Cigarettes with ultralow nicotine levels are now being called the game-changer in the fight against smoking. If you are having trouble in quitting smoking, then, it is for you, that soon the Biden White House is expected to formally propose a plan that will order cigarette nicotine levels to be reduced, reports The Washington Post. For now though, it has been a failure, as these cigarettes, also known as VLN cigarettes that stands for very low nicotine are only available in 5,100 stores in 26 states. This is a very small fraction of the overall market for cigarettes. The company that makes it, 22nd Century, is struggling not because of the low supply, but also from the advocates who have long believed slashing nicotine levels altogether.

The Advent and ideation

Nicotine is a chemical that is produced naturally from tobacco that makes the cigarette and also keeps people hooked. While it is believed that it makes people alert, and get the "hit" to keep them going, it exposes the users to harmful substances, carcinogens, and increases the risk of heart disease, lung cancer, and other illness.

Ultralow-nicotine cigarettes, like the VLN brand, contain about 95% less nicotine than the regular cigarettes. The idea is quite simple: without the addictive grip of nicotine, smokers will find it easier to quit. Research too has shown some promise. For instance, the studies funded by the National Institute on Drug Abuse revealed that very low nicotine cigarettes reduced addiction potential significantly without having users to increase their smoking frequency. However, the problem is, why would anyone choose for a low-nicotine that does not make them feel the same way, when the high-nicotine cigarette is right next to it, making them feel the same way, with the same alertness, sold at the same price.

“It’s very hard to imagine someone actively choosing to continue to use a low-nicotine product for the same price when a high-nicotine product is right next to it,” said Eric Donny, a Wake Forest University School of Medicine nicotine researcher.

No wonder, the experiment with low nicotine product by Philip Morris' Next cigarettes in the 1980s and Vector Tobacco's Quest brand in the early 2000s, flopped.

FDA's Role in the Push

The Food and Drug Administration (FDA) has supported the development of such products, even allowing VLN cigarettes to be marketed as lower-risk options. However, these products remain a niche market, available in only a fraction of U.S. stores.

Recently, the Biden administration has considered a bold step—mandating a dramatic reduction in nicotine levels for all cigarettes sold in the United States. Supporters believe this move could save millions of lives, while critics, including tobacco companies, warn of potential unintended consequences.

What Could Be The Challenges?

Resistance from Big Tobacco Companies: They could argue that slashing nicotine levels could backfire. Their claim is, smokers will turn to black markets or smoke more to satisfy their cravings, which may lead to greater exposure to harmful substances.

Consumer Reluctance: History is proof to the instances of smokers being hesitant to embrace the low-nicotine products.

Political Hurdle: It may face political roadblocks, as under the Trump administration, plans to cut nicotine were shelved.

Could Low-Nicotine Cigarettes Be The Solution?

Advocates believe that ultralow-nicotine cigarettes could be a game-changer, comparing them to decaf coffee or non-alcoholic beer—products that reduce harm while offering a similar experience.

Some experts warn that a black market for traditional cigarettes could undermine these efforts. They also stress the need for safer alternatives, such as vaping products, to support smokers transitioning away from traditional cigarettes.

Col Anurag Upadhyay, a former Indian Army officer and Special Forces veteran, is living with locked-in syndrome, a rare neurological condition in which a person can remain conscious and aware while losing the ability to speak and move most muscles.

While there is currently no medicine or injection proven to reverse established locked-in syndrome, experts stress the importance of specialized neurorehabilitation, communication aids and appropriate assistive technologies.

Col Anurag’s Journey

A decorated Army officer and Special Forces veteran, Col Upadhyay suffered a severe posterior circulation stroke in August 2025. The stroke reportedly caused extensive neurological damage and left him with locked-in syndrome.

Despite being unable to move or speak normally, Col Upadhyay is conscious and aware. According to a social media post seeking medical and rehabilitation support for him, he communicates complete thoughts through eye movements and an alphabet-based scanning system.

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What Is Locked-In Syndrome?

Cleveland Clinic defines the syndrome as "a rare and serious neurological disorder that causes complete paralysis of all voluntary muscles except for the eyes, while leaving the person fully conscious and aware"

“Locked-in syndrome is one of the most devastating neurological conditions,” said Dr Sudhir Kumar, neurologist at Apollo Hospitals, Hyderabad, in a post on social media platform X.

The condition can leave a person unable to speak or move most muscles despite remaining conscious and aware.

It can severely affect communication and physical independence. However, the extent of impairment and potential for recovery can vary depending on the cause, location and severity of the brain injury, as well as whether the syndrome is complete or incomplete.

Is There A Medicine To Reverse It?

Dr Kumar said, “The honest answer is: There is currently no medicine or injection proven to reverse established locked-in syndrome.”

However, the absence of a proven medicine does not mean that supportive treatment and rehabilitation have no role.

