expert opinion is divided as to the value of e-cigarettes as a smoking cessation tool. Despite offering a vehicle for nicotine replacement, e-cigarettes present their own health risks, and the devices may not encourage individuals to quit smoking because they <a href="https://www.sciencedaily.com/releases/2014/01/140129164653.htm">do not break the link between their oral fixation and nicotine</a>.</p>
<h2>Nicotine: New look, more danger</h2>
<p>Another concern is that increased vaping could reverse the <a href="https://www.cps.ca/en/documents/position/e-cigarettes">advances made over decades by anti-smoking campaigns by Canadian organizations</a>. </p>
<p>A single e-cigarette pod can contain <a href="https://www.aafp.org/patient-care/public-health/tobacco-nicotine/tools/e-cigs.html">as much nicotine as an entire pack of cigarettes</a>. Approximately 90 per cent of students who use e-cigarettes said they used products containing nicotine on the 2018-19 CSTADS. </p>
<p>In <a href="http://dx.doi.org/10.1136/tobaccocontrol-2018-054565">a study published in <em>BMJ Tobacco Control</em> that compared nicotine levels</a> in young people who regularly smoked pod-style e-cigarettes (such as the very popular Juul) to those who regularly smoked conventional cigarettes, the e-cigarette smokers had higher nicotine levels. Additionally, e-cigarettes carry a greater risk of addiction, among youth, than smoking tobacco products, <a href="https://dx.doi.org/10.3390%2Fijerph16132279">according to new research published in the <em>International Journal of Environmental Research and Public Health</em></a>.</p>
<p>Nicotine is a powerful drug when it is delivered efficiently. This new delivery device was designed to accomplish that, and is additionally enticing because <a href="https://globalnews.ca/news/2830789/teens-use-e-cigarettes-because-they-are-cool-fun-and-new-study/">it is seen as novel and trendy</a>.</p>
<h2>Cannabis: Easy access, quicker high</h2>
<p>With the evolution of <a href="https://www.drugabuse.gov/publications/drugfacts/marijuana">new types of cannabis concentrates</a> (extracts such as shatter, crumble, budder and wax), greater risk of harm to youth has been created because these derivatives allow larger concentrations of compounds, like THC, to be inhaled very quickly. </p>
<p>Concentrate vaping is rapidly gaining in popularity and further expanding the room for experimentation with vaping among youth. Recent data suggest that <a href="https://doi.org/10.1542/peds.2019-0338">youth are using highly potent cannabis concentrates in the form of oil, wax or liquid preparations</a>, the health effects of which are yet to be well-researched, tested and standardized.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/324183/original/file-20200331-65528-1wxxm82.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/324183/original/file-20200331-65528-1wxxm82.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=344&fit=crop&dpr=1 600w, https://images.theconversation.com/files/324183/original/file-20200331-65528-1wxxm82.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=344&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/324183/original/file-20200331-65528-1wxxm82.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=344&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/324183/original/file-20200331-65528-1wxxm82.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=432&fit=crop&dpr=1 754w, https://images.theconversation.com/files/324183/original/file-20200331-65528-1wxxm82.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=432&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/324183/original/file-20200331-65528-1wxxm82.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=432&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A dab of marijuana resin.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Joe Mahoney</span></span>
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</figure>
<p>Furthermore, the impact of these highly concentrated products on brain development is unknown and may place youth at <a href="https://www.drugfreekidscanada.org/prevention/drug-info/cannabis/">risk of cannabis use disorder and psychosis</a>. These risks are further compounded by the emergence of vaping-related illnesses, such as e-cigarette or vaping use associated lung injury (EVALI), which to date has <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html">resulted in 68 deaths and over 2,807 cases</a> in the United States.</p>
<p>In terms of substance use by youth, <a href="https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey/2018-2019-summary.html">cannabis was second only to alcohol in 2019</a>. In the same time period, cannabis vaping was reported by 42 per cent of youth, compared to 30 per cent the previous year. </p>
<p>With changing marijuana legislation, use and access to cannabis products by youth has increased, with <a href="https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey/2018-2019-summary.html">four per cent of youth reporting that it has become easier for them to get cannabis for themselves</a>. This increased access to such products may alter how cannabis is consumed by the over one million youth currently consuming cannabis.</p>
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Read more:
<a href="https://theconversation.com/british-columbias-vaping-crackdown-could-offer-a-roadmap-for-the-rest-of-the-world-128378">British Columbia's vaping crackdown could offer a roadmap for the rest of the world</a>
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<p>Increased vaping and its unknown consequences threaten the health of our youth; it has been linked to <a href="https://doi.org/10.1542/peds.2016-0379">higher risk of progression to cigarette smoking</a>. Higher concentrations of <a href="https://doi.org/10.1371/journal.pone.0220300">nicotine</a> and <a href="https://www.drugabuse.gov/publications/drugfacts/marijuana">THC</a> are becoming available to the youth consumer, with unknown prevalence and effects that warrant further research.</p>
