heart failure

A new study has shown that three-Quarters of the 200 million Nigerians are at risk of Non-Communicable Diseases, NCDs, amidst coronavirus pandemic.

The study also found that men are more at risk than women.

The year-long study which commenced in 2019, by WellNewMe in collaboration with Novartis was aimed at determining Nigerians risks for developing chronic diseases as part of the disease activities for World Hypertension Day.

According to the World Health Organisation (WHO), people with noncommunicable diseases (NCDs), such as hypertension, cardiovascular diseases, diabetes, or cancer are at higher risk of complications of COVID-19.

The result of the study released weekend revealed that a total of 1,900 people were enrolled for the pilot, and 1,269 of them completed the assessment as part of the pilot.

The participants were drawn from different parts of Nigeria including the Federal Capital Territory, Abuja, which majority of them coming from Lagos 30 percent, Oyo 8 percent, Abuja FCT 8 percent, Ogun 7 percent, and Rivers 5 percent.

Three-quarters of those who completed the assessment were found to have an increased risk of developing a chronic disease.

It was also found that risk increases as the age increases, while all of those aged 50 and above have an increased risk.

The results also showed that 43 percent of women seem more at risk than 36 percent of men for developing hypertension, while the risk increases as the age of the pilot enrolee increased.

With diabetes, it was found that almost three-quarters of those assessed had an increased risk of having diabetes with 10 percent having a high risk while men were more at risk than women. The diabetes risk also increases as the age of the pilot enrolee increases.

Some of the other interesting anecdotes from the pilot revealed that men were four times more likely to be at risk for developing the cardiac disease, and in Rivers, 85 percent of the adults assessed had an increased risk for developing chronic disease.

Commenting on the study, Co-founder of WellNewMe and author of the pilot report, Dr. Obi Igbokwe, said:” report of the pilot, while not extensive does lends importance to considerations by the Nigerian health authorities when designing the country’s response to the COVID-19 pandemic, that they need factor in NCDs as well.”

Igbokwe further explained that “As patients with chronic diseases are at greater risk of the coronavirus, that in itself presents an extra burden on our already struggling health services across the country. It is also of great importance, that even when the pandemic has passed, we will still have to deal with the burden of tackling these chronic diseases which by all accounts are here to stay.”

Meanwhile, WellNewMe has designed an algorithm-based health risk assessment platform that encompasses psychological, physical, and social domains that are known to influence NCD risk and prognosis in cases of established disease.

Being a global leader in the cardiovascular healthcare space, Novartis is mobilizing the setup of these cardiovascular risk assessment stations at various pharmacies across the country with the aim of reaching a thousand patients.

The platform incorporates the ability for healthcare providers (HCPs) to standardize their approach to cardiovascular disease management by using an algorithmic process and harnessing relevant data to ensure a set of potential outputs that result in better outcomes for the patient.

WHO Regional Director for Europe, Dr. Hans Henri P. Kluge had also said that the prevention and control of NCDs have a crucial role in the COVID-19 response and if not adapted to encompass prevention and management of NCD risks, countries will fail many people at a time when their vulnerability is heightened.

An estimated 1.7 billion people — more than 20 percent of the world’s population — risk becoming severely infected with COVID-19 due to underlying health problems such as obesity and heart disease, analysis showed Tuesday.

The novel coronavirus, which has killed more than 420,000 people globally during the first wave of the pandemic, adversely effects patients suffering from co-morbidities.

A team of experts from the London School of Hygiene and Tropical Medicine analysed global data sets of illnesses including diabetes, lung disease and HIV used these to estimate how many people are at heightened risk of serious COVID-19 infection.

They found that one in five people have at least one underlying health problem putting them in greater danger.

While not all of those would go on to develop severe symptoms if infected, the researchers said around 4 percent of the global population — around 350 million) would likely get sick enough to require hospital treatment.

“As countries move out of lockdown, governments are looking for ways to protect the most vulnerable from a virus that is still circulating,” said Andrew Clark, who contributed to the study.

“This might involve advising people with underlying conditions to adopt social distancing measures appropriate to their level of risk.”

Clark said the findings could help governments make decisions on who receives a COVID-19 vaccine first when one becomes available.

Consistent with other studies about COVID risk, the authors found that older people are in greater danger of getting seriously unwell from the virus.

Less than 5 percent of people aged under 20 have an underlying risk factor, compared with two thirds of over 70s.

Countries with younger populations have fewer people with at least one underlying condition, but risks vary globally, according to the analysis.

Small island states such as Fiji and Mauritius have among the highest rates of diabetes — a known COVID-19 risk factor — on Earth, for example.

