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Background: Smokers with medical illnesses are at particular risk for complications caused by tobacco. Clinical trial data on the effectiveness of triple-combination pharmacotherapy for tobacco dependence treatment in these high-risk smokers are not available. Objective: To evaluate extended duration of a triple-medication combination versus standard-duration therapy with the nicotine patch alone and 6-month abstinence rates in smokers with medical illnesses. Design: Randomized clinical trial from 2005 to 2007. Setting: Single primary care setting. Patients: 127 smokers 18 years or older with predefined medical illnesses were recruited from the local community. Intervention: Participants were allocated by blocked randomization to receive either the nicotine patch alone for a standard 10-week, tapering course (n = 64) or the combination of nicotine patch, nicotine oral inhaler, and bupropion ad libitum (n = 63). Nonstudy staff, who used computer-generated tables, assigned participants by telephone. No study staff had access to the randomization tables before randomization, thus maintaining concealment. Participants and study personnel were not blinded to treatment assignment. Measurements: The primary outcome was 7-day, exhaled carbon monoxide--confirmed point abstinence at 26 weeks after target quit date. Secondary outcomes were the time to first relapse, duration of medication use, and adverse effects of medications. Analyses were conducted on an intention-to-treat basis with participants who were lost to follow-up (patch alone In = 13] and combination therapy [n = 18]) classified as still smoking. Results: Both treatment groups had similar baseline characteristics. Abstinence rates at 26 weeks were 35% (22 of 63 patients) for the combination group versus 19% (12 of 64 patients) for the patch-alone group (relapse benefit, 16% [95% CI, 1% to 31%]; P= 0.040). The adjusted odds ratio for abstinence in the combination group was 2.57 (CI, 1.05 to 6.32; P = 0.041). The median time to relapse was significantly longer in the combination group than in the patch-alone group (65 days vs. 23 days; P = 0.005). Some side effects occurred more frequently in the combination group (for example, insomnia [25% vs. 9%] and anxiety [22% vs. 3%]), but the proportion of participants who discontinued study medications because of adverse events was similar in both groups (6%). Limitations: Approximately 25% of participants were lost to follow-up (proportions were similar between treatment groups). Treatment personnel and participants were unblinded. Conclusion: Flexibly dosed triple-combination pharmacotherapy for up to 6 months was more effective than standard-duration nicotine patch therapy for outpatient smokers with medical illnesses. Primary Funding Source: Cancer Institute of New Jersey and Robert Wood Johnson Foundation.

Background: Epidemiologic studies have suggested that vitamin E and [Bets]-carotene may each influence the development of prostate cancer. In the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, a controlled trial, we studied the effect of [Alpha]-tocopherol (a form of vitamin E) and [Beta]-carotene supplementation, separately or together, on prostate cancer in male smokers. Methods: A total of 29133 male smokers aged 50-69 years from southwestern Finland were randomly assigned to receive [Alpha]-tocopherol (50 mg), [Beta]-carotene (20 mg), both agents, or placebo daily for 5-8 years (median, 6.1 years). The supplementation effects were estimated by a proportional hazards model, and two-sided P values were calculated. Results: We found 246 new cases of and 62 deaths from prostate cancer during the follow-up period. A 32% decrease (95% confidence interval [CI] = -47% to -12%) in the incidence of prostate cancer was observed among the subjects receiving [Alpha]-tocopherol (n = 14564) compared with those not receiving it (n = 14 569). The reduction was evident in clinical prostate cancer but not in latent cancer. Mortality from prostate cancer was 41% lower (95% CI = -65% to -1%) among men receiving [Alpha]-tocopherol. Among subjects receiving [Beta]-carotene (n = 14560), prostate cancer incidence was 23% higher (95% CI = -4%-59%) and mortality was 15% higher (95% CI = -30%-89%) compared with those not receiving it (n = 14573). Neither agent had any effect on the time interval between diagnosis and death. Conclusions: Long-term supplementation with [Alpha]-tocopherol, substantially reduced prostate cancer incidence and mortality in male smokers. Other controlled trials are required to confirm the findings. [J Natl Cancer Inst 1998;90:440-6]

