[Bronchial diseases and heroin use. A systematic review]. / Pathologies bronchiques et usage d'héroïne. Revue systématique.

INTRODUCTION: Heroin use can cause respiratory complications including asthma, chronic obstructive pulmonary disease (COPD) and bronchiectasis (BD). OBJECTIVES: A general review of the literature presenting the data on the relationships between heroin consumption and bronchial complications, while underlining the difficulties of diagnosis and management. DOCUMENTARY SOURCES: Medline, 1980-2022, keywords "asthma" or "bronchospasm" or "COPD" or "bronchiectasis" and "heroin" or "opiate" or "opiates", with limits pertaining to "Title/Abstract". Concerning asthma, 26 studies were included, as were 16 for COPD and 5 for BD. RESULTS: Asthma and COPD are more prevalent among heroin addicts, who are less compliant than other patients with their treatment. The authors found a positive association between frequency of asthma exacerbations, admission to intensive care and heroin inhalation. Late diagnosis of COPD worsens the course of the disease; emphysema and BD are poor prognostic factors. CONCLUSION: Bronchial diseases in heroin users can be identified by means of respiratory function exploration and chest CT scans. These tests should be performed frequently in view of optimizing their care, which includes their weaning themselves from addictive substances.

[Diffuse alveolar hemorrhage in cannabis smokers. A systematic literature review]. / Hémorragies alvéolaires diffuses chez les fumeurs de cannabis. Revue systématique.

Cannabis is the most widely used illicit psychoactive substance in France. It can be responsible for numerous pulmonary complications, including diffuse alveolar hemorrhage (DAH). The objective of this systematic review of the literature was to present data concerning the relationship between cannabis smoking and DAH, which has rarely been reported in the literature. The review was based on a Medline search covering the 1980-2022 period and utilizing data drawn from 10 articles. DAH diagnosis is based on an association of hemoptysis, anemia and diffuse alveolar opacities on chest radiography with siderophages in the Bronchoalveolar Lavage Fluid (BAL). The 11 patients identified in this review were daily or regular cannabis smokers; in 4 cases they presented recent or recurrent hemoptysis with anemia; imaging revealed diffuse alveolar opacities in 10 of them, while BAL endoscopy highlighted a diffuse hemorrhage in the bronchial tree, and siderophages were observed in 6 cases. While evolution was favorable when cannabis consumption was discontinued, resumption occasioned DAH recurrence, and one patient died. Advice to quit should systematically be accompanied by addictological follow-up.

[What is the contribution of smoking to the increased risk of suicide in young smokers? A systematic review]. / Quelle est la part du tabagisme dans l'augmentation du risque suicidaire chez les jeunes fumeurs ? Revue systématique.

OBJECTIVES: The correlation between smoking and suicide is well documented in the general population: there is an increased risk of suicide among tobacco smokers. However, the association between smoking and suicidal behaviors (ideations, plans, attempts) in youth is poorly elucidated. This is a systematic review of the literature examined data on the relationship between active and passive smoking and suicidal ideation (SI), suicide planning (SP), and suicide attempts (SA) among youth in the general population. METHOD: Medline searches were performed for the period 1980-2020. Cross-sectional, case-control, prospective population-based studies of young people (age less than 18 years) were included in this review; studies of specific populations (patients with an identified pathology of any kind) were excluded. RESULTS: This review included 43 studies: 23 studies on the association between active smoking and SI, SI and/or PS, TS; three studies on the association between passive smoking and suicidal behavior, three studies on the association between smoking and suicidal behavior in young people in psychiatric hospital settings, and five studies comparing the suicidal behavior of girls and boys. Analysis of the data collected lead to the conclusion that active or passive smoking is associated with suicidal behavior in young people. Smoking appears to contribute to psychopathological disorders, including depression, the use of other psychoactive substances, or psychosocial suffering which are often associated with an increased risk of suicide in young people. The correlations between smoking and the presence of mental disorders have been highlighted; tobacco use may contribute to the development of depression, anxiety and stress. Further studies are needed to verify the existence of a causal link between smoking and suicide. CONCLUSION: Smoking is associated with the risk of suicidal behavior in young people; it should be included among the criteria for assessing suicidal risk in youth. Smoking cessation, which improves psychological well-being, should be further integrated into the prevention of suicidal behavior.

