Current status of tobacco use, cessation and control policy in Korea.

Background: Tobacco use is a leading cause of countless deaths and disabilities worldwide. An estimated 11 million Korean adults were still using tobacco in 2020, according to the Korea National Health and Nutrition Examination Survey. This review aims to explain the current trends in tobacco use, sales, cessation, and control policies in South Korea. Current Concepts: Heated tobacco products (HTPs), a hybrid between conventional and electronic cigarettes, were first launched in South Korea in June 2017. Advertisements stating that HTPs are odorless, tar-free, and less harmful to health have caused sales of HTPs to grow quickly over the past 5 years, such that they account for about 15% of the total tobacco market. According to national smoking rate statistics and tobacco sales trends, declines in current smoking rates have slowed and even risen in some groups, and declines in total tobacco sales have slowed but also risen again during the coronavirus 19 pandemic. In addition, the number of visitors to smoking cessation clinics decreased just after the advent of HTPs and social distancing policies triggered by the coronavirus. Nicotine replacement therapy can serve as a drug therapy for smoking cessation, or bupropion and varenicline can be prescribed. Korea's representative tobacco control policies include the tax increase policy, non-smoking area policy, cigarette pack warning picture policy, and support policy for visiting smoking cessation clinics. Discussion and Conclusion(s): There is a pressing need to reflect tobacco control policies in line with changes in tobacco user behaviors and tobacco company marketing strategies.Copyright © Korean Medical Association.

Associations of Combustible Cigarette, Electronic Cigarette, and Dual Use With COVID Infection and Severity in the U.S.: A Cross-sectional Analysis of the 2021 National Health Information Survey.

Given the potential respiratory health risks, the association of COVID infection and the use of combustible cigarettes, electronic nicotine delivery systems (ENDS), and concurrent dual use is a priority for public health. Many published reports have not accounted for known covarying factors. This study sought to calculate adjusted odds ratios for self-reported COVID infection and disease severity as a function of smoking and ENDS use, while accounting for factors known to influence COVID infection and disease severity (i.e., age, sex, race and ethnicity, socioeconomic status and educational attainment, rural or urban environment, self-reported diabetes, COPD, coronary heart disease, and obesity status). Data from the 2021 U.S. National Health Interview Survey, a cross-sectional questionnaire design, were used to calculate both unadjusted and adjusted odds ratios for self-reported COVID infection and severity of symptoms. Results indicate that combustible cigarette use is associated with a lower likelihood of self-reported COVID infection relative to non-use of tobacco products (AOR = .64; 95% CI [.55, .74]), whereas ENDS use is associated with a higher likelihood of self-reported COVID infection (AOR = 1.30; 95% CI [1.04, 1.63]). There was no significant difference in COVID infection among dual users (ENDS and combustible use) when compared with non-users. Adjusting for covarying factors did not substantially change the results. There were no significant differences in COVID disease severity between those of varying smoking status. Future research should examine the relationship between smoking status and COVID infection and disease severity utilizing longitudinal study designs and non-self-report measures of smoking status (e.g., the biomarker cotinine), COVID infection (e.g., positive tests), and disease severity (e.g., hospitalizations, ventilator assistance, mortality, and ongoing symptoms of long COVID).

E-Cigarette Use among Sexual Minoritized Women and Nonbinary People Assigned Female at Birth: Assessing the Roles of Discrimination, Perceived Stress, and Social Support.

Background: Young adult sexual minoritized women (SMW) are at disproportionate risk for e-cigarette use, which may in part be due to excess minority stress imposed by discrimination exposure. While discrimination exposure is associated with risk for combustible tobacco/nicotine use among SMW, similar associations have yet to be tested with e-cigarettes. Moreover, it is unknown if discrimination-related risk may be mitigated by protective factors such as social support. This study examined concurrent associations of discrimination, perceived stress, and social support with past 30-day e-cigarette use in a sample of young adult SMW during the COVID-19 pandemic. Methods: N = 501 SMW and nonbinary people assigned female at birth (AFAB) aged 18-30 completed an online survey. A series of logistic regressions examined associations of discrimination, perceived stress, and four forms of social support received during the COVID-19 pandemic with past-30-day e-cigarette use. Results: Among SMW, greater perceived stress (OR = 1.10, p = .03), but not discrimination exposure, was associated with e-cigarette use. Associations of discrimination with e-cigarette use were nonsignificant when most forms of social support (emotional, material/financial, and virtual) were accounted for. Associations of perceived stress with e-cigarette use were strongest among those who needed but did not receive material support. Conclusions: Perceived stress, but not discrimination exposure, was associated with risk for e-cigarette use among young SMW during the COVID-19 pandemic. Effects of nonspecific stress may be compounded by insufficient material/financial support.