<p>It took <a href="https://www.ncbi.nlm.nih.gov/books/NBK222369/">decades to understand the lethal health effects of smoking tobacco</a>, which still <a href="https://www.who.int/news-room/fact-sheets/detail/tobacco">kills over eight million people annually</a>. We should not ignore those crucial lessons. We need to be vigilant and take all steps necessary to avert a public health catastrophe, now and in the future.</p><img src="https://counter.theconversation.com/content/134467/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tracey-Ann Stitchell is a former secondary and post-secondary biology teacher and currently is a PhD candidate in Community Health and Epidemiology at the University of Saskatchewan. She receives funding from the College of Medicine Graduate Student funding initiative.</span></em></p><p class="fine-print"><em><span>Nazeem Muhajarine works for the University of Saskatchewan. He receives funding from Global Affairs Canada, Canadian Institutes of Health Research, and Saskatchewan Health Research Foundation.</span></em></p>Even as evidence of its adverse effects emerges, vaping is growing more popular among young people.Tracey-Ann Stitchell, PHD Student, Community Health and Epidemiology, University of SaskatchewanNazeem Muhajarine, Professor, Department of Community Health and Epidemiology and Director, Saskatchewan Population Health and Evaluation Research Unit, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1354002020-04-09T12:09:32Z2020-04-09T12:09:32ZFor asthma patients, the novel coronavirus can be scary. Here’s what you need to know<figure><img src="https://images.theconversation.com/files/325909/original/file-20200406-160446-1etekq9.jpg?ixlib=rb-1.1.0&rect=4%2C24%2C1659%2C1078&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Hospitals have started using albuterol inhalers with coronavirus patients, making the rescue medication harder for asthma patients to find in some areas.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/cogdog/14716567729">Alan Levine/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>The new coronavirus’s ability to wreak havoc in the lungs is raising a lot of concerns and questions from my asthma patients. They already know how it feels to have trouble breathing. Now, they are wondering what risks they face amid this new pandemic.</p>
<p>Some worry that their asthma inhalers could increase their risk of COVID-19 infection. Others are asking if nebulizers are safe, and if they can use expired inhalers.</p>
<p>Here are answers to some of the common questions I’m hearing as <a href="https://providers.keckmedicine.org/provider/Cindy+Xi/526776">an allergist</a>. </p>
<h2>Do people with asthma face a higher risk of severe illness if they get COVID-19?</h2>
<p>There’s a lot we still don’t know about COVID-19 and how it affects asthma patients. </p>
<p>Based on the data we have so far, asthma <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102618/">does not</a> appear to increase the risk of acquiring COVID-19. However, the Centers for Disease Control and Prevention does list “chronic lung disease or moderate to severe asthma” under <a href="https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html">groups at higher risk</a> for severe illness if they get COVID-19.</p>
<p>It’s important to understand what “severe illness” means. </p>
<p>One complication from COVID-19 is acute respiratory distress syndrome, a severe lung disease that results from damage to the alveoli, the air sacs of the lungs. When COVID-19 patients require ventilators, it’s often for acute respiratory distress syndrome. We don’t know very much about the risk factors for developing acute respiratory distress syndrome or how to treat the specific type of inflammation that drives this condition, but there is no evidence that asthma is a risk factor for developing acute respiratory distress syndrome if infected with COVID-19. </p>
<p>In contrast to acute respiratory distress syndrome, asthma is a chronic condition that <a href="https://www.aafa.org/asthma.aspx">we know a lot about</a>. It is <a href="https://www.cdc.gov/asthma/faqs.htm">characterized</a> by airway inflammation, mucous production and airway spasm. Respiratory viruses, including strains of coronavirus that cause the common cold, can trigger <a href="https://community.aafa.org/blog/coronavirus-2019-ncov-flu-what-people-with-asthma-need-to-know">asthma symptoms</a>, and it’s likely that COVID-19 could do the same. Even though asthma is also an inflammatory condition, in contrast to acute respiratory distress syndrome, we have very effective treatments for asthma. </p>
<h2>What should I do to protect myself?</h2>
<p>Get your asthma under control and maintain that control. I cannot stress that enough. That means <a href="https://www.aaaai.org/conditions-and-treatments/library/asthma-library/covid-asthma">staying on your usual medications</a>.</p>
<p>At the first onset of respiratory symptoms, asthma patients should follow their individualized <a href="https://www.aafa.org/asthma-treatment-action-plan/">asthma action plan</a> and contact their health care provider to see if additional treatments are necessary to prevent symptoms from worsening. </p>
<h2>Can I keep using steroid medications?</h2>
<p>A few patients have told me they stopped their inhaled corticosteroid medication because they were concerned that the steroids would suppress their immune systems. That’s exactly what asthma doctors <a href="https://www.aaaai.org/conditions-and-treatments/library/asthma-library/covid-asthma">don’t want to hear</a>. </p>
<p>Asthma controller therapies reduce the frequency and severity of everyday asthma symptoms as well as asthma attacks. Stopping asthma controllers can increase the likelihood of a severe asthma attack when exposed to a trigger, such as a virus or allergen. An asthma attack, even if unrelated to COVID-19, may result in an emergency room visit, which can then increase risk of exposure to COVID-19.</p>
<p>For patients with COVID-19, the messages about corticosteroids can be confusing. In <a href="https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected">SARS and MERS</a>, as well as emerging studies on <a href="https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa243/5814897">COVID-19</a>, corticosteroids have not been shown to have a survival benefit. The <a href="https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected">World Health Organization</a> and the <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html">CDC</a> recommend that corticosteroids not be used routinely to treat viral pneumonia or ARDS due to COVID-19. </p>
