[Questionnaire polls on health awareness of second-hand smoking exposure among non- and ex-smoker school teachers].

An accurate education of the harmful health effects of second-hand smoke on young people is important, and school teachers play a critical role. We polled school teachers about health awareness of second-hand smoking and the effectiveness of 4 methods of protecting against second-hand smoke. Self-reporting questionnaires were given to 452 non-smoker and ex-smoker subjects. To evaluate social nicotine dependence, we used the Kano Test for Social Nicotine Dependence (KTSND) questionnaire. Of 364 teachers (80.5%) who answered and were at risk of second-hand smoke exposure, 39.6% had respiratory symptoms, and 34.9% answered "ignore" or "slightly anxious" about second-hand smoking. The mean KTSND scores of those who answered "extremely anxious", "moderately anxious", "slightly anxious", and "ignore second-hand smoking" were 10.5 +/- 5.7, 12.3 +/- 6.0, 14.7 +/- 5.8, and 18.4 +/- 4.9, respectively. The KTSND scores of teachers who answered "ignore second-hand smoke" were higher than those of teachers who answered "anxious". The scores were also higher in subjects who believe second-hand smoke can be avoided by the recommended protective measures, than in subjects who know that avoidance is impossible, indicating that these teachers accepted smoking behavior. These results suggest that non-smoking and ex-smoking teachers with high KTSND scores might underestimate the health hazards of second-hand smoke, and overestimate the recommended protective measures. Therefore, re-education about awareness of the harmful effects of second-hand smoke should be given to them.

[Sustainable efficacy of oral varenicline for smoking cessation].

Varenicline (Champix) is an alpha4beta2 nicotinic receptor antagonist that is used orally for treatment of nicotine dependence. We conducted a study to examine the sustainable efficacy of varenicline in smoking cessation. The subjects were 148 outpatients (113 men, 35 women; average age; 54.4 +/- 14.0 years) at 6 different hospitals, and their adverse events were monitored in each hospital. The 4-week continuous abstinence rates of smoking cessation were 17.6%, 75.0%, and 84.6% in groups treated for 4 or fewer weeks, 5 to 8 weeks, and 9 to 12 weeks, respectively, with the rate showing a significant increase according to treatment period. Among 83 patients who had adverse events, the abstinence rates were 76.9%, 92.3%, 54.5%, and 55.6% in an observed (OB) group, a nosotropic medication (NM) group, a dose-reduction (RD) group, and a drug-discontinuation (DC) group, respectively. Among 56 patients with nausea, the respective rates were 80.8%, 100.0%, 61.1%, and 50.0%, respectively, with a significantly higher success rate in the NM group than in the RD or DC groups (each p < 0.05). To sustain the efficacy of varenicline in patients with adverse events, we recommend a therapeutic strategy in which the active nosotropic medicine is administered over 12 weeks at the regular dosage.

Gefitinib-induced interstitial lung disease showing improvement after cessation: disassociation of serum markers.

Gefitinib (ZD1839), a small-molecule epidermal growth factor receptor tyrosine kinase inhibitor, is an anticancer agent for patients with non-small cell lung carcinoma. Recently, however, as a result of accumulating evidence, it has been recognized that gefitinib can give rise to lethal lung toxicity. The authors report a case of interstitial lung disease (ILD) induced by gefitinib, which improved promptly following cessation of the administration of the agent. Clinical signs suggesting a good prognosis were noted, namely, findings similar to acute eosinophilic pneumonia on CT and a disassociation in the elevation of specific serum markers of ILD. At the time of onset of ILD, serum concentrations of surfactant protein (SP)-A and SP-D were significantly increased, whereas that of KL-6 was not increased. A previous study of three cases of lethal lung toxicity resulting from gefitinib administration revealed a significant and almost equal increase in KL-6, SP-A and SP-D. These results suggest that SP-A and SP-D may be indicators of gefitinib-induced ILD and that KL-6 is a predictor of outcome. Using a combination of these markers may help to establish a differential prognosis in patients with gefitinib-induced ILD.