[Tobacco and tuberculosis: the nature of the links and the consequences of this association]. / Tabac et tuberculose : nature des liens et conséquences de cette association.

Tuberculosis and smoking are responsible for significant mortality worldwide. Smoking is spreading in emerging countries, and its prevalence is high in developed countries among socially disadvantaged populations; it could be the source of a resurgence of tuberculosis in future years. The aim of this review is to clarify the consequences of the association between smoking and tuberculosis, and the benefits of smoking cessation for smokers with tuberculosis.

[Smoking cessation in smokers under treatment for lung cancer. Current data]. / L'arrêt du tabac chez les fumeurs traités pour cancer du poumon.

In 2020, lung cancer was the cause of 18 % of all cancer deaths; smoking accounting for around 90 % of all lung cancers. Despite advances in lung cancer treatment, tobacco control measures are the most effective in curbing the lung cancer epidemic. Nevertheless, smoking cessation at all stages of the cancer process is associated with benefits in terms of cure, improved life expectancy and quality of life for patients, reduced medical or surgical complications, and reduced risk of recurrence or occurrence of a second primary cancer. Consequently, smoking cessation is an essential component of lung cancer treatment. All healthcare professionals, particularly those involved in the care of lung cancer patients, must help smokers to quit.

En 2020, le cancer du poumon était la cause de 18 % des décès par cancer; le tabagisme est à l'origine d'environ 90 % des cancers du poumon. En dépit des progrès réalisés dans le traitement de ce cancer, les mesures de contrôle du tabac sont les plus efficaces pour enrayer l'épidémie de cancer du poumon. Néanmoins, le sevrage tabagique, à tous les stades du processus cancéreux s'accompagne de bénéfices en termes de guérison, d'amélioration de l'espérance de vie, de la qualité de vie des patients, de réduction des complications médicales ou chirurgicales et du risque de récidive ou d'apparition d'un second cancer primitif. Par conséquent, le sevrage tabagique est une composante essentielle du traitement du cancer du poumon. Tous les professionnels de santé, particulièrement ceux impliqués dans le soin aux patients souffrant de cancer du poumon, doivent aider les fumeurs à arrêter le tabac.

Systematic Review and Critical Analysis of Longitudinal Studies Assessing Effect of E-Cigarettes on Cigarette Initiation among Adolescent Never-Smokers.

Prospective longitudinal studies mainly conclude on a causal role of e-cigarettes in the initiation of cigarettes in flagrant contradiction with conclusions drawn from epidemiology and other studies showing a sharp decline in cigarette use in parallel with the spread of e-cigarette use. This systematic review explores the reasons for this discrepancy. METHODS: Among 84 publications on e-cigarette/cigarette association in adolescents identified in the Medline database from 2011 to 2022, 23 concern 22 never-smoker longitudinal sub-cohorts. RESULTS: A link between e-cigarette experimentation at T1 and cigarette initiation at T2 is reported in sub-cohort analyses of never-smokers (AOR: 1.41 to 8.30). However, studies exclude 64.3% of T1 e-cigarette experimenters (because of dual-use) and 74.1% of T2 cigarette experimenters. With this study design, e-cigarettes contribute only to 5.3% of T2 cigarette experimentation, casting major doubt on the external validity of results and authors' conclusions that e-cigarettes have a significant effect on the initiation of cigarettes (Gateway effect) at the population level. This sub-cohort design prohibits highlighting any Diversion effect, which is the most likely mechanism accounting for the competition between these two products. CONCLUSIONS: While nicotine abstinence remains the best medical option, over-regulation of e-cigarettes because of misinterpretation of longitudinal study results may be detrimental to public health and tobacco control.

[Shisha smoking: infatuation and harmfulness]. / La chicha : engouement et nocivité.

"Shisha smoking: infatuation and harmfulness. The use of shisha (hookah, water pipe, narghile) consists in the inhalation of tobacco smoke, after passing through water is spreading among young people. This practice induces dependency and short and long-term health risks like those of smoking to health. Control measures against the practice of regulatory order, preventive, including strengthening the cessation aid users and conduct research on this mode of consumption are essential."

