Search for tag: "lungs"

Interviewer: Getting a better understanding of the long-term effects of poor air quality in Utah. That's next on The Scope.

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Interviewer: Heidi Hanson is a researcher that studies poor air quality and its adverse health effects. Heidi, when you look outside on one of our inversion type days, knowing what you know, what goes through your mind? Because I'd imagine it's a little different than what goes through my mind because of what you do know.

Heidi: Yeah, so I know that it's not great to be out there and it concerns me for a lot of the populations, especially the long-term effects of it. If a child's being exposed in utero, what are the long-term effects of this bad air quality? I'm thinking a lot further down the road. We also want to think about, obviously, our young children are a sensitive population and then older individuals as well.

Interviewer: Why young children? Is it because they're still developing?

Heidi: Yeah, yeah. So they're sensitive at the time of the exposure, but they're also sensitive for other reasons as well. So they're going through a period of development and so any environmental exposure to them may have long-term adverse effects. Because they're still developing, they're still growing their . . . environmental shock may really affect them in a long term and what we call that is a critical or sensitive period. When a child in utero, or is a fetus, they're going through a lot of rapid development at that time and any sort of environmental shock or exposure can change the way that they're developing.

And what we call that is scarring. Basically what that is, is that's a change to them that cannot be reversed. And for childhood, we usually we call it a sensitive period. So it's not quite as a critical growth period, but it's sensitive to environmental exposures, a lot more sensitive than an adolescent or an adult.

Women are another population that may be affected more than men by the poor air quality. And so that's something that's very interesting to look at the sex differences and really understanding if women are, what are those mechanisms? Then, another population that I've been working on with Dr. Anne Kirchhoff and Dr. Judy Ou at the Huntsman Cancer Institute is looking at cancer survivors. So trying to think through how cancer survivors are affected by bad air quality as well.

Interviewer: I guess I'm fairly fortunate the fact that I'm a male and I'm an adult and I don't have respiratory issues so, quite honestly, a lot of times I go out and I can smell the air, and I can see the air and I don't like the air, but I don't know that it affects me, really. Is that accurate or is it, "Oh, yes, it affects you, Scott"? What's your answer to that?

Heidi: I think it probably affects you a little bit more than you realize. So yeah, you may not have an asthma event or an asthma attack, but it's really . . . I don't know if you've noticed your nose running a little bit more or your body reacting because there are foreign materials going into your body that it's not expecting to deal wit. And your body does have to deal with them in some form. Even though you're not having an event that's taking you to the hospital, it's still affecting your health in some way.

Interviewer: Yeah, that would make sense. You look out and you look at that air and you go, "That can't be healthy," and the research shows that that's indeed the case?

Heidi: Absolutely. There is so much research on this topic and I really think it's pretty hard to refute that there are adverse health effects that are associated with air quality just because of the volume of research that's pointing to this. Not only is it just epidemiological research, but we're looking at animal models and you're seeing the same kinds of things. We're seeing there are definite effects to their quality. Even things you wouldn't necessarily think of, like your fertility. We're seeing there are studies out there showing that bad air quality may affect semen quality in men or bad air quality may affect fecundity for women. It's not just like your normal things, asthma, cardiovascular disease, but it may be affecting a lot more than just that.

Interviewer: And other stuff that we don't even realize.

Heidi: Right.

Interviewer: I know when you're doing research, when you're dealing with anything environmental, it can be very difficult because there are a lot of things in the environment. When you're looking at the effects of air pollution on the populations you're looking at, how do you know that it's air pollution that's causing it? How do you figure all that out?

Heidi: Yeah, so that's extremely difficult. A lot of what we are doing is with some of the methods we can do so you're comparing an individual to theirself in the statistical methods that we're using. And so what that does is that pretty much makes it so that anything we're not able to observe is kind of taken out of the equation. Basically, we're looking at the only things that are changing for that person on that day is their exposure to the air quality.

Air pollution is this amazing thing in Utah so we have this natural laboratory for doing this type of work where we have very clean air days and we have terrible air days. It leads to a kind of a perfect set up for this kind of research where there are strong environmental exposures that are well documented to have. There are biological mechanisms that are plausible that make us think this really may go on to have later life effects.

Interviewer: How do we get to a point where more people care? How do we get to a point where somebody . . . do you feel that we get to a point where somebody like me goes outside and I go, "This is terrible. We've got to do some about this," and then goes on with their day to day? Versus the people that are passionate about it are trying to make change. How we get more people like that?

Heidi: I think people really need to understand that this not just an acute effect. It's not something I'm only dealing with today and then tomorrow it's gone and it's okay. But if people really start to realize that what they're being exposed to may affect them now. It has potential to affect them long-term, especially when they start to get older. But not only that, it really has the potential to affect multiple generations.

