Health effects of passive somking studied in first-of-a-kind clinical study

Until bans on in-flight smoking took effect, beginning in 1988, flight attendants were regularly exposed to secondhand smoke.

These men and women and other service industry professionals are now being recruited for a landmark series of clinical studies on the health effects of secondhand smoke on nonsmokers, taking place at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and other locations.

Funded through an $8.7 million Flight Attendant Medical Research Institute (FAMRI) grant to Weill Cornell Medical College, the initiative will employ a multidisciplinary research and clinical program to enhance early detection and treatment of diseases related to secondhand smoke (SHS) exposure -- including cancer, heart disease, emphysema, asthma, chronic bronchitis and osteoporosis.

The initiative, called the FAMRI-IELCAP Collaborative Network, is a joint effort between FAMRI and the International Early Lung Cancer Action Program (I-ELCAP), the largest collaborative CT screening effort in the world.

A total of 5,000 patients will be recruited, with an emphasis on workers in industries with a high degree of secondhand smoke exposure -- including flight attendants, restaurant and entertainment professionals.

"I want to recognize FAMRI for their leadership as they have made a major contribution toward properly addressing this important public health issue. Together, through this new initiative, we hope to better understand, prevent and treat the pernicious effects of secondhand smoke," says Dr. Antonio M. Gotto, the Stephen and Suzanne Weiss Dean of Weill Cornell Medical College.

Stanley M. Rosenblatt, chairman of FAMRI, says, "My wife, Susan, and I established FAMRI in 1997 with $300 million from a court-approved partial settlement of a class-action lawsuit we had filed in 1991 in Miami-Dade County, Florida, on behalf of non-smoking flight attendants against the tobacco industry. Susan and I selected a majority of flight attendants to serve on the Board of Trustees. We know that early screening saves lives and we enthusiastically support the FAMRI-IELCAP Collaborative Network."

"It is well established that secondhand smoke causes a wide variety of health problems, from heart disease to lung cancer and beyond. This bold series of collaborative and multidisciplinary studies is designed to bring the maximum benefit for the millions exposed, and in the most timely and cost-effective manner possible," says Dr. Herbert Pardes, president and CEO of NewYork-Presbyterian.

"Secondhand smoke is a vital issue for flight attendants and anyone who has been exposed, willingly or unwillingly, to secondhand smoke. The FAMRI-IELCAP Collaborative Network represents an important opportunity to help ensure that exposure to secondhand cigarette smoke doesn't equate to a death sentence for its accidental victims," says Elizabeth A. Kress, executive director of FAMRI.

"The good news is that we expect to show that it is possible to screen for disease caused by secondhand smoke early enough for effective treatment," says Dr. Claudia Henschke, chief of the chest imaging division at NewYork-Presbyterian/Weill Cornell and professor of radiology and cardiothoracic surgery at Weill Cornell Medical College. She is principal investigator of I-ELCAP and of the entire FAMRI-IELCAP Collaborative Network projects.

The new initiative will employ many disciplines, ranging from diagnostic imaging for early detection of disease combined with advanced image processing to laboratory development of key biomarkers.

The FAMRI-IELCAP Collaborative Network has planned three major projects, lasting five years, to:

1. Determine the probability of specific respiratory diseases (emphysema, chronic bronchitis, bronchiectasis, focal pneumonia, lung and mediastinal cancer) among patients exposed to secondhand smoke, with the aim of developing appropriate screening programs. (The principal investigator is Dr. Claudia Henschke.)

2. Assess the increased risk of cardiovascular disease from secondhand smoke, independent of other risk factors, and develop guidelines for a clinical screening program for cardiovascular diseases. (The principal investigator is NewYork-Presbyterian/Weill Cornell's Dr. David Yankelevitz, co-director of the Lung Cancer Screening Program, attending radiologist at NewYork-Presbyterian/Weill Cornell and professor of radiology and cardiothoracic surgery at Weill Cornell Medical College.)

3. Determine if increased levels of prostaglandins (PGE-M) in urine, a marker of inflammation, particularly of diseases of the lung, can be used as a biomarker of the effects of tobacco smoke. (The principal investigator will be NewYork-Presbyterian/Weill Cornell's Dr. Andrew Dannenberg, director of cancer prevention at NewYork-Presbyterian/Weill Cornell and the Henry R. Erle, M.D.– Roberts Family Professor of Medicine at Weill Cornell Medical College.)

Additionally, two pilot projects will be initiated each year. The first two pilot projects will (1) look at rhinologic disease in patients exposed to SHS headed by Dr. Michael Stewart (otorhinolaryngologist-in-chief at New York Presbyterian/Weill Cornell and chairman of the Department of Otorhinolaryngology at Weill Cornell Medical College) and (2) use gene expression tests to look at changes in histone H3 phosphorylation in patients exposed to SHS to provide a platform for rational targeted interventions headed by Dr. Kotha Subbaramaiah (associate attending physician at NewYork-Presbyterian/Weill Cornell and associate professor of medicine at Weill Cornell Medical College).

Interested participants must be 40 and over, and must have been exposed -- either as a child or as an adult -- to an environment where heavy smoking took place. All participants will receive a low-dose CT screening.