More lung injury from smoking

Researchers at the University of Alabama Medical Center have discovered a new reason cigarette smoke causes lung damage.

They found that smoke inhibits leukotriene A4 hydrolase (LTA4A). This molecule is important in shutting down white blood cells following a successful response to inflammation. By not shutting down white blood cells, smokers experience ongoing inflammatory damage to the lung and airways; this leads to COPD and emphysema.

The same researchers also discovered previously unknown substrata of LTA4H called proline-glycine-proline (PGP), which actively recruits white blood cells into lunch tissues.

Discovering these two molecules naturally helps understand how smoking injures lungs, but may also lead to research that allows manipulating these molecules to reduce lung injury.

This could be of benefit not only for smoke-related lung disease, but also for other inflammation problems such as asthma and cystic fibrosis.



The lead article in a recent issue of the New England Journal of Medicine was on leukotriene antagonists in treating asthma. The lead-article status reflects the importance of this research.

As reported, scientists at the University of Aberdeen, U.K., evaluated leukotriene antagonists in two ways.

The first part of the study compared the adding of inhaled steroids to the adding of leukotriene antagonists as add-on therapy for control of asthma. In the hundreds of patients they studied, the researchers found the two therapies to be equally effective. Both restored asthma control so that symptoms improved and the need for rescue medication was reduced.

The second prong of the study looked at patients who were already on an inhaled steroid but still needed more controller help. Again the patients had additional therapy either in the form of a leukotriene antagonist or a long-acting bronchodilator (Salmeterol).

Both groups improved with the add-on medication, and the improvement was similar in both groups.

The leukotriene antagonist used in this study was montelukast (Singulair), but there are two other drugs in this family – Accolate and Xyflo. They work by reducing the inflammation that causes asthma. This is also how steroids work.

Hum Away Your Sinutitis

Simple viruses or colds can often lead to sinusitis because the cold causes the sinus cavity to obstruct, thus trapping bacteria in a closed space. Once in this closed space, bacteria multiply and lead to the pain and pus of sinusitis.

Keeping the sinuses healthy and bacteria overgrowth-free requires good ventilation of the sinuses.

A recent article in the American Journal of Respiratory and Critical Care Medicine cited a research project on humming. The scientists conducting this study found that humming leads to higher levels of exhaled nitric oxide, a gas produced in the sinuses.

It seems that humming exerts a positive pressure into the sinuses in a fluttering way that promotes their unblocking.

Another research group also studied humming and sinusitis and published their data in the European Respiratory Journal.

Both groups found that repeated humming sessions during days when people had colds markedly reduced the incidence of sinusitis.

Gluten Avoidance & Celiac Disease

Dear Dr. K: I tested negative for celiac disease and I’m not allergic to wheat, but I feel better when I avoid gluten. Why?

Your question is a good one in a specific sense and in a global one.

It is reliable maxim that the feedback your body gives you is a more sensitive crucible for problems than any medical test. If your body tells you to avoid gluten, then you should do so. 

In an effort to explore your conundrum there are several possibilities.

First of all, it is possible that you do have celiac disease and your test is falsely negative. This could be due to lack of sensitivity of the test. It could also be due to the fact that a once-positive test can become negative as a person avoids gluten, and therefore avoids the stimulus that causes a positive test.

Another possibility is that your gut flora is altered and the ingestion of gluten leads to fermentation in the gut with resultant cramps, gas and diarrhea. The most common reason for this would be an overgrowth of yeast due to antibiotics, steroids, hormones or immunosuppressive drugs.

Lastly it may be that you fall into a category of people recently reported in the American Journal of Gastroenterology. The scientists who did this research project found a moderately large group of patients who have been labeled IBS (Irritable Bowel Syndrome) who simply felt better on a gluten-free diet. The scientists concluded that gluten can cause GI symptoms by a mechanism as yet not understood.

Bitter Might Be Good!

The University of Maryland Medical School has discovered taste receptors found on the tongue are also in human lungs. The specific receptor in the lungs is for tasting bitterness.

Of exceeding interest is the lung receptor being connected with the muscle that regulates airway contraction and relaxation.

The Maryland scientists feel they can help treat asthma by manipulating the bitterness receptor.

Perhaps this will mean lemon or rhubarb inhalers!