And countries with the highest prevalence of HIV/AIDS, such as eSwatini and Lesotho, also need to be vigilant, said authors of the research published in The Lancet.

In Europe, more than 30 percent of people have one or more health conditions, it showed.

Writing in a linked comment, Nina Schwalbe from Columbia University Mailman School of Public Health, said the study showed “it is time to evolve from a one-size-fits-all approach to one that centres on those most at risk.”

Photo Taken In Oradea, Romania

A new study has identified how ketamine can combat difficult-to-treat depression.

New research has revealed the specific parts of the brain that ketamine affects when doctors use it to treat people with difficult-to-treat depression.

The study, which appears in the journal Translational Psychiatry, may open the door to new therapies in the treatment of depression.

According to the Centers for Disease Control and Prevention (CDC), in the United States, about 7.6% of people over the age of 12 have depression during any 2-week period. The CDC describe depression as a sad mood that extends for a long period and affects a person’s ability to live a normal life.

When severe, depression can have a serious negative effect on a person’s life, sometimes leading to suicidal thoughts.

Experts do not fully understand why some people experience depression, although the National Institute of Mental Health suggest that genetic, environmental, biological, and psychological factors may play a role. It is treatable with medication, psychological therapy, or a combination of the two.

Previous research has made it clear that the drug ketamine can be an effective antidepressant, and some scientists have proposed it as a treatment in cases of depression that do not respond to conventional treatments.

However, precisely how and why ketamine functions as an antidepressant is less clear. As a consequence, the authors of the present study wanted to identify precisely what effects ketamine has on the brain of a person who is not responding to conventional treatments. They hope that this research may lead to better treatment options for these individuals.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours per day at 800-273-8255. During a crisis, people who are hard of hearing can call 800-799-4889.

Looking at ketamine’s effect in the brain

To do this, the researchers gave participants doses of ketamine that were low enough not to have an anesthetic effect and then took images of their brains using a positron emission tomography (PET) camera.

According to the study’s first author, Dr. Mikael Tiger, a researcher at the Department of Clinical Neuroscience at the Karolinska Institutet in Solna, Sweden, “In this, the largest PET study of its kind in the world, we wanted to look at not only the magnitude of the effect but also if ketamine acts via serotonin 1B receptors.”

“We and another research team were previously able to show a low density of serotonin 1B receptors in the brains of people with depression.”

By using a radioactive marker that binds to a person’s serotonin receptors, the PET images could highlight what effects ketamine was having on these receptors, which play a crucial role in depression by modulating the amount of serotonin that a person receives. Experts believe that low levels of serotonin correlate to more severe experiences of depression.

The authors of the study recruited people through internet advertising. After receiving 832 volunteers, the authors reduced this number to 30 to make sure that the participants were as relevant to the study as possible.

Other than having major depressive disorder (MDD), the participants were healthy. They had not responded to previous treatment for MDD.

The researchers split the participants into two groups, treating 20 people with ketamine and the other 10 with a placebo.

The study was a randomized, double-blind, placebo-controlled study, meaning that neither the doctors nor the participants initially knew to which group each participant belonged.

Prior to the treatment, the researchers took a baseline scan of the participants’ brains. They took a second scan in the days following the treatment.

For the second phase of the study, 29 of the participants agreed to take ketamine twice a week for 2 weeks.

Serotonin reduced, dopamine increased

Using a rating scale for depression, the researchers found that 70% of the participants in the second phase of the study responded to the ketamine.

Furthermore, after analyzing the PET images, the authors found that the ketamine was affecting the participants’ brains in a previously unidentified manner, reducing the output of serotonin but increasing the output of dopamine, which is also important for mood regulation.

According to the last author of the study, Dr. Johan Lundberg, research group leader at the Department of Clinical Neuroscience, Karolinska Institutet, “We show for the first time that ketamine treatment increases the number of serotonin 1B receptors.”

“Ketamine has the advantage of being very rapid-acting, but at the same time, it is a narcotic-classed drug that can lead to addiction. So it’ll be interesting to examine in future studies if this receptor can be a target for new, effective drugs that don’t have the adverse effects of ketamine.”

– Dr. Johan Lundberg

According to a new study analyzing the data of thousands of people, an excessive intake of a certain kind of amino acid — present in protein-rich foods — is associated with a higher cardiometabolic risk.

person slicing meat
A new study in humans adds to the evidence that protein-rich foods, such as meat, may have a negative effect on heart health.

Many people follow diets that are high in protein, which can help with weight loss and building muscle mass.

