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Women with asthma may notice that their asthma symptoms get worse at certain times of the month. Now, a new study confirms that fluctuating female hormone levels appear to affect airway inflammation, but oral contraceptives might help ease those changes.
In women who were not using birth control pills, the study found that increased levels of estrogen were associated with decreased levels of exhaled nitric oxide — indicating decreased airway inflammation. In these same women, increased levels of progesterone were associated with increased levels of exhaled nitric oxide, indicating increased airway inflammation.
However, birth control pills lessen dramatic hormone fluctuations, and researchers didn’t find differences in asthma symptoms throughout the month for women who took them.
“This study is a first step in looking at the relationship between hormones and asthma,” said the study’s lead author, Dr. Piush Mandhane, an assistant professor of pediatric pulmonology at the University of Alberta in Canada. The findings might be of use in managing asthma among premenopausal women, the researchers said.
“Among women not on oral contraceptives, we did have changes in exhaled nitric oxide that were related to estrogen and progesterone levels. We didn’t have an association with estrogen and progesterone in women on oral contraceptives,” said Mandhane.
Results of the study are published in the November issue of the journal Chest.
Mandhane said that because many women report a change in asthma symptoms related to menstrual cycles, it’s often assumed that there is an association. But, he said, the relationship between hormonal fluctuations and asthma symptoms hasn’t been well-studied.
The current study included 17 women. Eight were on birth control pills that contained estrogen and progesterone. The average age of the women using oral contraceptives was 25.5, while the average age of the women not taking birth control pills was 37.5.
Three of the women in the group not on birth control reported experiencing menstrual-cycle related asthma prior to the study, while just one woman in the birth control group did.
The researchers gathered daily information about symptoms and conducted blood tests to measure estrogen and progesterone levels, performed spirometry (a lung function test) and took measurements of exhaled nitric oxide. They also conducted allergy tests, via skin pricks every other day.
They found that women who didn’t take birth control pills had an average exhaled nitric oxide level of 48.2 parts per billion (ppb), while those on oral contraceptives had an average level of 27 ppb. In women who weren’t taking oral contraceptives, each increase in estrogen levels was associated with a decrease in exhaled nitric oxide, while each increase in progesterone was associated with an increase in exhaled nitric oxide. That means when progesterone levels are elevated (before menstruation), asthma symptoms are likely to be worse.
Progesterone increases also aggravated allergy symptoms, with more severe allergic reactions evident on skin prick tests when progesterone levels were elevated.
The researchers didn’t find any statistically significant differences in allergic reactions during the month for women on birth control pills.
Mandhane said that “birth control works by flattening out the fluctuations in hormone levels,” and that’s likely why there weren’t many differences in asthma symptoms for women taking birth control pills.
“Hormones do play a role,” said Mandhane, “and women need to be aware that there’s a potential relationship between their asthma symptoms and their menstrual cycles.”
Dr. Jennifer Appleyard, chief of allergy and immunology at St. John Hospital and Medical Center in Detroit, said that this study “lends credence to the fact that asthma is affected by hormones. This is definitely not something women should just write off. It’s not just all in their minds.”
But she also pointed out that this was a small study, and that the women in each group were very different from each other. “There were a lot of older women in one group who took more asthma medication. It’s not really comparing apples to apples,” she said.
Because birth control pills can have some serious side effects, Appleyard said she would not advise someone to go on oral contraceptives just to help their asthma. However, if a woman notices a difference in her symptoms throughout her menstrual cycle, she may want to talk to her doctor about increasing her asthma medications during that particular time in her cycle, she said.
Women who smoke while they are pregnant often don’t admit it, which means they’re missing out on an opportunity to get help to kick the habit, new research published in BMJ shows.
Smoking is well-known to increase the risk of premature births and other complications. “What these women are doing inadvertently is not allowing themselves to be guided to available smoking cessation services,” Dr. David M. Tappin of the University of Glasgow in Scotland, one of the researchers on the study, told Reuters Health.
