Air pollution linked to thousands of deaths

Thousands of lives are being put at grave danger from exposure to pollution emitted from everyday household objects and appliances, according to the findings of a new report.

Health problems could be linked to linked to frequently used items such as air fresheners, candles, cleaning products, fly sprays, personal care products, mould or mildew, fires or wood-burning stoves and poorly maintained gas heaters and boilers, claims the report conducted by the Royal College of Physicians (RCP) and the Royal College of Paediatrics and Child Health (RCPCH), titled Every Breath We Take: the lifelong impact of air pollution.

A person’s house itself and the materials it has been constructed could also be a source of concern regarding chemical pollutants. The authors say: “These include the construction materials, as well as paints, glues, furniture, wallpaper and drapery. Cleaning and DIY products, air fresheners and other consumer products such as insecticide sprays that we use in the home are also important.”

It has long been common knowledge that smoking causes indoor air pollution, but now health experts have warned of several other items that are risking the onset of conditions such as asthma, chronic obstructive pulmonary disease (COPD), respiratory problems, cancer and heart problems.

The report even claims indoor air pollution may have caused or contributed to at least 40,000 deaths a year in the UK, and 99,000 deaths in total in just one year across Europe.

Though being indoors may help to protect people from harmful outdoor pollution, this means that there is more time spent being exposed to pollution from inside their own homes, with the authors arguing that the drive to bringing energy costs by creating homes with tighter ventilation may be worsening the situation.

“Being indoors can offer some protection against outdoor air pollution, but it can also expose us to other air pollution sources,” the authors wrote.

“There is now good awareness of the risks from badly maintained gas appliances, radioactive radon gas and second-hand tobacco smoke, but indoors we can also be exposed to NO2 from gas cooking and solvents that slowly seep from plastics, paints and furnishings.

“The lemon and pine scents that we use to make our homes smell fresh can react chemically to generate air pollutants, and ozone-based air fresheners can also cause indoor air pollution.”

In particularly, the report highlighted the danger of potentially fatal carbon monoxide released from faulty boilers and heaters, in addition to the particulates and nitrogen oxides coming from heating and cooking appliances which can damage the lungs and heart.

Perhaps the most worrying alarming aspects of air pollution mentioned in the report is the threat posed by the common household items used daily by millions of people, like fresheners and personal hygiene, DIY and cleaning products.

Finally, the report concluded how there could be many more thousands of deaths from both inside and outside the home than has been previously thought.

Back in 2008, 29,000 deaths across the UK each year was the figure estimated as a result of long-term exposure to outdoor air pollution, but the latest estimates now put the figure at about 40,000.

Air pollution has been attributed to health problems such as asthma, cancer, dementia, diabetes, heart disease, obesity and stroke.

Grandchildren could develop asthma from their grandmother’s smoking

There are umpteen reasons to quit smoking for good, and it seems that on a daily basis there is yet another story to hit the headlines that highlights more evidence of the massive damage that tobacco does to a person’s health and wellbeing.

However, the researchers behind a study published in the March edition of Review of Obstetrics & Gynecology has pushed the boundaries a little further in this respect with claims regarding smoking and genetic inheritance.

Two Los Angeles Biomedical Research Institute (LA BioMed), John S. Torday, Ph.D, and Virender K. Rehan, M.D, believe that having a grandmother who smoked can greatly increase your chance of developing the lung respiratory condition asthma – even if your mother was a non-smoker.

They state that the chemicals and environmental factors which impact our body in the present day could have after-effects for family members in future generations due to the nicotine leaving a ‘mark’ on the genome (our complete set of DNA), making future generations more likely to develop conditions such as asthma or COPD.

Referencing studies conducted by Dr. Rehan, the researchers explained in their editorial that pregnant rats administered nicotine went on to breed asthmatic pups, who then also produced asthmatic pups – even though there was no exposure to nicotine in the third generation.

In addition, the researchers also cited the Children’s Health Study from Southern California, which demonstrated that grandmaternal smoking when pregnant can greatly increase the asthma risk for grandchildren, regardless of whether the mother had been a smoker.

The researchers concluded that asthma seen in the second generation was ‘epigenetic modification’ (an environmental factor resulting in a genetic alteration). It was determined that both the lung cells and sex cells were being impacted by nicotine in ways that caused the lungs that developed from those cells to then develop abnormally – resulting in asthma.