If people are concerned about the health of their children and their grandchildren, they should be concerned about the air quality right now. There are studies that are just starting to come out showing there may be epigenetic changes related to air pollution. Basically, what they're saying is that air pollution may affect you, but it also may affect your sperm, which may go on to affect your children, or your grandchildren, or that exposure in utero may lead to epigenetic changes that go on to affect that child and also that child's child.

This is all newer research and so that has to be considered when you're thinking about this. But there is potential that this goes on to affect generations and it's not just that the only person that's affected it's you on the day of bad air quality.

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Interviewer: Exercising outside in winter. I'm here with Dr. Russell Vinik, Internal Medicine at University of Utah Health Care. Dr. Vinik, should we exercise in the winter?

Dr. Vinik: Absolutely. Exercise is good for you, whether it's summer or winter. There's always a fear of going outside in winter. We worry about frostbite, but frostbite is very rare especially if you're dressed appropriately. There is some risk in people with heart conditions. It does create a little bit more work on your heart to exercise in the extremes of temperature, whether it be very hot or very cold. But for most of us, it will do us a lot of good.

And it's certainly not a good reason to stay at home and sit on the couch because you're worried about the temperature. People often dress very, very warmly, and there's actually a risk of overheating in the winter if you dress too warmly. So the most important thing you could do exercising in the winter is to wear layers that way, you can take off layers as you get too hot. But overall, it will do you a lot of good. You'll pump a lot of blood through your body and it'll help your cardiovascular health, as well as your mental health.

Interviewer: I heard you mention, it's probably people with heart conditions shouldn't exercise as much. That surprises me. It seems like people would be more worried about the cold air in their lungs, and the cold and dry air.

Dr. Vinik: Yeah. So even people with heart conditions can and should exercise because there's still benefit in doing that. I would just talk with the doctor before you do that. Now, obviously, we all feel that cold air in our lungs when we're exercising in the outside on cold days. That's not necessarily bad for you. If you have asthma, some people do have asthma that can worsen with cold and that's something to be cautious with, and even have an inhaler if you're going to run. One thing we worry about in Salt Lake City, though, is our inversion.

And when it gets cold outside the inversion settles in the valley, and that increases air pollution. And the two together can actually make things worse on your body than just one or the other. So the times to be very cautious are those days when the ozone is collected in the valley, we see a lot of particulate pollution, and it's cold. Especially if you have heart or lung problems, then you should probably consider staying indoors. But for the most part, getting outside is a good thing. It's hard to get enough exercise indoors. Some of us have the ability to do it easier than others, but it shouldn't be a good reason to sit on the couch.

Interviewer: So if we're middle-aged or younger, and pretty much healthy all the time, even when there's inversion, we shouldn't really worry about it, we should still go for that run?

Dr. Vinik: Absolutely. You could still easily go out for a run. The risk to your body is very, very low. In fact, the benefit to your body is a lot more than the risk associated with going out in cold weather or the inversion.

I think just getting out and working, and it doesn't have to be a huge amount of exercise, 20 minutes, three, four times a week would do a great deal for your heart/lungs, as well as your body, just weight and preventing obesity and all the bad things that come with a sedentary lifestyle

updated: December 29, 2021
originally published: January 7, 2016

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Interviewer: If you have chronic shortness of breath while exerting yourself or exercising, it could be a condition called dyspnea. Dr. John Ryan is the director of the new dyspnea clinic here at the University of Utah Division of Cardiology. It's one of the first clinics of its kind and currently the only one here in the Mountain West region. Tell me, dyspnea; what causes it?

Dr. Ryan: Dyspnea is, as you described, a shortness of breath on exertion. It can be driven by a lot of things. A lot of the time it's due to stiff hearts or diastolic dysfunction. Other times it's due to chronic lung disease; asthma, emphysema, bronchitis, etc. Obesity in particular can also contribute to it. Then sometimes, of course, it can be due to deconditioning.

However, most of the time that we see is a combination. People have problems with their heart and problems with their lungs and then become deconditioned, and then their shortness of breath begets more shortness of breath and begets more dyspnea. The analogy we give when people come in is that if your work life isn't going well, your home life likely won't be going well either, because everything just has a knock-on effect. Therefore, in dyspnea when you have the chronic shortness of breath in the setting with exertion, there will be knock-on effects on your heart, on your lungs, on your waist, and also, incidentally actually, on your mood as well.

So all of these things tie together and we really wanted to break down the traditional barriers in medicine which are organ-based barriers, which are incredibly artificial and evolve into a more patient-centered approach in order to figure out what it is that's going on with you and what we can do to help you.

Interviewer: And what's causing your problem.