However, increasingly, researchers are starting to question whether protein-rich foods provide enough benefits to offset the potential risks.

For the most part, various recent studies have suggested that high protein foods may affect the health of the heart and the cardiovascular system.

For example, a study in animal models that Medical News Today covered last week found that diets that are high in protein may be directly responsible for cardiovascular problems, such as atherosclerosis.

Now, hot on its heels, a new study in humans points out a link between eating foods with a high sulfur amino acid content — typically high protein foods — and an increased cardiometabolic risk.

The research — the findings of which appear in EClinicalMedicine — comes from Pennsylvania (Penn) State University in State College.

Proteins comprise tiny compounds called amino acids, which vary in their components. Some contain atoms of the element sulfur, which gives them their name: sulfur amino acids.

Cardiometabolic risk and diet

Two sulfur amino acids occur in protein-rich food. These are methionine, an essential amino acid, and cysteine, a semi-essential amino acid.

The human body needs these amino acids to function well, and it must obtain them from a food source. The body cannot synthesize essential amino acids, and it cannot make enough of the semi-essential ones.

However, as with many other nutrients, if they are present in excessive quantities, amino acids can end up doing more harm than good.

This is what Penn State researchers noticed when they looked at the diets and health status of 11,576 individuals, whose data they accessed via the third National Health and Nutrition Examination Survey (NHANES III), which the Centers for Disease Control and Prevention (CDC) conducted.

The researchers came up with a composite cardiometabolic disease risk score assessing each participant’s risk of developing cardiometabolic problems, such as heart disease, stroke, and diabetes.

To do this, they measured the levels of tell-tale biomarkers — including cholesterol, triglycerides, glucose (sugar), and insulin — in the participants’ blood following a 10–16 hour fast.

“These biomarkers are indicative of an individual’s risk for disease, just as high cholesterol levels are a risk factor for cardiovascular disease,” explains study co-author Prof. John Richie.

“Many of these levels can be impacted by a person’s longer-term dietary habits leading up to the test,” Prof. Richie adds.

The researchers also analyzed information about the participants’ dietary habits, which included nutrient intake calculations. They excluded from the study any individuals who reported having an overly low intake of sulfur amino acids.

‘First epidemiologic evidence’

The team’s final analysis, which accounted for body weight measurements, revealed that the participants had an average intake of sulfur amino acids that was almost 2.5 times higher than the estimated average requirement of 15 milligrams per kilogram of body weight per day.

“Many people in the U.S. consume a diet rich in meat and dairy products, and the estimated average requirement is only expected to meet the needs of half of healthy individuals,” points out study co-author Xiang Gao.

“Therefore, it is not surprising that many are surpassing the average requirement when considering these foods contain higher amounts of sulfur amino acids,” says Gao.

Moreover, the investigators found that participants with higher sulfur amino acid intakes also tended to have higher composite cardiometabolic risk scores.

This association remained in place even after the researchers accounted for confounding factors, including age, biological sex, and a history of health conditions such as hypertension and diabetes.

As for the source of the sulfur amino acids, the team said that they were present in almost all foods, excluding grains, fruit, and vegetables.

“Meats and other high protein foods are generally higher in sulfur amino acid content,” notes lead author Zhen Dong, Ph.D.

“People who eat lots of plant-based products like fruits and vegetables will consume lower amounts of sulfur amino acids. These results support some of the beneficial health effects observed in those who eat vegan or other plant-based diets,” Dong adds.

The researchers caution that the current findings are, so far, only observational, pointing to an association rather than verifying causality.

“A longitudinal study would allow us to analyze whether people who eat a certain way do end up developing the diseases these biomarkers indicate a risk for,” notes Prof. Richie.

Nevertheless, he stresses that the recent study shows that researchers should pay more attention to the possible risks associated with dietary amino acids.

“For decades, it has been understood that diets restricting sulfur amino acids were beneficial for longevity in animals. This study provides the first epidemiologic evidence that excessive dietary intake of sulfur amino acids may be related to chronic disease outcomes in humans.”

– Prof. John Richie

New research uses high quality data to find that the type 2 diabetes drug rosiglitazone raises the risk of adverse cardiovascular events by 33%.

Rosiglitazone is a drug originally developed to treat type 2 diabetes. The United States Food and Drug Administration (FDA) approved it in 1999 under the name Avandia.

Although Europe suspended the drug due to concerns about its adverse effects on heart health, and the United States restricted its use, the research on its safety has so far yielded mixed results.

Now, a new study, appearing in the journal The BMJ has used more reliable data to investigate the effects of this drug on cardiovascular health.