Clinical insight level predicts successful quit or control attempts during the first three months of outpatient addiction treatment.

INTRODUCTION: Low clinical insight in psychiatry is defined as poor recognition of one's mental illness, including disability to self-evaluate symptom severity. It has been reported as common in addiction and is associated with lower treatment compliance. Longitudinal studies suggest that low clinical insight could be linked to more relapse. However, association with successful quit attempts remains unknown. OBJECTIVE: Our objective was to examine the prospective link between baseline clinical insight level and self-reports of successful attempts to quit / control use during the first 3 months of outpatient addiction treatment. METHODS: Participants were recruited from the ADDICTAQUI cohort at outpatient treatment intake for substance or behavioral addictions. They completed a baseline evaluation using the Addiction Severity Index (ASI), the Mini International Neuropsychiatric Interview (MINI), and the modified Hanil Alcohol Insight Scale (m-HAIS) with a follow-up ASI 3 months later. Data were analyzed using multiple logistic regression and non-parametric tests. RESULTS: Lower clinical insight level at baseline was associated with less successful quit / control attempts during the first 3 months of outpatient treatment compared to a higher clinical insight level, controlling for sociodemographic factors, baseline addiction severity, and comorbidities (n = 54; exp(B) = 0.76; p (FDRcor) = 0.033). CONCLUSION: Poor clinical insight may be a barrier to treatment success, and future studies should examine underlying mechanisms.

[Combinations of pharmacological treatments in smoking cessation. A systematic review]. / Combinaisons des traitements pharmacologiques au cours du sevrage tabagique. Revue systématique.

INTRODUCTION: The effectiveness of the three validated smoking cessation medications, nicotine replacement therapy, varenicline and bupropion, may be insufficient, in hard-core smokers. OBJECTIVES: This systematic review investigates the efficacy of combinations of different medications in smoking abstinence and their tolerability. RESULTS: Three randomized controlled trials (RCTs) compared the combined medications with varenicline and nicotine patches vs. varenicline; two found an increase in abstinence rates with the combined medications. In one study, the beneficial effect was only observed in heavy smokers. The four RCTs comparing the combined medications with varenicline and bupropion (vs. varenicline) demonstrated an increase in abstinence rates with the combined medications, most often in heavy smokers who are very dependent on tobacco. The results of the three RCTs comparing the combined medications with bupropion and nicotine replacement therapy vs. varenicline were discordant. Three studies included other molecules (mecamylamine, selegiline, sertraline, buspirone). Combined medications were well tolerated. CONCLUSION: Combination treatments can achieve higher smoking abstinence rates than monotherapies, especially in smokers who have failed to quit (Hard-core smokers). Treatment with a combination of varenicline and nicotine replacement therapy is a therapeutic option in smoking cessation.

[Contribution of electronic cigarettes in smoking patients with psychotic disorders. A literature review]. / Cigarette électronique chez les patients fumeurs présentant une pathologie psychotique. Revue de la littérature.

OBJECTIVES: This systematic literature review focused on patients suffering from schizophrenia (SZ), psychotic disorders or mental illness (MI) including SZ. It was interested in data on prevalence of electronic cigarette (EC) use, patient perceptions and expectations, as well as caregivers' attitudes towards the EC and its benefit in helping to stop or reduce smoking. METHOD: The research was carried out on Medline for the period 2000-2020. Cross-sectional, case-control, prospective, randomized controlled studies and preliminary studies were included in this review. RESULTS: EC is widely used by MI patients with current and lifetime use from 7.4% to 28.6%. More specifically, patients with SZ and schizoaffective disorders observe current and lifetime use from 7% to 36%, respectively. Many reasons are given by patients for its use including the possibility of using it in places where smoking is prohibited, its lower toxicity compared to cigarettes for oneself and those around, its lower cost, and the help provided to reduce consumption. CONCLUSION: EC is used by smokers with MI; several studies confirm the possibility for these smokers to reduce tobacco consumption through EC and without disturbing their mental state. However, its value in helping to quit smoking remains uncertain.