Dr. Ryan: And what's causing your problem, specific to you rather than saying, "It's not this organ, it's not that organ," but actually say, "Listen, this is what's going on."

Interviewer: So is dyspnea hard to diagnose for a regular physician? If I went in to my physician and said, "I exercise and I get really short of breath," are they going to miss that a lot of times, or no?

Dr. Ryan: Yeah. Dyspnea is more of a symptom. It's what people describe or what they complain of. Ironing it out is not difficult, but it just takes time or takes testing to figure out what the cause is.

Interviewer: It takes an expert that knows, because there are a lot of different things that can cause it, right?

Dr. Ryan: Yeah, and it really takes an involved program as well, and a protocol. We have a protocol in terms of when people come in, what testing we recommend.

Interviewer: Who are some of the common patients that come in? Are they people that are athletes or like to exercise? You mentioned some of these rural areas. I suppose you get a lot of farmer ranchers?

Dr. Ryan: The patients that we get really vary considerably. We get a lot of young ladies in their 20s who really are thin and have previously been quite active and find themselves getting fatigued very easily. Then we get a lot of folks in their 50s and 60s who, again, similar to the farmers that you described who are just becoming very, very fatigued and aren't able to do the full days of work or are just very tired by the end of the full days of work.

I think the main thing that we're trying to move away from is a 60-year-old person who isn't able to exercise as much as they used to and telling them, "It's just because you've gotten older." So I think that shouldn't happen and that's not exactly very rewarding, either.

Interviewer: You said you can't help everybody, but for the most part do you find that people live better lives after they come to you?

Dr. Ryan: I think so, and that's our goal, that their quality of life improves. A lot of the times we try and rule out the things that will shorten their length of life, so coronary artery disease, valvular disease, pulmonary hypertension, and then once we've ruled out the things that will shorten their length of life, then we re-focus on improving their quality of life so that they are able to do more.

Most people have realistic expectations. Even your 60-year-old farmer from Idaho knows that they're not going to be able to do as much as when they were 20 or 30. So most people's expectations are realistic, it's just they want a better quality of life. I think we're doing that.

Interviewer: Are you somebody that a patient can come directly to or do they have to go to their primary care physician first?

Dr. Ryan: Folks can come to us directly. Most of the time, 90% of our patients are coming through their primary care doctor probably because dyspnea is a medical term for shortness of breath and most folks, patients themselves, don't describe dyspnea but their doctors would. So the moniker of the clinic is kind of designed that way. We do have 10% of patients self-refer or come in through other patients who've been through our clinic and liked what we did.

Interviewer: Where can somebody go to get some more info on this condition and the clinic?

Dr. Ryan: Through the University of Utah Heart website, which is heart.uofuhealth.org, and then find our dyspnea clinic through there.

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updated: September 19, 2018
originally published: February 24, 2015

Interviewer: A new video game that teaches about air pollution in Utah. What does the creator hope to accomplish? We'll talk about that next on The Scope.

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Interviewer: "Bad Air Day: Play It Like UCAIR" is a brand new web-based game that teaches why Utah's air pollution woes are local and frequently misunderstood, their words not mine. Actually, I want to ask a question about that because I found that misunderstood thing interesting. Kerry Kelly is in the Department of Chemical Engineering at the University of Utah and the game was originally her idea. So first of all, tell me about the game, what is it about? What is the objective?

Kerry: Okay, so you get to be the mayor of Salt Lake City, and you get to decide what kind of policies you're going to make to either help improve air quality or maybe you don't care about air quality and you'll make other decisions.

Interviewer: Sure.

Kerry: So you get to fly a paper airplane around the city, and it is your job to collect votes. If you make decisions that improve air quality, you'll have a nice clear day and you'll fly quickly around the city. If you choose to make air quality poor, you'll see a visible deterioration in air quality and it will also be much more difficult for you to fly around the city. In fact, if you make enough bad choices, you'll have trouble seeing.

Interviewer: Really?

Kerry: Yeah.

Interviewer: Okay. One of the other aspects of it that I thought was interesting is that you have what is called a "Wall of Public Anger".

Kerry: Yes!

Interviewer: How does that play into it?

Kerry: We were trying to figure out how to address the challenges when you're looking at public policies and strategies, and we developed this "Wall of Public Anger" as a way to address that some of these strategies might incite a lot of public anger. For example, if you forbid all driving, we believe that there would likely be a lot of Walls of Public Anger. In the game that means these walls go up and you can see shadows of angry people and you'll have to fly around the Wall of Public Anger if you wish to continue to collect your votes.

Interviewer: And it makes it a lot more difficult. I think that's an interesting juxtaposition that a lot of people don't think about is, sure, you'd have great clean air but you're also making people angry because it's really unrealistic to think everybody is going to stop driving.