Circular medicine. a paradigm of sustainability and resilience in education and professional development

Circular economy is a model of economic, social and environmental production and consumption, aimed to build a sustainable society in tune with the available resources. In the Brundtland Report, (1987, United Nations) sustainability it is defined as an approach focused on "meeting the needs of the present without compromising the ability of future generations to meet their own needs." The European Medical Association (EMA), that has currently more than 50 000 members, is involved in the advancement of health, pursuing educational and professional goals addressed to the quality of environment, lifestyle and civil society through a circular medicine approach. This is a comprehensive strategy, integrating best medical practice, bioinformatics and molecular biology with economy, artificial intelligence and machine learning. Circular Medicine is the resilient framework linking all these topics with circular economy methods. Innovative possibilities of circular medicine are many: it is a comprehensive paradigm shift, countering a non-medicine based on simplistic algorithms with guidelines of insufficient effectiveness, reliability and generalizability, often passed off as innovative Artificial-Intelligence approaches. We launched in 2020 a still ongoing survey aimed at the dissemination of information and at a greater sensitivity of all our members and followers on these topics, striving to build circular medicine in the real-world. This position document is based on its preliminary results: 1. Studying and investigating the links among health, climate change, biodiversity, circular economy, robust Artificial Intelligence and Machine learning support are goals and needed practice suitable to be pursued by EMA and other medical and scientific associations. Circular economy will be fruitfully used in health facilities, including hospitals, with health professionals and life science researchers acting also in the role of influencers and opinion leaders. 2. The interventions based on epidemiology, environmental sciences, best practice in medicine, sustainable technologies and molecular biology, the pillars of a potential framework of circular medicine, need a robust bioinformatics and Artificial Intelligence support. 3. Academic curricula and health professionals CME courses should provide stronger digital knowledge, reliable procedures trainings and expertise along these lines. Daily routine of clinical observation and participatory dialogue are key elements for the progress toward a culture, practice and accomplishments of circular economy and medicine. 4. Molecular biology, still the most innovative field of medical and life science, has a role for strengthening the pathways of the circular economy, as a reliable and resilient basis of "circular medicine." 5. The lessons of COVID19, the ongoing battles for healthier lifestyles dealing with nutrition, exercise and against alcohol and cigarette smoking, and the concept of smart cities are some of the cornerstones of the proposed strategy for a real-world circular medicine. Debunking interventions against the misuse of scientific and medical are means for the development of circular economy and medicine. Effective roadmaps, guidelines and grids for recognizing and counteracting the overlap of bullying, imposter's fear, insufficient expertise and knowledge, fake assertions and evaluations are actively developed by EMA's ad-hoc workshops. AI knowledge and skills should be implemented within innovative molecular biology and medical best-practice academic-CME curricula.Copyright © 2023 The American Society for Biochemistry and Molecular Biology, Inc.

Lung injury associated with an e-cigarette (vaping) use during the COVID-19 pandemic

In recent years, the excessive use of electronic cigarettes (e-cigarettes), and vaping, as a re-placement for traditional tobacco cigarettes, have highlighted potential health risks for users. One such risk is the development of "electronic cigarette (vaping) product use-associated lung injury" (EVALI). This type of lung injury has an unclear cause that may be related to the various components found in e-cigarette fluids. The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection (coronavirus disease . 2019 or COVID-19) may worsen EVALI symptoms in individuals with both conditions. This could be due to the increased oxidative stress and inflammation caused by e-cigarette use, as re-search shows increased levels of reactive oxygen species (ROS) and decreased glutathione. In this paper, we present two critical cases of COVID-19 patients with a history of chronic e-cigarette smoking and describe their clinical progression during hospitalization. The findings suggest that their prolonged use of e-cigarettes may have sig-nificantly impacted the severity of the disease.Copyright © 2023, The Indonesian Foundation of Critical Care Medicine. All rights reserved.