La chicha : engouement et nocivité. L'usage de la chicha (hookah, pipe à eau, narguilé) consiste en l'inhalation de fumée de tabac après passage dans de l'eau se répand parmi les jeunes. Cette pratique induit une dépendance et des risques à court et long terme pour la santé analogues à ceux de la cigarette pour la santé. Des mesures de lutte contre cette pratique d'ordre réglementaires, préventives, incluant le renforcement de l'aide à l'arrêt des usagers et la réalisation de recherches sur ce mode de consommation sont indispensables.

[From reducing tobacco consumption to stopping completely, what accompaniment?] / De la réduction de consommation du tabac vers l'arrêt complet, quel accompagnement ?

Reducing tobacco consumption does not reduce the risk of mortality and morbidity associated with pathologies caused by smoking. It should therefore only be a transitional step towards a complete stop. Caregivers will encourage the use of smoking cessation medication that avoid the phenomenon of compensation and promote complete cessation of smoking.

[Influence of post-traumatic stress disorder on asthma]. / Influence du trouble stress post-traumatique sur l'asthme.

INTRODUCTION: Exposure to a traumatic event may not only lead to a large variety of mental disorders, such as post-traumatic stress disorder (PTSD) but also respiratory symptoms and/or respiratory diseases, as asthma. OBJECTIVES: Systematic literature review of data on the impact of post-traumatic stress disorder on asthma. DOCUMENTARY SOURCES: Medline, on the period 1980-2018 with the following keywords: "PTSD" or "post-traumatic stress disorder" or "post-traumatic stress disorder" and "asthma", limits "title/abstract"; the selected languages were English or French. Among 141 articles, 23 abstracts have given use to a dual reading to select 14 studies. RESULTS: While PTSD may develop 4 weeks after being exposed to a traumatic event during which the physical integrity of the person has been threatened, it might also develop several months or years later. PTSD has been reported to be a risk factor for asthma and also a factor that might enhance a preexisting asthma. It is also important to note that this relation has been highlighted among several populations, traumatic events and regardless the gender and/or cultural factors. Despite its impact on the development of asthma, in asthmatic patients, PTSD may be responsible for poor asthma control, increased rates of healthcare use (visit in the emergency department and/or hospitalization for asthma) and poor asthma-related quality of life. The study of the association between PTSD and asthma have to take into account some potentially confounding factors, such as smoking status and dust exposure (e.g.: asthma following the terrorist attacks of the World Trade Center). Less is known regarding the potential mechanisms involved in the association between PTSD and asthma. Several factors including the nervous system, the hypothalamo-pituitary-adrenal axis, the inflammatory response and the immune system may explain the association. CONCLUSION: PTSD is a risk factor for the development of asthma and for the worsening of preexisting asthma. In asthmatic patients, it is of primary importance to systematically screen potential PTSD that might be developed after a traumatic event or a preexisting traumatic condition. Moreover, after exposure to a traumatic event, a special attention needs to be paid to somatic reactions such as asthma. The majority of studies having been conducted on American samples, replicating studies among European samples appears of prime importance in order to add a body of knowledge on the association between somatic and psychiatric conditions.

[Helping the smoker at each stage of maturation of the decision to quit smoking]. / Aider le fumeur à chaque étape de maturation de la décision d'arrêt du tabac.

Une personne qui arrête de fumer passe par cinq stades de maturation de la décision et par le stade, facultatif, de rechute. L'évaluation de la motivation à l'arrêt à l'aide d'autoquestionnaires simples et rapides est recommandée. À chaque stade, le soignant peut et doit aider le fumeur à faire face aux éventuelles difficultés, en utilisant les techniques des thérapies cognitives et comportementales.

[COPD: think about occupational exposures!] / Bpco : pensez aussi aux causes professionnelles !

Copd: think about occupational exposures! Unfortunately, the occupational exposures of COPD are still poorly taught and poorly researched, although they account for 15 to 20% of all COPD. The clinician must know them well and therefore systematically seek them for any newly diagnosed case. A thorough and rigorous professional interview allows to trace the entire professional career, even when the patient smokes. The main exposures in industrial and agricultural sectors are described. Recognition of COPD in occupational diseases is only possible in France since a few years, in a restrictive way. The prevention of occupational COPD (reduction or elimination of environmental pollution in the workplace) is likely to reduce the incidence of COPD in exposed workers. A regular monitoring to detect early COPD (spirometry) is needed.