Kerry: Exactly.

Interviewer: Or people are going to give up their wood-burning fireplaces.

Kerry: Yes, that's another very hot topic.

Interviewer: I bet it is. What are some of the other hot topics like that?

Kerry: Increased use of mass transit, so how aggressive you are with encouraging that. A shutting down of a variety of permutations of industry, so for example, shutting down the refineries or shutting down all large industry in the valley, so you get to see what that would do to air quality.
I guess one important aspect of the game that I wanted to mention, is that every single strategy that we've proposed in the game we are able to link to a quantifiable change in air quality. We had a lot of strategies that came up in our meetings with the stakeholders, and there are some really interesting strategies, but we weren't able to come up with a quantified change in air quality. So we stuck only with the strategies, I believe there are 20 or 30 of them, and how they will affect our air quality.

Interviewer: And you know exactly how that will affect the air quality, and you can actually watch that in the game so you can experiment and play around with the different choices.

Kerry: Yeah, in fact I think it's kind of fun to select poor air quality choices to see what happens.

Interviewer: Yeah, and how bad it really makes it.

Kerry: And this is from an air quality researcher, so . . .

Interviewer: Exactly. How do you hope that parents will help kids use this game as a learning experience? Because the target is teens, correct?

Kerry: Yes, but we're partnering with Breathe Utah so they have a big educational component to their organization and they're going to be testing this game with a variety of high school and even some middle school students, so we'll see how it plays with each of those two groups. And they're developing some lesson plans that will accompany the game.
One challenge we faced was how much information to put in the game versus how much to just inspire curiosity. I think we went more on the inspiring curiosity and left it up to the teachers and the experts in developing lesson plans, so that they could develop materials that would then tie to state core or whatever they needed it to. We just wanted to make sure that the air quality part of it was correct.

Interviewer: So after some teens, or anybody, plays the game, if they were to walk by you and you were to stop them and say, "Hey, what's your takeaway?", what would you hope their takeaways would be?

Kerry: Well, A, that it's a tough problem, first of all, and that they have a little bit of a feeling for the variety of strategies that we could take, and that it's going to take a combination of strategies to solve this problem, and that there will be some trade-offs. Some of the things we'll have to do will cause us some sacrifices. Whether or not it's paying a few cents a gallon more for gasoline, or not burning wood, we'll all have to make some choices.

Interviewer: Yeah, so kind of educate people on the basics of it, help them understand that there are trade-offs, help them understand that it is a complicated problem.

Kerry: Right, yeah.

Interviewer: So it sounds like there was probably a lot of thought put into this game, a lot of scientific fact, a lot of work and effort from a lot of different people.

Kerry: Exactly, and I wanted to thank the partners we had. In particular, I wanted to thank the students in Engineering Arts and Entertainment. They did the lion's share of the work, they made this all happen. I wanted to thank Breathe Utah. They helped with the educational side of the game, and they're currently out there play-testing the game.
I wanted to thank Utah Education Network, that's who is hosting the game. I wanted to thank the Utah Health Department and the Utah Division of Air Quality. They really helped as we developed strategies and vetted strategies and the Division of Air Quality was invaluable as we were trying to put numbers on each of those strategies we were considering.

Interviewer: In the description of the game it said, "Air pollution woes that are local and frequently misunderstood". Have we covered the misunderstood part of that?

Kerry: Yeah, I think so.

Interviewer: Okay, that's what you referred to there, all right. You can get the game at badairday.org. Kerry Kelly, good luck with your game and thanks for taking time.

Kerry: Oh, thank you very much.

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Dr. Jones: The number one cause of cancer deaths in women? Most women would say breast cancer, but its lung cancer, and although the rate of lung cancer in men is falling, lung cancer deaths in women is rising. This is Dr. Kirtly Jones from the Department of Obstetrics and Gynecology at University of Utah Health Care and November is Lung Cancer Awareness Month. Lung cancer in women, today on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Jones: The white ribbon. We see pink ribbons everywhere for breast cancer, teal ribbons for ovarian cancer, but where are the white ribbons for lung cancer? The CDC reports that more women die of lung cancer than breast, uterine, and ovarian cancers combined. Twenty-seven percent of all cancer deaths in the US are caused by lung cancer. The five year survival rate for those diagnosed with lung cancer is 16%, which makes it a particularly deadly cancer. Now, the lung cancer rate has fallen 21% among men, but for reasons that remain unclear, the rates have risen 116% among women. Of course, we all know that smoking is the major risk factor. Since 1960, the rate of smoking in men has gone down, but for women, not so much.