Biologic Potential of Human Umbilical Cord Derived Mesenchymal Stem Cells Exposed to Maternal Smoking and Active Sars-Cov-2 Infection at Delivery

Purpose of Study: COVID-19 caused by the SARS-CoV-2 virus has led to a worldwide pandemic with cytokine storm as the leading cause of morbidity and mortality. It is known that pregnant women are at higher risk of viral infections given an alteration in immune response. Mothers who smoke cigarettes during pregnancy are even at higher risk. The infection varies from asymptomatic to severe disease in pregnant women depending upon the degree of inflammation and cytokine storm. At present, limited data are available to show the effects of simultaneous maternal smoking and SARS-CoV-2 infection on the biologic efficacy of human umbilical cord derived mesenchymal stem cells (MSCs). We hypothesized that SARS-CoV-2 infection in combination with smoking of the pregnant mother at the time of delivery will lead to an alteration in the growth and differential potential of cord-derived MSCs. Our aims included collection, isolation and growth of human umbilical cord derived MSCs followed by assessment of their differentiation potential. Methods Used: The study was approved by the Institutional IRB. The umbilical cords were collected from the following groups of pregnant mothers at the time of delivery: Normal (non-smoking and negative SARS-CoV-2 infection), Smoker (smoking with negative SARS-CoV-2), Covid Smoker (smoking with positive SARS-CoV-2 infection) and Covid non-smoker (non-smoking with positive SARS-CoV-2 infection). Plastic adherent cells were harvested from 3 pooled human umbilical cords from each group. These cells were cultured and underwent immunodepletion per International Society for cellular therapy guidelines to isolate MSCs. MSCs were cultured in MSC-culture media to assess the duplication time. Similarly, MSCs were cultured in differentiation media (adipocytes and osteocytes) to assess differentiation time. Summary of Results: Picture shows the duplication and differentiation time from each group. Smoker group showed the longest duplication and differentiation time. Covid non-smoker group showed the shortest duplication and differentiation time. Covid Smoker group showed similar duplication and differentiation time as normal controls. All these results were statistically significant (T-test). Conclusion(s): Maternal smoking and active SARS-CoV-2 infection at the time of delivery alters the growth and differentiation potential of cord-derived MSCs. Further in vitro and in vivo studies are currently in progress to determine how this change effects the biological potential of these cells.

TOBACCO USE IN STUDENTS OF THE THIRD FACULTY OF MEDICINE OF CHARLES UNIVERSITY IN THE CZECH REPUBLIC

Objectives: This study assessed trends in tobacco use in students of the Third Faculty of Medicine of Charles University in the Czech Republic between academic years 2012/13 and 2019/2020. Methods: Two cross-sectional surveys designed to obtain information on smoking history, smoking status, tobacco products use, and cessation were conducted among 382 students of the 6-year Master's Study Programme (General Medicine) and the 3-year Bachelor's Study Programme (Public Health) in 2012/2013;and among 580 students of General Medicine and of the Bachelor's Study Programmes (Public Health, Dental Hygiene and Nursing) in 2019/2020. Results: Regular/daily smoking was reported by 4.4 ± 2.4% (with 95% CI) of General Medicine students and 4.8 ± 4.1% of Public Health students in 2012/2013, and 1.3 ± 1.1% of General Medicine students and 14.4 ± 4.8% of students of bachelor studies in 2019/2020. The share of regular and occasional smokers was higher among junior students in both academic years (23.9 ± 5.1% and 20.1 ± 4.7%, respectively) compared to senior students (23.6 ± 9.8% and 9.6 ± 5.7%). Cigarettes were the most common products used in both academic years (67.0 ± 4.7% and 45.5 ± 4.0%). There was a significant increase in proportion of students using more tobacco products in the course of the time (from 12.1 ± 3.1% to 53.7 ± 4.1%). The proportion of students who quitted smoking has risen from 11.4 ± 3.2% to 16.1 ± 3.0%. On the contrary, the proportion of students who started smoking has dropped from 15.9 ± 3.7% to 2.9 ± 1.4%. The proportion of non-smokers has risen from 57.6 ± 5.0% to 65.3 ± 3.9%. Conclusions: The study revealed some positive trends concerning tobacco use in students (decline in regular smokers among students of General Medicine, senior students, cigarette smokers, water pipe smokers;rise in non-smokers), but also negative ones (rise in regular smokers among students of Public Health, students who used more tobacco products).