In the UK, most women are “booked” into maternity services at eight to 12 weeks of pregnancy. At booking, a midwife interviews the woman, and asks whether or not she smokes. Women who say yes will get a follow-up call to enroll them in a smoking cessation program.
“It’s quite an evidence-based, well organized service for them,” Tappin noted. “You’re not just advising them to stop smoking, you’re actually giving them a lot of support to achieve that aim of they want to.”
Studies have shown that many women continue smoking while pregnant, especially those living in more deprived areas, Tappin and his colleagues note in their report; in Scotland, 38 percent of women living in the poorest areas admit to smoking while pregnant, while 8 percent of those living in the least deprived areas do.
There’s evidence that many women who smoke in pregnancy don’t admit to it, the researchers add. To investigate how common this might be, Tappin and his team looked at a random sample of roughly 21,000 women in western Scotland who had their blood tested in their second trimester to screen for Down’s syndrome and birth defects over a one-year period.
The researchers tested blood samples from 3,475 of these women for cotinine, a nicotine byproduct that remains in the blood for about three days after a person smokes a cigarette, and then compared these results to the answers women had provided at their booking interview when asked if they smoked.
Around 24 percent of the women had reported being current smokers. But the blood tests revealed that 30 percent were actually smoking. The women living in the least-deprived areas were the most likely to give a false statement about smoking; 39 percent of smokers living in these areas didn’t admit to it, compared to 22 percent of the more deprived women.
But given that so many more women smoked during pregnancy in the more deprived areas, Tappin and his colleagues say, there were probably twice as many pregnant smokers going undetected in these areas.
A woman’s maternity booking visit is often hectic, and many women may choose not to admit to smoking simply to speed up the process, or because they are ashamed to admit to smoking, Tappin noted.
“There is quite a significant number of women who actually say that they don’t smoke because that’s the easiest thing for them to do,” he said. “They don’t want to be seen as bad people by their midwives.”
In Glasgow, he added, women undergo carbon monoxide breath tests at their booking visit; these tests can show whether a woman smoked within the past eight to 10 hours. Even women who told the midwife that they did not smoke are willing to undergo the test, which is usually administered by nursing auxiliaries, not midwives.
“It’s really not a hassle and nobody complains about it,” he said. And by using this test, Tappin added, it’s possible to identify 95 percent of pregnant smokers, while self-reports will only capture around 75 percent.
And the women who don’t admit to smoking are just as likely to seek help for quitting as those who do admit to it, he added. “I don’t think these women who give a false answer are any different from anybody else.”
Phone counseling to help smokers kick the habit won’t do much if it doesn’t include callbacks or other follow-up strategies, new research shows.
While studies have shown that “proactive” telephone counseling, in which counselors make calls to smokers based on a prearranged schedule, is effective in helping people to quit, evidence for “reactive” counseling, in which smokers themselves initiate all calls to the quit line, isn’t as strong, Dr. Akshay Sood of the University of New Mexico School of Medicine in Albuquerque and his colleagues note in their report.
To investigate the “real world” effectiveness of the reactive approach, Sood and his team randomly assigned 990 men and women who called a telephone helpline between 2003 and 2006 to receive self-help information on quitting by mail or the mailed information plus telephone counseling.
Each person in the phone counseling group had at least one counseling session, but the schedule for calls was at the smokers’ discretion. The researchers followed up with study participants one, three, six and 12 months later.
Sood and his colleagues found no difference in smoking abstinence between the groups that received mailings only and the groups that used reactive phone counseling at any of the follow-up points.
They did find, however, that black callers had lower abstinence rates than whites three and 12 months into the study, while black smokers were also less likely than whites to have tried aids such as nicotine gum or patches.
The US is relying heavily on phone counseling in its efforts to help smokers quit, Sood noted in an interview; now all 50 states have smoking cessation phone lines. The services provided vary by state.