Lung cancer develops differently in women than men. Women who have never smoked have a greater risk of developing lung cancer than men who've never smoked. Go figure. Worldwide, 53% of women with lung cancer were never smokers. They could have been exposed to more indoor air pollution related to cooking and heating, and that may be the risk factor for women in Asia and in China and somewhat in the United States. Women tend to develop lung cancer at a younger age than men, too. The good news is women are more likely than men to be diagnosed in early stages of lung cancer, because women probably get more health care, and women tend to live longer than men after treatment for lung cancer. So, that's the good news.

Well, I'm thrilled to live in Utah where smoking is so uncommon, and where it's against the law to smoke in enclosed public places. However, a notable trend in the increase in lung cancer among healthy non-smokers is known primarily in women. If lung cancers in non-smokers were its own category, it would rank among the top 10 of fatal cancers in the US. Lung cancer can result from factors other than smoking. Genetic mutations, as well as exposure to radon gas, secondhand smoke, air pollution and asbestos, among some other things. In Utah, we have particular geographic risks related to radon and air pollution.

So, what to do for this largely preventable, common cancer? If you're a smoker, you should stop smoking. Ten years after quitting, your risk of lung cancer is half of what it would have been if you didn't quit. If you're a heavy smoker over 50, talk to your doctor about the pros and cons of low dose CT scans for screening. If you aren't a smoker, don't start. If you're an adolescent or the parents of one, starting smoking is especially bad, as you're more likely to be addicted to nicotine, and have your developing brain wired for risky behavior, like alcohol.

Lowering your risk of secondhand smoke. If someone in your family smokes, no smoking in the house or in the car. Check your home for radon. Now, radon is a naturally occurring radioactive gas that results from the breakdown of uranium and soil and rocks. It cannot be seen, tasted, or smelled, and according to the EPA, radon is the second leading cause of lung cancer in this country, and it's the leading cause among non-smokers. Outdoors, there's so little radon that it's not likely to be dangerous, but indoors, radon can be more concentrated. When it's breathed in, it enters the lungs and exposes them to radiation. Homes in some parts of the US, like Utah, which are built on soil with natural uranium deposits can have high indoor radon levels, especially in basements. My basement is ventilated and has a fan in it specifically for that reason, and I live here in Salt Lake City.

If you are concerned about radon exposure, you can use a radon detection kit. State and local offices of the EPA can give you the names of reliable companies who can test your home. So get it checked and get it fixed. Limit your time on the freeway and be an advocate for clean air. Eat your fruits and vegetables. Antioxidants in your diet is associated with lower risk of lung cancer. Vitamin pills won't do the trick. So, ladies and gentlemen, put on your white ribbons this month. Lung cancer is largely a preventable disease. Think about the air you breathe and what's in it. Protect yourself and the people around you. This is Dr. Kirtly Jones and thank you for joining us on The Scope.

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Interviewer: You may think that e-cigarettes are safer than conventional cigarettes, but did you know that in 2014, poison control centers in the United States received up to 215 calls per month about e-cigarette poisoning? That's next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier, healthier life. You're listening to The Scope.

Interviewer: I'm talking with Dr. Zane Horowitz today. He's the Medical Director of the University of Utah Poison Control Center. Dr. Horowitz, I read something from the Center for Disease Control recently about the rise in poison control center calls regarding poisoning from e-cigarettes. What's that all about?

Dr. Horowitz: Well it's not so much the cigarettes themselves but the refillable cartridge where you put the liquid that you vape, in. Right now the amount of nicotine that's in that can vary dramatically. The flavors are tasty flavors that are attractive to kids, bubble gum, cherry, and all these fruity flavors. A few sips of that will deliver sometimes as much as anywhere from on the low side 10 milligrams of nicotine all the way up to 200 to 400 milligrams of nicotine. To put that in perspective, when we smoke a single cigarette, that delivers about 1 milligram of nicotine.

So a child who accidentally takes the top off this and smells it and it smells nice and fruity, and tastes it and it tastes really delicious, and takes a gulp or two, he's getting the equivalent of maybe 200 or more cigarettes delivered all at once. And he's going to get quite sick. The poison centers nationwide and here in Utah have been receiving increasing number of calls as these products have grown on the market. People are having these out on the kitchen table and the coffee table in the living room, so children just reach over. A sip later, and all of a sudden they're vomiting and they're sick and they have to go into the emergency room to be treated.

Interviewer: I guess maybe we need to go back and talk a little bit about e-cigarettes to begin with. Tell me what an e-cigarette is and how a person uses it.

Dr. Horowitz: The "e" stands for electronic. They're made to look a lot of times like cigarettes or cigars, although sometimes they're made to look like other objects. There's a long chamber where you can put a liquid, and the liquid contains mostly nicotine, but it could be flavored and there could be other things in it as well. There's a little heater that warms that up and creates a vapor. You inhale it just like a cigarette and you just get the vapor of nicotine without all that other smoke, all that burning tobacco leaves stuff that makes you smell like an ashtray. So it's reasonably odorless, although they tend to have a fruity odor about them. When that portion gets burned up, you take a refill out of your pocket or wherever you have it and you fill up that little chamber again so you can keep on vaping, is the term.