Characterization of patients with COVID-19 in pinar del rio, March 2020 - March 2021

Introduction: the study of the characteristics of patients with COVID-19 makes it possible to determine risk groups in specific populations and to outline strategies by the institutions to improve the quality of care for these patients. Background: to characterize patients with COVID-19 in Pinar del Rio between March 2020 and March 2021. Methods: an observational, descriptive and cross-sectional study was carried out in patients diagnosed with COVID-19 in the province of Pinar del Rio between March 2020 and March 2021. The sample consisted of 450 patients who met the inclusion and exclusion criteria. Descriptive statistics were used for data analysis. Results: female patients predominated (56%), with a history of arterial hypertension (24,6%). A high incidence of COVID was found in individuals with between two and five chronic non-communicable diseases (40,2%). Of all patients diagnosed with COVID-19, 49% were passive smokers. Conclusions: COVID-19 occurred mainly in patients with several chronic diseases, as well as in those exposed.

Where There Is (No) Smoke, There Is Still Fire: a Review of Trends, Reasons for Use, Preferences and Harm Perceptions of Adolescent and Young Adult Electronic Cigarette Use.

Purpose of the review: To review the current prevalence, trends, perceptions, and effects of e-cigarette or vaping product use associated lung injury (EVALI) on e-cigarette use among US adolescents and young adults. Recent findings: COVID-19 diagnosis was more likely among the current/ever dual cigarette and e-cigarettes users, as well as ever e-cigarette only users. Additionally, the EVALI outbreak may have influenced harm perceptions, as daily nicotine vaping declined significantly from 2019 to 2020, and more youth and young adults perceived vaping as harmful. Summary: The prevalence of e-cigarette use, specifically flavored use, remains high among adolescents and young adults, which is concerning due to the short-term and unknown long-term effects of e-cigarettes and their association with future cigarette and other substance use.

Smoking increases expression of the SARS-CoV-2 spike protein-binding long ACE2 isoform in bronchial epithelium.

After more than two years the COVID-19 pandemic, that is caused by infection with the respiratory SARS-CoV-2 virus, is still ongoing. The risk to develop severe COVID-19 upon SARS-CoV-2 infection is increased in individuals with a high age, high body mass index, and who are smoking. The SARS-CoV-2 virus infects cells of the upper respiratory tract by entering these cells upon binding to the Angiotensin-converting enzyme 2 (ACE2) receptor. ACE2 is expressed in various cell types in the lung but the expression is especially high in goblet and ciliated cells. Recently, it was shown that next to its full-length isoform, ACE2 also has a short isoform. The short isoform is unable to bind SARS-CoV-2 and does not facilitate viral entry. In the current study we investigated whether active cigarette smoking increases the expression of the long or the short ACE2 isoform. We showed that in active smokers the expression of the long, active isoform, but not the short isoform of ACE2 is higher compared to never smokers. Additionally, it was shown that the expression of especially the long, active isoform of ACE2 was associated with secretory, club and goblet epithelial cells. This study increases our understanding of why current smokers are more susceptible to SARS-CoV-2 infection, in addition to the already established increased risk to develop severe COVID-19.

Oral epithelium response of electronic cigarette users to electronic cigarette.

