This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 report focuses primarily on the revised and novel parts of the document. The most significant changes include: (1) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; (2) for each of the groups A to D, escalation strategies for pharmacologic treatments are proposed; (3) the concept of deescalation of therapy is introduced in the treatment assessment scheme; (4) nonpharmacologic therapies are comprehensively presented; and (5) the importance of comorbid conditions in managing chronic obstructive pulmonary disease is reviewed.

/pdf/global-strategy-for-the-diagnosis-management-and-prevention-2tve0rxywh.pdf

Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary

Background E-cigarettes are commonly used in attempts to stop smoking, but evidence is limited regarding their effectiveness as compared with that of nicotine products approved as smoking-...

https://www.nejm.org/doi/suppl/10.1056/NEJMoa1808779/suppl_file/nejmoa1808779_appendix.pdf

A randomized trial of E-cigarettes versus nicotine-replacement therapy

This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: 1) the assessment of COPD has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; 2) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; 3) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; 4) nonpharmacologic therapies are comprehensively presented and; 5) the importance of comorbid conditions in managing COPD is reviewed.

/pdf/global-strategy-for-the-diagnosis-management-and-prevention-3ziakcdle4.pdf

Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary

Millions of Americans use e-cigarettes. Despite their popularity, little is known about their health effects. Some suggest that e-cigarettes likely confer lower risk compared to combustible tobacco cigarettes, because they do not expose users to toxicants produced through combustion. Proponents of e-cigarette use also tout the potential benefits of e-cigarettes as devices that could help combustible tobacco cigarette smokers to quit and thereby reduce tobacco-related health risks. Others are concerned about the exposure to potentially toxic substances contained in e-cigarette emissions, especially in individuals who have never used tobacco products such as youth and young adults. Given their relatively recent introduction, there has been little time for a scientific body of evidence to develop on the health effects of e-cigarettes.Public Health Consequences of E-Cigarettes reviews and critically assesses the state of the emerging evidence about e-cigarettes and health. This report makes recommendations for the improvement of this research and highlights gaps that are a priority for future research.

/pdf/public-health-consequences-of-e-cigarette-use-4ui7nfi810.pdf

Public Health Consequences of e-Cigarette Use.

This Executive Summary of the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: (i) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; (ii) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; (iii) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; (iv)non-pharmacological therapies are comprehensively presented and (v) the importance of co-morbid conditions in managing COPD is reviewed.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/resp.13012

Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary

E-cigarettes are 95% less harmful to your health than normal cigarettes. When supported by a smoking cessation service, they help most smokers to quit tobacco altogether.

Key messages:
1. Smokers who have tried other methods of quitting without success could be encouraged to try e-cigarettes (EC) to stop smoking and stop smoking services should support smokers using EC to quit by offering them behavioural support. 

2. Encouraging smokers who cannot or do not want to stop smoking to switch to EC could help reduce smoking related disease, death and health inequalities. 

3. There is no evidence that EC are undermining the long-term decline in cigarette smoking among adults and youth, and may in fact be contributing to it. Despite some experimentation with EC among never smokers, EC are attracting very few people who have never smoked into regular EC use. 

4. Recent studies support the Cochrane Review findings that EC can help people to quit smoking and reduce their cigarette consumption. There is also evidence that EC can encourage quitting or cigarette consumption reduction even among those not intending to quit or rejecting other support. More research is needed in this area. 

5. When used as intended, EC pose no risk of nicotine poisoning to users, but e-liquids should be in ‘childproof' packaging. The accuracy of nicotine content labelling currently raises no major concerns. 

6. There has been an overall shift towards the inaccurate perception of EC being as harmful as cigarettes over the last year in contrast to the current expert estimate that using EC is around 95% safer than smoking. 

7. Whilst protecting non-smoking children and ensuring the products on the market are as safe and effective as possible are clearly important goals, new regulations currently planned should also maximise the public health opportunities of EC. 

8. Continued vigilance and research in this area are needed.

E-cigarettes: an evidence update. A report commissioned by Public Health England.

The report covers e-cigarette use among young people and adults, public attitudes, the impact on quitting smoking, an update on risks to health and the role of nicotine It also reviews heated tobacco products

The main findings of PHE’s evidence review are that:
• vaping poses only a small fraction of the risks of smoking and switching completely from smoking to vaping conveys substantial health benefits
• e-cigarettes could be contributing to at least 20,000 successful new quits per year and possibly many more
• e-cigarette use is associated with improved quit success rates over the last year and an accelerated drop in smoking rates across the country
• many thousands of smokers incorrectly believe that vaping is as harmful as smoking; around 40% of smokers have not even tried an e-cigarette
• there is much public misunderstanding about nicotine (less than 10% of adults understand that most of the harms to health from smoking are not caused by nicotine)
• the use of e-cigarettes in the UK has plateaued over the last few years at just under 3 million
• the evidence does not support the concern that e-cigarettes are a route into smoking among young people (youth smoking rates in the UK continue to decline, regular use is rare and is almost entirely confined to those who have smoked)

Evidence review of e-cigarettes and heated tobacco products 2018: a report commissioned by Public Health England.

Vaping in England: an evidence update February 2019: A report commissioned by Public Health England

Contingency Management interventions for non-prescribed drug use during treatment for opiate addiction: A systematic review and meta-analysis

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)00079-3.pdf

Robert Calder

Papers

E-cigarettes: an evidence update. A report commissioned by Public Health England.

Evidence review of e-cigarettes and heated tobacco products 2018: a report commissioned by Public Health England.

Vaping in England: an evidence update February 2019: A report commissioned by Public Health England

Contingency Management interventions for non-prescribed drug use during treatment for opiate addiction: A systematic review and meta-analysis

E-cigarettes: the need for clear communication on relative risks