Interviewer: Recently the CDC put out a report that stated that back in 2010, poison control centers were getting about one call per month on e-cigarettes. In 2014, they're getting as many as 215 calls per month. That's a pretty astounding jump, don't you think?

Dr. Horowitz: Right. It's been rising almost every month, month to month, as more and more of these products are sold and they're in people's homes and they're where children are. Currently because there isn't any regulation one way or the other, how much is in these liquids is unknown. There's no safety cap as there would be with a medicine bottle or an automotive product. Other consumer products that we have around the house that we know can be dangerous to children often have some sort of cap that the child can't take off easily. And it's usually the exploratory 1 or 2 year old child who's learning how to manipulate things and pulls it off that and it smells delicious and they stick in their mouth and it tastes delicious and they drink a gulp. It doesn't take much with this. That's probably the key point. One gulp can be quite toxic to children.

Interviewer: And you're talking specifically about the flavored liquid that goes inside of these e-cigarettes.

Dr. Horowitz: Right.

Interviewer: What do the containers look like?

Dr. Horowitz: They look like a little eye dropper bottle. So far there aren't giant companies making these yet, so a lot of these are home grown little stores. They buy a little plastic bottle with a little screw top on it and you pour that little screw top or an eye dropper full into your chamber of your e-cigarette and put the cap back on. It doesn't take more than a quarter turn twist to get the cap back off, and that's easy for a child of 1 or 2 years old to manipulate and they have access to it.

Interviewer: The CDC Director, Tom Frieden, actually mentioned that these e-cigarette liquids are not required to be childproof.

Dr. Horowitz: Right now there isn't any regulation about that. That's being considered. I think we have to take a very rational common-sense approach to it. The simplest thing is obviously make these things childproof like we've made medicine bottles, automotive products, and some household cleaners that are toxic. That's the first big thing. Then I think the number of exposures will go down.

The second thing is just educating parents and uncles and aunts and whoever else is going to be visiting with little children, use some common sense. Don't put this out on the table and have your 2-year-old watch you pull it out and spill it in your little chamber of the e-cigarette and sit there vaping. They'll all look at it and go, "Wow. That looks like a cool little toy that I can play with now." Then you put it back on the counter or the table and they're going to take it apart and try to figure it out for themselves because that's what kids do.

Interviewer: If a child ingests this, what do some of the symptoms look like?

Dr. Horowitz: Usually they have nausea and vomiting. Sometimes they vomit over and over and over again. They can get pretty dehydrated pretty quickly for a small child. But in large amounts, like I said those concentrations sometimes can be equal to 200 cigarettes, this could potentially be fatal. A child could die if he takes those really concentrated liquids, and some stores are selling those, the high concentration, meant to be diluted down by the person who's going to be vaping. If a child gets into a few gulps of that, they can have seizures. They can have heart arrhythmias, where their heart beats very irregularly, and in severe cases, if they took enough of that, they could die.

Most of the things we're seeing are the lower concentrations, but there's no labeling. We don't know how much is in any product, and the size of these can vary from a tiny little dropper size to something that looks like a soda bottle size.

Interviewer: How long does it take for some of these symptoms to appear?

Dr. Horowitz: Usually pretty quickly, usually within minutes. Usually within five or ten minutes we're going to see something. The child is going to start vomiting and sweating and feeling pretty miserable.

Interviewer: Let's say they get a really heavy dose, one of these that could be fatal. How long does the child have to get treatment before they die?

Dr. Horowitz: Well if someone accidentally drank one of these with a high concentration, we would probably advise parents to call 911 and have an ambulance drive them to the hospital.

Interviewer: With a lower dose poisoning, do you still recommend that parents take their children into the emergency room, or what do you suggest to them?

Dr. Horowitz: Well I think if there's an accidental little taste or a lick, they certainly can call the poison center 24 hours a day. We have nurses and pharmacists with training, we've briefed everybody on this, and they can talk through the particulars of each individual occurrence. So if it's a small amount and the child's not having immediate nausea and vomiting, we may not have to send you to the hospital or the doctor. We'll just sort of call you back and see how you're doing.

Interviewer: Can you just tell us the number to the Poison Control Center for parents that might be interested to know that?

Dr. Horowitz: Yes. It's a universal 800 number. In whatever state you are in it will get you to your state's poison center. It's 1-800-222-1222. 24 hours a day that phone will be answered live by our poison information specialists and they're very happy to talk to you. No question's too small, whether it's e-cigarettes or any other product that your child might get into at home.