BACKGROUND: Electronic cigarettes are increasing in popularity, but there is only little information on their biologic effects on the oral epithelium, the initial site exposed to electronic cigarette smoke. METHODS: We assessed the oral epithelium response to electronic cigarettes by comparing the histology and RNA transcriptome (mRNA and miRNA) of healthy electronic cigarette vapers to nonsmokers. mRNA was assessed based on: (1) genome-wide; (2) genes previously identified as dysregulated in the oral epithelium of electronic cigarette vapers versus nonsmokers; (3) immune and inflammatory-related genes previously identified as dysregulated in the nasal epithelium of electronic cigarette vapers compared to nonsmokers; (4) genes previously identified as dysregulated in the small airway epithelium of nonsmokers following an acute exposure to electronic cigarette; and (5) genes related to the initial steps of COVID-19 infection. In addition, miRNA was assessed genome-wide. Comparisons were performed using analysis of variance, and Benajmini-Hochberg corrected p < 0.05 was considered significant. RESULTS: The histology of the epithelium, lamina propria and basal layer in electronic cigarette vapers appeared normal. Assessment of mRNA and miRNA, based on all gene lists, did not identify any genes significantly modified in the oral epithelium of electronic cigarette vapers in response to electronic cigarette use. CONCLUSION: An average history of 2 years of vaping results in no detectable histologic or transcriptome abnormalities in the buccal mucosa.

Using the Statistical Machine Learning Models ARIMA and SARIMA to Measure the Impact of Covid-19 on Official Provincial Sales of Cigarettes in Spain

From a public health perspective, tobacco use is addictive by nature and triggers several cancers, cardiovascular and respiratory diseases, reproductive disorders, and many other adverse health effects leading to many deaths. In this context, the need to eradicate tobacco-related health problems and the increasingly complex environments of tobacco research require sophisticated analytical methods to handle large amounts of data and perform highly specialized tasks. In this study, time series models are used: autoregressive integrated moving average (ARIMA) and seasonal autoregressive integrated moving average (SARIMA) to forecast the impact of COVID-19 on sales of cigarette in Spanish provinces. To find the optimal solution, initial combinations of model parameters automatically selected the ARIMA model, followed by finding the optimized model parameters based on the best fit between the predictions and the test data. The analytical tools Autocorrelation Function (ACF), Partial Autocorrelation Function (PACF), Akaike Information Criterion (AIC), and Bayesian Information Criterion (BIC) were used to assess the reliability of the models. The evaluation metrics that are used as criteria to select the best model are: mean absolute error (MAE), root mean square error (RMSE), mean absolute percentage error (MAPE), mean percentage error (MPE), mean error (ME) and mean absolute standardized error (MASE). The results show that the national average impact is slight. However, in border provinces with France or with a high influx of tourists, a strong impact of COVID-19 on tobacco sales has been observed. In addition, the least impact has been observed in border provinces with Gibraltar. Policymakers need to make the right decisions about the tobacco price differentials that are observed between neighboring European countries when there is constant and abundant cross-border human transit. To keep smoking under control, all countries must make harmonized decisions. © 2023, Universidad Internacional de la Rioja. All rights reserved.

The impact of perceived risk of COVID-19 from smoking on the change in number of cigarettes smoked

Introduction: Smoking increases the risk of severe illness and mortality from COVID-19. However, the impact of risk perception on smoking over time is unknown. Method(s): Participants (n = 487) who reported having smoked daily or nondaily in February 2020 were recruited through Reddit and completed a cross-sectional survey. Linear regression models examined the impact of perception that smoking increases the risk of COVID-19 on changes in cigarettes per day (CPD). Result(s): The greater perceived risk of smoking on COVID-19 predicted greater decreases in CPD from before the pandemic (December 2019-February 2020) to March-May 2020, but no change was observed from March-May 2020 to June-August 2020. However, greater perceived risk predicted increases in CPD from June-August 2020 to November 2020-January 2021. Participants with high levels of perceived risk (>75th percentile) were more likely to reduce their CPD in the beginning of the pandemic compared to those with low perceived risk (<=25th percentile), but more likely to increase their CPD between June-August 2020 to November 2020-January 2021, even though perceived risk remained stable over time. Conclusion(s): Perceived risk is associated with a reduction in CPD, but participants returned to their pre-COVID smoking behavior within less than a year.Copyright © 2023 Taylor & Francis Group, LLC.