<p>However, <a href="https://www.aaaai.org/conditions-and-treatments/library/asthma-library/covid-asthma">if a patient has an asthma attack</a>, regardless of whether the trigger is COVID-19, corticosteroids are usually effective and should be used.</p>
<h2>Are nebulizers OK to use at home?</h2>
<p>Sometimes patients have difficulty using handheld inhalers and instead use nebulizers, which turn liquid medicine into a mist. Particularly when the patient is experiencing severe asthma symptoms, nebulizers can be more effective at delivering medication slowly into the airways. </p>
<p>The current concern about nebulizers is that if they are used by a patient with a respiratory infection, the nebulizer could aerosolize droplets containing virus, allowing the virus to stay in the air longer. Hospitals and other facilities are being <a href="https://nam.edu/duty-to-plan-health-care-crisis-standards-of-care-and-novel-coronavirus-sars-cov-2/">advised to reduce their use of nebulizers</a> to reduce spread of the new coronavirus.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/325914/original/file-20200406-103556-ghbkcl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/325914/original/file-20200406-103556-ghbkcl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/325914/original/file-20200406-103556-ghbkcl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/325914/original/file-20200406-103556-ghbkcl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/325914/original/file-20200406-103556-ghbkcl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/325914/original/file-20200406-103556-ghbkcl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/325914/original/file-20200406-103556-ghbkcl.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">Nebulizers turn liquid medication into a mist that the asthma patient inhales. The way they work has raised concerns that nebulizers could spread coronavirus.</span>
<span class="attribution"><a class="source" href="http://www.gettyimages.com">BSIP/Universal Images Group via Getty Images</a></span>
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</figure>
<p>If an asthma patient finds that nebulized therapy is more effective than inhalers, the nebulizer should be used in a room that is <a href="https://community.aafa.org/blog/coronavirus-2019-ncov-flu-what-people-with-asthma-need-to-know">isolated</a> from other household members.</p>
<h2>What can I do if my pharmacy runs out of albuterol rescue inhalers?</h2>
<p>Some parts of the country are experiencing <a href="https://community.aafa.org/blog/albuterol-inhaler-shortage-due-to-covid-19-could-impact-people-with-asthma?nc=1">shortages of albuterol inhalers</a>, in part because hospitals are using them more for COVID-19 patients. If the pharmacy is out of stock, patients have some options:</p>
<ul>
<li><p>Albuterol handheld inhalers are marketed under various names, and not all are in short supply. It’s worth asking the pharmacist if another formulation is available.</p></li>
<li><p>Nebulized albuterol is widely available and may be an alternative if the user takes the recommended precautions. </p></li>
<li><p>Check with mail order or other local pharmacies. </p></li>
<li><p>Ask your physician whether other inhalers, such as levalbuterol or ipratropium, would be appropriate. Your physician may also suggest other alternatives.</p></li>
<li><p>If necessary, patients can use albuterol that <a href="https://acaai.org/news/message-asthma-sufferers-about-shortage-albuterol-metered-dose-inhalers">has expired</a>. In general, medications are thought to be safe one year after their expiration date, but they are not guaranteed to have the same potency.</p></li>
</ul>
<h2>What else should I do to stay healthy?</h2>
<p>Asthma care is individualized, and I recommend that asthma patients check in with their health care providers to make sure they are using daily controller medications correctly have a plan in place in case asthma symptoms worsen. Keep a 30-day supply of your usual medications, but don’t stockpile medications, which can lead to shortages. </p>
<p>At this point, most people are aware of the CDC’s recommendations on how to protect yourself, including social isolation, hand hygiene and disinfecting surfaces. I would add one more – pay attention to your <a href="https://theconversation.com/how-to-maintain-physical-and-mental-health-during-coronavirus-133602">mental health</a>, too.</p>
<p>When I asked one patient whether she had experienced asthma symptoms recently, her response was that she was hyperventilating at times just sitting and watching the news. She knew it was time to turn off the TV. </p>
<p>It’s a stressful time. Getting <a href="https://theconversation.com/beyond-sanitizing-and-social-distancing-a-healthy-circadian-rhythm-may-keep-you-sane-and-increase-resilience-to-fight-covid-19-135535">good sleep</a> and being kind to yourself and others is more important than ever. </p>
<p>[<em>Get facts about coronavirus and the latest research.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=upper-coronavirus-facts">Sign up for The Conversation’s newsletter.</a>]</p><img src="https://counter.theconversation.com/content/135400/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>S. Cindy Xi does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Asthma rescue inhalers are in short supply, and asthma sufferers are worried about the risks they face from COVID-19. A doctor answers six key questions.S. Cindy Xi, Clinical Assistant Professor of Medicine, University of Southern CaliforniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1359352020-04-08T05:40:48Z2020-04-08T05:40:48ZDoes JK Rowling’s breathing technique cure the coronavirus? No, it could help spread it<p>Harry Potter author JK Rowling says a breathing technique has helped her coronavirus-like respiratory symptoms, a claim that has been <a href="https://thenewdaily.com.au/entertainment/celebrity/2020/04/07/coronavirus-breathing-jk-rowling/">widely reported</a> and shared on social media.</p>
<p>Her tweet includes a video from a UK hospital doctor describing the technique, a type of controlled coughing. This involves taking six deep breaths and on the last one covering your mouth and coughing. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1247121896082157568"}"></div></p>