What the findings show, the researcher said, is that in order to be effective, phone counseling must include some proactive component.
“We’re not telling them to pack up and go, that’s certainly not the message of this paper,” Sood said. “Overall they play a very important role. They attract a clientele that otherwise is underserved.”
He added, “Reactive recruitment is still a good idea but then there should be some built-in accountability with call-back counseling.” Also, Sood added, efforts should be made to ensure that helplines are useful for black individuals as well as whites.
Most quitlines supported by states offer proactive counseling, Dr. Lori Pbert, of the University of Massachusetts Medical School in Worcester, notes in an editorial accompanying the study. Also, she adds, research shows that the more frequently smokers receive callbacks, the more effective this type of counseling is.
Nevertheless, she added, just 1 percent of smokers in the US make use of quitlines. The new findings, Pbert concludes, demonstrate “the need to evaluate strategies to enhance and maximize the utilization of existing, effective smoking cessation telephone counseling offered through quitlines, including the use of proactive, call-back counseling and linking quitlines to health-care systems and providers.”
An analysis of 19 studies provides additional evidence of increased asthma risk in children and adults given acetaminophen.
The study’s lead author told Reuters Health, while this type of study isn’t the best way to prove that the medication actually causes the illness, it does show that the relationship should be investigated further.
“We know acetaminophen affects inflammatory cells in the airway,” said Dr. J. Mark FitzGerald of the Vancouver Coastal Health Research Institute in British Columbia. But even if the medication does boost asthma risk, he added, it’s likely only one factor in the rise in asthma prevalence seen in recent years.
Asthma has become increasingly common worldwide, and some investigators have suggested that more widespread acetaminophen use could be one contributing factor, given that the drug lowers levels of an antioxidant called glutathione found in lung tissue, FitzGerald and his team note in the journal CHEST.
Also, the researcher pointed out in an interview, a study of about 200,000 patients published in 2008 suggested an increased risk of asthma and wheezing in those who took acetaminophen.
To investigate further, FitzGerald and his associates searched the medical literature for studies that looked at acetaminophen and risk of asthma and wheezing.
When the researchers did a combined analysis of the 19 studies they identified, which included 425,140 patients in all, they found acetaminophen use was associated with a 1.6-fold increased risk of asthma. Children exposed to the drug in the womb were at 1.3-fold greater risk of asthma and 1.5-fold increased risk of wheezing.
The one study that looked at high-dose acetaminophen in children found it more than tripled asthma risk.
At this point, FitzGerald said, parents shouldn’t purge their medicine chests of acetaminophen.
When a pediatrician recommends acetaminophen to treat fever in a child, according to the researcher, parents should follow this advice. The drug “works very well to do what it is supposed to do,” he noted, adding “there’s always a risk benefit in terms of medication.”
Rough buffing of the skin does a better job of removing wrinkles and acne scars and stimulating healing than a gentler rubbing, University of Michigan researchers report.
Known as microdermabrasion, skin buffing has become a popular way to improve the appearance of wrinkles, acne scars, skin discoloration and other signs of aging skin. The procedure involves buffing the skin with grains of diamond or another hard substance such as aluminum oxide crystals, the researchers explain.
Laser resurfacing is considered the “gold standard” for removing wrinkles, acne scars and skin discoloration, but it requires a long healing period after treatment and can sometimes leave the skin damaged, said study leader Dr. Darius J. Karimipour, an assistant professor of dermatology at Michigan.
But with microdermabrasion, he said, the skin heals quickly. Someone could have a treatment at lunchtime and return to work with only a little redness. The researchers’ goal was to make microdermabrasion more effective, he said.
“We came up with the idea of a more aggressive approach,” Karimipour said. “If we treated the skin more aggressively with microdermabrasion, we could generate more collagen.”