This latest study is not the first one to connect smoking asthma, however could be deemed one of the more controversial. Previous studies have long established a link between a mother smoking at her children having a higher risk of developing asthma. Dr. Erika von Mutius published a study in The Journal of Allergy and Clinical Immunology over ten years ago where he said: “exposure to tobacco smoke in utero significantly increases asthma risk.”

Dr. Torday commented: “These studies break new ground in validating and further explaining the mechanisms involved in the transmission of epigenetic human diseases. The transmission of the asthma to the second generation and its prevention by a specifically-targeted molecular intervention are the first unequivocal demonstrations of multi-generational transmission of an epigenetically-mediated effect on the offspring.”

Dr. Rehan further added: “Asthma is the most common chronic disease of childhood, resulting in a significant impact on the lives of children and driving up medical costs for all. While many factors contribute to asthma, smoking during pregnancy is a well-established one and one that can be avoided. Eliminating smoking during pregnancy would significantly reduce the prevalence of childhood asthma for this generation and for future generations.”

Risk of death for female smokers has soared over the years

Research published in today’s The New England Journal of Medicine shows that women who smoke in the present day face a much higher risk of dying from lung cancer and other diseases connected to smoking than they did decades ago in the 1960s.

This is because many are starting to light-up much younger and smoking more cigarettes than their ancestors did.  Another finding to emerge from the study may not be surprising when you consider the thousands of harmful chemicals in a single cigarette but on average, smokers (of either gender) are dying at least a decade earlier than non-smokers.

Researchers in the studies wanted to determine if smoking was still as lethal as it was during 1980s as cigarettes now contain less tar, many smokers have quit, and treatments for many smoking-related diseases have improved.

Part of the analysis comprised of a study led by Dr. Michael Thun of the American Cancer Society, who used seven population surveys to track the number of smoking related fatalities between three time periods: 1956 – 1965, 1982 – 1988 and 2000 – 2010. In total, 2.2 million men and women were assessed, just a small fraction however of the 1.3 billion estimated smokers around the globe.
During the 1960s it was established that smoking increased a woman’s chances of succumbing to lung cancer by 2.7 times. However, by 2000 to 2010, the risk had now skyrocketed 25-fold. It was determined that both current smokers of either sex today were almost equally more at risk than non-smokers of developing conditions such as COPD, heart disease, lung cancer and strokes, the research showed.

Chronic obstructive pulmonary disease (COPD) is similar in certain characteristics to asthma and therefore can be treated with the use of Ventolin Evohaler with symptoms including chronic cough, tightness in the chest, and excessive phlegm. Like asthma, it is often an underestimated condition and not taken seriously enough as a life-threatening health problem.  However this study showed that the risk of dying increased four times greater than it was for people who had never smoked in the 1960s, to 22.5 times.

Dr. Thun implies that an explanation for the rise in risk of dying from lung cancer among women smokers between 1960 and 2000 could be linked to tobacco manufacturers releasing milder ‘light’ products solely aimed at the female market. For example it was in the 1960s when tobacco giant Philip Morris introduced its Virginia Slims brand – the very first cigarette marketed just at women.

He says: “The steep increase in risk among female smokers has continued for decades after the serious health risks from smoking were well established, and despite the fact that women predominantly smoked cigarette brands marketed as lower in tar and nicotine. So not only did the use of cigarette brands marketed as ‘light’ and ‘mild’ fail to prevent a large increase in risk in women, it also may have exacerbated the increase in deaths from chronic obstructive lung disease in male smokers, since the diluted smoke from these cigarettes is inhaled more deeply into the lungs of smokers to maintain the accustomed absorption of nicotine.”

In the U.S. there are over 35 million smokers — about 20% of men and 18% of women. It was during the 1980s though when women began smoking in their masses – two decades later than when large smoking rates were witnessed for males. Smoking rates were particularly high during the ’60s, when around 1 in 3 adult women smoked.

Dr. Thun says that the data in his study shows that women who smoke have the same risk for death as men. “When women smoke like men, they die like men”, Thun explained.
Within the same journal were the findings of a study led by Dr. Prabhat Jha of the Center for Global Health Research in Toronto, who looked at data contained on 217,000 Americans over the age of 25 who had responded to federal health surveys between 1997 and 2004. It was observed that around 16,000 of these people had died many years later.

