CME: E-Cigarettes & Cough Reflex Sensitivity

CME: E-Cigarettes & Cough Reflex Sensitivity

Evidence suggests that electronic cigarette (e-cig) use has grown rapidly in recent years. “There seems to be a perception among the public—and perhaps even some physicians—that e-cigs are a benign substance because users are essentially inhaling water vapor,” says Peter V. Dicpinigaitis, MD. “However, few studies have assessed how e-cig use affects the respiratory tract or pulmonary function.” Previous studies have shown that otherwise healthy smokers of tobacco cigarettes experience decreased cough reflex sensitivity when compared with non-smokers. Dr. Dicpinigaitis is one of few researchers worldwide with the ability to measure the effects of an external influence on cough reflex sensitivity in the laboratory using capsaicin, which has been shown in previous research to induce cough in a safe, dose-dependent, and reproducible manner. With this background, he and his colleagues sought to determine the effects of a single exposure to e-cig vapor on cough reflex sensitivity.   A Closer Look For a study published in Chest, healthy adult lifetime nonsmokers visited a study site on 3 consecutive days. “Unlike previous research assessing cough reflex sensitivity in which chronic cigarette smokers were easy to recruit, there are few chronic e-cig users,” explains Dr. Dicpinigaitis. On Day 1 of the study, participants underwent cough reflex sensitivity measurements in order to establish a baseline. On Day 2, they underwent an e-cig vaping session using the disposable e-cig Blu (Fontem US, Inc). “Blu is one of the most commonly used disposable e-cigs in the United States, and use of a disposable e-cig is easiest for a research study,” says Dr. Dicpinigaitis. The vaping session consisted of 30 puffs on the e-cig 30 seconds...
E-Cigarettes & Cough Reflex Sensitivity

E-Cigarettes & Cough Reflex Sensitivity

Evidence suggests that electronic cigarette (e-cig) use has grown rapidly in recent years. “There seems to be a perception among the public—and perhaps even some physicians—that e-cigs are a benign substance because users are essentially inhaling water vapor,” says Peter V. Dicpinigaitis, MD. “However, few studies have assessed how e-cig use affects the respiratory tract or pulmonary function.” Previous studies have shown that otherwise healthy smokers of tobacco cigarettes experience decreased cough reflex sensitivity when compared with non-smokers. Dr. Dicpinigaitis is one of few researchers worldwide with the ability to measure the effects of an external influence on cough reflex sensitivity in the laboratory using capsaicin, which has been shown in previous research to induce cough in a safe, dose-dependent, and reproducible manner. With this background, he and his colleagues sought to determine the effects of a single exposure to e-cig vapor on cough reflex sensitivity.   A Closer Look For a study published in Chest, healthy adult lifetime nonsmokers visited a study site on 3 consecutive days. “Unlike previous research assessing cough reflex sensitivity in which chronic cigarette smokers were easy to recruit, there are few chronic e-cig users,” explains Dr. Dicpinigaitis. On Day 1 of the study, participants underwent cough reflex sensitivity measurements in order to establish a baseline. On Day 2, they underwent an e-cig vaping session using the disposable e-cig Blu (Fontem US, Inc). “Blu is one of the most commonly used disposable e-cigs in the United States, and use of a disposable e-cig is easiest for a research study,” says Dr. Dicpinigaitis. The vaping session consisted of 30 puffs on the e-cig 30 seconds...
CME – Smoking & PAD: Assessing the Costs