Even after 13 months, Dr Kumar strongly recommended assessment at a specialised centre with experience in long-term neurorehabilitation and assistive technology.

Why Neurorehabilitation and Communication Matters

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Dr Kumar recommended a detailed reassessment by a multidisciplinary team that could include a neurologist, rehabilitation physician, physiotherapist, occupational therapist, speech and swallowing therapist, respiratory therapist, psychologist and specialist nurses.

Such an assessment can help identify even small voluntary movements that may have been missed or may have emerged over time.

He also recommended intensive, individualised neurorehabilitation focused on maintaining joint mobility, preventing contractures, improving head and trunk control, increasing sitting tolerance and supporting any residual voluntary movement.

“Even a small movement of a finger, thumb, head or eye can sometimes become functionally very important,” Dr Kumar said.

For people with locked-in syndrome, establishing a reliable way to communicate can be particularly important.

Dr Kumar stressed that “communication should be a top priority” and recommended considering an eye-gaze or eye-tracking communication system where appropriate.

“Restoring a reliable means of communication can dramatically improve autonomy and quality of life,” he said.

Swallowing, Respiratory Care And Mental Health

Dr Kumar also suggested “periodic reassessment of swallowing and bulbar function” and “speech-language therapy”, along with “chest physiotherapy, respiratory exercises, secretion management and periodic reassessment of ventilatory requirements”.

Emphasising the importance of mental health and quality of life, he said, “Never assume that a person with locked-in syndrome does not understand what is happening around them.”

What New Technologies Could Offer

Dr Kumar also highlighted “exciting ongoing research” into several technologies that could potentially improve communication, interaction and rehabilitation for people with severe paralysis.

These include:

1. Eye-tracking and advanced communication systems
2. Brain-computer interfaces (BCIs) that translate brain signals into computer commands
3. BCI-assisted communication for people with severe paralysis
4. Robotics and functional electrical stimulation
5. Virtual reality and technology-assisted rehabilitation
6. Non-invasive brain stimulation, such as transcranial direct current stimulation, currently being explored as an adjunct to rehabilitation

However, these technologies should not be presented as established treatments for locked-in syndrome.

“These technologies are promising, but it is important to be realistic: most are not yet proven treatments capable of reliably reversing locked-in syndrome,” Dr Kumar said.

For people living with locked-in syndrome, continued access to evidence-based rehabilitation, communication tools, assistive technologies and specialised care can remain important.

“For a man who has served our country, we owe him continued care, respect and access to every evidence-based opportunity for rehabilitation,” Dr Kumar said.

“There may not be a miracle medicine today. But there is still meaningful medicine to be practiced and meaningful hope to be offered.”

Tozorakimab, an investigational drug developed by AstraZeneca, reduced moderate-to-severe flare-ups of chronic obstructive pulmonary disease (COPD) in two late-stage trials, the company has announced.

Presented at the ongoing European Respiratory Society Congress in Barcelona, the results showed that patients receiving tozorakimab experienced about 29% to 34% fewer COPD exacerbations over one year compared with placebo, when added to standard inhaled therapy.

The results, also published in the New England Journal of Medicine, showed that the drug was generally well tolerated, with injection-site reactions reported as the only adverse drug reaction.

Researchers from the University of Pittsburgh who led the trials said the findings highlight tozorakimab’s potential as a treatment for people with COPD who remain at risk of exacerbations despite standard inhaled therapy.

What Is Tozorakimab?

Tozorakimab is a potential first-in-class monoclonal antibody targeting interleukin-33 (IL-33).

The drug is designed to inhibit signalling from both the reduced and oxidised forms of IL-33, with the potential to reduce inflammation and disrupt the cycle of mucus dysfunction that contributes to COPD worsening.

AstraZeneca is developing tozorakimab as an add-on maintenance treatment for adults with COPD.

What Did the COPD Trials Find?

The findings come from two replicate Phase 3 trials, OBERON and TITANIA, which included a total of 2,306 adults with symptomatic COPD who were current or former smokers and had a history of exacerbations despite stable standard-of-care inhaled maintenance therapy.

Tozorakimab 300 mg, given once every four weeks, reduced moderate-to-severe COPD exacerbations among former smokers by:

• 29% in OBERON

• 34% in TITANIA

In the overall population of current and former smokers, exacerbations were reduced by:

• 30% in OBERON

• 29% in TITANIA

The reductions were compared with placebo while patients continued inhaled standard-of-care treatment.

A pooled analysis of the two trials also showed clinically meaningful reductions across all prespecified patient subgroups, including those defined by blood eosinophil count (BEC).

Patients with a baseline BEC below 150 achieved a 23% reduction in moderate-to-severe exacerbations, while those with a BEC of 150 or higher achieved a 34% reduction. Among patients with a BEC of 300 or higher, the reduction was 43%.

