[Behavioral and cognitive therapies in smoking cessation: What tools for the pulmonologist?] / Les thérapies comportementales et cognitives (TCC) dans le sevrage tabagique : quels outils pour le pneumologue ?

Behavioral therapies have been developed from Pavlov and Skinner's theories on learning. They have been enriched with knowledge about the processing of information, a process organizing the perception of events. For these two reasons they are called behavioral and cognitive therapies (CBT). CBTs take place in four stages: therapeutic alliance, functional analysis, behavioral and cognitive methods, and evaluation. Seven techniques allow the pulmonologist to increase motivation in patients, particularly at the contemplation stage: the motivational interviewing, the decision-making balance technique, recognition of vicious circles and their substitution by constructive circles, short and long-term evaluation of life, the "I owe it", being the Devil's advocate and the letter of rupture. The analysis of the literature highlights the effectiveness of CBT techniques, especially when they are combined with pharmacological treatments for smoking cessation (dual nicotine replacement therapy, bupropion or varenicline).

[Establishment of a therapeutic alliance in smoking cessation within the framework of behavioral and cognitive therapies]. / Etablir une alliance thérapeutique en tabacologie dans le cadre des thérapies comportementales et cognitives.

The therapeutic alliance that is created within the framework of behavioural and cognitive therapy is called the collaborative relationship. The active participation of the patient is fundamental. This initial stage is indispensible but insufficient for treatment. As a first step we have developed the notion of a collaborative relationship requiring empathy, truthfulness, warmth and professionalism and the technique of discussion of the 4 R. The four techniques to increase motivation are discussed. The notions of reaction and resistance as well as the pitfalls of this therapy are explored. Finally a practical example of therapeutic alliance is presented.

[The contribution of cognitive-behavioural therapies to smoking cessation]. / Apport des thérapies cognitivo-comportementales dans le sevrage tabagique.

INTRODUCTION: Behavioural therapies have been developed on the basis of Pavlov's and Skinner's learning theories. They have recently benefited from advances in the understanding of information handling and the organisation of perceptions of experience. It is for these two reasons that these treatments are called cognitive behaviour therapies (CBT). They have now achieved an important role in the treatment of addictions including tobacco smoking. Currently CBT's are seen as promising because they rely on cognitive restructuring combined with learning of new behaviour while following a process appropriate to the changing dynamic of the smoker. BACKGROUND: They have recently been recognised as of grade A effectiveness by the French Institute of Medical Research and may be recommended to all smokers whose primary intention is to stop. The establishment of a collaborative rapport and a therapeutic attitude are essential. They may be used during the three stages of cessation: preparation, stopping, and the prevention of relapse. A personalised functional analysis provides the patient with a management program using behavioural and, above all, cognitive techniques. The ideal is to combine a pharmacological and an optimised cognitive-behavioural approach. VIEWPOINT: The management of smoking patients has advanced with the understanding of a very complex problem, often associated with anxiety-depressive co-morbidities and other addictions. Tobacco specialists, psychiatrists, cognitive-behavioural therapists and addiction therapists must work together in the future, particularly in respect of research protocols. CONCLUSIONS: Cognitive-behavioural therapy is a useful technique in the personalisation and optimisation of management of the patient, particularly in the prevention of relapse. However, the evaluation of CBT is difficult methodologically and there are few studies evaluating CBT alone. On the other hand, CBT is effective, particularly where there are anxiety or depressive co-morbidities or other addictions that are found more and more frequently during consultations for tobacco smoking.

[Smoking cessation in patients with lung cancer]. / Indications et méthodes d'aide au sevrage tabagique chez un patient fumeur atteint de cancer bronchique.

Smoking cessation is an important part of the management of patients with lung cancer. Continued smoking has been found to diminish treatment efficacy, to exacerbate side effects and to have a detrimental effect on survival. Smoking increases postoperative pulmonary complications and tolerance and efficacy of medical treatment (chemotherapy, targeted therapy, radiotherapy) are diminished. Moreover, the quality of life of current smokers is lower and the risk of a second primary malignancy is increased. Hospitalization is a good opportunity to propose smoking cessation. Clinical practice guidelines recommend the use of combined behavioral and pharmacological therapies. The efficacy of smoking cessation programs for cancer patients has been demonstrated. There is a clear dose-response relationship between number of contacts, intensity level of person-to-person contact and total amount of contact time. Multidisciplinary approaches increase abstinence rates. First line phamacotherapies (nicotine replacement therapy and sustained-release antidepressant bupropion) have been found to be safe and effective. Varenicline is a new drug for smoking cessation but it remains to be evaluated in oncology patients.

[What are the epidemiological data on the consequences of smoking-related increased risk in pregnant women? Dermatological consequences]. / Quelles sont les données épidémiologiques concernant les conséquences de l'excès de risque lié au tabagisme chez les femmes enceintes? Conséquences dermatologiques.

Smoking has numerous effects on skin. Some of them are well established, others are more debatable. Smoking is a cofactor of skin aging after chronic sun exposure, as demonstrated by recent histological, biochemical and cutaneous relief studies. Smoking is a well established risk factor of cutaneous, mucous membrane cancers, and some gynecologic cancers as well, in some cases increased by pregnancy. However, published studies have included small numbers of subjects. Some skin affections are worsened by smoking, and others might be improved. However scientific data on smoking and skin or pregnancy are both scarce.

[Bronchial tuberculosis in the elderly: apropos of 9 cases. Radioclinical, endoscopic and developmental aspects]. / Tuberculose bronchique chez la personne âgée: à propos de neuf cas. Aspects radiocliniques, endoscopiques et évolutifs.

We report nine cases of elderly French patients (more than 65 years old) with bronchial tuberculosis. We report the clinical features, radiological and endoscopic aspects. The symptoms are non specific and may delay the diagnostic. The chest X-ray and endoscopic aspects are tumor like. Retractile bronchial stenosis is a potential evolution.

[Two complications of bullous emphysema. Apropos of a case]. / Deux complications d'un emphysème bulleux. A propos d'un cas.

Infection and cancer are two classical complications of bullous emphysema. We report the case of a 47-year-old patient who presented a tuberculous infection then cancer within less than one year interval. The questions concerning diagnosis of infection are discussed. Pyogenic germs are usually involved and tuberculosis much less often. Exceptionally atypical mycobacteria, notably xenopi, are rarely the cause. The diagnosis can be particularly difficult in case of haemorrhage or cancer on bullae. The diagnosis of cancer in bullous emphysema is also studied. The relationships between tuberculosis and cancer in bullous emphysema are discussed.