Asafetida (Ferula asafoetida) and its Potential Risks on Respiratory Disorders

Ferula asafoetida is an endemic species in Iran and is rich in oleo-gum resin with high economic value in the world. One important application of F. assafoetida is its traditional use for the management of respiratory ailments. The aim of this review was to collect papers dealing with F. asafoetida oleo-gum resin in respiratory tract's diseases in modern medicine. For preparing the manuscript the scientific databases (Google scholar, PubMed, Springer, Science Direct, Magiran), books, thesis, etc. were searched using the keywords of "Ferula asafoetida", "Ferula scorodesma", "Scorodesma foetida", "Northex asafoetida" plus "respiratory tract", "respiratory disorder" "infection", "cough", "trachea", "traditional medicine" up to Feb 2022 and the collected data were sum-marized, analyzed, and discussed. The results of the investigation confirmed the traditional belief on the efficacy of Ferula asafoetida in the treatment of respiratory viral infection (Coronavirus, influ-enza), cigarette smoking, asthma, cough and cancer, but most studies were limited to in vitro. There was only one registered randomized, blinded, placebo controlled clinical trial for 300 mg F. asafoet-ida aqueous extract capsules (three times a day for 14 days) on 40 patients with COVID-19 without any published results. Although, the studies implied the efficacy of F. asafoetida in the treatment of respiratory treatments, but design large clinical studies for evaluating its efficacy and safety is essential in future investigations.Copyright © 2023 Bentham Science Publishers.

Assessment of Sleep Quality among Medical Students During the Covid- 19 Pandemic

Objective: To assess the sleep quality among medical students, comparing their sleep cycles during physical and online studies along with other factors associated with sleep patterns. Study Design: Cross-sectional Questionnaire based survey Place and Duration of Study: Department of Community Medicine, HITEC Institute of Medical Sciences Taxila from 1st January 2020 to 31st March 2020 Methodology: One hundred and forty seven students were surveyed in a time period of 1 month. The questionnaire included PSQI Pittsburgh Sleep Quality Index and other clinically validated questions. Students with known sleeping disorders were excluded from this survey. Result(s): There were 81 (55.1%) females and 65 (44.2%) males with mean age 20+/-1.4 years. Out of these 94(63.9%) were classified as "Poor Sleepers" and only 53 (36.1%) were "Good Sleepers". Poor sleep quality was associated with female gender (p<0.05), day-scholar residence status (p<0.054), excessive time required to sleep (p<0.00), excessive screen time usage (p<0.007), increased hours of study (p<0.089), experiencing trouble while driving, eating and socializing (p<0.002), lack of enthusiasm (p<0.000), unsatisfactory daily activities (p<0.000) and poor daytime alertness levels (p<0.360). 104 (70.7%) were aware of the effects of melatonin on sleep, only 51 (34.7%) admitted to have used coffee to stay awake at night. 98 (66.7%) subjects were pre-exam workers, 95 (64.6%) admitted not being able to wake up easily in the morning. Conclusion(s): The students and hostelites that used less screen time slept better. Excessive daytime tiredness was also a result of poor sleeping habits. Students who studied for longer periods of time and had difficulty waking up in the morning slept poorly. Poor sleepers also find it difficult to interact and are often unambitious about performing their daily menial tasks, as well as displeased with their daily activities. As a matter of fact, we deduce that sleep quality has unanticipated consequences for medical students' social and mental health.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

The Effect of Smoking and Opioid Consumption on the Severity of the Disease and Duration of Hospitalization in COVID-19 Patients

