SAN FRANCISCO—Reducing some of the negative effects of smoking may be as easy as maintaining a diet that includes a high intake of fruits and vegetables, according to one of several studies presented at the American Thoracic Society’s 97th International Conference held in San Francisco. According to the presenters, the antioxidants found in apples and tomatoes are especially helpful in reducing wheezing, asthma, and other maladies in people who have extensive smoking histories.

Also discussed was the use of distraction therapy as a psychosocial aid to pain reduction during bronchoscopy. According to researchers from Johns Hopkins University, Baltimore, nature sights and sounds left patients with more positive impressions of their examinations.

Other topics included the way elderly asthma patients’ awareness about proper treatment affected their health and the effect of inhaled-powder insulin treatments on lung function in patients with diabetes. Additionally, the use of leukotriene modifiers by patients with severe asthma was discussed.

DIET AND COPD

Daily intake of fruits and vegetables, particularly apples and tomatoes, may be helpful in reducing the incidence of chronic obstructive pulmonary disease (COPD) in smokers. Presenters from the University of Nottingham, England, noted that in the 2,633 adults they evaluated for self-reported wheeze, physician-diagnosed asthma, and lung function, those who ate at least five apples or three tomatoes a week had better lung function and a decreased risk for wheezing. This may have been due to the combined effect of all the nutrients in apples and tomatoes, as well as the antioxidants that pigment them. Sarah Lewis, PhD, one of the researchers, speculated that antioxidants might play a specialized role in protecting airways from the negative effects of tobacco smoke.

Carol Trenga, PhD, a research scientist from the Department of Environmental Health at the University of Washington, Seattle, noted that the most beneficial substances found in these foods and their mechanisms of action are still unclear. Nevertheless, she believes that dietary supplementation with certain nutrients for patients at risk for diseases like COPD may be appropriate at times. Dr. Trenga stated that sufficient evidence existed to support a goal of five servings of fruits and vegetables per day, and that supplementation with vitamins C and E would also be advisable for populations at risk for COPD.

DISTRACTION THERAPY FOR BRONCHOSCOPY

In an effort to reduce the anxiety and pain that patients experience during flexible bronchoscopy, researchers from Johns Hopkins University tested the effects of “biophilic” images and sounds on 41 men and women who required the procedure. To supplement standard pain medication, the experimenters hung a 4-by-6–foot nature scene at patients’ bedsides and had them listen to audiotapes of nature sounds during their 25-minute procedures and three-hour recovery periods. Lead author Gregory Diette, MD, reported that patients given this therapy were 43% more likely to rate pain control as very good or excellent than were those in a control group (n = 39).

The researchers were sufficiently satisfied with their results that they plan to test the distraction technique on bone marrow transplant patients, who also experience significant discomfort and extended hospital stays as part of their treatment.

ELDERLY PATIENTS AND ASTHMA

Underuse of preventive medications and overuse of short-term relief drugs for asthma are reasons why asthma patients older than 70 years are twice as likely to be hospitalized as are patients ages 18 to 35 years, according to research from Johns Hopkins University. Elderly patients also are 17 times more likely to die from asthma.

The researchers examined records from 237 elderly men and women and found that the less-than-adequate care of their conditions fell short of National Asthma Education and Prevention Program guidelines. They were insufficiently informed on how to treat their illness; 80% lacked a peak flow meter that might be used to help adjust drug dosages, and 60% were unaware of which allergens could initiate their asthma attacks. Twenty percent of the patients did not use inhaled corticosteroids to prevent onset of asthmatic symptoms; overuse of ß-agonists and theophylline for relief from acute symptoms was also noted. Research fellow Linda Wolfenden, MD, said that these findings proved that physicians must redouble their efforts to educate their elderly patients in the proper treatment of asthma symptoms.

DRY-POWDER–INSULIN INHALATION SAFE AND EFFECTIVE

The use of inhaled insulin powder may be a reasonable means of controlling blood sugar levels in diabetic patients, according to a research team lead by William T. Cefalu, MD, of the University of Vermont College of Medicine, Burlington. This method utilizes an aerosol-type inhaler to deliver the insulin powder to the lungs. During the course of a 24-month study, the powder provided good glycemic control without negatively affecting lung function (as measured by forced expiratory volume in one second, forced vital capacity, total lung capacity, or diffusing capacity of the lung for carbon monoxide). Should these results be verified in phase III clinical studies, Dr. Cefalu stated, inhaled insulin might provide diabetic patients with an alternative to insulin injection.

LEUKOTRIENE MODIFIERS FOR SEVERE ASTHMA

Although leukotriene modifier use is recommended for mild to moderate asthma, many patients with severe asthma are using them, Mark D. Eisner, MD, of the University of California at San Francisco reported. He and his colleagues surveyed medication use in 401 adults with asthma.

Fifteen percent of the patients had used a leukotriene modifier during the preceding year and a half, and three quarters of those described their asthma as moderate to severe. Only 45% of those who had not used leukotriene modifiers said that their asthma was as serious. Users of leukotriene modifiers reported that they had visited hospitals five times more frequently in the preceding year because of their asthma than had nonusers.

Almost 90% of the patients given leukotriene modifiers were already using inhaled corticosteroids, and 55% were using both inhaled corticosteroids and long-acting ß-agonists. Users of leukotriene modifiers were markedly more likely to be dependent on oral corticosteroids than were nonusers (43% vs 9%, respectively). Thus, it is not clear whether the use of these agents contributed to or is simply a marker for more severe disease.

—Owen McCarthy