[Smoking cessation in asthmatic patients and its impact]. / Spécificité du sevrage tabagique chez l'asthmatique et effets du sevrage sur l'asthme.

INTRODUCTION: The prevalence of smoking in asthmatic patients is similar to, or even higher than in the general population. OBJECTIVES: This systematic review addresses (1) the effects of smoking on asthma, (2) smoking cessation strategies in asthmatic patients, and (3) the consequences of smoking cessation for people with asthma. RESULTS: Active or passive smoking can promote the development of asthma. The few studies on smoking cessation in asthma confirm the efficacy of validated smoking cessation strategies in these patients (nicotine replacement therapy, varenicline, bupropion, cognitive and behavioural therapies). Smoking cessation in parents with asthmatic children is essential and is based on the same strategies. Electronic cigarettes may be a useful help to quit smoking in some patients. Smoking cessation is beneficial in asthmatic smokers and associated with (1) a reduction of asthma symptoms, acute exacerbations, bronchial hyperresponsiveness, and bronchial inflammation, (2) decreased use of rescue medications and in doses of inhaled corticosteroids, (3) improved asthma control, quality of life, and lung function. CONCLUSION: In asthmatic patients, it is essential to assess smoking status and health professionals must assist them to quit smoking.

[Electronic cigarette use in patients with asthma]. / Usage de la cigarette électronique chez le patient asthmatique.

The proportion of patients whose asthma is poorly controlled due to their smoking remains high. Electronic cigarette (EC) is a new tool to help people stopping smoking, which substitutes a much less irritating aerosol to very toxic cigarette smoke, but it cannot be considered completely healthy. It represents a possible assistance for asthmatic smokers who wish using it to stop smoking. This article is a systematic review of the literature on the data concerning the relationships between EC use and asthma. There is a positive association between asthma symptoms, their severity and current use of CE in adolescents. The results are more contrasted in adult asthmatic CE users compared to cigarette smoking. CE should not be used by adolescents but can help, in exclusively use, adults with asthma stopping smoking.

La proportion de patients dont l'asthme est mal contrôlé du fait de leur tabagisme demeure élevée. La cigarette électronique (CE) est un nouveau moyen d'aide à l'arrêt du tabac qui substitue, à la fumée de cigarette très toxique, l'inhalation d'un aérosol beaucoup moins irritant mais elle ne peut pas être considérée comme parfaitement saine. Elle est un recours possible pour les asthmatiques fumeurs qui souhaite l'utiliser pour arrêter le tabac. Cet article réalise une revue systématique de la littérature sur les données concernant les relations entre l'usage de la CE et l'asthme. Il existe une association positive entre les symptômes d'asthme, leur sévérité et l'usage actuel de la CE chez les adolescents. Les résultats sont plus contrastés chez les adultes asthmatiques usagers de la CE comparativement à l'usage de la cigarette. La CE ne doit pas être utilisée par les adolescents mais peut aider, en usage exclusif, les adultes asthmatiques à arrêter de fumer.

[Asthma and cannabis, cocaine or heroin use]. / Asthme et usage de cannabis, de cocaïne ou d'héroïne.

