Asthma Hits Black Patients Worse, Not Matter What The Disease Severity Is

Hospitalization or a visit to the emergency department is more likely for black patients with asthma than for white patients, regardless of what the managed care settings are, according to an article published in Archives of Internal Medicine (JAMA/Archives), September 24th issue.

As background information, the authors explain that black patients who suffer from asthma have worse control of their symptoms and are more likely to be hospitalized than white patients. The reasons could be differences in access to good health care, lower socioeconomic status, behavioral, genetic, environmental, poor communication between patient and doctor, and racial bias among doctors. Prior studies had found that even when such variables as socioeconomic status were factored in the racial disparities in asthma outcomes persisted.

Sara E. Erickson, M.D., of the University of California, San Francisco, and team looked at 678 patients from a large health plan who had been hospitalized for asthma during the period 2000-2004. After they had been discharged the patients were interviewed – the aim was to find out about their disease and what impact it had on their lives, health status and socioeconomic status. By drawing on information from the US Census, the researchers were also able to retrieve socioeconomic data from within one block of each patient’s home. To find out how many patients were re-hospitalized or had to visit an emergency room after the interviews, they were followed up for a median of 1.9 years.

Of the 678 patients, 154 were black and 524 were white. Despite there being no difference in asthma severity, physical health status or controller medication use, the black patients were much more likely than the white ones to have had outpatient visits because of their asthma during the follow-up. 35.7% of black patients and 21% of white patients visited the emergency department for asthma symptoms. Hospitalization rates post follow-up were 26.6% for blacks and 15.3% for whites. Even when socioeconomic status and differences in asthma therapy were taken into account, the figures persisted, say the authors.

The researchers wrote “The reasons underlying the racial disparities observed in this study are not clear, although they are likely to be complex.” As knowledge of the racial disparities regarding asthma is widespread, perhaps doctors are more likely to encourage black patients to seek emergency care. Also, for the same reason, maybe emergency room doctors might be more likely to admit (hospitalize) blacks, the authors write.

They conclude “Even in a health care setting that provides uniform access to care; black race was associated with worse asthma outcomes, including a greater risk of emergency department visits and hospitalizations. These findings suggest that genetic differences may underlie these racial disparities.”

Archives of Internal Medicine


Hopkins emergency physician warns of post-hurricane disease and illness

A Johns Hopkins emergency physician who spent the past five weeks working on public health issues in the Gulf Coast region following hurricane Katrina warns that the disaster’s potential for wreaking havoc and damage to people’s health may continue for months after the hurricane has passed.

In an editorial published this month in The New England Journal of Medicine, Thomas Kirsch, M.D., M.P.H., an assistant professor and director of emergency operations at The Johns Hopkins University School of Medicine, reports that large numbers of displaced people are at increased risk of infectious diseases, such as chicken pox, gastroenteritis, scabies and influenza, which can spread quickly in disaster shelters. In these confined quarters, Kirsch says, crowded and poor sanitary conditions, including limited access to clean water and insufficient numbers of toilets, help spread disease from person to person.

However, Kirsch notes that people with chronic health conditions face the biggest threats by far, lacking immediate access to their routine medical services for hemodialysis, or access to medications for diabetes, heart disease, HIV or tuberculosis.

Kirsch, who went to the Gulf Coast area to conduct medical needs assessments for the American Red Cross, says constant monitoring and surveillance are required to contain disease outbreaks. More importantly, he adds, improving the current public health care system so that it is strong enough to prevent disease through mass vaccinations and large enough to survive a natural disaster is the best means of guarding population health.

David March
Johns Hopkins Medical Institutions

Greater Risk For Cardiac Stress On Airline Flights For People With Obstructive Sleep Apnea

People with severe obstructive sleep apnea (OSA) on commercial airline flights may have a greater risk of adverse events from cardiac stress than healthy people, according to new research presented at the American Thoracic Society’s 2008 International Conference in Toronto.

The researchers compared oxygen levels and ventilation of healthy people and people with severe OSA during simulated flight conditions replicating the oxygen and pressure levels of typical commercial flights that have “cabin altitudes” (a measure of the air pressure and oxygen) ranging from 6,000 feet and 8,000 feet – the maximum allowed, even if the airplane is flying at 30,000 feet. This is the first study to use these measurements to assess fitness to fly without supplemental oxygen.