CME – Smoking & PAD: Assessing the Costs

Peripheral artery disease (PAD) is one of the most common cardiovascular diseases among adults in the United States. The risk for developing PAD increases as people age and are exposed to specific atherosclerosis risk factors. Previous published research has linked continued tobacco use to an increasing number of heart attacks and strokes, worsened claudication, increased amputations, aneurysms, exposure to costly medical procedures, and death in people with PAD. Tobacco use has been identified as an important preventable cause of PAD and is a major determinant of adverse clinical outcomes. Taking a Closer Look Surprisingly, no prior studies have specifically explored the contribution of tobacco use to short-term healthcare utilization and medical costs in PAD. To address this research gap, Sue Duval, PhD, FAHA, and colleagues evaluated this risk in a large, population-based, cross-sectional study published in the Journal of the American College of Cardiology that analyzed 2011 claims data of more than 22,000 people with PAD. “Our study was designed to define the associated immediate health and economic burden of tobacco use in Minnesota and the United States,” says Dr. Duval. “It represents one of the largest measurements of the impact of PAD on health.” Claims data used in the study were provided by Blue Cross and Blue Shield of Minnesota, the state’s largest health plan. The total study group included individuals with 12 months of continuous enrollment and one or more PAD-related claims. The authors also queried tobacco cessation pharmacotherapy billing codes in a subgroup of patients with pharmacy benefits in order to better identify current smokers. Outcomes assessed in the study included the annual proportion of members hospitalized,...
Updated Stroke Prevention Guidelines

Updated Stroke Prevention Guidelines

The American Heart Association and American Stroke Association (AHA/ASA) have updated guidelines on primary stroke prevention based on comprehensive and timely evidence from clinical investigations and research trials. Recommendations are included for controlling risk factors, using interventional approaches to atherosclerotic disease, and antithrombotic treatments for preventing stroke. The guidelines were published in Stroke and are available for free online at http://stroke.ahajournals.org. “One of the most important changes in the AHA/ASA guidelines is that newer anticoagulants can be used as alternatives to warfarin to prevent stroke in patients with atrial fibrillation (AF),” says James F. Meschia, MD, FAHA, who chaired the AHA/ASA committee that developed the recommendations. The guidelines note that although some of the new AF drugs are more expensive, they require less ongoing monitoring and therefore represent reasonable options for patients. Another key recommendation from the guidelines is that clinicians are urged to use of statins, along with diet and exercise, to help lower the stroke risk in patients at high risk for experiencing a stroke within the next 10 years. “In addition, the CHA2DS2-VASc is recommended for stratifying the risk for stroke,” says Dr. Meschia. “Patients with a score of 0 on the CHA2DS2-VASc do not require anticoagulants, but those with a score of 2 or higher should receive these therapies.” He adds that patients with a score of 1 on CHA2DS2-VASc can be considered for anticoagulants.   Women & Stroke According to the AHA/ASA, women have higher stroke risks if they are pregnant, use oral contraceptives, use hormone replacement therapy, have migraines, and/or have depression. The guidelines recognize the different risk factors women face throughout their...
Migraine & Stroke Risk

Migraine & Stroke Risk

Migraines affect more than 10% of all Americans and are three times more common in women than in men, according to data from the National Institute of Neurological Disorders and Stroke (NINDS). Although the link between migraine and stroke is not fully understood, research suggests that the two conditions have some clinical features that overlap. The NINDS has reported that risk factors for stroke with migraine-like features include being female, being older than 40, and having low cardiovascular risk profiles. Over the years, many studies have suggested that migraine is a risk factor for stroke. Some analyses have shown that stroke risks are twice as high in people who suffer from migraine with aura than those without aura. For women, stroke risks have been reported to be three times higher when they have migraine with aura. “To date, most of the research examining the link between stroke and migraine has shown that there is a correlation in migraineurs with aura,” says Teshamae S. Monteith, MD.   Taking a Deeper Look For a study published in Neurology, Dr. Monteith and colleagues aimed to determine the association between migraine and stroke and a combination of vascular events, including stroke, heart attack, and death. Participants in the study were from the Northern Manhattan Study, a population-based cohort of stroke incidence. The participants were from an older, ethnically-diverse community in which the population was predominately Hispanic, a patient group that has historically been at a higher risk for stroke. The association between migraine and the combination of vascular events was estimated over an average follow-up of 11 years. After reviewing 1,292 people who reported...
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