<p>The internet is full of home grown cures for the coronavirus. And when doctors propose them, they appear credible. </p>
<p>While special breathing techniques have their place in hospital, under the supervision of a respiratory physiotherapist or respiratory doctor, and for certain medical conditions, using them at home to manage coronavirus symptoms could be dangerous.</p>
<p>The technique in the video could help spread the coronavirus to people close by. </p>
<p>By coughing, you could directly infect people with droplets, or these droplets on someone’s hands can be transferred to a surface others can touch.</p>
<p>So JK Rowling’s well-meaning advice could inadvertently help spread the virus to your family, or to the person next to you on the bus.</p>
<h2>Controlled coughing helps with cystic fibrosis</h2>
<p>The cells in our lungs produce a sticky mucus as part of our body’s defence system. And when we have a viral lung infection, such as with the virus that causes COVID-19 or the influenza virus, we produce more of it. </p>
<p>The mucus traps the invading pathogen. Normally, this mucus is removed from the lungs by the movement of tiny hair-like projections in our airways. From there, we either swallow the mucus or cough it out as phlegm. </p>
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Read more:
<a href="https://theconversation.com/health-check-why-do-i-have-a-cough-and-what-can-i-do-about-it-119172">Health Check: why do I have a cough and what can I do about it?</a>
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<p>However, sometimes we produce so much mucus it is difficult to breathe. The mucus can block our tiny airways, preventing us from obtaining oxygen from our lungs.</p>
<p>In other diseases, such as <a href="https://www.cff.org/What-is-CF/About-Cystic-Fibrosis/">cystic fibrosis</a>, controlled coughing <a href="https://books.google.com.au/books?id=mOqODwAAQBAJ&pg=PA107&lpg=PA107&dq=hypoxemia++%22controlled+cough%22&source=bl&ots=k254DYbDkD&sig=ACfU3U2C5lJuGblV3mgKdKX2Ej5Dcp1XyA&hl=en&sa=X&ved=2ahUKEwjOqdm0xtfoAhUQzDgGHWAVDuQQ6AEwA3oECAgQNQ#v=onepage&q=controlled%20cough&f=false">can help</a> remove the mucus and make it easier for people to breathe. </p>
<p>This technique may be done as part of chest physiotherapy, along with other lung clearance techniques, in a hospital. The technique is not dangerous, but the contents of what is coughed out can be.</p>
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Read more:
<a href="https://theconversation.com/explainer-what-is-cystic-fibrosis-and-how-is-it-treated-59681">Explainer: what is cystic fibrosis and how is it treated?</a>
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<h2>So can it help with the coronavirus?</h2>
<p>So what’s the evidence controlled coughing could help people manage their coronavirus symptoms? Put simply, there are no clinical trials or good evidence. </p>
<p>One common COVID-19 symptom is a <a href="https://www.who.int/news-room/q-a-detail/q-a-coronaviruses#:%7E:text=symptoms">dry cough</a>. So it’s difficult to imagine why controlled coughing would help when you’re coughing so much anyway.</p>
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Read more:
<a href="https://theconversation.com/can-coronavirus-spread-through-food-can-anti-inflammatories-like-ibuprofen-make-it-worse-coronavirus-claims-checked-by-experts-133911">Can coronavirus spread through food? Can anti-inflammatories like ibuprofen make it worse? Coronavirus claims checked by experts</a>
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</em>
</p>
<hr>
<h2>Is there any harm in trying?</h2>
<p>There is a very real risk that unintentionally this technique would actually spread the virus. </p>
<p>When we cough we produce a lot of droplets of mucus from the <a href="https://academic.oup.com/cid/article/46/1/93/338992">lungs</a> that are spread as a spray.
My research <a href="https://iopscience.iop.org/article/10.1088/1752-7155/10/4/046002">has also shown</a> breathing out forcefully is enough to propel viruses from the lungs this way.</p>
<p>Either way large sprays of viruses could infect other people. </p>
<p>In hospital, this risk is minimised by having specialised negative pressure rooms that remove the contaminated air. Patients wear masks to capture the sprays and clinical staff wear personal protective equipment, including masks and face shields. There are also strict infection control measures, such as limits on visitors and hand washing. Yet the risks of transmission remain high.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/no-5g-radiation-doesnt-cause-or-spread-the-coronavirus-saying-it-does-is-destructive-135695">No, 5G radiation doesn't cause or spread the coronavirus. Saying it does is destructive</a>
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</em>
</p>
<hr>
<p>But if you practise controlled coughing at home or on the bus, it’s easy to see how you could inadvertently spread the virus.</p>
<p>And of course, the technique doesn’t kill the virus or cure anyone.</p>
<h2>So what are we to make of all this?</h2>
<p>So why did JK Rowling endorse this technique? In essence, it’s because she believed it helped her, and thought it would help others.</p>
<p>However, her tweet says she <a href="https://twitter.com/jk_rowling/status/1247121896082157568">hadn’t been tested</a> for COVID-19, so it’s not certain she had the infection. And she may or may not have benefited from the technique. Perhaps her symptoms may have improved by themselves anyway. It’s hard to know.</p>
<p>My advice is to seek medical advice if you suspect you have the coronavirus rather than rely on testimonials, however well meaning. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-how-long-does-it-take-to-get-sick-how-infectious-is-it-will-you-always-have-a-fever-covid-19-basics-explained-132963">Coronavirus: how long does it take to get sick? How infectious is it? Will you always have a fever? COVID-19 basics explained</a>
</strong>
</em>
</p>
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<img src="https://counter.theconversation.com/content/135935/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brian Oliver receives funding from the NHMRC and the ARC.