“It is normal for the rate of breathing to increase when air pressure falls. We predicted that patients with OSA would have a much sharper fall in oxygen levels because they might not increase their breathing as much,” said Leigh Seccombe, M.Sc., senior scientist in the Department of Thoracic Medicine at Concord Repatriation General Hospital in Sydney, Australia. “And in fact, we found that patients with OSA do have a lower blood oxygen level before and during aircraft cabin condition stimulation, but that the change in oxygen was similar. We also found that their breathing intensity increases at about the same rate as it does in healthy people.”

But what was different was the physiological stress and demand for oxygen was increased in people with OSA. “In short, the work they do to run the core range of body functions (heart, lungs, brain) is much greater under cabin conditions,” explained Ms. Seccombe, who is currently part of a group working on a consensus statement which will help guide respiratory physicians as to whether their patients are at risk from air travel.

“We addressed OSA because it is becoming so much more common as obesity increases and there are greater numbers of obese passengers on commercial flights,” said Ms. Seccombe. “Half of the patients with OSA would require supplemental oxygen in-flight if current guidelines (for those with lung disease) were strictly followed if these results are typical.”

Source: Keely Savoie

American Thoracic Society

Smokers Consuming Both Marijuana And Tobacco Have An Increased Risk Of COPD

A study in CMAJ reports the risk of respiratory symptoms and chronic obstructive pulmonary disease (COPD) increases when smoking both tobacco and marijuana. The increased risks however were not linked when smoking marijuana only.

The study differed from others since the population involved was older, and the incidence of tobacco smoking was lower in the 878 participants all from Vancouver, Canada aged 40 or over. The research was part of Burden of Obstructive Lung Disease (BOLD) Initiative that aims to find out the incidence of COPD in adults over 40 years old in the general population.

COPD is identified by diseased lungs and narrowed airways and linked to a high death rate.

Smokers were defined by the authors, as people having reportedly smoked at least 365 cigarettes in their lifetime and individuals who reported having smoked only marijuana.

The increased risk was linked with tobacco smoking. For smokers of both tobacco and marijuana the risk of developing respiratory symptoms was 2.5 higher and 3 times higher of having COPD as defined by spirometric testing.

“We were able to detect a significant synergistic effect between marijuana smoking and tobacco smoking,” explains Dr. Wan Tan, University of British Columbia and St. Paul’s Hospital and collaborators. “This effect suggests that smoking marijuana (at least in relatively low doses) may act as a primer, or sensitizer, in the airways to amplify the adverse effects of tobacco on respiratory health.”

The limitations of the research were restricted to the available information on the potential differences in marijuana strength, on the variations in inhalation and the number of smokers who mix both substances in the same cigarette.

In an associated observation, Dr. Donald Tashkin, University of California Los Angeles (UCLA) says “the findings of Tan and colleagues add to the limited evidence of an association between marijuana use and COPD because their study focuses on an older population (aged 40 or older) that is at greater risk of COPD.” Earlier studies were unsuccessful in discovering an additive effect of marijuana and tobacco on either chronic respiratory symptoms or abnormal lung functions in younger smokers. Dr. Tashkin remarks that “we can be close to concluding that marijuana smoking by itself does not lead to COPD.”

However, Dr Wan Tan and colleagues write in conclusion that “Although our study had insufficient power to show an association between marijuana alone and increased risk for COPD, it remains uncertain whether marijuana by itself is harmful for the lungs. Larger studies are needed to address this critically important issue in the future.”

“Marijuana and chronic obstructive lung disease: a population-based study”
Wan C. Tan, MB, Christine Lo, BSc, Aimee Jong, BSc, Li Xing, MSc, Mark J. FitzGerald, MB, William M. Vollmer, PhD, Sonia A. Buist, MD PhD, Don D. Sin, MD MPH for the Vancouver Burden of Obstructive Lung Disease (BOLD) Research Group

CMAJ ??? April 14, 2009; 180 (8). doi:10.1503/cmaj.081040.

Stephanie Brunner (B.A.)