INTRODUCTION: The use of cannabis, cocaine or heroin can be responsible for many respiratory complications including asthma. OBJECTIVES: The aim of this systematic literature review of data was to expose the relations between cannabis, cocaine or heroin use and asthma. RESULTS: Cannabis, cocaine or heroin use by inhalation may be responsible for respiratory symptoms (cough, wheezing), asthma onset, acute asthma exacerbations (which may require intubation and invasive ventilation) or deaths related to asthma. Lower adherence to asthma treatment is also observed. Cannabis induces a rapid bronchodilator effect. In contrast, its chronic use may induce a decrease in specific airway conductance. Studies on forced expiratory volume in one second (FEV1) reduction or decline are discordant. CONCLUSION: Cannabis, cocaine or heroin use must be considered in cases of acute respiratory symptoms or asthma exacerbation in young persons and practitioners must help illicit substance users to stop their consumption.

[Carbon monoxide poisoning in active or passive shisha smokers]. / Intoxication au monoxyde de carbone chez les fumeurs actifs ou passifs de chicha.

In France, shisha (narghile) smoking is increasingly popular among adolescents and young adults and is generally thought to be less harmful and addictive than cigarettes. This systematic review of data on carbon monoxide (CO) poisoning in active or passive shisha tobacco smokers selected 17 studies. Sixteen case reports, including 39 patients (mean age: 22.3 years; males: 51.3%), described acute carbon monoxide poisoning in active shisha smokers. The most common symptoms were dizziness, headache, and nausea. Loss of consciousness occurred in 43.6% of patients. Two patients had an epileptic seizure. The mean carboxy-haemoglobin (HbCO) blood level was 17.3%. Electrocardiographic changes were present in five patients. Most patients were treated with normobaric oxygen therapy while only four received hyperbaric oxygen therapy; two of whom were non tobacco smokers exposed to shisha smoke during their work. The outcome was favourable in all patients. Shisha use must be suspected in cases of CO poisoning, especially in adolescents and young adults. Practitioners must help shisha users to stop their consumption.

[Acute eosinophilic pneumonia and illicit psychoactive substance use]. / Pneumonies aiguës à éosinophiles et usage de substances psychoactives illicites.

Illicit psychoactive substance (IPAS) use can lead to a number of respiratory complications, including acute eosinophilic pneumonia (AEP). Systematic literature review of data on AEP in IPAS users (cannabis, cocaine, heroin and amphetamine). Of two cases of cannabis and tobacco users reported to have developed AEP, one, a teenage15 year old boy presented with acute respiratory distress syndrome (ARSD) which necessitated extracorporeal membrane oxygenation (ECMO). Five cases of AEP in cocaine smokers (crack) are reported, one of which was fatal. The patient presented with acute pulmonary edema and ARDS which progressed to ventricular fibrillation and asystole. A 24-year-old woman presented with AEP after repeated inhalation of heroin. Finally, a case of an amphetamine abuser who developed AEP and ARDS after amphetamine inhalation is reported. The time between the first IPAS use and admission in cases reported ranged from 7 days to 4 years, while time between the last IPAS use and admission was short (less than 15 days). IPAS use must be sought in case of AEP, especially in young adults, and practitioners must advise and help users to stop their consumption.

[Pulmonary complications in cocaine users]. / Complications pulmonaires chez les consommateurs de cocaïne.

Cocaine can be responsible for many psychiatric and/or somatic disorders. The aim of this systematic literature review of data was to expose relations between cocaine use and pulmonary complications. Cocaine can be responsible for acute respiratory symptoms (cough, black sputum, hemoptysis, dyspnea, wheezing, chest pain) and for various pulmonary disorders including barotrauma (pneumothorax, pneumomediastinum, subcutaneous emphysema, pneumopericardium), airway damage, asthma, bronchiolitis obliterans with organizing pneumonia, acute pulmonary edema, alveolar hemorrhage, alveolar pneumonia with carbonaceous material, bullous emphysema, acute eosinophilic pneumonia, pulmonary granulomatosis caused by talc or cellulose, interstitial pneumonitis and pulmonary fibrosis, vasculitis, pulmonary hypertension, pulmonary embolism and pulmonary infarction, mycotic pulmonary arterial aneurysms, septic emboli, aspiration pneumonia, community-acquired pneumonia, HIV-related opportunistic infections, latent tuberculosis infection, pulmonary tuberculosis, lung cancer and crack lung. Some of these complications are serious and may have a fatal outcome. Pulmonary function tests, thoracic tomodensitometry, bronchial fibroscopy with bronchoalveolar lavage and lung scintigraphy may be an aid to the diagnosis of these pulmonary compications. Cocaine use must be sought in case of respiratory symptoms in young persons.