Bpco : pensez aussi aux causes professionnelles ! Mal connues, les causes professionnelles des bronchopneumopathies chroniques obstructives (BPCO) sont encore peu enseignées et mal recherchées, bien qu'à l'origine de 15 à 20 % des BPCO. Le clinicien doit bien les connaître et donc les rechercher systématiquement devant tout cas nouvellement diagnostiqué. Un interrogatoire professionnel complet et rigoureux permet de retracer toute la carrière professionnelle, même lorsqu'il existe une intoxication tabagique avérée. Les principales expositions en milieu industriel et en secteur agricole sont décrites. La reconnaissance des BPCO en maladie professionnelle n'est possible en France que depuis quelques années, de façon encore très limitative. La prévention des BPCO d'origine professionnelle (réduction ou suppression des pollutions de l'environnement du travail) est susceptible de diminuer l'incidence de cette pathologie chez les travailleurs exposés. Ils doivent bénéficier d'une surveillance régulière nécessaire pour dépister une BPCO débutante (spirométrie).

[Asthma and heroin use]. / Asthme et usage d'héroïne.

INTRODUCTION: Heroin use can be responsible for many respiratory complications including asthma. OBJECTIVES: Systematic literature review of data on asthma in heroin users. DOCUMENTARY SOURCES: Medline®, on the period 1980-2017 with the following keywords: keywords: "asthma" or "bronchospasm" and "heroin" or "opiate" or "opiates", limits "title/abstract"; the selected languages were English or French. Among 97 articles, 67 abstracts have given use to a dual reading to select 23 studies. RESULTS: The seven case reports included 21 patients (mean age: 28 years [19-46 years]; sex-ratio: 2.5 [males: 71.5%]). Heroin was inhaled (71.4%), sniffed (19%) or injected by intravenous route (9.5%). Associated addictive substances were tobacco (81%), cannabis (38%), alcohol (4.7%) and cocaine (4.7%). Outcome was fatal in 3 subjects (14.3%). Other studies included one cross-sectional study, 3 case-control studies and 12 longitudinal studies (11 retrospective studies and one prospective study). The proportion of heroin users was higher in asthmatic subjects and the prevalence of asthma and bronchial hyperreactivity was higher in heroin users. Heroin use can be responsible for asthma onset, with a temporal relationship between the onset of heroin use and asthma onset in 28 to 31% of subjects. A positive association between inhaled heroin use and acute asthma exacerbation was observed. Asthma treatment observance was lower in heroin users. In case of asthma exacerbation, heroin users were more likely to seek care in the emergency department, to be admitted in intensive care units and to require intubation and invasive ventilation. Asthma deaths related to heroin use mainly occurred following an intravenous injection (especially in the case of overdose), but also following heroin use by nasal (sniff) or pulmonary route. CONCLUSION: Heroin use may be responsible for asthma onset, acute asthma exacerbations (which may require intubation and invasive ventilation) or deaths related to asthma. Heroin use must be sought in case of asthma exacerbation in young persons and practitioners must help heroin users to stop their consumption.

[Pneumomediastinum and cocaine use]. / Pneumomédiastin et consommation de cocaïne.