“Today’s groundbreaking tozorakimab results, from two replicate trials, set a new standard for COPD treatment outcomes in a broad population of patients. AstraZeneca has clinically validated the novel approach of targeting the signalling of the two forms of IL-33 to both decrease inflammation and disrupt the cycle of mucus dysfunction. With our FDA Priority Review, we look forward to bringing this treatment to patients as quickly as possible,” said Sharon Barr, Executive Vice President, BioPharmaceuticals R&D, AstraZeneca.

What Happens Next?

The Biologics License Application for tozorakimab 300 mg, administered once every four weeks, has been accepted by the US Food and Drug Administration for Priority Review as an add-on maintenance treatment for adults with COPD.

Tozorakimab is also under regulatory review for COPD in major markets, including the EU and China.

The drug is being studied in a Phase II trial for severe asthma and a Phase III trial for severe viral lower respiratory tract disease. It received FDA Fast Track Designation for severe viral lower respiratory tract disease in November 2023 and for COPD in December 2024.

Why COPD Flare-Ups Matter

COPD is the third leading cause of death worldwide, excluding COVID-19. It is a progressive respiratory condition characterized by persistent airflow limitation and chronic inflammation of the airways.

Common symptoms include breathlessness, chronic cough, and excess mucus production.

COPD exacerbations can worsen these symptoms and contribute to ongoing inflammation and bronchoconstriction, making it difficult to breathe. They can also accelerate disease progression, increase hospitalizations and raise the risk of future cardiopulmonary events, including heart attacks.

In the US, COPD exacerbations cause more than 2,500 emergency department visits each day. Only 50% of COPD patients live more than 3.5 years after their first severe exacerbation.

Bangladesh was once close to eliminating measles but is now battling what has been described as the world’s largest measles outbreak. With close to 1,000 suspected and confirmed measles-related deaths since March 2026, the country is grappling with its worst outbreak.

According to Bangladesh health ministry data cited by Reuters, 999 deaths have been associated to the measles outbreak, including 100 laboratory-confirmed measles fatalities.

More than 166,000 suspected cases have been reported, including nearly 20,000 laboratory-confirmed infections. More than 146,000 suspected patients have also been hospitalised.

Bangladesh, who is already battling a worsening dengue crisis, is dealing with enormous strain on its healthcare system.

How Did Bangladesh Go From Near Elimination To A Massive Outbreak?

Measles is one of the world’s most contagious infectious diseases. It spreads through respiratory droplets and airborne particles when an infected person coughs, sneezes or breathes. But measles is also highly preventable through vaccination.

For much of the past decade, Bangladesh maintained measles vaccination coverage at or above the 95% level recommended by the World Health Organization (WHO) for preventing long-term transmission.

The vaccine coverage dropped during the COVID-19 pandemic, but the country had otherwise made substantial progress toward elimination.

The political upheaval in 2024 and 2025 disrupted routine immunisation which contributed to the current crisis.

Bangladesh’s health minister, Sardar Md. Sakhawat Husain, told parliament that changes in vaccine procurement contributed to shortages.

A vaccination programme was postponed in 2024, while a nationwide measles-rubella campaign planned for the following year was cancelled, according to Reuters. That left growing numbers of children without adequate immunity.

“Bangladesh missed its measles elimination target because of vaccination gaps in 2024 and 2025,” said Professor Mahmudur Rahman, an epidemiologist and former director of the Institute of Epidemiology, Disease Control and Research.

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Young Children Bearing The Brunt

Children under five have been particularly affected, making up for about 80% of cases during the initial stages of the outbreak.

Infants are especially vulnerable because babies younger than nine months may be too young to receive the routine measles vaccine, according to the country’s vaccine schedule.

When vaccination coverage falls in older children and adults, the virus can circulate more widely, increasing the chances that infants will encounter it before they are protected.

Measles itself can cause high fever, cough, runny nose and the characteristic rash. But the danger comes from its complications.

Children can develop pneumonia, severe dehydration, ear infections and encephalitis, or inflammation of the brain. Malnutrition can make severe disease more likely.

“To my knowledge, Bangladesh has never witnessed so many children dying from measles. Nor have we ever seen such a high number of patients in a single year. This is a truly terrible situation, and the saddest part is that the victims are children,” Rahman said.

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Bangladesh Has Started A Massive Vaccination Response

The government launched an emergency measles-rubella vaccination campaign in April, supported by international health agencies.

More than 19.7 million children have been vaccinated through the campaign, according to Reuters. But public health experts say emergency campaigns alone cannot solve the problem.

The country also needs to restore routine childhood immunisation, identify children who missed earlier doses and close the immunity gaps that allowed the virus to spread so rapidly.

UNICEF had already warned in April that the outbreak was disproportionately affecting young children. Its early situation report recorded nearly 10,000 suspected cases and 128 suspected measles-related deaths by April 7, highlighting how quickly the outbreak escalated.