Interviewer: All right. Thank you.

Announcer: Examining the latest research and telling you about the latest breakthroughs. The Science and Research Show is on the Scope.

Host: Only 15% of patients with squamous cell lung cancer survive to five years past their diagnosis. It is a difficult cancer to treat. My guest, Dr. Trudy Oliver has developed a new tool for understanding the disease and developing targeted therapies.

Dr. Oliver, you've developed a mouse model for lung squamous cell carcinoma. Why is this important?

Interviewer: I think we've all realized that smoking while you're pregnant is bad for your baby, but it could be worse than you thought. We'll examine that next on The Scope.

Announcer: Examining the latest research and telling you about the latest breakthroughs. The Science and Research Show is on The Scope.

Interviewer: When a child's in the womb, it's very sensitive to the environment it's subjected to, and the consequences of that environment can really have a long-term effect for the baby afterwards. That's according to new research from Lisa Joss-Moore. She's a PhD. and also an associate professor in the Division of Neonatology at the University of Utah. Tell me about your research and what you found out.

Dr. Joss-Moore: Well, we're interested in how early life events, like maternal tobacco smoke, can have a life-long influence on the development of disease. What we do in our lab is we look at early insults, for example, maternal tobacco smoke. What we do is we have an animal model where we introduce tobacco smoke just like it would be if it were a pregnant woman smoking. We give the same amount of tobacco smoke that you would see in an active smoker, and we only give that tobacco smoke exposure during the fetal period.
During the post-natal period, there's no further exposure, and what happens in the long-term is that the model animal developed Type 2 diabetes, obesity, insulin resistance, and various kinds of lung deficiencies. What we're focusing on in this particular study is the effect of prenatal smoke exposure on the development of lung disease. So this is like if you were a human baby, this means that your mom smoked while she was pregnant, but then you had no other exposures after you were born. What's very interesting and somewhat disturbing is that we have shown that if you have that early exposure, you can grow up to develop insulin resistance, Type 2 diabetes, obesity, and changes in your lung structure and function.

Interviewer: Wow. So it goes way beyond just lungs?

Dr. Joss-Moore: It goes way beyond just lungs.

Interviewer: Yeah.

Dr. Joss-Moore: We focus on the lung and the other aspects in our lab. One of the things that we have learned about the lung, which was previously characterized mildly, but we're studying to understand the mechanisms now is that when you have these fetal exposure to tobacco smoke, your lung changes in terms of its molecular composition. It changes in terms of its structure, and mostly importantly, it changes in terms of its function.

Interviewer: So it's a different lung than somebody that hasn't been exposed?

Dr. Joss-Moore: Correct.

Interviewer: Wow.

Dr. Joss-Moore: Correct. And while these studies are ongoing, we expect that this new lung, this different lung, is actually much more sensitive to damage from subsequent insults, such as a Salt Lake inversion or exposure to tobacco smoke. Should that individual grow up to become a smoker themselves, their lungs are going to be much at risk of damage than had they have never had the in-utero exposure.

Interviewer: Is that because the fetus is still developing, and it's somehow changing the way that genes are doing what the genes do?

Dr. Joss-Moore: That's exactly what we found. We looked at various pathways. One of the pathways that we're particularly fond of involves signaling from fatty acids, particularly omega-3 fatty acids. The downstream targets of some of those signaling includes epigenetic modifying molecules, and what happens when you mess up those epigenetic pathways, you change the gene expression program. When you change gene expression in an organ that's developing, the result is that you develop a slightly different organ than you would've had otherwise.

Interviewer: So the analogy would be that your genes are these little machines that are manufacturing the parts, and if something isn't manufactured properly, you get a part that's not what you expect?

Dr. Joss-Moore: Exactly. If you live in an extraordinarily clean environment, and you have no other insults on your lungs, maybe you get to be an old person before you notice. Sadly, that's not the case. We have a lot of other lung irritants that we're exposed to, and we expect that what you would see is a more rapid onset of damage. There are studies that link early tobacco and nicotine exposure to the development of asthma, hypersensitivity of the airways, and other lung disorders.
What we're trying to do in my lab is really trying to understand some of the mechanisms by which this early exposure produces these changes. We want to understand the mechanisms because once we do we can really begin to develop targeted interventions that may make a difference.

Interviewer: Gotcha. And understanding, too, that it would mean that you would hurt something else when you're trying to . . .

Dr. Joss-Moore: Exactly. Because the population that we're really looking at is newborn infants, there's a lot of development going on. While we may have something that's really good for the lungs, it might mess up the kidneys, for example. So one of the reasons why we focus on what we do in an animal model is that it gives us the ability to use our intervention, and one of our interventions involves an omega-3 fatty acid DHA. We can look at the effect on the organ that we care about in this case, which is the lung, but at the same time we could look at other organs, such as the brain and the kidney, and we can make sure that our treatment that's helping the lung is not hurting any of those other organs.