Dr. Jha and colleagues found that:

. Those who stopped smoking in their mid-30s to mid-40s managed to extend their lifespan by nine years. Those who quit from their mid-40s to mid-50s gained six years. Those quitting later than this period this but prior to age 65, gain about four years.
. Smokers aged 25 to 79 were around three times more likely to die as non-smoking counterparts in the same age group.
. Those who had never smoked are twice as more likely to reach the age of 80 than smokers.
Over one hundred thousand people in the UK die each year due to smoking. Smoking-related deaths are mainly due to cancers, COPD (chronic obstructive pulmonary disease) and heart disease.

Smoking is a worldwide issue and not just one in the U.S. Cutting down on the number of cigarettes each day will only go so far to improving health, the best solution is to completely stop altogether. As these studies have highlighted, smoking increases the risk of developing a number of diseases which may not always be fatal, but can result in many years of unpleasant symptoms.

Quit smoking today with the help of the smoking cessation medication Champix. The Doctors at Medical Specialists can help you do this. Complete the simple 4 step online questionnaire, and if the online consultation is approved by one of our Doctors, they will write a prescription that will be dispensed by our in-house pharmacy team.

Daily fizzy drink intake linked to aggressive prostate cancer

As if there weren’t enough reasons to give-up sugary fizzy drinks, a new Swedish study has perhaps added another persuader to this. In addition to helping to rot teeth and adding extra inches to your waistline due to the massive sugar content, there have been studies to emerge this year that have found that fizzy drinks can have even more detrimental effects to health. For instance, in February it was revealed in an Australian study that soft drinks could result in an increased danger of developing asthma or chronic obstructive pulmonary disease (COPD).


Then in June, high levels of the dangerous colouring agent 4-methylimidazole (4-MI)  were found in cans of Coca-Cola in numerous countries around the world, a chemical shown in tests to be connected to cancer within some animals. Past research has also linked brittle bones, heart attacks, diabetes, pancreatic cancer, muscle weakness and even paralysis as possible dangers from the long-term heavy consumption of such drinks.

The new study, conducted by scientists at Lund University in Sweden, has found evidence that shows men who consume just one solitary 300ml soft drink each day  - less than a standard 330ml can – could be at a 40% higher risk at developing serious forms of prostate cancer; the most prevalent type of cancer in UK males. This is in comparison to men who refrain from drinking soft drinks.
Prostate cancer develops in the prostate – a gland in the male reproductive system. In the UK alone there are an estimated 36,000 to 40,000 men who are diagnosed with prostate cancer and there are about 250,000 men currently living with the disease. It tragically claims the lives of over 10,000 men in the UK every year.

The Swedish study involved tracking 8,000 healthy men who were aged between 45 to 73 years of age for an average of around 15 years.  All the men were in perfect health at the beginning of the study and were continually quizzed about their dietary preferences, including soft drink intake.
At the close of the study, the researchers compared the diets of the men who had been diagnosed with prostate cancer against that of the healthy men, and subsequently established a link between intake of sugary drinks and the potentially fatal disease.

Isabel Drake, Lund University researcher, commented on the study findings and said: “Among the men who drank a lot of soft drinks we saw an increased risk of prostate cancer of around 40 per cent.”
Their investigation also established some link between a less severe type of prostate cancer and large amounts of rice and pasta, cakes and biscuits, and sugary breakfast cereals that were in the subject’s diet.

However, before people start to panic and banish these foods from their diet completely, Dr Iain Frame, director of research at Prostate Cancer UK, attempted urged caution in interpreting the study findings and said:  “We cannot be certain whether any particular dietary pattern has a significant impact on a man’s risk of getting prostate cancer but it is highly unlikely that any single food source will lead to an increased chance of developing the disease.” In addition, Drake also stressed that more research would be required to fully prove any definite links between dietary choices and prostate cancer.