Joshua D. Wallach, who is an assistant professor in the Department of Environmental Health Sciences at Yale School of Public Health in New Haven, CT, is the lead author of the new paper.

The need for more accurate data

The FDA approved rosiglitazone in 1999, a year ahead of Europe, note Wallach and colleagues in their paper.

Regulatory bodies warned about its potential effects on heart failure as early as 2006, and a meta-analysis of several trials pointed to a 43% higher risk of heart attack in 2007.

As a result, by 2010, the drug was pulled off European markets because it raised the risk of heart attack and stroke.

In the U.S., the drug is still available, although it features warnings on its packaging, and the FDA restricted its availability in 2010-2011.

The fact that the drug is still available is primarily due to the mixed results yielded by the investigation into the drug’s cardiovascular effects.

However, the new research suggests that these mixed results are due to the poor quality of the data that these previous studies used.

Namely, these previous papers did not have access to “individual patient data (IPD),” that is, raw data, such as the medical records of patients, instead of summary-level data, which are the final results of clinical trials, for example.

Studying rosiglitazone and heart health

To rectify this methodological problem, Wallach and colleagues set out to analyze over 130 clinical trials; the researchers had access to IPD for 33 of these trials. This totaled 48,000 adult patient data, of which researchers had IPD for 21,156.

The clinical trials were randomized, controlled, phase II-IV trials that had studied and compared the effects of rosiglitazone with any other control for at least 24 weeks.

“The control group was defined as patients who received any drug regimen other than rosiglitazone, including placebo,” explain the researchers.

The team examined the outcomes of “acute myocardial infarction, heart failure, cardiovascular-related death, and noncardiovascular-related death” in their analysis of trials for which they had IPD.

For the other trials, the researchers examined myocardial infarction and cardiovascular-related death only, using summary-level data.

A 33% higher risk of cardiovascular disease

The analysis revealed a 33% higher risk of heart attack, heart failure, cardiovascular deaths, and noncardiovascular-related deaths combined for people who were taking the drug compared with people who were taking another control substance, including placebo.

Wallach and colleagues conclude:

“The results suggest that rosiglitazone is associated with an increased cardiovascular risk, especially for heart failure events.”

The findings also serve to emphasize the importance of using raw data to accurately assess the safety of a drug, say the authors.

“Our study suggests that when evaluating drug safety and performing meta-analyses focused on safety, IPD might be necessary to accurately classify all adverse events,” they write.

“By including this data in research, patients, clinicians, and researchers would be able to make more informed decisions about the safety of interventions.”

“Our study highlights the need for independent evidence assessment to promote transparency and ensure confidence in approved therapeutics, and postmarket surveillance that tracks known and unknown risks and benefits.”

Hands of a couple having beer and white wine sitting in a table outdoors a bar in Split, Croatia.

According to a recent study, more people in the United States are drinking more alcohol and experiencing the harmful effects. The number of hospitalizations is rising, as are death rates.

“Alcohol is not a benign substance, and there are many ways it can contribute to mortality,” says George F. Koob, Ph.D., director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

These range from more apparent contributors, such as liver disease and overdoses, to less obvious ones, such as falls.

A growing concern among experts is that rising consumption levels are leading to an increasing number of related deaths.

In the past 2 decades, alcohol consumption has risen sharply in the U.S., according to the findings of a new analysis, now summarized in the journal Alcoholism: Clinical and Experimental Research.

According to data from 2017, the researchers report, 70.1% of the U.S. population aged 18 and older drank alcohol that year. Each person who drank consumed approximately 3.6 gallons of pure alcohol, or about 2.1 standard drinks daily.

As consumption has risen, so has the level of harm. Various studies have noted an increase in alcohol-related hospitalizations and emergency department visits since 2000.

Between 2000 and 2015, the number of hospital visits related to alcohol shot up by 76.3% for people aged 12 and over.

The total number of emergency department visits linked with alcohol rose by over 47% between 2006 and 2014.

The researchers saw the biggest increases among the female population. They reported a 10.1% rise in the number of women who consumed alcohol between 2000 and 2016, and a 23.3% increase in binge drinking among women during the same period.

Similarly, the authors found that the increases in hospitalizations and emergency department visits were greater among women than men.

Studying death certificates 

After considering the increases in alcohol consumption and associated medical intervention, the researchers — all of whom work for the NIAAA — set out to investigate whether alcohol-related deaths were similarly on the rise.

Death certificates provide the most comprehensive way of determining the causes of death among large populations. However, tracking alcohol-related mortality is difficult because a certificate may be issued before the doctor can tell that alcohol was involved.