INTRODUCTION: In France, cocaine is the second most commonly used illicit drug after cannabis. It can be responsible for many respiratory disorders among which pneumomediastinum. OBJECTIVES: Systematic literature review of data on pneumediastinum in cocaine users. Documentary sources. Medline, on the period 1980-2016 with the keywords "pneumomediastinum" and "cocaine" or "free-base" or "freebasing" or "crack"; limits "title/abstract"; the selected languages were English or French. Among 72 articles, 48 abstracts have given use to a dual reading to select 37 studies. RESULTS: Thirty-five selected articles related 44 subjects (sex-ratio: 5.2) whose age ranged from 15 to 36 years. Fourteen subjects used cocaine nasally and 30 others smoked it (12 as free-base and 18 in the form of crack). Thirty-two subjects had an isolated pneumomediastinum and 12 others had a pneumomediastinum combined with other gaseous effusions (pneumothorax, pneumopericardium, pneumoperitoneum or pneumorachis). Chest pain of sudden onset in the most common symptom which is often associated with tightness or swelling of the neck; more rarely there are dyspnea and/or a dry cough. The time between taking cocaine and the onset of the symptoms varies from a few minutes to 3 days. The course is usually good with healing in 1 to 4 days. CONCLUSION: Cocaine use may be responsible for spontaneous pneumomediastinum. Practitioners must seek cocaine use in case of pneumomediastinum in a young person and consider the diagnosis in the case of sudden chest pain in cocaine users; they must help them to stop their consumption.

[Efficacy and security of electronic cigarette for tobacco harm reduction: Systematic review and meta-analysis]. / Efficacité et sécurité de la cigarette électronique pour la réduction du tabagisme : revue systématique et méta-analyse.

CONTEXT: Smoking is the first cause of preventable death in France and in the world. Without help, it was shown that 80 % of smokers who try to quit smoking relapse after one month with a low long-term success rate. Smoking reduction can concern smokers who did not want to quit or failed in their attempt to weaning. The final aim is to increase attractiveness of drug therapies by developing new products, such as electronic cigarettes, that can compete cigarette without reproducing its harmful effects. OBJECTIVE: Assess the capacity of electronic cigarettes to reduce or stop tobacco use among regular smokers. DATA SOURCES: Consultations MEDLINE and COCHRANE databases. KEYWORDS: e-cigarette; electronic cigarettes; ENDD (electronic nicotine delivery system); ENDS (electronic nicotine delivery device); vaping were used. TRIAL SELECTION: Randomized controlled trials (RCTs) comparing the electronic cigarette with nicotine versus placebo device. RESULTS: Two randomized controlled trials were included in the quantitative analysis. The nicotine electronic cigarette users have tobacco consumption significantly decreased compared to the placebo group (RR: 1.30, 95 % CI [1.02 to 1.66]) at 6 months. Smoking cessation rate at 3 months was greater with the electronic cigarette contains nicotine (RR: 2.55, 95 % CI [1.31 to 4.98]). LIMITS: The small number of RCTs included does not allow definitive conclusions about the effectiveness of electronic cigarettes, especially in the medium to long term. CONCLUSION: The use of electronic cigarette with nicotine decreases tobacco consumption among regular smokers. Further studies are needed to specify electronic cigarettes safety profile and its ability to cause a reduction in consumption and a long-term cessation in smokers.

[Smoking, smoking cessation and Crohn's disease]. / Tabagisme, sevrage tabagique et maladie de Crohn.

CONTEXT: Smoking whose prevalence is higher in patients with Crohn's disease (CD) worsens its evolution. Ulcerative colitis mostly affect non- or ex-smokers; smoking may improve the course of the disease. OBJECTIVES: Systematic literature review of data on the relationship between smoking, smoking cessation and Crohn'disease. DOCUMENTARY SOURCES: Medline, on the period 1980-2015 with the keywords "Crohn's disease" or "inflammatory bowel disease" and "smoking" or "smoking cessation"; limits "Title/Abstract"; the selected languages were English or French. STUDY SELECTION: Among 1315 articles, 168 abstracts have given rise to a dual reading to select 69 studies (case-control, retrospective, reviews or meta-analysis). Data were extracted using a reading gate. RESULTS: Smoking increases the risk of complications, recurrences and resort of surgery, corticosteroids or immunosuppressants. These deleterious effects are more common in women. Stopping smoking improves the course of the disease and represents an essential component of its management. LIMITS: Heterogeneity of the studies collected according to the type, population characteristics, definition of smoking status and the validation of smoking cessation. CONCLUSION: Smokers suffering from CD must routinely be made aware of the disadvantages of smoking, benefits of abstinence and helped to quit smoking.

[Smoking and tuberculosis]. / Tabac et tuberculose.