[Stopping and reducing smoking in patients with schizophrenia]. / Arrêt et réduction du tabac chez le patient souffrant de schizophrénie.

OBJECTIVES: This systematic review of the literature looked at data on pharmacological and non-pharmacological strategies of smoking cessation and reduction of consumption in patients with schizophrenia. METHOD: The research was conducted on Medline for the period 1980-2018. We included randomized controlled trials, including preliminary studies of stable schizophrenic patients with no other severe psychiatric disorder and no other substance use than tobacco, treated with antipsychotic medications. Individual or group smoking cessation programs with or without pharmacological treatment, including a validation of abstinence, were included. RESULTS: Pharmacotherapies for nicotine dependence-nicotine replacement therapy (n=3), bupropion (n=6), varenicline (n=8), association of medications (n=4)-were used in 23 studies combined with behavioral support. Compared to the placebo, bupropion and varenicline at the end of treatment were found to be the most effective pharmacotherapies to stop or reduce smoking and control craving. All the medications were well tolerated and did not lead to aggravation of psychosis or changes in symptoms. Non-pharmacological interventions: behavioral and cognitive therapies (n=5) combined with pharmacological treatment facilitated the management of smoking risk situations and improved adherence to antipsychotics; other psychosocial interventions (n=7) allowed the development of social skills; contigency management strategies with financial reinforcement can be used (n=4); the practice of physical activity and the use of an electronic cigarette allowed reduction of tobacco consumption. The results of transcranial electromagnetic stimulation studies (n=6) were discordant. Atypical antipsychotics appear to be associated with a better success of attempts to stop smoking. CONCLUSION: Smoking cessation strategies for patients with schizophrenia appear to be effective and should combine (1) smoking cessation medications with sufficient duration, (2) diversified psychosocial approaches and (3) physical activity practice.

[Why stopping smoking is difficult in patients suffering from schizophrenia? How better to take care of them?] / Pourquoi l'arrêt du tabac est-il difficile pour les fumeurs souffrant de schizophrénie ? Comment mieux les prendre en charge ?

Smoking is much higher among patients suffering from schizophrenia compared to the general population. These patients inhale the smoke more deeply and extract a significant amount of nicotine from the cigarette. They are highly addicted to tobacco and their attempts to stop smoking are more frequently marked by failures. The continuation of consumption exposes them particularly to the risk of diseases and mortality related to smoking. Various hypotheses are advanced to explain the association between schizophrenia and tobacco smoking. Tobacco smoke and/or nicotine appear to compensate for certain cognitive deficits due to the disease or to correct adverse events of anti-psychotics. Furthermore, genetic factors, personality traits and socio-cultural factors appear to be jointly implicated in mental illness and smoking. Smoking cessation, which does not aggravate schizophrenia, combines psycho-social approaches and medication treatments; it can be helped by the use of the electronic cigarette and the practice of physical exercise. Professionals must ensure long-term personalized follow-up.