The key to improving the appearance of skin is to have the treatment induce the production of collagen, which is an important skin protein, Karimipour explained. Earlier studies had found that aluminum oxide microdermabrasion does not always stimulate collagen production, but he said it was not known if that could be achieved with a more abrasive substance.
To find out, Karimipour’s team took skin samples from the arms of 40 people with sun-damaged skin. Samples were taken before and after the participants had microdermabrasion with either a coarse- or medium-grit, diamond-studded wand.
The researchers found that the course-grit diamond increased the production of compounds associated with wound healing and skin remodeling. These included cytokeratin 16, which helps skin heal after injury.
In addition, the coarse-grit buffing produced antimicrobial peptides that fight infection and substances that break down the skin’s structural proteins to let the skin rebuild. The researchers also found that skin produced other substances that induce collagen production.
These changes were not seen in skin treated with the medium-grit device, they noted.
Their findings are published in the October issue of Archives of Dermatology.
“This research gives us the basis to believe that aggressive microdermabrasion abrasion could potentially result in beneficial effects like we see in other more aggressive procedures, like laser resurfacing,” Karimipour said.
However, he predicted that aggressive microdermabrasion would not replace laser resurfacing. Microdermabrasion is not for the most severe cases but rather for fine-line wrinkles and shallow acne scars, he said.
Dr. Jeffrey Salomon, an assistant clinical professor of plastic surgery at Yale University School of Medicine, said that “the more damage induced to the skin, by whatever mechanism, the stronger the body’s repair response.”
For microdermabrasion-induced injury, coarseness of the grit is only one part of the picture, Salomon said. “The duration of application, pressure applied during the application and the recipient skin thickness are also parameters, just like different grit of sandpaper are used for different types of wood and different types of applications,” he said.
Treating the skin first with chemical peeling agents can reduce the amount of grit needed to get a skin-repair response equivalent to that of a coarser-grit wand, Salomon said.
“So there are a variety of parameters that can be manipulated to achieve equivalent results, independent of the coarseness of the grit,” he said. “In the end, you do need to induce an injury to the skin to get objective evidence of skin rejuvenation.”
Worldwide immunization rates are at their highest-ever levels, a new report shows.
A record number of vaccines — 120 — are now available to prevent deadly diseases, and more than 80 new vaccines are in late-stage clinical testing, according to the report scheduled to be released Wednesday by the World Health Organization, UNICEF and the World Bank.
A record 106 million infants were immunized in 2008, reversing a downward trend. Measles deaths worldwide decreased 74 percent between 2000 and 2007, the report authors noted.
“Such progress must inspire new efforts to immunize children around the globe against life-threatening diseases,” UNICEF executive director Ann M. Veneman, said in a news release.
Along with the good news, the “State of the World’s Vaccines and Immunization” report also said rich nations need to contribute more to eliminate an annual $1 billion funding gap that leaves about 24 million children at risk, particularly in the poorest nations and communities.
Recently developed vaccines include those to protect against meningococcal meningitis, rotavirus diarrhea, pneumococcal disease and human papillomavirus (HPV). Vaccines now in late-stage testing include more than 30 that target diseases for which no vaccine currently exists. Researchers are also working to create vaccines against HIV/AIDS, malaria, tuberculosis and dengue.
The report also said that manufacturers in developing countries now fill 86 percent of the demand for traditional vaccines such as those that protect against measles, whooping cough, tetanus and diphtheria.
“We have seen a dramatic turnaround in the availability of vaccines in even the poorest countries,” Graeme Wheeler, managing director of the World Bank Group, said in the news release. “Yet the international community, together with the countries themselves, must ensure that new and existing technologies actually reach the most vulnerable populations, especially children.”
A new study suggests that the cancer drug Gleevec may benefit people with scleroderma, a chronic connective tissue disease.
No effective treatment currently exists for scleroderma, which affects the skin, blood vessels and often muscles and joints, as well as the gastrointestinal tract, kidneys, heart and lungs. About 300,000 people in the United States have scleroderma, which typically strikes people between the ages of 30 and 50, according to the Scleroderma Foundation.