2014 study found that only 1 in 6 certificates recording death as a result of drunk driving listed alcohol as a contributor.

Fully aware of the unreliability of the reporting, the NIAAA team analyzed all death certificates filed in the U.S. between 1999 and 2017, in an effort to determine the number of alcohol-related deaths among people aged 16 and over.

They looked for any certificates that listed alcohol as a contributing cause of death. They also included certificates that recorded an alcohol-induced cause of death.

The investigators analyzed the results as a whole before separating them by age, sex, ethnicity, and race.

Highest rises among women, younger adults

The team found that the number of deaths linked to alcohol had more than doubled within the period of their investigation. Almost 1 million people had died from alcohol-related causes between 1999 and 2017.

In 1999, there were only 35,914 such deaths. In 2017, this figure had increased to 72,558.

That year, almost one-third of these deaths had resulted from liver disease, and nearly one-fifth had resulted from overdoses — either from alcohol alone or in combination with other drugs.

Although people aged 45–74 had the highest rate of alcohol-related death, the most significant increase occurred among people aged 25–34. In fact, every age group, except people aged 16–20 and 75 or over, saw an increase.

Although rates among Hispanic men and non-Hispanic black people decreased at first, they later increased, in line with all other groups.

As with rises in consumption and subsequent hospital visits, the increases in alcohol-related deaths were higher among women than men. The female population demonstrated an 85.3% rise, compared with a 38.7% rise among men.

A wake-up call 

The head of the NIAAA describes alcohol as “a growing women’s health issue.” He says: “The rapid increase in deaths involving alcohol among women is troubling and parallels the increases in alcohol consumption among women over the past few decades.”

Speaking about the report in its entirety, Koob states that it is “a wake-up call to the growing threat alcohol poses to public health.”

Koob also reminds us that the number of recorded alcohol-related deaths may be greatly underestimated, “We know that the contribution of alcohol often fails to make it onto death certificates.”

The middle-aged and elderly range is of particular concern. With that population set to almost double by 2060, the researchers point out, complications of their alcohol consumption could place a considerable burden on the healthcare system. The NIAAA director emphasizes:

“Better surveillance of alcohol involvement in mortality is essential in order to better understand and address the impact of alcohol on public health.”

A new form of viral pneumonia is spreading in China and has already been detected in neighbouring countries. In response to the outbreak of new strand of coronavirus, the World Health Organisation has urged countries to “strengthen their preparedness for health emergencies”.

Meanwhile, the Chinese government is keen to avoid a repeat of Severe Acute Respiratory Syndrome (SARS) or severe acute respiratory syndrome, another coronavirus that started in 2002 and killed nearly 800 people. But what is this new strand and what effect does it have on people?
Here is what you need to know.

What is the virus?
Coronaviruses (CoV) are a large family of viruses causing illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV).It is called a novel coronavirus (nCoV) when a new strain has been identified in humans.

Public Health England (PHE) is currently using the name Wuhan novel coronavirus (WN-CoV) for the new strand – named after where it was discovered – until there is an internationally accepted name for the virus and the disease or syndrome it causes. You may also see it referred to as the 2019 novel coronavirus (2019-nCoV) elsewhere.

Where did the virus come from?
On December 31, last year, the World Health Organisation (WHO) was informed of a cluster of cases of pneumonia of unknown cause in Wuhan City, Hubei Province, China.

On January 12 this year the novel coronavirus had been identified in samples obtained from cases. Initial analysis suggested that this was the cause of the outbreak. Many, but not all, of the cases identified in Wuhan had been to or worked in a seafood and live animal market in the city (Huanan South China Seafood Market).
This market was closed on January 1, 2020, and sanitised. As of January 14, no additional cases had been detected in Wuhan since January 3.

What are the symptoms?
A vendor gives out copies of newspaper with a headline of ‘Wuhan break out a new type of coronavirus, Hong Kong prevent SARS repeat’ at a street in Hong Kong.

Fever, fatigue and dry cough are the main symptoms in the early stage of illness and some patients may not progress to more severe illness, according to PHE.

Dyspnoea – a condition that causes difficulty with breathing – is said to be common in hospitalised patients, while vital signs were reported to be generally stable at the time of admission. Older patients with an underlying disease were more likely to progress to severe disease.

As of January 12, six of the 41 patients had recovered and been discharged, six have severe illness, and one patient died – though at least two more have died since. One individual who died was 61 and had pre-existing significant medical conditions and required intensive care.

How is the virus passed on?
Some coronaviruses are passed on easily from person to person, while others are not. Little is known about WN-CoV at this stage and investigations are ongoing but it is “reasonable to assume” the strand could be passed on between animals and humans, according to government advice.