Symptoms of prostate cancer include: having to urinate more frequently, difficulty beginning to urinate, a feeling that your bladder has not been fully emptied and a weak flow of urine. If you are suffering with any symptoms similar to these you should visit your own GP as soon as possible for a check-up. The earlier prostate cancer is spotted – the better chance of treatment being effective and a full recovery can be made. If it is not prostate cancer then you may be one of 2.4 million men in the UK suffering from a condition called benign prostatic hyperplasia. Also known as an enlarged prostate gland, it can be treated through the use of effective medication such as Flomax Relief, which eases the symptoms associated with lower urinary tract symptoms (LUTS) of a BPH. Flomax works by relaxing muscles in the prostate gland, relaxing the muscles in the urethra (the tube from the bladder to the outside of the body).  This allows urine to travel more comfortably through the urethra, making it easier to urinate. Flomax is available today from the Medical Specialists Pharmacy chemist shop priced at just £8.75 for 14 capsules, or £15.95 for 28.

High levels of air pollution can age the brain by 3 years

A study recently presented in San Diego at The Gerontological Society of America’s (GSA) 65th Annual Scientific Meeting, has linked a high level of air pollution to cognitive decline, with data suggesting that increased pollution levels could be ageing the brains of over-50s by up to three years. In addition, previous research had also found that the problems of pollution are connected to cardiovascular and respiratory conditions such as asthma and COPD. This is because pollutants such as cigarette smoke and car exhaust fumes emit gases and particles into the atmosphere, causing irritation to the airways.

The latest research on air pollution was conducted by the US-based National Institute on Aging, who analysed 14,793 men and women aged over 50. The scientists specifically looked at the results of cognitive tests and correlated the results against geographical data of air pollution.  Participants were tested on knowledge, language, orientation and word recall, being measured on a scale of 1 to 35.
As it currently stands, health experts estimate that air pollution is already effecting the heart and lungs and slashing the life expectancy of everybody living in the United Kingdom by approximately seven to eight months.

The U.S. scientists were studying exactly how the particle matter ‘PM2.5’ affected health and well-being of the participants. PM2.5 is released via dust, dirt, liquid droplets, soot and smoke. It is commonly breathed in after being emitted by vehicle exhaust emissions, in addition to gas boilers and heavy industry.  The name PM2.5 stems from the fact that the particles which are 2.5 micrometres in diameter or smaller, are unfortunately small enough to be inhaled and deposit deep inside the lungs and the brain.

In order to obtain accurate information, numerous factors were taken into account such as age, race/ethnicity, education, smoking behaviour and respiratory and cardiovascular conditions. It was determined that exposure to fine air particulate matter ranged from 4.1 to 20.7 micrograms (mcg) per cubic metre, and for every extra 10 micrograms of PM2.5 in a cubic metre of air (about the difference between inner London and rural Britain), the decline of brain power in the study subjects equated to roughly three years of ageing.

Dr Jennifer Ailshire, from the Andrus Gerontology Center at the University of Southern California, carried out the analysing by utilising data obtained from the American Environmental Protection Agency and the Health and Retirement Study. Regarding the results of the research, she said: “As a result of age-related declines in health and functioning, older adults are particularly vulnerable to the hazards of exposure to unhealthy air. Air pollution has been linked to increased cardiovascular and respiratory problems, and even premature death, in older populations, and there is emerging evidence that exposure to particulate air pollution may have adverse effects on brain health and functioning as well.”

Adding to Dr Ailshire’s comments was Professor Frank Kelly, a professor of environmental health at King’s College London. He offered his thoughts on the problem of air pollution and said: “The average amount of this pollutant in London is around 13 to 15 mcg per cubic metre, while in some rural areas away from traffic it can be as low as three or four mcg. The research shows that living somewhere with clean air means your will retain your brain power for a longer period of time than if you live in an urban area. Here is another study showing that the quality of the air that we breathe can not only affect for our heart and lungs, but our brains as well.”

COPD drug could be used to treat asthma patients

Patients with poorly controlled asthma are a step closer to a new treatment option, after Phase III data showed that Boehringer Ingelheim’s lung drug Tiotropium, significantly reduced exacerbations and improved both lung function and quality of life.

The phase III research, presented at the European Respiratory Society conference in Vienna, also showed adding the once daily drug could cut the risk of any asthma exacerbation by 31%.

Tiotropium, a long-acting inhaled bronchodilator commonly used to treat chronic obstructive pulmonary disease (COPD), is currently unlicensed for treating asthma.