Brian Oliver is the co-director of the Respiratory, Sleep, Environmental and Occupational Health Clinical Academic group of Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), A NHMRC AHRTC. He is also president of the NSW branch of the thoracic society of Australia and New Zealand. </span></em></p>Controlled coughing can help people with cystic fibrosis, under supervision and in hospital. But when done at home, it could help spread the coronavirus.Brian Oliver, Research Leader in Respiratory cellular and molecular biology at the Woolcock Institute of Medical Research and Professor, Faculty of Science, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1286072019-12-19T13:50:23Z2019-12-19T13:50:23ZGiving pregnant women antibiotics could harm the lungs of preemies, according to study in mice<figure><img src="https://images.theconversation.com/files/306434/original/file-20191211-95149-1gyrcya.jpg?ixlib=rb-1.1.0&rect=71%2C44%2C5919%2C3943&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Premature infants are at higher risk for lung diseases.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newborn-premature-baby-being-held-fathers-580721992">Sarahbean/Shutterstock.com</a></span></figcaption></figure><p>Born after just 23 of the normal 40 weeks of pregnancy, the extremely preterm baby is small enough to fit in the palm of my hand and weighs just one and a quarter pounds. <a href="https://www.researchgate.net/profile/Kent_Willis">I am a neonatologist</a>, a physician that cares for these preterm babies in intensive care. Most of these preterm infants, particularly the smallest and sickest who require oxygen to help them breathe, are at high risk of developing lung inflammation and <a href="http://dx.doi.org/10.1016/S1084-2756(02)00193-8">scarring</a>. </p>
<p>This early damage will lead to a chronic lung disease called <a href="https://www.nhlbi.nih.gov/health-topics/bronchopulmonary-dysplasia">bronchopulmonary dysplasia</a>. Bronchopulmonary dysplasia can be one of the most severe and long-lasting complications of being a preterm baby. Many require oxygen for years and often have severe asthma-like episodes during which they are hospitalized for difficulty breathing. </p>
<p>Bronchopulmonary dysplasia affects many of the tiniest preterm babies that I care for and often leads to severe long-term disability. But it’s tricky to prevent preterm babies from developing bronchopulmonary dysplasia, and the situation is a bit of a Catch-22. That is because oxygen and breathing machines, which are essential for keeping these babies alive, also increase the likelihood of developing bronchopulmonary dysplasia. This dilemma has inspired my research into lung disease in preterm babies to discover new ways of preventing bronchopulmonary dysplasia.</p>
<h2>The gut-lung axis</h2>
<p>In newborns, research into <a href="http://dx.doi.org/10.1126/scitranslmed.aab2271">asthma</a> and <a href="http://dx.doi.org/10.1126/scitranslmed.aaf9412">pneumonia</a> has indicated that the microbial communities, known as the microbiome, that live inside the human gut can influence inflammation – the response of the body to pathogens or cellular damage – in their host. This may happen because of changes in the host immune system, which in turn may shape the course of lung diseases that result from <a href="http://dx.doi.org/10.1016/j.jaci.2014.06.027">inflammation</a>.</p>
<p>This recently discovered connection between the gut microbes and lung health or disease is called the <a href="https://doi.org/10.1513/AnnalsATS.201503-133AW">gut-lung axis</a>, and it may reveal new ways to treat lung diseases.</p>
<p>Over the last several years, neonatologists have done retrospective studies in which they looked back over several years of babies’ records to see if they could identify events that happened to babies who later developed bronchopulmonary dysplasia. These studies were designed to try to identify new exposures that might cause bronchopulmonary dysplasia. </p>
<p>One potential trigger for bronchopulmonary dysplasia was <a href="http://dx.doi.org/10.1016/j.jpeds.2014.09.041">antibiotics</a>. One thing that stood out to researchers, including myself, was a potential link between the mother being exposed to antibiotics and babies who developed <a href="http://dx.doi.org/10.1016/j.jaci.2014.06.027">bronchopulmonary dysplasia</a>. However, because a lot of babies and mothers are given antibiotics, this research wasn’t enough to prove that antibiotic exposure causes bronchopulmonary dysplasia.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/306454/original/file-20191211-95165-1y2x986.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/306454/original/file-20191211-95165-1y2x986.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/306454/original/file-20191211-95165-1y2x986.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=369&fit=crop&dpr=1 600w, https://images.theconversation.com/files/306454/original/file-20191211-95165-1y2x986.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=369&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/306454/original/file-20191211-95165-1y2x986.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=369&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/306454/original/file-20191211-95165-1y2x986.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=464&fit=crop&dpr=1 754w, https://images.theconversation.com/files/306454/original/file-20191211-95165-1y2x986.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=464&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/306454/original/file-20191211-95165-1y2x986.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=464&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 premature baby with neonatal infant pulse oximeter.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/premature-baby-legs-neonatal-infant-pulse-1073367044">Kristina Bessolova/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>Maternal antibiotic exposure worsens bronchopulmonary dysplasia</h2>
<p>In my <a href="https://doi.org/10.1152/ajplung.00561.2018">latest study</a>, I used mice to test whether there was a causal link between the state of the gut-lung axis and how bronchopulmonary dysplasia develops. </p>
<p>I wanted to investigate how maternal exposure to antibiotics affects the lung development of offspring. I thought this research would not only lead to a better understanding of the gut-lung axis but also identify a new way to potentially prevent bronchopulmonary dysplasia. </p>
<p>My colleagues and I sorted pregnant mice into four groups and exposed the mothers to antibiotics at different points during gestation. </p>
<p>The first group of mother mice was exposed to antibiotics throughout their pregnancy and for the first two weeks of their pups’ life while they nursed. The second group was exposed just during pregnancy, but not after. Group three was exposed just while nursing. The fourth group wasn’t exposed at all. After the pups were born, we also exposed some to oxygen – just as we would do for a premature infant – which triggered bronchopulmonary dysplasia. </p>
<p>At the end of the experiment we looked at the lung structure of the baby mice. All the newborn mice that were exposed to oxygen developed bronchopulmonary dysplasia to some extent, but the mice whose mothers were exposed to antibiotics developed more severe disease. In fact, mice exposed to antibiotics at any stage were more deformed and had a more simplified structure than the animals that were never exposed to antibiotics. </p>