This study included 30 patients with diffuse scleroderma, a widespread, severe form of the disease. They took 400 milligrams of Gleevec a day and were evaluated monthly for 12 months during treatment and were seen for follow-up three months after they stopped taking the drug.
The researchers assessed the effectiveness of the drug treatment by using a tool called the modified Rodnan skin score, a measure of how much skin is affected by the disease.
“The skin score seems to be a very good marker of disease status and most scleroderma trials use this as an outcome measure,” study leader Dr. Robert Spiera, an associate attending rheumatologist at the Hospital for Special Surgery and an associate professor at Weill Cornell Medical College, said in a hospital news release.
They also used two tests (forced vital capacity and diffusion capacity) to measure patients’ lung function. Lung disease is one of the main causes of death in scleroderma patients.
Interim findings showed a 23 percent improvement in skin scores and improvements in the lung function tests — 9.6 percent in forced vital capacity scores and 11 percent to 18 percent in diffusion capacity scores.
“The lung function data was really exciting,” Spiera said. “In patients with scleroderma, you usually see lung function tests getting worse over time, and if doctors try a therapy for a year and a patient doesn’t get any worse, we get pretty excited. What is amazing to me in this study is that we actually saw improvements in both lung function tests.”
The interim results were presented Sunday at the American College of Rheumatology annual meeting in Philadelphia. The study received funding and donated drugs from Novartis, which makes Gleevec.
The drug is approved in the United States to treat two types of cancer — chronic myeloid leukemia and gastrointestinal stromal tumor.
New research links high blood pressure in children to bones that are more mature than average, suggesting that advanced bone age may predict cardiovascular problems.
The new study, published Oct. 19 in the journal Hypertension, looked at children and found that those without high blood pressure had bones that reflected their chronological age within four months.
But in kids with high blood pressure, there was an average difference of nearly two years between “bone age” (16 years) and chronological age (14 years).
“Accelerated maturation is not the same as precocious puberty, the onset of signs of puberty before age 7 or 8 in girls and age 9 in boys,” study co-author Dr. Mieczyslaw Litwin, scientific director of Children’s Memorial Health Institute in Warsaw, Poland, said in a statement. “Accelerated maturation means that the tempo of biological maturity is greater than average. We found that accelerated skeletal maturation may be the early tell-tale sign of developing hypertension.”
The study authors examined bone age in the 108 Polish white children in the study by examining X-rays of wrists of the left hand. They compared the maturity of the bone structure to a reference atlas.
The researchers report that they found that the bone structures were mature in 20 of 54 children without high blood pressure, but 48 of the 54 with it.
“It is difficult to imagine that the process of biological maturity can be reversed,” Litwin said. “But we think that some lifestyle modifications, such as increased physical activity and diet modification, can influence both metabolic abnormalities and the tempo of biological maturity.”
New insight into how primary lung cancer turns into invasive, or metastatic, cancer could lead to treatments that improve patient survival, U.S. scientists say.
The research team at the University of Texas M.D. Anderson Cancer Center found that lung cancer becomes invasive by suppressing a type of microRNA that normally keeps tumors in a non-metastatic state. Specifically, when microRNA-200 was suppressed in mice prone to metastatic lung cancer, all their primary lung tumors became invasive, the study found.
The study appears in the Sept. 15 issue of the journal Genes & Development.
“Existing treatments have little success against cancer that has spread to other organs, so finding a way to prevent metastasis could have a huge impact on survival,” senior author Dr. Jonathan Kurie, a professor in M.D. Anderson’s Department of Thoracic/Head and Neck Medical Oncology, said in a university news release.
“To do that, we need to understand the cues that initiate metastasis. In this paper, we show that microRNA-200 is one of those central cues,” he explained.
The researchers are now trying to identify regulators of microRNA-200 that might offer targets for treatment.