[Smoking and tuberculosis]. / Tabac et tuberculose.

SMOKING AND TUBERCULOSIS. Tuberculosis and smoking are responsible for high mortality worldwide. Tuberculosis causes 9 million incident cases and 1.6 million deaths every year. Smoking increases the risk of infection by Mycobacterium tuberculosis and of severe tuberculosis disease with death or recurrence. Cessation of smoking improves the course of the disease, promoting adherence to anti-tuberculosis treatment and definitive cure. All health-care professionals involved in tuberculosis care must be involved to help smokers with tuberculosis to quit.

TABAC ET TUBERCULOSE. La tuberculose et le tabagisme sont à l'origine d'une importante mortalité dans le monde. La tuberculose cause 9 millions de cas incidents et 1,6 million de décès chaque année. Le tabagisme augmente les risques d'infection par Mycobacterium tuberculosis et de tuberculose maladie sévère avec décès ou récidive. L'arrêt du tabac améliore le cours de l'infection, favorisant l'adhésion des patients au traitement antituberculeux et la guérison définitive. Tous les professionnels de santé doivent s'investir dans la mission d'aide à l'arrêt du tabac des fumeurs atteints de tuberculose.

[How can we prevent teenage smoking ?] / Comment prévenir le tabagisme chez l'adolescent ?

Smoking rates in Europe are falling steadily among teenagers. The main reasons why young people start smoking are highlighted. Preventing young people from starting to smoke is based on a combination of three approaches: firstly, interventions in schools, incorporating educational programs from an early age; secondly, comprehensive tobacco control measures, such as bans on sales to minors and higher taxes on tobacco products; -thirdly, targeted communication campaigns. Finally, parents and families play an important role in providing a smoke-free environment and setting an example by giving up smoking. Many prevention programmes have been validated, but are still too infrequently deployed. We also need to prevent new modes of consumption that bring nicotine. In this way, we can work by accelerating progress to curb the tobacco epidemics and moving towards the ultimate goal of a smoke-free generation.

Les taux de tabagisme en Europe diminuent régulièrement parmi les adolescents en âge de commencer à fumer. Les principales raisons d'entrée en tabagisme des jeunes sont rappelées. La prévention du tabagisme chez les jeunes repose sur des actions dans trois directions : tout d'abord, des interventions en milieu scolaire en intégrant des programmes éducatifs dès le plus jeune âge, ensuite, des mesures globales de lutte antitabac telles que l'interdiction de vente aux mineurs et l'augmentation des taxes sur les produits du tabac, des campagnes de communication ciblées, et enfin, des actions ciblant les parents et les familles qui jouent un rôle important en fournissant un environnement sans fumée et en servant d'exemple en arrêtant de fumer. De nombreux programmes de prévention sont validés, mais encore trop peu souvent déployés. Il faut également prévenir les nouveaux modes de consommation, apportant de la nicotine. Ainsi, on œuvrera pour accélérer les progrès pour freiner l'épidémie tabagique et viser l'objectif ultime d'atteindre une génération sans tabac.

[The shared educational assessment in the smoking cessation process]. / Le bilan éducatif partagé dans le processus de sevrage tabagique.

In the context of smoking cessation, the shared educational assessment (BEP) enables us to assess the smoker's needs, define specific objectives and set up appropriate educational workshops. This multidisciplinary approach helps smokers to maintain their smoking cessation. The BEP is the first step in the educational process, exploring the various classic dimensions of therapeutic patient education (TPE) and then defining an action plan based on the priorities identified.

[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.

[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.

[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.

Smoking habits in French farmers: a cross-sectional study.

BACKGROUND: Farmers are exposed to multiple air contaminants that may interact with tobacco smoking in the development of respiratory diseases. Farmers are currently considered to smoke less than non-farmers, but precise data in different categories of age and farming activities are lacking. METHODS: Smoking habits were studied in a cross-sectional study involving 4105 farmers and 996 non-farming controls aged 40-74 years in 9 French departments between October 2012 and May 2013. Three age groups were defined (40-54, 55-64 and 65-74years). Farmers were divided into four activity groups, namely cattle breeders, livestock farmers working in confined spaces, crop farmers and others. Smoking prevalence was compared between farmers and controls, and odds ratios (ORs) for smoking adjusted for age were calculated. RESULTS: The adjusted OR for ever-smoking was lower among farmers than among non-farmers in all age categories, but the ORs for current smoking were similar in farmers and controls. Smoking prevalence varied according to the type of farming activity, and was lower than in non-farming controls only among cattle breeders and confined livestock farmers. In farmers, the proportion of smokers was higher in the youngest age categories compared with the older age classes. CONCLUSIONS: Our results confirm that the prevalence of ever-smokers is lower in farmers than in non-farmers. Nevertheless, our data show that active smoking prevalence is similar in farmers and in non-farmers. This suggests that farmers, just like non-farmers, should be targeted by primary prevention campaigns against smoking.