Interviewer: Yeah. So what's the big take-away from this research for the average person?

Dr. Joss-Moore: Well, the first thing is that it's very important to realize that these early life exposures really do have long-term effects on the fetus.

Interviewer: Would you describe them as profound?

Dr. Joss-Moore: Yes. Absolutely. There's a big body of evidence now that's really identified that. The general field is known as the developmental origins of health and disease, and the idea that if you have toxic insults, like, for example, tobacco smoke, there's other maternal conditions such as hypertension that can really change the way a fetus develops. Some of those consequences in the fetus may not be felt until later on in life. But if we can understand what's causing them, it's going to allow us to intervene and perhaps prevent some of those diseases from developing later on.

Interviewer: So could you actually make a lung that wasn't made properly the first time right, years after the fact?

Dr. Joss-Moore: Well, I don't know about years, but we know that we can correct a number of the molecular, structural, and functional findings that we found. So that's very exciting for us to continue down that path and see how long those effects remain in place. We're hoping that they're permanent.

Announcer: Interesting, informative, and all in the name of better health. This is The Scope Health Sciences Radio.

Oh, little bits of dirt that you breathe that get into your body and affect your baby. Air pollution in pregnancy: What do we know and what should you do?

You thought that your lungs filtered out dirt and the placenta filtered out bad stuff? Well, that's sort of true, mostly true, but not completely true. Recently we've had yellow air days and orange air days and even a red day. What does this mean to you if you're pregnant, and what happens to you and your baby on a red-air day? And what can you do about it?

In Utah and across the west, we settled our towns in valleys where there was water. That was a good thing, right? And the towns grew and the cars were invented and industry grew and that was a good thing, right?

Well, we know in the past London, England had some of the worst air quality episodes in the world. And we know that people died when air got that bad. So what's happening in the Salt Lake Valley, a city in a valley prone to air inversions and when you have to breathe what your car and the refineries have pooped? Bad air has a lot of bad stuff to it-ozone, sulfur dioxide, nitrogen dioxide, and particles of incompletely burned stuff, the thing I so inelegantly called poop.

From your cars, from your favorite barbeque place, from the big industries, and from refineries. The incompletely burned particles come in different sizes, but the worrisome ones are very small, and they are called PM2.5 and they are too small for your lungs to clean and they get into your body and inflame your body and your placenta.

It is hard to do research on pregnant women. In fact, we're specifically told we have to be very careful doing research on pregnant women. And it's really hard to put pregnant women into a controlled room and expose them to various amounts of bad air. And some women get good air. And then see what happens to their pregnancies and their babies. We do have research from areas with bad air that look at pregnancy outcomes and children's health. California has been very active and looking at outcomes of pregnancy and bad air. Women exposed to bad air, living close to a freeway when they were pregnant, had smaller babies and more premature babies. And their children had more asthma and more autism.

Can we prove it was the bad air or something else, like freeway noise instead of bad air? This is hard, but here in Utah we had an experiment in Utah County about 20 years ago. We used to have really bad air when Geneva Steel was open, so we could look at outcomes when it was open and when it was closed. One specific outcome, prematurity, was a lot worse when it was open.

So what do you do if you're pregnant in bad air days, on orange days or red days? I'm not suggesting that you get in your car and go to Park City; that just makes air worse. And in recent years, the bad air has traveled up to Park City anyway. So don't drag your bad air up to Park City. You should never use a wood fireplace or wood-burning stove when you're pregnant. The air quality inside is many, many times worse than the worst air day.

I hope staying inside on bad air days helps, but our inside air comes from outside. There is some research that home air filters that can filter PM2.5 might make the air better in your home. There will be more information on this in the future as we get better small air quality measuring devices and the U is funding research just for this purpose.

Don't use your snow blower. It's a very inefficient high polluting engine. Get someone to shovel your snow.

Stay off the road; air quality on bad days is worse next to the freeways. Minimize your trips, not just for you but also for everyone, and don't wait for bad air day to limit your trips. Don't idle your car. The Utah Department of Air Quality has predictions about the next few days; act now to make tomorrow's air better.

Google the Utah Air Department of Air Quality or you can go to Airnow.gov and get a look at the country and click on Utah.

So pay attention to the air quality and the Department of Air Quality's predictions. Be an advocate; let your local and state representatives know that you're very concerned about Utah air quality; you're willing to put up with tighter controls for cars and industry, and you vote. And don't hold your breath; you're breathing for two.

updated: February 18, 2020
originally published: March 13, 2014