<p>A simplified lung structure, with giant, partially formed air sacs instead of tiny, well-shaped air sacs, is the hallmark of bronchopulmonary dysplasia. The more abnormal the air sac structure, the worse the bronchopulmonary dysplasia. These changes in lung structure are evidence that antibiotic exposure caused more severe bronchopulmonary dysplasia in these mice. </p>
<p>My colleagues and I were also surprised to find that antibiotics given to the mother also increased scarring in the lungs of their babies, abnormal blood vessel structure and more white blood cells in their lung tissue. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/307531/original/file-20191217-58353-am76m.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/307531/original/file-20191217-58353-am76m.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/307531/original/file-20191217-58353-am76m.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/307531/original/file-20191217-58353-am76m.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/307531/original/file-20191217-58353-am76m.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/307531/original/file-20191217-58353-am76m.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/307531/original/file-20191217-58353-am76m.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/307531/original/file-20191217-58353-am76m.png?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"></a>
<figcaption>
<span class="caption">Giving antibiotics during pregnancy causes more severe lung damage in the pups. This figure created with the aid of BioRender.</span>
<span class="attribution"><span class="source">Kent Willis</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>Reshaping the gut-lung axis to prevent bronchopulmonary dysplasia</h2>
<p>Finally, to understand what the gut-lung axis had to do with bronchopulmonary dysplasia, we looked at the microbes in the guts of the baby mice during the first two weeks of life. My colleagues and I found that that giving antibiotics to their mothers likely prevented them from acquiring normal bacterial communities like those found in the guts of pups with no antibiotic exposure.</p>
<p>However, the way we administered the antibiotics did not directly affect the pups. Rather, the antibiotics altered the mother’s microbiome. The pups then inherited this altered set of bacteria from her. We also showed that molecules that allow gut microbes to signal to the lungs about the status of the microbial communities in the gut in newborn mice were reduced in newborn mice with abnormal microbial communities.</p>
<p>These experiments imply that the gut-lung axis may be involved in causing bronchopulmonary dysplasia. Because a lot of human mothers and preterm babies are given antibiotics, our research suggests that physicians should consider the risks to the fetus when giving a pregnant mother antibiotics and only do so when there are no other alternatives.</p>
<p>A lot more research needs to be done. First, we would like to test if we can change the microbial communities in newborn mice so that they are more resistant to getting bronchopulmonary dysplasia. Next I plan to investigate what part of the microbial communities alters the gut-lung axis. This may reveal a way to make human preterm babies resistant to developing bronchopulmonary dysplasia.</p>
<p>[ <em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/128607/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kent Willis does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Prenatal and postnatal antibiotic exposure combined with oxygen treatment led to lung inflammation and altered immunity in a study in mice.Kent Willis, Assistant Professor of Neonatology, University of TennesseeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1275162019-11-22T02:17:37Z2019-11-22T02:17:37ZHow to manage your essential medicines in a bushfire or other emergency<figure><img src="https://images.theconversation.com/files/303054/original/file-20191121-112975-14msbiq.jpg?ixlib=rb-1.1.0&rect=2%2C4%2C994%2C652&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In an emergency, like a bushfire, making sure you have enough of your regular medication can mean the difference between life and death. But there are many ways to prepare.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/australian-bushfires-2018-nsw-1314222035?src=e0689ffc-a914-4f72-9942-0725c91c91c9-1-4&studio=1">from www.shutterstock.com</a></span></figcaption></figure><p>Some people find managing their medication difficult at the best of times. But in an emergency, like a bushfire or cyclone, this can be harder still. </p>
<p>As catastrophic bushfires burn across Australia, here’s what to think about as part of your emergency planning to make sure you have access to the medicines you need.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-you-can-do-about-the-health-impact-of-bushfire-smoke-19333">What you can do about the health impact of bushfire smoke</a>
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</em>
</p>
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<p>As part of your emergency plan, list your medications and where you keep them, along with contact details for your doctor and pharmacist and any other relevant emergency services. </p>
<p>If you have advanced warning of emergency conditions, check both your supply of tablets and any prescriptions you may need. Your prescription label will tell you how many repeats you have left. Try and keep at least one week’s medication on hand.</p>
<h2>I need to evacuate. Now what?</h2>
<p>If you need to evacuate, know how best to store and transport your medication. Most medications for conditions such as blood pressure or cholesterol need to be stored below 25-30°C. These medications will be OK if temperatures are higher than this for short periods of time, while you transport them.</p>
<p>Medicines sensitive to temperature will need to be stored or transported with cold packs in an insulated container of some sort, such as an esky. Putting them in a ziplock bag will help protect them from moisture.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/evacuating-with-a-baby-heres-what-to-put-in-your-emergency-kit-127026">Evacuating with a baby? Here's what to put in your emergency kit</a>
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<p>Insulin is one common medication you need to <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/diabetes-and-insulin">store cold</a>. Your current insulin pen can be stored at room temperature. But store unused pens with a cold pack in an esky until you find refrigeration.</p>
<p>This also applies to <a href="https://www.nps.org.au/medicine-finder/eutroxsig-tablets">thyroxine</a> tablets. Fourteen days supply (usually one strip of tablets) is OK if stored at room temperature. But keep the rest with a cold pack. If you don’t think it will be possible to keep the rest below 25°C for a long time, also keep these with the cold pack.</p>
<p>Many antibiotic syrups, such as <a href="https://www.healthdirect.gov.au/cephalexin">cefalexin</a>, also need to be kept cold. But check the dispensing label or speak to your pharmacist if you are not sure.</p>
<h2>What if I run out of medicine?</h2>
<p>If you are caught without essential medication, doctors and pharmacists can help in a number of ways.</p>