[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.

[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.

The French Observational Cohort of Usual Smokers (FOCUS) cohort: French smokers perceptions and attitudes towards smoking cessation.

BACKGROUND: Despite increasing governmental anti-smoking measures, smoking prevalence remains at a high level in France. METHODS: The objectives of this panel study were (1) to estimate smoking prevalence in France, (2) to identify smokers' profiles according to their perceptions, attitudes and behaviour in relation to smoking cessation, (3) to determine predictive factors of quit attempts, and (4) to assess tobacco-related behaviours and their evolutions according to the changes in the smokers' environments. A representative sample of French population was defined using the quota method. The identified cohort of smokers was assessed, in terms of smoking behaviour, previous quit attempts, and intention to quit smoking. RESULTS: A response rate of 66% for the screening enabled to identify a representative sample of the French population (N = 3 889) comprising 809 current smokers (21%). A majority of current smokers (63%) had made an attempt to quit smoking. Main reasons for having made the last attempt were cost (44%), social pressure (39%), wish to improve physical fitness (36%), fear of a future smoking-related disease (24%), and weariness of smoking (21%). Few attempts (16%) were encouraged by a physician. In those who used some kind of support (38%), NRT was the mostly used. Relapse was triggered by craving (45%), anxiety/stress (34%), a significant life event (21), weight gain (18%), and irritability (16%). Depression was rarely quoted (5%). Forty percent of smokers declared they intended to quit smoking permanently. Main reasons were cost (65%), physical fitness improvement (53%), fear of a future smoking-related disease (43%), weariness of tobacco (34%), and social pressure (30%). Using a smoking cessation treatment was considered by 43% of smokers that intended to quit. Barriers to smoking cessation were mainly fear of increased stress (62%), irritability (51%), and anxiety (42%), enjoying smoking (41%), and weight concerns (33%). CONCLUSION: Smoking prevalence and smoking cessation attempts rate were lower in this survey than in previous reports. Cost and social pressure were the main reasons for quitting smoking, maybe an effect of dramatic tax increases and smoking ban.

Characteristics of tobacco withdrawal in pregnant women.

OBJECTIVE: To describe the management of tobacco withdrawal in pregnant women. STUDY DESIGN: The questionnaire-based, descriptive survey included 979 post-partum women. The variables analysed included the characteristics of the mother and neonate at delivery, her smoking habits, her level of exposure to passive smoking, and the barriers to giving up smoking. The chi square test was used to analyse qualitative variables and the Students t-test for quantitative variables. RESULTS: 76% of women who smoked at the start of pregnancy said that they had been asked about their tobacco consumption. However, only 16% had been asked by a clinician or midwife about their attempts to stop smoking. Seven percent were offered a specialised consultation, but only one-third attended. Seventy-six percent of women who failed to stop smoking during pregnancy had a partner who smoked compared with 63% of women who gave up. Dependency and stress during pregnancy also were lower for women who stopped smoking. CONCLUSIONS: Healthcare professionals seems to offer only rudimentary care. Simple strategies to help women give up smoking are required. The partner is an important target, especially if he can be persuaded to give up at the same time.

Description of tobacco addiction in pregnant women.

OBJECTIVE: To compare the characteristics of a group of pregnant women who smoked until delivery with women who gave up smoking during pregnancy. STUDY DESIGN: Questionnaire-based, descriptive study of 979 pregnant women in four regions of France. The variables analysed included the characteristics of the mother and neonate at delivery, the smoking habits of the mother before and during pregnancy, the perception of risk linked to smoking, and the reasons for giving up smoking. RESULTS: Eighteen percent of women smoked until delivery. Fifty-five percent of women gave up smoking during pregnancy, usually in the first trimester. Women who failed to give up smoking were more disadvantaged psychosocially and were more likely to live alone. There was a higher level of dependency among women who failed to give up smoking and a lower perception of risk to the foetus. Among the women who had tried to reduce their tobacco consumption without success, 6% stated that they had been motivated by medical information compared to 28% of women who succeeded in stopping smoking. CONCLUSIONS: Despite the risks associated with smoking the number of pregnant women who smoke until delivery remains high. Knowledge of the psychosocial profile and degree of dependency of these patients is an important step to managing this problem.