That is because many cases were associated with a market containing a range of dead and live animals. According to Public Health England (PHE), authorities in China reported on January 14 that an infected man had worked in the Huanan seafood market, but his wife, who is also a confirmed case, denied having been to the same market. This means it is possible that there is limited human-to-human transmission within a family setting, but investigations are ongoing. Other coronaviruses are airborne and can be passed on between humans.

Should tourists avoid any countries?
The WHO is not currently recommending any trade or travel restrictions, based on information available.

Is there a vaccine?
When a disease is new, there is no vaccine until one is developed. It can take a number of years for a new vaccine to be developed, according to WHO.

Asthma is a chronic lung condition in which the airways narrow and become inflamed, which leads to wheezing, coughing, and chest tightness. Extrinsic asthma and intrinsic asthma are subtypes of asthma.

The symptoms of these subtypes are the same, but they have different triggers:

  • Extrinsic asthma symptoms occur in response to allergens, such as dust mites, pollen, and mold. It is also called allergic asthma and is the most common form of asthma.
  • Intrinsic asthma has a range of triggers, including weather conditions, exercise, infections, and stress. People may call it nonallergic asthma.

In this article, we discuss the causes, symptoms, and treatment of intrinsic and extrinsic asthma.

Intrinsic vs. extrinsic asthma

Intrinsic and extrinsic asthma are two subtypes of asthma, which people more commonly refer to as allergic and nonallergic asthma.

Both types cause the same symptoms. The difference between the two subtypes is what causes and triggers asthma symptoms. The treatments are similar for each type, although the prevention strategies differ.

Triggers

Woman taking inhaler for asthma whilst playing football. Intrinsic and extrinsic asthma have the same symptoms but different triggers
Intrinsic and extrinsic asthma have the same symptoms but different triggers.

In people with extrinsic asthma, allergens trigger the respiratory symptoms. Common triggers for extrinsic asthma include:

  • pollen
  • mold
  • dust mites
  • pet dander
  • cockroaches
  • rodents

In some cases, a person is allergic to more than one substance, and several allergens trigger asthma symptoms.

In people with intrinsic asthma, allergies are not responsible for the symptoms. Instead, the following triggers cause symptoms:

  • cold
  • humidity
  • stress
  • exercise
  • pollution
  • irritants in the air, such as smoke
  • respiratory infections, such as colds, the flu, and sinus infections

In some cases, intrinsic asthma can occur with no known cause.

Prevalence

Extrinsic or allergic asthma is the most common form of the disease. According to the Asthma and Allergy Foundation of America, about 60% of people with asthma have allergic asthma.

Less commonly, intrinsic or nonallergic asthma occurs. Research in The Journal of Allergy and Clinical Immunologyindicates that intrinsic asthma occurs in anywhere from 10% to 33% of people with asthma.

It occurs more often in females than males and typically develops later in life than extrinsic asthma.

Causes

In all types of asthma, a person has overly sensitive airways and airway inflammation, which produces asthma symptoms.

Inflammation causes swelling in the airways that narrows the tubes and makes breathing difficult. The body also produces excess mucus, which further impairs breathing. These factors decrease the amount of air that can get into the lungs.

The inflammatory processes are similar in extrinsic and intrinsic asthma. In both, the immune system releases cells called T-helper cells and mast cells.

Research has found that there may be more similarities between the two types of asthma than researchers previously thought. Both types of asthma involve the production of IgE locally at the airways in response to the relevant triggers:

  • Extrinsic asthma occurs when the immune system overreacts to a harmless substance, such as pollen or dust. The body releases an antibody called immunoglobin E (IgE). The release of this antibody leads to inflammation and asthma symptoms.
  • Intrinsic asthma occurs when something other than allergens triggers an immune system response. People are not always able to identify the trigger.

Symptoms

The symptoms of extrinsic and intrinsic asthma are the same and may include:

  • wheezing
  • chest tightness
  • shortness of breath
  • coughing
  • increased mucus production
  • trouble breathing

Symptoms can vary in severity and may develop suddenly. Ignoring the signs and symptoms of an asthma attack can lead to a life-threatening situation. Recognizing symptoms as soon as possible and following an asthma action plan can help decrease the severity of an attack and reduce complications.

Treatments

The treatment options for intrinsic and extrinsic asthma are similar and include medications, lifestyle changes, and the avoidance of triggers. Since the triggers are different, the prevention strategies may differ.