Smoking and tuberculosis represent two major world health issues particularly in developing countries. Tobacco smoke increases risk of Mycobaterium tuberculosis infection by several means: alteration of muco-ciliary clearance, reduced alveolar macrophage activity; immune-depression of pulmonary lymphocytes, reduction of cytotoxic activity of natural killer cells, alteration of the activity of the pulmonary dendritic cells. Both active and passive smoking increases the risk of latent tubercular infection and of pulmonary and extra-pulmonary tuberculosis. Active smoking increases the severity of pulmonary tuberculosis (gravity of radiological lesions). The diagnostic delay and recovery details are more important for smokers. Active smoking increases relapses of both pulmonary and extra-pulmonary tuberculosis after treatment with or without the Directly Observed Treatment Short course (DOTS) with poor observance of treatment. The mortality risk from tuberculosis is heightened among smokers. Smoking cessation represents an essential means of controlling tuberculosis epidemics in developing countries.

[Smoking: what are the health risks?]. / Tabac: quels risques pour la santé?

Smoking is the primary cause of avoidable deaths in developing countries; it is the principal cause of many illnesses and is risk factor or aggravated cause. Cigarettes or smokeless tobacco have a direct or indirect toxicity effect on practically every organ. The induced diseases are cardiovascular, cancers, respiratory complaints and many consequences less well known but often serious. There is no smoking without risk; however, stopping smoking at any age is beneficial.

[Smokeless tobacco]. / Le snus.

The use of snus (smokeless tobacco) can be detrimental to health. Containing carcinogenic nitrosamines (Swedish snus do not contain nitrosamine). Snus delivers rapidly high doses of nicotine which can lead to dependence. It do not induce bronchial carcinoma differently smoked tobacco. Lesions usually develop in the area of the mouth where the snus is placed. Non-malignant oral lesions include leukoedema, hyperkeratotic lesions of the oral mucosa and localised periodontal disease. The most frequently occurring premalignant lesion is leukoplakia. Studies reveal conflicting evidence about the risk of oral and gastroesophageal cancer with regard to snus users. However, the use of snus has proved to be a risk factor in developing pancreatic cancer and increases the risk of fatal myocardial infarction and ischemic stroke. During pregnancy, snus is associated with an increased risk of pre-eclampsia and premature delivery. Nicotine substitution therapy and bupropion and varenicline reduce withdrawal symptoms and tobacco craving during snus cessation. However, they have not been shown to assist in long-term abstinence. Information concerning potential hazards of using snus products must be incorporated into health educational programmes in order to discourage its use. Snus is not a recommended product to help in stopping to smoke.

[Influence of doctors' smoking habits on minimal advice for smoking cessation. A survey of 369 general practitioners in the department of Vienne, France]. / Influence du tabagisme des médecins sur la pratique du "conseil minimal". Enquête auprès de 369 médecins généralistes de la Vienne.

INTRODUCTION: French doctors' smoking habits may interfere with the effectiveness of smoking prevention measures and particularly when providing minimal advice. OBJECTIVES: To assess the smoking habits of general practitioners in the department of Vienne, France, and to study how they affect minimal advice for smoking cessation. METHOD: 257 general practitioners took part in a phone survey (26.5%) or answered a written questionnaire (73.5%). The questions bore on socio-demographic characteristics, smoking habits and the of minimal advice provided whether partial or whole. Do you smoke? If so, have you ever thought of quitting? RESULTS: The participation rate was 70%. 26% of the participants were current smokers--16 % regular smokers, 10% infrequent smokers, 30% had quit and 44% had never smoke. 44.4% investigated smoking habits as a matter of course, and 41% provided intensive advice for smoking cessation. Doctors who had never smoked gave more advice than those who currently smoked or had quit. DISCUSSION: A comparison with former studies reveals that the number of doctors who smoke has decreased. However, minimal intervention on smoking cessation is put into practice by less than half of the doctors. CONCLUSION: The incidence of smoking among doctors in the Department of Vienne remains too high and minimal intervention on smoking cessation is still insufficient. However, doctors who had never smoked provided minimal advice more often than those who currently smoked or had quit.