<p>This is easier if you have a regular GP and pharmacist who will both have a complete record of your medication. Your pharmacist can call your GP and <a href="https://www.legislation.nsw.gov.au/#/view/regulation/2008/392/part3/div4/subDiv2/sec44">obtain verbal approval</a> to supply your medication. Your GP will then need to fax or email the prescription to your pharmacist as soon as possible and mail the original script within seven days.</p>
<p>Pharmacists can also dispense emergency supplies of cholesterol medicines and oral contraceptives, so long as you already take them. Under so-called <a href="https://www.humanservices.gov.au/organisations/health-professionals/services/medicare/pbs-pharmacists/initiatives/continued-dispensing">continued dispensing arrangements</a>, pharmacists can dispense a single pack of these medicines once every 12 months.</p>
<p>If you cannot get in touch with your GP, in an emergency, most states allow a pharmacist to dispense a <a href="https://www.legislation.nsw.gov.au/#/view/regulation/2008/392/part3/div4/subDiv2/sec45">three-day supply</a> of your medication. But this is only if the pharmacist has enough information to make that judgement.</p>
<p>Some medicines, such as strong pain medications and sleeping tablets, are not covered by these provisions.</p>
<h2>Medicines for people with lung conditions, like asthma</h2>
<p>People with existing lung conditions (such as asthma, chronic obstructive pulmonary disease or bronchitis), older people, young children and pregnant women are most likely to be vulnerable to the effect of <a href="https://www.nationalasthma.org.au/news/2019/record-pollen-fires-wind-and-storms-a-dangerous-mix-for-asthma">bushfire smoke</a>. They can also have symptoms long after a bushfire if fine particulate matter is still in the air.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-does-poor-air-quality-from-bushfire-smoke-affect-our-health-126835">How does poor air quality from bushfire smoke affect our health?</a>
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<p>If you have a respiratory condition, follow the <a href="https://www.nationalasthma.org.au/living-with-asthma/asthma-action-plans">action plan</a> you will have already discussed with your doctor, which outlines what to do in an emergency. </p>
<p>This plan includes instructions on what you should do if your asthma gets worse, such as taking extra doses or additional medication. It also tells you when you should contact your doctor or go to the emergency department.</p>
<p>If you have a respiratory condition, such as asthma, and live in a bush fire prone zone, this action plan needs to be part of your fire safety survival plan.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/thunderstorm-asthma-whos-at-risk-and-how-to-manage-it-86397">Thunderstorm asthma: who's at risk and how to manage it</a>
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<p>You also need to make sure you have enough <a href="https://www.nationalasthma.org.au/understanding-asthma/treatment-and-medicines">preventer and reliever medications</a>, for asthma for example, to hand just in case there is an emergency.</p>
<p>If you don’t have an action plan, taking four separate puffs of your reliever medication may relieve acute symptoms. This applies for adults and children.</p>
<h2>In a nutshell</h2>
<p>Being prepared for an emergency, like a bushfire, goes a long way to keeping you and your family safe. That applies to thinking about your supply of medicines well in advance, if possible. </p>
<p>But if conditions change rapidly and you need to evacuate, an esky containing medicines for a few days, and contact numbers for your GP and pharmacist, could save your life.</p><img src="https://counter.theconversation.com/content/127516/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Bartlett is a member of the Australian College of Pharmacy</span></em></p><p class="fine-print"><em><span>Bandana Saini receives funds from the NHMRC, Australian Department of Health (via Community Pharmacy Agreements) and Asthma Australia.</span></em></p>During bushfire season, managing medication as well as respiratory conditions should be part of any emergency plan.Andrew Bartlett, Associate Lecturer Pharmacy Practice, University of SydneyBandana Saini, Associate Professor, Pharmacy Practice, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1257302019-11-12T02:57:01Z2019-11-12T02:57:01ZVaping-related lung disease now has a name – and a likely cause. 5 things you need to know about EVALI<figure><img src="https://images.theconversation.com/files/300589/original/file-20191107-10973-voh39n.jpg?ixlib=rb-1.1.0&rect=5%2C0%2C3948%2C2632&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Health authorities in the United States are investigating what exactly has caused the recent outbreak of vaping-related illness.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p>More than <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html">2,000 people</a> in the United States have developed serious lung damage in a poisoning outbreak associated with the use of vaping devices this year. At least 39 people have died from the condition. </p>
<p>Most of those affected are young men. Their symptoms, which developed over a few days to several weeks, included cough, shortness of breath, chest pain, nausea, vomiting, abdominal pain, diarrhoea, fever, chills, and weight loss. </p>
<p>The United States Centers for Disease Control and Prevention (CDC) has recently named this combination of symptoms – “e-cigarette or vaping product use associated lung injury”, or EVALI.</p>
<p>Importantly, <a href="https://www.nytimes.com/2019/11/08/health/vaping-illness-cdc.html?smtyp=cur&smid=tw-nytimes">it has now implicated vitamin E acetate</a>, an ingredient added to illicit cannabis vaping liquids, as the most likely cause of EVALI.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1192867329278926848"}"></div></p>
<h2>1. What EVALI is and how it’s diagnosed</h2>
<p>EVALI cases are characterised by pneumonitis (lung inflammation). Some cases have involved the accumulation of oil in the lungs, while others have involved an accumulation of white blood cells – a marker of the immune system responding to a threat.</p>
<p>To be classified as EVALI, cases have to satisfy the following <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease/health-departments/index.html">criteria</a>:</p>
<ul>
<li>having vaped or “dabbed” (inhaled a concentrated cannabis product) in the 90 days before symptoms started</li>
<li>a chest image showing the presence of a substance denser than air in the lungs (pulmonary infiltrates) or pathology confirming acute lung injury</li>
<li>absence of lung infection or any alternative plausible medical diagnosis that explains the symptoms.</li>
</ul>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-safest-to-avoid-e-cigarettes-altogether-unless-vaping-is-helping-you-quit-smoking-123274">It's safest to avoid e-cigarettes altogether – unless vaping is helping you quit smoking</a>
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<h2>2. Why this new diagnosis was needed</h2>
<p>When investigating the causes of an outbreak like this, it’s important to have a clear definition that determines who is and who is not likely to be part of the outbreak. </p>
<p>For example, some people who vape may develop similar symptoms from other lung conditions unrelated to vaping (for example, they may have influenza, or chronic obstructive pulmonary disease due to a history of cigarette smoking). </p>
<p>If these people were included as outbreak cases it would be more difficult to identify the cause of EVALI.</p>
<h2>3. The cause of EVALI</h2>
