News Release

ALA/ATS Meeting Explores Gender Differences In Smoking And Lung Transplant Outcomes And Heart Attack Risk From Asthma Medication

Peer-Reviewed Publication

American Lung Association

SAN DIEGO, April 27 -- New findings on the different reasons men and women smoke, lung transplant outcomes and gender, and the risk of heart attack from a common asthma medication in people with heart disease were discussed here today by an expert panel at the American Lung Association/American Thoracic Society International Conference.

Gender Differences and Smoking

Men are more likely than women to grab a cigarette if they're angry, anxious, sad or tired, a new study presented at the conference suggests. Smoking also is more likely to decrease anger and sadness in men, according to the study, conducted by Dr. Ralph Delfino and Dr. Larry Jamner at the University of California, Irvine.

The study included 25 women and 35 men ages 18 to 42, who made three diary entries an hour, for up to 48 hours, recording their mood and smoking behavior. The urge to smoke was more strongly associated with anger, anxiety and alertness in men than in women; feelings of sadness or fatigue were linked with the urge to smoke in men only. Smoking seemed to decrease feelings of anger in those men who got angry more often, and to decrease feelings of sadness in men, but not in women. Smoking was associated with feelings of happiness in women, but not in men.

These findings suggests possible gender differences in the effect of nicotine on the central nervous system, possibly because of different interactions with hormones, according to the researchers. "The commonly held belief before this study was that women smoked more for emotional reasons, but this does not appear to be the case in the real-life settings measured in this study," Dr. Delfino said. "The results are consistent with the hypothesis that women are smoking less for mood control than men, and that social interactions may play a more important role in why women smoke. Ongoing research using similar diary techniques in adolescents may reveal targets for early preventive interventions."

The findings suggest that smoking prevention and cessation programs might be more successful if they had different approaches for males and females, and if they targeted people according to their personality profile, Dr. Delfino noted. "For instance, hostile people who smoke for mood-altering effects might benefit from an anger-management program," he said.

Lung Transplant Outcomes and Gender

There is a significant risk associated with transplanting lungs from male donors into female recipients, according to a study presented at the meeting. Researchers at the University of Wisconsin-Madison have studied 116 lung transplants, 19 of which were male donor organs transplanted into female recipients.

Graft outcome was assessed by either lung transplant failure/death or by poor function due to chronic rejection. They found that the rate of graft survival (a functioning transplanted lung) with good function was 29% at 24 months after transplantation for the male donor lung into female recipient combination. In contrast, the overall two-year rate for all other patients was 69%. Specifically, the two-year graft survival rate with good function was 87% in female-to-male transplants; 81% in female-to-female transplants; and 60% in male-to-male transplants.

The study findings appear somewhat unique to lung transplantation, because an increased incidence of graft failure (destruction of the transplanted lung, usually associated with death of the recipient due to respiratory failure) with this donor-recipient gender combination has not been identified for kidney or liver transplantation, said Dr. Keith C. Meyer. "The lungs are much more prone to injury than kidneys and livers," he noted. "Unlike kidneys and livers, with lungs there's no time to do tissue matching--we have to transplant the lung quickly."

He said that male-to-female lung transplants need to be studied at other transplant centers.

Approximately 1,000 to 1,200 lung transplants are performed in the United States each year, according to Dr. Meyer. About half of recipients of transplanted lungs are emphysema patients who developed the disease after years of smoking, he said.

Increased Heart Attack Risk From Beta-Agonists?

People with heart disease who start to use asthma drugs known as beta-agonists may be at increased risk of having a heart attack, according to a study presented at the conference. The study was comprised of 1,444 patients who had had a heart attack and 4,094 control patients. Dr. David Au of the Seattle Veterans Administration Medical Center and the University of Washington found that in comparison to patients who did not receive a beta-agonist prescription, patients who had received a prescription for a beta-agonist delivered through a device called a metered dose inhaler in the previous three months had a 67% increased risk of having a heart attack. Those patients with heart disease had three times the risk of a heart attack; patients with heart disease who were new users of beta-agonists had seven times the risk of a heart attack.

The researchers found no relationship between the amount of beta-agonist used and the risk of heart attack. They conclude that new users of beta-agonists might be at highest risk because their bodies have yet to become used to these drugs. While it is possible that beta-agonists could precipitate a heart attack directly, there's another possible explanation for the findings, Dr. Au said. Beta-agonists often are given to patients with shortness of breath, which can be caused by lung problems. But shortness of breath also could be caused by angina, which could be a precursor to a heart attack. "Physicians should consider other diagnoses in patients presenting with shortness of breath, especially those with history of heart disease," Dr. Au said.

Beta-agonists are bronchodilators, drugs that open up the air passages. They relax the smooth muscles that line the walls of the breathing tubes and make the airway wider and easier for air to move through. Beta-agonists have many potential side effects on the heart including irregular heart beats. The beta-agonists included in the study were short-acting.

Dr. Au says that these drugs are very safe and remain the first line therapy for asthma and chronic obstructive pulmonary disease, but that the study suggests that doctors should exercise caution when giving a patient with heart disease their first beta-agonist prescription.

A study published in 1994 that examined a possible link between beta-agonists and increased risk of death from asthma concluded that the medication itself was not responsible for asthma deaths, but rather the greater use of beta-agonists was principally a marker for more severe asthma, which itself was associated with an increased risk of fatal or near fatal asthma.

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For more information about the ALA/ATS International Conference, visit the American Lung Association web site at http://www.lungusa.org or the American Thoracic Society web site at http://www.thoracic.org.



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