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Low‐dose aspirin may reduce asthma risk Low‐dose aspirin may reduce the risk of new‐onset asthma, according to a US analysis ( Am J Respir Crit Care Med 2007;175:120‐5). Prompted by speculation of such a link, the authors conducted a post‐hoc analysis of the Physicians' Health Study, a placebo‐controlled study of aspirin 325mg on alternate days involving 22 071 men aged 40‐84. The risk of developing a new diagnosis of asthma during the five‐year study was reduced by 22 per cent ( p =0.045) among those taking aspirin. However, the number of cases was low: 113 among aspirin recipients and 145 with placebo. The clinical importance of this finding is therefore uncertain, though it received wide coverage in the lay media. Lifestyle change vs drugs in type 2 diabetes Modifying lifestyle is at least as effective as drugs in delaying the onset of type 2 diabetes in people with impaired glucose tolerance, according to a study from Leicester ( BMJ online. doi: 10.1136/bmj.39063.689375.55 ). The meta‐analysis of 17 trials involving 8084 participants found that lifestyle change or orlistat approximately halved the risk of progressing to diabetes, whereas oral hypoglycaemic agents reduced the risk by 30 per cent. A Chinese herb, jiang tang bushen, reduced the risk by two‐thirds. The analysis was conducted before the findings of major trials of rosiglitazone (Avandia) – DREAM and ADOPT – were published. Optician prescribing The diagnosis and treatment of disorders such as conjunctivitis by opticians is to be an enhanced service that PCTs can commission according to local need, a Department of Health review has concluded. The General Ophthalmic Services Review considered new arrangements to support PCTs provide ophthalmic services. Professional representatives proposed that the diagnosis and treatment of some eye conditions should be classed as ‘additional services’ that PCTs should be obliged to commission. While the Department agreed that opticians can play an important role, it found a lack of evidence of benefits and concluded that PCTs should be able to determine their level of services. A commissioning toolkit has been produced to help implement the review's findings. Warfarin stroke risk A four‐fold increase in warfarin use has been linked with an increased incidence of intracerebral haemorrhage in a US study ( Neurology 2007;68:116‐21). Reviewing all first admissions for haemorrhagic stroke in the Cincinnati area, the study found that the proportion of cases associated with warfarin or heparin increased from 5 per cent in 1988 to 9 per cent in 1993/94 and 17 per cent in 1999. The annual incidence among patients aged 80 or older increased from 2.5 to 46 per 100 000 from 1988 to 1999. During the same period, warfarin distribution increased four‐fold and there was no change in the incidence of thromboembolic strokes. Co‐proxamol will go, MHRA reaffirms The MHRA has confirmed that it still intends to withdraw co‐proxamol from the market despite protestations from MPs. The issue was raised by two MPs – one a member of the Health Select Committee – in a House of Commons debate. Both called for the withdrawal process to be abandoned, arguing that GPs should have the right to prescribe a drug for which there may be no alternative. The MHRA has restated its view that the risk from overdose with co‐proxamol outweighs its benefits, adding: ‘The avoidable death toll from co‐proxamol overdose cannot be ignored. Sometimes regulation has to balance the needs of the individual against the benefits at a population level. In this case the removal of marketing authorisations with continued use possible in exceptional circumstances is the best balance that could be achieved. The public health gain is already becoming apparent.’ Co‐proxamol may still be prescribed as an unlicensed drug after its product licence is withdrawn at the end of this year. Guide to pharmacy services A guide to community pharmacy services has been published for patients, carers and members of patient organisations. Developed by the South East Local Pharmaceutical Committee Forum, Understanding and Making the Best Use of Community Pharmacy explains what pharmacies offer and the services available under the 2005 pharmacy contract. Copies can be downloaded from www.psnc.org.uk/resources . Little benefit from opioids for back pain There is little evidence that opioids relieve chronic back pain but the risk of abuse is high, according to a US analysis ( Ann Intern Med 2007;146:116‐27). The systematic review of trials of oral, topical and transdermal opioids in the treatment of chronic back pain found no trials lasting more than 16 weeks. There was no significant reduction in pain in placebo‐controlled trials and limited, nonsignificant pain reductions in comparative trials. By contrast, estimates of prevalence of current substance misuse were as high as 43 per cent and that of ‘aberrant medication‐taking behaviours’ ranged from 5 to 24 per cent. Dual antiplatelet therapy with drug‐eluting stents Patients with drug‐eluting stents should not stop dual antiplatelet therapy prematurely ( Circulation 2007; published online 15 January; DOI: 10.1161/CIRCUL ATIONAHA.106.180944). Although 12 months' treatment with low‐dose aspirin plus a thienopyri‐ dine, eg clopidogrel (Plavix) and ticlopidine, has been shown to reduce cardiac events after implanting a drug‐eluting stent, it is not uncommon for the thienopyridine to be discontinued. Health professionals must do more to educate patients about their treatment and the risks associated with stopping. Scottish approval The SMC ( www.scottishmedicines.org.uk ) has approved varenicline (Champix) for use within NHS Scotland as part of a smoking cessation programme; it notes that the benefits of extending a course of treatment beyond the initial 12 weeks are modest. Controversially, the SMC has not approved omalizumab (Xolair) as add‐on therapy for severe persistent allergic asthma on the grounds that an economic case had not been made. Asthma UK criticised the decision as unjust and inhumane. NICE is due to publish an appraisal of omalizumab later this year. No decline with anti‐ psychotics Treatment with anti‐ psychotics does not hasten cognitive decline in patients with Alzheimer's disease, say investigators from London ( J Neurol Neurosurg Psychiatry 2007;78:25‐9). Their prospective study of 224 patients found no difference in the rate of cognitive decline in those treated with antipsychotics (atypical or otherwise) for at least six months. Label translation online Health IT consultancy Rxinfo has developed a website offering translations of the most common types of labelling. The site ( www.translabel.co.uk ) offers translations into 13 Asian and European languages for 15 standard labelling phrases covering oral medicines and ENT formulations. A free application can be downloaded to allow direct‐to‐printer printing. Copyright © 2007 Wiley Interface Ltd