Objective: In the Coronavirus 2019 (COVID-19) global pandemic, various studies on the target communities of this virus were widely started and rapidly progressed. Smokers and opioid consumers are one of the virus targets since they have a vulnerable respiratory system. Due to the contradictory results in previous studies and the lack of similar investigations in this area, we aimed to perform this study to investigate the effect of smoking and opioid consumption on the consequences of the COVID-19 disease. Material(s) and Method(s): In this retrospective study, the required information was collected and analyzed from the archives of Razi Hospital, Rasht, Iran. Study variables included age, sex, the need for intubation, hospital length of stay, history of current smoking or opioid consumption, and intensive care unit (ICU) admission, ICU length of stay, admission oxygen saturation, disease severity, and the outcome of death or recovery. Data were collected and divided into the case (including current cigarette smokers, opioid consumers, and cigarette-opioid consumers) and control (non-smokers and non-opioid-consumers) groups. Out of 986 patients, 489 patients met the criteria for inclusion and subsequent analysis. The average age was 69.79 +/- 16.06, and 294 (60.1%) patients were male. The median age of the case group (65.15 +/- 42.41) was older than the control group (57.45 +/- 15.71, P = 0.001). The case group consisted of more male patients than the control group (P = 0.001). Result(s): The adjusted regression models demonstrated that current cigarette smoking, opioid, and cigarette-opioid consumption did not significantly predict hospital and ICU length of stay, ICU admission, disease severity, and mortality outcomes (P > 0.05). Current cigarette smoking and opioid consumption could not be an independent predictor for the consequences of ICU admission, hospital and ICU length of stay, the need for intubation, disease severity, and mortality in COVID-19 patients.Copyright © 2023 H. S. Fayazi et al., published by Sciendo.

Clinical Approaches to Minimize Readmissions of Patients with COPD: A Narrative Review

Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease and also a lead-ing cause of morbidity and mortality worldwide. The frequent readmissions of patients with COPD may reduce lung function, mental health, and quality of life;it also increases the cost of treatment and mortality rate. Some common factors that may increase the readmission frequency of COPD patients include delay of diagnosis, advanced lung function decline, lack of adherence for COPD treatment, ineffective management of comorbidities, acute exacerbation or stable COPD, and infec-tions. However, these factors might be well controlled with appropriate approaches to minimize the readmission of patients with COPD. In this review, we propose a strategy with a seven-step approach to reduce the readmission in COPD patients, including early diagnosis of COPD, optimal treatment for stable COPD, targeted management of comorbidities, adequate therapy for acute ex-acerbations, individualized action plans for COPD patients, effective prevention of bacterial and viral infections, and adaptive program of pulmonary rehabilitation. Thus, implementing this approach may reduce the risk of readmission in patients with COPD.Copyright © 2023 Bentham Science Publishers.

SARS-CoV-2 infection aggravates cigarette smoke-exposed cell damage in primary human airway epithelia.

BACKGROUND: The coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a worldwide pandemic with over 627 million cases and over 6.5 million deaths. It was reported that smoking-related chronic obstructive pulmonary disease (COPD) might be a crucial risk for COVID-19 patients to develop severe condition. As cigarette smoke (CS) is the major risk factor for COPD, we hypothesize that barrier dysfunction and an altered cytokine response in CS-exposed airway epithelial cells may contribute to increased SARS-CoV-2-induced immune response that may result in increased susceptibility to severe disease. The aim of this study was to evaluate the role of CS on SARS-CoV-2-induced immune and inflammatory responses, and epithelial barrier integrity leading to airway epithelial damage. METHODS: Primary human airway epithelial cells were differentiated under air-liquid interface culture. Cells were then exposed to cigarette smoke medium (CSM) before infection with SARS-CoV-2 isolated from a local patient. The infection susceptibility, morphology, and the expression of genes related to host immune response, airway inflammation and damages were evaluated. RESULTS: Cells pre-treated with CSM significantly caused higher replication of SARS-CoV-2 and more severe SARS-CoV-2-induced cellular morphological alteration. CSM exposure caused significant upregulation of long form angiotensin converting enzyme (ACE)2, a functional receptor for SARS-CoV-2 viral entry, transmembrane serine protease (TMPRSS)2 and TMPRSS4, which cleave the spike protein of SARS-CoV-2 to allow viral entry, leading to an aggravated immune response via inhibition of type I interferon pathway. In addition, CSM worsened SARS-CoV-2-induced airway epithelial cell damage, resulting in severe motile ciliary disorder, junctional disruption and mucus hypersecretion. CONCLUSION: Smoking led to dysregulation of host immune response and cell damage as seen in SARS-CoV-2-infected primary human airway epithelia. These findings may contribute to increased disease susceptibility with severe condition and provide a better understanding of the pathogenesis of SARS-CoV-2 infection in smokers.