Pets On Planes Campaign Wraps Up After Thousands Call For Action

The Lung Association released the following statement with regards to their campaign to ban pets on board airplanes:

“Since July 2009, thousands of Canadians from across the country have joined our campaign to ensure pet-free flights from Canada’s major airlines. While Air Canada and WestJet continue to be uninterested in protecting the health of those with asthma, COPD, lung cancer and severe pet allergies, the House of Commons Standing Committee on Health has heard the concerns expressed. Committee Vice-Chairs Joyce Murray (L-BC) and Judy Wasylycia-Leis (NDP-MB) have agreed to move this issue forward when the Standing Committee resumes sitting next week.

Unfortunately, the voices of thousands of Canadians could not sway Committee Chair Joy Smith. However, we are confident that once hearings are called on this issue, she will see the public health merits in taking action to protect air passengers and crew who suffer from asthma, COPD, lung cancer and severe pet allergies. Ms. Smith has previously committed to being a strong ally in the fight to improve lung health in Canada, and this issue provides her with an opportunity to demonstrate that.

The Lung Association thanks all those Canadians who took part in this important public health effort. You made your voices count and we thank each of you for doing so.”

The Lung Association

Gregory Downey, MD, Honored For Scientific Accomplishments

Gregory Downey, MD, received the 2010 Recognition Award for Scientific Accomplishments at the American Thoracic Society’s (ATS) International Conference on Monday, May 17.

Dr. Downey, Executive Vice President of Academic Affairs and Professor of Medicine, Pediatrics and Immunology at National Jewish Health, has over 190 publications to his credit. He has been cited by other authors more than 5,000 times, putting him in the top one percent of cited authors.

Dr. Downey’s current research interests include innate immunity, signaling mechanisms in lung injury and repair, anti-microbial defenses in the context of cystic fibrosis, and pulmonary fibrosis.

The Recognition Award for Scientific Accomplishments is given each year to ATS members who demonstrate outstanding scientific contributions in basic or clinical research to the understanding, prevention and treatment of respiratory disease or critical illness. Awardees make a 25-minute presentation on their research at the ATS conference. Dr. Downey discussed “Mechanisms of Acute Lung Injury and Repair.”

“It is truly an honor to be recognized by one’s peers for such a prestigious award and I am deeply touched by this recognition,” said Dr. Downey. “The ATS represents the premier organization internationally that promotes research and clinical care in the area of respiratory disorders.”

Dr. Downey received his medical degree from the University of Manitoba in 1980, completed his internship and residency in internal medicine at Beth Israel Hospital, Harvard Medical School, and completed his clinical fellowship in pulmonary medicine at the University of Colorado Denver and National Jewish Health in 1986. He then completed a research fellowship in pulmonary cell biology in 1988 at National Jewish Health, while simultaneously serving as a staff physician and Medical Director for the Adult Special Care Unit at National Jewish Health.

Dr. Downey then joined the faculty of the University of Toronto, where he remained for nearly 20 years. In 2006 he left his position as Vice-Chair of Medicine there and returned to National Jewish Health, where he has continued his research and been instrumental in developing programs in personalized medicine.

He is a member of the American Thoracic Society, the American Society for Clinical Investigation, the American College of Chest Physicians, the Royal College of Physicians and Surgeons of Canada, and is an Associate Editor for the American Journal of Respiratory Cell and Molecular Biology.

William Allstetter
National Jewish Medical and Research Center

Alpine Mountaineer And Alzheimer’s Advocate To Climb Highest Peak On Each Continent To Raise Awareness Of Growing Prevalence And Burden Of Alzheimer’s

Alpine mountaineer and Alzheimer’s disease advocate Alan Arnette will embark later this month to climb the 7 Summits, the highest peak on each continent. This ambitious year-long climbing campaign The 7 Summits Climb for Alzheimer’s: Memories are Everything aims to raise awareness of the growing Alzheimer’s prevalence in our aging population and the enormous financial and personal burden it places on people with the disease, their caregivers and society.

“The mental and physical demands of scaling seemingly insurmountable peaks are not unlike the everyday challenges faced by those living with Alzheimer’s disease and their caregivers,” said Mr. Arnette, who cared for his mother with Alzheimer’s until her death last year. “Both involve understanding personal limitations, reaching out for support and taking steps daily on a very long road.”