Spiriva, which is known chemically as Tiotropium is delivered by the Respimat Soft Mist inhaler. The research was published in the New England Journal of Medicine. Tiotropium has comprehensive clinical trial data, demonstrating an extensive wealth of experience since its introduction almost 10 years ago and over 25million patient years of real life experience, to support the efficacy and safety profile.

However, there remain concerns over the drug’s risk in patients with heart disease. Last year an analysis published by the British Medical Journal, found that the use of Spiriva delivered in a mist form (via Respimat), was linked with a 52% increase in the risk of death.

Boehringer Ingelheim said, “It did not agree with the authors conclusion that there is an increased mortality risk for Spiriva Respimat in COPD, and that its risks and benefits were included in its label.”

The German drug maker went on to say, “There were also significant improvements in lung function, asthma control and asthma related quality of life, lending further weight to the case for its use in controlling the disease. The need for new and effective asthma treatments is great, because a significant proportion of patients remain symptomatic and may experience asthma exacerbations, despite current therapies.”

In two trials supported by the drug’s marketers, Boehringer Ingelheim and Pfizer, researchers recruited 912 patients with asthma already taking inhaled glucocorticoids and long-acting beta-agonists (LABAs).

Despite their drug regimen, all patients remained symptomatic and had at least one severe exacerbation within the past year. Researchers randomised these patients to receive either Tiotropium once daily or placebo alongside their usual treatment. These were administered using a soft mist inhaler.

The team found that after 24 weeks patients receiving Tiotropium went on average 282 days without a first exacerbation, 21% longer than those on placebo, who experienced an exacerbation within an average of 226 days. The effects were sustained over 24 hours. Adverse events were similar between treatment and placebo groups.

The researchers concluded that, “In patients with poorly controlled asthma despite treatment with inhaled glucocorticoids and LABAs, adding Tiotropium significantly reduced the risk of episodes of the worsening of asthma and asthma exacerbations, requiring treatment with systemic glucocorticoids and provided sustained bronchodilation.”

Could a ‘Virtual Doctor’ improve patient care and save money?

For many elderly patients particularly ones suffering from diseases such as chronic obstructive pulmonary disease (COPD), heart disease or diabetes, getting to the doctors can be an ordeal.

Such patients need to have their vital signs and other parameters regularly monitored in order to effectively control and treat their conditions. However such patients may only see their doctor or nurse for such checks every few months, and if there is a problem in between then often they will have to be admitted to hospital.

However there is now a programme called Telehealth that has been in development since 2007, and is now being trialed by the North Yorkshireand York Primary Care Trust, using 500 patients suffering from diseases such as COPD, heart disease and diabetes.

The equipment called a Telestation is placed in a patient’s home and can monitor key readings from a patient within just five minutes every morning. The equipment has an integral scale to weigh the patient, a blood pressure cuff to take blood pressure readings, a pulse oximeter to measure pulse and blood oxygen levels, a glucose meter to measure blood sugar levels and even has a video camera built in so the doctor/nurse can physically see the patient if the need arises.

The really clever part of the Telehealth system is that the Telestation wirelessly transmits the readings once taken, to the patient’s phone line where they are transmitted directly to the Telehealth central control, where their own dedicated Telehealth nurse will daily review the readings.

The machine verbally takes the patient step by step throughout the five minute checkup and will also ask pre-set questions as well as taking various readings. If any of the readings fall outside of the pre-set parameters, an alarm will be triggered and the patient will immediately be contacted by their own dedicated Telehealth nurse.

Vera who is 71 and is suffering from COPD was initially skeptical about the scheme, but after taking part in the year long trial Vera claimed that the Telehealth system is “the best thing since sliced bread and that they should be in everybody’s home.” Normally patients suffering from COPD can easily be susceptible to infections that though may be easy to treat, often escalate into much larger problems necessitating hospital admission. The reason for this is that often patients leave it too late to get help, however with the Telehealth system the infection can be nipped in the bud by early diagnosis and treatment. Patients such as Vera suffering from COPD are given medication rescue packs containing antibiotics and steroids that can be taken as soon as needed after a consultation with their Telehealth nurse.