Reducing triggers

It may be easier to identify the triggers for extrinsic asthma because allergies are the culprit. With both types of asthma, the identification of triggers allows an individual to take steps to reduce exposure and decrease symptoms.

The following steps can help reduce asthma symptoms in people with extrinsic asthma:

  • fixing leaky pipes to prevent mold buildup
  • keeping doors and windows closed when the pollen count is high
  • vacuuming often to reduce dust
  • keeping pets out of the bedroom

Triggers of intrinsic asthma do not involve a specific allergen. Due to the variability of triggers, it can take a little longer to determine the cause of flare-ups. People may find that avoiding humid, dry, or cold weather can prevent symptoms.

Medications

People can use the following medications to treat flare-ups of both intrinsic and extrinsic asthma:

Short-acting bronchodilators

Short-acting bronchodilators, also called quick relief medications, reduce symptoms fast. They work by relaxing the muscles of the airways.

Long-acting medications

People take long-acting bronchodilators daily, and they also open up the airways. Long-acting bronchodilators do not treat sudden symptoms as they take longer to work than short-acting bronchodilators.

Corticosteroids

Corticosteroids decrease inflammation in the airways. People take steroids daily to prevent symptoms.

Omalizumab

Omalizumab is an anti-IgE antibody therapy that prevents the release of IgE. Reducing IgE decreases the allergic response and prevents asthma symptoms.

People usually use omalizumab to treat extrinsic asthma, but it may also help with intrinsic asthma.

Lifestyle changes

Lifestyle changes might also help decrease symptoms of both types of asthma.

People with asthma may wish to consider adopting the following lifestyle practices:

  • maintaining a healthy weight
  • quitting smoking
  • avoiding secondhand smoke
  • reducing stress
  • getting a flu vaccine each year
  • washing the hands frequently to decrease the risk of infection

Outlook

Although there is currently no cure for either extrinsic or intrinsic asthma, people can manage the symptoms with medications, prevention methods, and lifestyle changes.

Intrinsic asthma is often harder to control than extrinsic asthma, as identifying its triggers is sometimes difficult. People can work closely with a doctor to determine the causes of asthma symptoms and find an effective treatment.

Walnuts may not just be a tasty snack, they may also promote good-for-your-gut bacteria. New research suggests that these “good” bacteria could be contributing to the heart-health benefits of walnuts. In a randomized, controlled trial, researchers found that eating walnuts daily as part of a healthy diet was associated with increases in certain bacteria that can help promote health. Additionally, those changes in gut bacteria were associated with improvements in some risk factors for heart disease.

Kristina Petersen, assistant research professor at Penn State, said the study — recently published in the Journal of Nutrition — suggests walnuts may be a heart- and gut-healthy snack.

“Replacing your usual snack — especially if it’s an unhealthy snack — with walnuts is a small change you can make to improve your diet,” Petersen said. “Substantial evidence shows that small improvements in diet greatly benefit health. Eating two to three ounces of walnuts a day as part of a healthy diet could be a good way to improve gut health and reduce the risk of heart disease.”Previous research has shown that walnuts, when combined with a diet low in saturated fats, may have heart-healthy benefits. For example, previous work demonstrated that eating whole walnuts daily lowers cholesterol levels and blood pressure.

According to the researchers, other research has found that changes to the bacteria in the gastrointestinal tract — also known as the gut microbiome — may help explain the cardiovascular benefits of walnuts.“There’s a lot of work being done on gut health and how it affects overall health,” said Penny Kris-Etherton, distinguished professor of nutrition at Penn State. “So, in addition to looking at factors like lipids and lipoproteins, we wanted to look at gut health. We also wanted to see if changes in gut health with walnut consumption were related to improvements in risk factors for heart disease.”

For the study, the researchers recruited 42 participants with overweight or obesity who were between the ages of 30 and 65. Before the study began, participants were placed on an average American diet for two weeks. After this “run-in” diet, the participants were randomly assigned to one of three study diets, all of which included less saturated fat than the run-in diet. The diets included one that incorporated whole walnuts, one that included the same amount of alpha-linolenic acid (ALA) and polyunsaturated fatty acids without walnuts, and one that partially substituted oleic acid (another fatty acid) for the same amount of ALA found in walnuts, without any walnuts.

In all three diets, walnuts or vegetable oils replaced saturated fat, and all participants followed each diet for six weeks with a break between diet periods. To analyze the bacteria in the gastrointestinal tract, the researchers collected fecal samples 72 hours before the participants finished the run-in diet and each of the three study diet periods. “The walnut diet enriched a number of gut bacteria that have been associated with health benefits in the past,” Petersen said. “One of those is Roseburia, which has been associated with protection of the gut lining. We also saw enrichment in Eubacteria eligens and Butyricicoccus.”