Alzheimer’s, the nation’s 6th most deadly disease, robs individuals of collected memories, corrupts their distinct and true personalities and makes them unable to function independently. The burden of caring for these patients often falls to family members. In the United States, an estimated 10.9 million unpaid caregivers see to the daily needs of people struck by Alzheimer’s. Last year, these caregivers provided about 12.5 billion hours of care.

Mr. Arnette, who has been mountain climbing since he was 38, retired from his job with a leading technology company to care for his mother, Ida, who has since died from Alzheimer’s. Since then, the 54-year-old advocate has worked tirelessly to inspire people to join his efforts to help raise $1 million to advance Alzheimer’s research.

The Alzheimer’s Immunotherapy Program of Janssen Alzheimer Immunotherapy and Pfizer Inc. (NYSE: PFE) is funding Mr. Arnette’s climbs. All money Mr. Arnette raises from donations will go directly to the organization he selected, the Cure Alzheimer’s Fund™, for research. International Mountain Guides is also supporting Mr. Arnette’s efforts.

“As a former caregiver for his mother, Alan understands the burden of Alzheimer’s and the needs of patients and caregivers who are devastated by the disease. “His efforts to embark on this incredible journey are an inspiration to Alzheimer’s patients, caregivers and beyond,” said Gregory Rippon, MD, MS, Disease Area Medical Lead, Specialty Neuroscience, Clinical Development & Medical Affairs, Pfizer, on behalf of the Alzheimer’s Immunotherapy Program. “We are proud to support Alan Arnette’s efforts to advance education and research to help fight this disease.”

Every 70 Seconds, Someone is Diagnosed With Alzheimer’s

Alzheimer’s disease is the 6th leading cause of death in the United States, with another person newly diagnosed every 70 seconds. It has been estimated to affect more than 5 million Americans and more than 25 million people worldwide. The lack of awareness around dementia is a global problem, leading to misunderstandings of Alzheimer’s disease. Alzheimer’s disease is not a normal part of aging and gradually destroys a person’s memory and their ability to learn, reason, make judgments, communicate and carry out basic daily activities like bathing and eating. As there is neither a cure nor a treatment that addresses the underlying cause of Alzheimer’s, there remains a significant need to advance treatment options that change the course of Alzheimer’s, improve patient outcomes and reduce the burden on caregivers.

The indirect and direct costs of caring for people with Alzheimer’s disease is estimated to be more than $100 billion a year in the United States alone. The worldwide costs of dementia are estimated to exceed one percent of global gross domestic product (GDP) in 2010, which equates to $600 billion, further demonstrating the global prevalence of the disease.

“Research is the key to solving the complexities of Alzheimer’s disease and Alan Arnette’s courageous fundraising efforts will help the Alzheimer’s community come one step closer to finding a cure,” said Tim Armour, President of the Cure Alzheimer’s Fund™.

The Summits

Mr. Arnette, a resident of Colorado, departs on the first climb of his seven climbs on November 24, 2010. The first peak is the 16,067-foot (4897 meter) Mt. Vinson Massif in Antarctica. By December 2011, he intends to reach the summits of:

– Aconcagua, Argentina, South America – 22,841ft/6962m

– Everest, Nepal, Asia – 29,035ft/8850m

– Denali, Alaska, North America – 20,320ft/6194m

– Elbrus, Russia, Europe – 18,481ft/5633m

– Kilimanjaro, Tanzania, Africa – 19,340ft/5896m

– Carstensz Pyramid, Indonesia, Oceania – 16,023ft/4884m

Mr. Arnette is taking on the extended challenge of climbing an eighth mountain, Mt. Kosciuszko in Australia, which is part of the Oceania continent.

Alzheimer’s Immunotherapy Program

The Alzheimer’s Immunotherapy Program of Janssen Alzheimer Immunotherapy and Pfizer Inc. is an equal collaboration committed to researching and developing selective products for the treatment and/or prevention of neurodegenerative conditions, including Alzheimer’s disease.

The Alzheimer’s Immunotherapy Program believes that it is possible to reduce the burden of disease through early intervention in the illness. It is dedicated to delivering comprehensive and integrated solutions that help address the needs of people impacted by Alzheimer’s disease.

Its research focuses on the beta amyloid hypothesis. Scientific evidence supports the idea that preventing the accumulation and/or promoting the removal of beta-amyloid may have the potential to slow the progression of Alzheimer’s disease and help preserve function in people with the disease. This theory is being tested in clinical trials.