Telehealth nurse Dawn Watson who looks after Vera, tells how by working remotely she can look after more than 200 patients instead of the normal caseload of closer to 30 patients. As well as improved patient care the Telehealth system could obviously cut costs for the NHS especially when you consider that seven out of ten hospital beds are occupied by patients with long term conditions like Vera’s.

Paul Burstow, the minister for care services, claimed at a conference in March that “Telehealth could save the NHS up to £1.2 billion by 2014.” That claim seems to be well backed up as the trial which claims to be a success was launched in 2007, cost £30million, lasted three and a half years and was one of the most complex trials ever carried out by the NHS.

However the jury is still out on whether the Telehealth system is capable of saving the amount of money claimed, and also whether it can provide the improved patient care it claims. The reason the jury is still out on this is that the data analysis is being carried out by five academic institutions, and that for the findings to be both credible and useful, the academic analysis needs to be peer reviewed (a vital process of evaluation by independent experts.)

New drug Tudorza Pressair is given FDA backing for the treatment of COPD

This week has seen yet another new drug been given a clearance by The Food and Drug Administration (FDA), following the recent seal of approval for two new weight loss medications, Qsymia and Belviq, as we reported last week.

On this occasion, the drug to be given an authorisation for public use is a twice-daily inhaled medication named ‘Tudorza Pressair’, which is used to help treat symptoms of bronchospasm. This is associated with chronic obstructive pulmonary disease (COPD), aka ‘smoker’s cough’.

COPD is a term used for numerous conditions, including chronic bronchitis and emphysema, and is similar in certain characteristics to asthma. Bronchitis and emphysema are commonly co-existing diseases of the lungs in which the airways become narrowed, thus making it difficult for air to get in or out of the lungs.  Obvious symptoms can include chronic cough, tightness in the chest, and excessive phlegm.

Asthma and COPD can exist in the same person. However, in contrast to asthma, the inflammation of the lungs with COPD is not triggered by allergies and does not respond well to anti-inflammatory medication. In 2005, there were over 3 million deaths worldwide linked to COPD, with the main cause being the damaging effects of cigarette smoking.

On Tuesday, Spain’s biggest pharmaceutical company Almirall, and US drugmaker Forest Laboratories, confirmed they had been given the coveted FDA green light for Tudorza Pressair. This followed a slight hiccup back in March when the FDA demanded that it wanted a three-month extended time period to analyse the review data supporting the New Drug Application for aclidinium bromide (the powder ingredient within Tudorza Pressair).

Despite entering into an already competitive market where highly popular effective medications such as Ventolin can alleviate COPD symptoms, analysts at Sanford Bernstein say that sales of the Forest/Almirall drug could hit $164 million by 2015.

A spokesperson at Forest commented saying, “As the first long-acting inhaled anticholinergic agent approved in over 8 years for COPD, Tudorza will be an important treatment option.”
Curtis Rosebraugh, MD, Office of Drug Evaluation II, FDA’s Center for Drug Evaluation and Research, Rockville, Maryland, said, “COPD is a serious disease that gets worse over time. The availability of long-term maintenance drugs for COPD provides additional treatment options for the millions of people who suffer with this debilitating disease.”

However, the FDA have also warned that the drug may cause some serious side effects such as paradoxical bronchospasm, new or worsened urinary retention, or new or worsened pressure in the eyes (known as acute narrow-angle glaucoma). The FDA also says the medication is not fit to be used as a rescue therapy to help aid sudden breathing difficulties such as acute bronchospasm.

When Medical Specialists Pharmacy know more about this and other medications that are being approved by the FDA to help with asthma or COPD, we will update our patients immediately. In the meantime, Medical Specialists Pharmacy provides a huge range of medications to help asthma sufferers, all at great prices. If you have already been prescribed an inhaler, have lost your inhaler, or run out and cannot get a prescription immediately, we are able to supply you an inhaler to help your asthma symptoms.   After undergoing a private and confidential online consultation with one of our Doctors, if you are suitable they will then write you a prescription which is passed to our in-house Pharmacists and dispensed to a location of your choice. This is all done discretely and within just 24 hours. We offer both blue (relievers) inhalers such as Ventolin and Salbutamol, and brown (preventers) inhalers such as Qvar Beclomethasone, Qvar Easi-Breathe, and Pulvinal Beclomethasone.