<p>Cases have followed a typical acute outbreak pattern, with most occurring over a number of months. The <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html">peak</a> was in September this year when 463 cases were admitted to hospitals. </p>
<p>This pattern indicates EVALI is a form of acute poisoning, rather than a condition that has developed from chronic vaping over many years. It’s most likely there’s something new in vaping products used by these patients that’s caused the spike in lung injuries.</p>
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Read more:
<a href="https://theconversation.com/how-a-person-vapes-not-just-what-a-person-vapes-could-also-play-a-big-role-in-vaping-harm-122527">How a person vapes, not just what a person vapes, could also play a big role in vaping harm</a>
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<p><a href="https://www.washingtonpost.com/health/2019/10/25/cdc-most-people-who-died-vaping-linked-disease-used-products-containing-thc/">Most people with EVALI</a> have either admitted using, or later been found to have vaped products containing tetrahydrocannabinol (THC), the major psychoactive ingredient in cannabis. They have typically purchased these products from <a href="https://www.cdc.gov/mmwr/volumes/68/wr/mm6845e1.htm">illicit sources</a>. </p>
<p>Laboratory analyses of THC vaping product samples supplied by EVALI cases have found many of these contain vitamin E acetate (oil). Vitamin E acetate is sometimes <a href="https://www.leafly.com/news/health/toxic-vaping-vapi-evali-lung-injury-rise-and-fall-of-vitamin-e-oil-honey-cut">added to illicit THC vaping products</a> to dilute and then thicken the liquid to hide the dilution, in the same way other illicit drugs are “cut” with other substances to reduce their purity.</p>
<p>The CDC tested fluid samples collected from the lungs of 29 EVALI cases and found <a href="https://www.cdc.gov/mmwr/volumes/68/wr/mm6845e2.htm">all samples contained vitamin E acetate</a>. </p>
<p>One theory is the oil may be the direct cause of the lung injury, because some of these patients have been diagnosed with lipoid pneumonia (lung inflammation associated with oil inhalation). However, it increasingly looks like a <a href="https://www.nejm.org/doi/full/10.1056/NEJMc1913069">chemical</a> formed from the vitamin E acetate may be causing the toxicity. Research is continuing to test this hypothesis. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/301158/original/file-20191111-178520-ahczjc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/301158/original/file-20191111-178520-ahczjc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=345&fit=crop&dpr=1 600w, https://images.theconversation.com/files/301158/original/file-20191111-178520-ahczjc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=345&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/301158/original/file-20191111-178520-ahczjc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=345&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/301158/original/file-20191111-178520-ahczjc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=434&fit=crop&dpr=1 754w, https://images.theconversation.com/files/301158/original/file-20191111-178520-ahczjc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=434&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/301158/original/file-20191111-178520-ahczjc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=434&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">Vitamin E oil is safe to use on the skin, but not to inhale via vaping.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
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<p>It appears increasingly unlikely standard commercially produced nicotine vaping products are a cause of EVALI. </p>
<p>Of 849 EVALI patients who provided information about the <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html">products they used</a>, only 10% reported exclusive use of nicotine-containing products, while 78% reported using THC-containing products. Some EVALI patients who initially denied using THC vaping products <a href="https://www.cdc.gov/mmwr/volumes/68/wr/mm6839e2.htm">were later found to have used them</a>.</p>
<p>EVALI has not been evident in other countries with widespread use of nicotine vaping products but little use of THC vaping products, <a href="https://publichealthmatters.blog.gov.uk/2019/10/29/vaping-and-lung-disease-in-the-us-phes-advice/">such as the UK</a>.</p>
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Read more:
<a href="https://theconversation.com/vaping-likely-has-dangers-that-could-take-years-for-scientists-to-even-know-about-123051">Vaping likely has dangers that could take years for scientists to even know about</a>
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<h2>4. How EVALI can be treated</h2>
<p>Many patients with EVALI have developed a severe illness that requires hospitalisation. In the most serious cases, <a href="https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease/healthcare-providers/pdfs/evaluating-caring-evali-patients.pdf">treatment</a> has involved intubation and mechanical ventilation because the patient cannot breathe on their own. </p>
<p>Most patients have been treated with corticosteroids to reduce the inflammation on the lungs. Antiviral and antibiotic medicines may also be given on a case-by-case basis. </p>
<p>EVALI patients are strongly advised to avoid vaping and cigarette smoking, so treatment may be needed to address dependence on nicotine and/or cannabis, such as behavioural support and non-inhaled nicotine replacement therapies like nicotine gum and patches.</p>
<h2>5. How you can avoid EVALI</h2>
<p>The US authorities recommend consumers <a href="https://www.fda.gov/consumers/consumer-updates/vaping-illness-update-fda-warns-public-stop-using-tetrahydrocannabinol-thc-containing-vaping">do not use any cannabis or THC vaping products</a>, especially those purchased illegally. </p>
<p>Only one EVALI case has been reported outside the US, <a href="https://www.cbc.ca/news/canada/montreal/vaping-related-illness-quebec-1.5299487">in Canada</a>, but it’s difficult to rule out the possibility illicit THC vaping products sold in other countries may also be contaminated with the causative agent.</p>
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Read more:
<a href="https://theconversation.com/vaping-as-an-imaging-scientist-i-fear-the-deadly-impact-on-peoples-lungs-123435">Vaping: As an imaging scientist I fear the deadly impact on people’s lungs</a>
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<img src="https://counter.theconversation.com/content/125730/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Coral Gartner receives funding from the National Health and Medical Research Council (NHMRC), the Australian Research Council (ARC), Queensland Health, and previously the Health Promotion Foundation of Victoria (VicHealth), the New South Wales Ministry of Health, and the HIV Foundation Queensland.</span></em></p><p class="fine-print"><em><span>Wayne Hall has received funding from VicHealth and NHMRC for research on tobacco harm reduction and e-cigarettes. </span></em></p>Defining what this disease is and who has it has helped those investigating the outbreak understand what caused it.Coral Gartner, Associate Professor, School of Public Health, The University of QueenslandWayne Hall, Professor and Director, Centre for Youth Substance Abuse Research, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.