Source: Pfizer Inc

The Garden City Group, Inc. Makes Donation To Autism Speaks

The Garden City Group, Inc. (GCG), and its associates contributed $7368.20 to Autism Speaks as part of its annual charitable giving program. The goal of Autism Speaks is to change the future for all who struggle with autism spectrum disorders. Donations were raised by GCG associates participating in functions such as fleece and shirt sales, jeans days, and bake sales.

“GCG is proud to make this donation to help individuals with autism and their families,” said GCG CEO David Isaac. “We sincerely hope that 2008 brings us closer to finding a cure for this condition that affects so many American families. Autism Speaks has dedicated itself to finding a cure,” Isaac said. “And their commitment is an inspiration to us.”

The mission of Autism Speaks is to change the future for all who struggle with autism spectrum disorders. Autism Speaks is dedicated to funding global biomedical research into the causes, prevention, treatments, and cure for autism; to raising public awareness about autism and its effects on individuals, families, and society; and to bringing hope to all who deal with the hardships of this disorder. Autism Speaks is committed to raising the funds necessary to support these goals.

The Garden City Group, Inc. , a subsidiary of Crawford & Company, administers class action settlements, designs legal notice programs, manages Chapter 11 administrations, and provides expert consultation services.

Based in Atlanta, Georgia, Crawford & Company is the world’s largest independent provider of claims management solutions to insurance companies and self-insured entities, with a global network of more than 700 offices in 63 countries. Major service lines include property and casualty claims management, integrated claims and medical management for workers’ compensation, legal settlement administration, including class action and warranty inspections, and risk management information services. The Company’s shares are traded on the NYSE under the symbols CRDA and CRDB.

Crawford & Company

Alzheimer’s Is Not The Only Dementia, Says Soap Star, Dot – UK

In the midst of recent news stories which have been raising public awareness about dementia, the Lewy Body Society, Europe’s only charity dedicated to the second most common form of age-related dementia, known as Dementia with Lewy bodies (DLB), celebrates its first year with a dinner at the Reform Club, London on Friday 15 June. Guest of Honour is octagenerarian actress Miss June Brown, also known as Dot on the popular BBC 1 television soap, EastEnders.

“Alzheimer’s is not the only dementia,” said Miss Brown, whose late husband, the actor Bob Arnold, died of DLB in 2003. “It is important for people, especially doctors, to know about Lewy Body Disease so that fewer people are misdiagnosed and so they can receive the proper treatment.”

The charity, which has raised more than ??70,000 in its first year is information driven, with aims of raising awareness of and supporting research into Dementia with Lewy bodies. Between 120- 130,000 people in the UK are thought to suffer from this terrible neurodegenerative disease.

Lewy bodies, first identified by Dr Friedrich Lewy in 1912, are microscopic protein deposits found in the brain. Their presence disrupts the brain’s normal functioning, causing progressive mental and motor dysfunction.

Because DLB shares common characteristics with both Alzheimer’s and Parkinson’s Diseases, it is often misdiagnosed. Accurate and early diagnosis is crucial because administering the wrong drugs can have extremely adverse and even fatal consequences.

The Lewy Body Society’s President and Chairman of its Medical and Scientific Advisory Panel is Professor Ian McKeith of Newcastle University, who is acknowledged as the world’s leading expert in DLB , having published more than 200 peer-reviewed papers on the subject.

“Virtually unrecognised 20 years ago, DLB could within this decade be one of the most treatable neurodegenerative disorders of late life,” said Prof McKeith. “The first goal must be to raise awareness.”

The Lewy Body Society
Holland House
10 Chestnut Drive
Hatfield Heath
CM22 7EZ
Registered charity No. 1114579

Stanford Packard researchers identify T cell that relieves asthma in mice

For the second time in two years, scientists at the Stanford University School of Medicine have discovered a new type of regulatory T cell that reduces asthma and airway inflammation in mice, bolstering the theory that a deficiency of such cells is a prime cause of the breathing disorder as well as allergies.

The team’s research not only provides a detailed profile of these newfound cells but also sheds light on how such cells are related to other T cells and suggests that there exists a spectrum of regulatory T cells, known as Tregs, to be identified and studied.