La consommation de tabac est beaucoup plus élevée parmi les patients souffrant de schizophrénie comparativement à la population générale. Ces patients inhalent plus profondément la fumée et extraient une importante quantité de nicotine de la cigarette. Ils présentent une forte dépendance tabagique et leurs tentatives d'arrêt du tabac sont plus fréquemment marquées par des échecs. La poursuite de la consommation les expose particulièrement au risque de maladies et de mortalité en lien avec le tabagisme. Diverses hypothèses sont avancées pour expliquer l'association entre la schizophrénie et le tabagisme : le tabagisme et/ou la nicotine paraissent compenser certains déficits cognitifs dus à la maladie ou corriger des événements indésirables des anti-psychotiques. De plus, des facteurs génétiques, des traits de personnalité et des facteurs sociaux culturels paraissent conjointement impliqués dans la maladie mentale et l'usage du tabac. Le sevrage tabagique qui n'aggrave pas la maladie associe les prises en charge psycho-sociales et les médicaments d'aide à l'arrêt; il peut être aidé par l'usage de la cigarette électronique et la pratique de l'exercice physique. Les professionnels doivent assurer un suivi personnalisé de longue durée.

[Spontaneous pneumothorax and lung emphysema in cannabis users]. / Pneumothorax spontané et emphysème pulmonaire chez les consommateurs de cannabis.

INTRODUCTION: If pulmonary complications of tobacco smoking are well documented, those associated with cannabis use are less known. OBJECTIVES: Systematic literature review of data on pneumothorax and lung emphysema in cannabis users. DOCUMENTARY SOURCES: Medline, on the period 1980-2018 with the following keywords cannabis or marijuana and pneumothorax or emphysema, limits "title/abstract". Among 97 articles, 42 abstracts have given use to a dual reading to select 20 studies. RESULTS: Eighteen case reports (8 with SP) showed bullae in the upper lobes in combined cannabis and tobacco smokers (CS) and in the 2 cannabis only smokers (COS). The risk of SP was increased in CS, but not in COS. In patients less than 35-years old presenting with SP, the incidence of bullae on thoracic computed tomography (CT) was higher in CS than in tobacco only smokers (TOS). CT in patients with SP showed no significant difference as regards of the prevalence, location and type of emphysema between CS and TOS. Proportion of low lung density areas was higher in CS than in non-smokers (NS), but was similar in TOS and NS. CONCLUSION: These results suggest a cumulative toxic effect of tobacco and cannabis on the risk of SP and lung emphysema.

[Is reduction of tobacco consumption associated with reduced risk of cardiovascular and pulmonary mortality and morbidity?] / La diminution de la consommation de tabac est-elle associée à une réduction du risque de morbi-mortalité cardiovasculaire et pulmonaire ?

INTRODUCTION: Smokers without an intention to completely quit smoking often try to reduce their daily tobacco consumption. However, smoking reduction is not associated with reduced risk of all-cause mortality. The aim of this systematic literature review of data was to expose relations between reduction of daily tobacco consumption and a potential decrease in the risks of cardiovascular and pulmonary mortality and morbidity. METHOD: Medline, on the period 1980-2018 with the following keywords: "smoking reduction", "harm reduction", "mortality", "morbidity", "cardiovascular disease*", myocardial infarction", "coronar*", "stroke", "lung cancer", "COPD", "chronic obstructive pulmonary disease", "asthma", "pulmonary disease*" and "respiratory disease" limits "title/abstract"; the selected languages were English or French. Among 158 articles, 32 abstracts have given use to a dual reading to select 19 studies. RESULTS: Reduction of daily tobacco consumption by at least 50% is not associated with (1) reduced risk of cardiovascular mortality and morbidity and (2) reduced risk of lung cancer mortality. Results of studies on the risk of lung cancer morbidity are conflicting. Smoking reduction by at least 50% has no or little effect on the incidence of chronic obstructive pulmonary disease (COPD) and FEV1 decline. In asthmatic patients, smoking reduction is associated with small improvement for night use of short acting beta2-agonists, doses of inhaled corticosteroids and bronchial hyper-reactivity. CONCLUSION: Smoking cessation is the only effective strategy to reduce the harm caused by tobacco smoking. This finding should lead clinicians to offer support to smokers in order to assist them to completely quit smoking.