The researchers also found that after the walnut diet, there were significant associations between changes in gut bacteria and risk factors for heart disease. Eubacterium eligens was inversely associated with changes in several different measures of blood pressure, suggesting that greater numbers of Eubacterium eligens was associated with greater reductions in those risk factors.

Additionally, greater numbers of Lachnospiraceae were associated with greater reductions in blood pressure, total cholesterol, and non-High Density Lipo-protein (HDL) cholesterol. There were no significant correlations between enriched bacteria and heart-disease risk factors after the other two diets.

Regina Lamendella, associate professor of biology at Juniata College, said the findings are an example of how people can feed the gut microbiome in a positive way. “Foods like whole walnuts provide a diverse array of substrates — like fatty acids, fiber and bioactive compounds — for our gut microbiomes to feed on,” Lamendella said. “In turn, this can help generate beneficial metabolites and other products for our bodies.” Kris-Etherton added that future research can continue to investigate how walnuts affect the microbiome and other elements of health.

“The findings add to what we know about the health benefits of walnuts, this time moving toward their effects on gut health,” Kris-Etherton said. “The study gives us clues that nuts may change gut health, and now we’re interested in expanding that and looking into how it may affect blood sugar levels.”

A team at George Mason University, Fairfax, VA, has uncovered another electronic cigarette health concern. This time, it relates to stroke risk.

In recent years, the popularity of e-cigarettes has soared.

A 2016 study found that 10.8 million adults in the United States were current e-cigarette users. It is common for people to switch from traditional cigarettes to the e-variety because they think they are a healthier option.

But newly issued health warnings have pointed to the potential risks of smoking e-cigarettes. In June 2019, the U.S. saw an outbreak of lung injuries associated with e-cigarettes.

Experts believe that vitamin E acetate — an ingredient found in some e-cigarettes containing THC — may be the link.

In December 2019, the Centers for Disease Control and Prevention (CDC) reported that more than 2,500 individuals from the U.S., Puerto Rico, and the U.S. Virgin Islands were hospitalized or died as a result of using vapes, e-cigarettes, or associated products.

Recent studies, albeit small-scale, have found both benefits and risks to e-cigarettes.

One study that appears in PNAS found that nicotine from e-cigarette smoke caused lung cancer in mice as well as precancerous growth in the bladder.

However, a second study, appearing in the Journal of the American College of Cardiology, noted a significant improvement in vascular health within a month of a traditional smoker switching to e-cigarettes.

A trend among the young

Despite their nicotine content, the variety of e-cigarette flavors available has led to the products becoming a trend among young adults. There is also a concern this habit could lead to conventional cigarette smoking.

Equally worrying findings have come from a new study that appears in the American Journal of Preventive Medicine. The study found that young adults smoking both traditional and e-cigarettes face a significantly higher risk of stroke.

Using data from the 2016-17 Behavior Risk Factor Surveillance System (BRFSS), the study examined smoking-related responses from a total of 161,529 people aged between 18 and 44.

Just over half of the respondents were female, with 50.6% identifying as white and just under a quarter identifying as Hispanic.

The team calculated the adjusted odds ratios for strokes among those who currently smoked, former smokers who now used e-cigarettes, and people who used both.

“It’s long been known that smoking cigarettes is among the most significant risk factors for stroke,” says lead investigator Tarang Parekh from George Mason University.

“Our study shows that young smokers who also use e-cigarettes put themselves at an even greater risk.”

Tarang Parekh

An important message and a ‘wake-up call’

The study identified that young adults who smoked both traditional and e-cigarettes were almost twice as likely to have a stroke compared with conventional cigarette smokers.

This risk rose to almost three times as likely when compared with non-smokers. Results also showed there was no clear advantage to switching from traditional cigarettes to e-cigarettes.

However, people using e-cigarettes who had never smoked before did not display an increased stroke risk. This may be down to factors including young age and normal heart health.

This study relied on self-reported data, which is a limitation. However, the findings prove the need for large-scale, long-term studies to confirm which detrimental health effects e-cigarettes are causing and which ingredients are responsible.

“This is an important message for young smokers who perceive e-cigarettes as less harmful and consider them a safer alternative,” Parekh states.

According to Parekh, the results are “a wake-up call” for policymakers to urgently regulate e-cigarette products “to avoid economic and population health consequences.”

“We have begun understanding the health impact of e-cigarettes and concomitant cigarette smoking, and it’s not good.”

Tarang Parekh