“It’s likely that Tregs aren’t functioning or developing properly in people who suffer from asthma and allergies,” said Dale Umetsu, MD, PhD, professor of pediatrics who led the research team. “This new understanding of the fine characteristics of regulatory T cells brings us closer to developing therapies that will provide cures for allergies, asthma, and perhaps a number of other diseases involving immune dysregulation,” added Umetsu, who is also chief of the division of allergy and immunology at Lucile Packard Children’s Hospital at Stanford.

Humans have a variety of T cells – including regulatory (Tregs), helper (Th) and natural killer (NKTs) – and there are different types within each of those categories. But all of them play a critical role in how, ideally, the human immune system responds when invaded by viruses, bacteria and allergens: the cells fight the enemies – the viruses and bacteria – and ignore the innocuous visitors – the allergens. The problem for allergy and asthma sufferers is that the body responds to allergens as if they were reviled foes, engaging in a full-out battle that inflames airways and impedes breathing.

In hopes of preventing such reactions, the Stanford researchers have been studying the Tregs, which appear to act as the immune system’s peacekeepers, signaling to other T cells when to hold off from attacking an intruder. Two years ago, they identified one type of Treg cell that could reduce airway inflammation and asthma in mice. And now, in a study published in the Sept. 26 online version of Nature Immunology, they have identified another type of regulatory T cell that produced the same result: the airways of mice that received injections of the cells were not inflamed despite confrontation with allergens.

The team’s findings also show that all of the Tregs share important features that might explain how they exert a calming influence on their battle-hungry brethren. Before now, researchers had identified two broad categories of Tregs – natural and adaptive. Natural Tregs are produced in the thymus, are always present in predictable quantities and appear to be important in the prevention of autoimmune disease. Adaptive regulatory T cells, the type studied by Umetsu and his colleagues, develop in response to incoming invaders and have been thought be to quite distinct from natural Tregs.

But Umetsu and his colleagues found that both the adaptive and natural Tregs depend on a gene called Foxp3. When this gene doesn’t function properly in humans, they lack natural Tregs and develop an autoimmune disorder called IPEX Syndrome, which includes severe allergies among its symptoms. By identifying this gene in the adaptive Tregs, the researchers add credence to the idea that nonfunctional or inadequate Tregs lead to allergies.

The researchers also found that the two adaptive Tregs share certain characteristics. Both appear to communicate their peacekeeping message using the same language: they produce a chemical called IL-10 and signal their desires through the same pipeline, known as the ICOS-ICOSL regulatory pathway.

But the two types of Tregs exhibit intriguing differences. Umetsu said each appears to be associated with a different helper T cell (Th cell). Each Treg has a gene turned on that is also turned on in the corresponding Th cell, and each Treg appears to be produced in greater numbers when its corresponding Th cell responds to an intruder. Although an excess of one of the Th cells is associated with autoimmune diseases such as multiple sclerosis and type 1-diabetes, and an excess of the other is linked to allergies and asthma, both Th cells cause inflammation. In turn, the two Treg cells have the opposite effect. “Both can help reduce airway inflammation,” said Umetsu.

“We have now found several subtypes of regulatory T cells,” he added, “and we are proposing how these are all interrelated. We believe this study provides a scaffold for future studies of regulatory T cells.”

Umetsu’s Stanford collaborators include Philippe Stock, MD, PhD; Omid Akbari, PhD; Rosemarie DeKruyff, PhD, professor of pediatrics; and Gerald Berry, MD, associate professor of pathology.

Stanford University Medical Center integrates research, medical education and patient care at its three institutions – Stanford University School of Medicine, Stanford Hospital & Clinics and Lucile Packard Children’s Hospital at Stanford. For more information, please visit the Web site of the medical center’s Office of Communication & Public Affairs at mednews.stanford.

Lucile Packard Children’s Hospital at Stanford is a 264-bed hospital devoted to the care of children and expectant mothers. Providing pediatric and obstetric medical and surgical services and associated with Stanford School of Medicine, LPCH offers patients locally, regionally and nationally the full range of health-care programs and services – from preventive and routine care to the diagnosis and treatment of serious illness and injury. To learn more about Lucile Packard Children’s Hospital, please visit our Web site at lpch.

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Contact: Katharine Miller
Stanford University Medical Center