The effects of smoking and age on the safety and effectiveness of the antibiotic temafloxacin were assessed in patients with infections of the lower respiratory tract. These effects were compared with similar findings reported in studies of the antibiotics ciprofloxacin and amoxicillin; in all, the findings of six clinical trials were reviewed. Temafloxacin is a new fluoroquinolone antibiotic that kills a wide range of gram-negative and gram-positive bacteria that often cause lower respiratory tract infections. Ciprofloxacin is another fluoroquinolone and it has been previously tested. Amoxicillin is another type of antibiotic that is frequently used to treat lower respiratory tract infections. The abilities of the three drugs to relieve patients' clinical symptoms were comparable in both smokers and elders (aged 65 years and older) with lower respiratory tract infections. However, more effective killing of bacteria, that is, a higher cure rate, occurred with temafloxacin. No differences were seen in the development of adverse side effects with the three drugs in either group of patients. Therefore, temafloxacin can be used as an alternative treatment of lower respiratory infections in smokers and the elderly. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cigarette smokers are about four times more likely than nonsmokers to have advanced gum disease, according to a study published in the Journal of Periodontology The study, published in May [...]

200J JUL 5 - (NewsRx Network) -- Here's one more reason for women to avoid smoking: breast cancer patients who smoke have a much higher risk of the disease spreading [...]

2001 MAY 17 - (NewsRx Network) -- Current use of oral contraceptives (OCs) is unrelated to an increased risk of a nonfatal first myocardial infarction (MI) among women who do [...]

The prevalence of asthma has more than doubled in 20 years. This increase is largely associated with trends in atopy, as measured indirectly by the prevalence of hay fever. Greater [...]

Background: Higher blood levels of [Alpha]-tocopherol, the predominant form of vitamin E, have been associated in some studies with a reduced risk of lung cancer, but other studies have yielded conflicting results. To clarify this association, we examined the relationship between prospectively collected serum [Alpha]-tocopherol and lung cancer in the [Alpha]-Tocopherol, BetaCarotene Cancer Prevention (ATBC) Study cohort. Methods: The ATBC Study was a randomized, clinical trial of 29133 white male smokers from Finland who were 50-69 years old and who had received [Alpha]-tocopherol (50 mg), [Beta]-carotene (20 mg), both, or neither daily for 5-8 years. Data regarding medical histories, smoking, and dietary factors were obtained at study entry, as was a serum specimen for baseline [Alpha]-tocopherol determination, [Alpha]-Tocopherol measurements were available for 29 102 of the men, among whom 1144 incident cases of lung cancer were diagnosed during a median observation period of 7.7 years. The association between [Alpha]-tocopherol and lung cancer was evaluated with the use of multivariate proportional hazards regression. Results: A 19% reduction in lung cancer incidence was observed in the highest versus lowest quintile of serum [Alpha]-tocopherol (relative risk = 0.81; 95% confidence interval = 0.67-0.97). There was a stronger inverse association among younger men ([is greater than] 60 years), among men with less cumulative tobacco exposure ([is greater than] 40 years of smoking), and possibly among men receiving [Alpha]-tocopherol supplementation. Conclusions: In the ATBC Study cohort, higher serum [Alpha]-tocopherol status is associated with lower lung cancer risk; this relationship appears stronger among younger persons and among those with less cumulative smoke exposure. These findings suggest that high levels of [Alpha]-tocopherol, if present during the early critical stages of tumorigenesis, may inhibit lung cancer development. [J Natl Cancer Inst 1999;91:1738-43]

Women tended to have fewer high-grade bronchial lesions than men in a study of 401 subjects who had a history of long-term smoking. Women also had more peripherally located lesions [...]

INTRODUCTION: Foreign body aspiration (FBA) in adults is uncommon but may present as a diagnostic dilemma. The clinical picture may vary from chronic nonspecific symptoms mimicking other lung diseases to [...]

Glenn Stanton has trouble breathing if he walks across a room to answer the phone. Every four hours, around the clock, he must hook himself up to an oxygen tank [...]