Introduction Acute Inflammation and Brief Symptoms Mechanisms: Experimentally Induced Allergic Reactions Clinical Consequences and Treatment Chronic Inflammation Site of the Inflammation in Asthma Cell Survival in Airway Tissues Characteristics of Chronic Inflammation Chronic Inflammation in the Different Forms of Asthma Clinic Consequences Treatment of Exacerbations Onset and Duration of Treatment Remodeling of the Airways Characteristics of Airways Remodeling in Asthma Clinical Consequences Radiographic Findings Treatment and Prevention of Airways Remodeling Conclusions

https://www.atsjournals.org/doi/pdf/10.1164/ajrccm.161.5.9903102

Asthma. From bronchoconstriction to airways inflammation and remodeling.

Perinatal outcomes in women with asthma during pregnancy

There are around 1.1 thousand million smokers in the world which is approximately one third of the global population who are aged 15 years and over (47% of men and 12% of women).1 Most smokers live in developing countries (800 million) and most are male (700 million).1 While smoking rates have decreased in developed countries over the last 13 years, there has been a corresponding 50% increase in smoking rates in developing countries.2 

The most important determinant of human health trends is the increase in tobacco related mortality and disability. Tobacco related deaths have been projected to increase from 3.0 million in 1990 to 8.4 million in 2020, which will make tobacco the largest single health problem at this time.3 There are 80–90% of deaths from chronic obstructive lung disease attributed to tobacco, and smokers have six times the risk of contracting this disease compared with smokers; similarly, 80–85% of lung cancer deaths are attributed to tobacco use, with smokers having 10 times the risk compared with non-smokers.4-6 

National and international responses to the public health problem of tobacco therefore need to be intensified. Primary care physicians have a vital role to play in advising patients to stop smoking as most smokers visit their doctor.7-9 Studies have shown that very brief advice from the doctor yields one year quit rates of 5–10%,10-12 and interventions that are more comprehensive, including follow up sessions, produce abstinence rates of 20–36%.13-15 

Another important way to control tobacco use is to encourage medical schools to teach about tobacco issues in the curriculum. It is vital that medical students, the future medical practitioners, have adequate knowledge of smoking related diseases and skills in smoking cessation. The purpose of this paper is to review the literature on medical students’ …

https://thorax.bmj.com/content/thoraxjnl/54/1/70.full.pdf

Teaching medical students about tobacco.

A Comparison of Smoking Habits Among Medical and Nursing Students

Are nonsmoking physicians more likely to give smoking cessation advice to their patients? To determine this, we sent a questionnaire individually to physicians in Tokyo. The average age of the 323 respondents was 59.8±12.9 (mean±SD); 84.8% of them were male and 21.1% were smokers. Among the respondents, 88.8% asked their patients about their smoking status, 79.9% advised smoking patients to stop, and 93.5% believed smoking cessation interventions to be necessary. Nonsmoking physicians were more likely to advise patients to stop smoking (85.6%) than smoking physicians (70.1%); the smoking physicians who themselves wished to reduce cigarette consumption or stop smoking were more likely to do so (85.0%) than those who did not wish to reduce or stop (43.5%). Moreover, more nonsmoking physicians seriously felt that smoking cessation interventions are necessary (31.2%) than did smoking physicians (6.5%). In conclusion, the smoking status and attitude towards smoking of physicians influences their enthusiasm to give advice to their patients against smoking.(Internal Medicine 36: 162-165, 1997)

Relation between smoking status of physicians and their enthusiasm to offer smoking cessation advice.

From an ongoing global international survey we present the results for 14 European countries. The survey was carried out through a WHO-based questionnaire given to the students at the beginning of their first year and during the course of their final year. Daily smokers comprised 13.7% in first year and 21.5% in final year, with an overall variation between 3 and 33% according to country. There were already 16% of ex-smokers among first year students. More than 50% of smokers had made attempts to quit. 60% of daily smokers, and almost all others, thought that they would no longer be smoking in five years time. Knowledge of aetiology was moderate in first year. It later improved but there remained many lacunae in final year, e.g. less than 30% were aware that smoking was a cause of coronary artery disease. There was little knowledge of public health measures for smoking control. Attitudes were greatly influenced by smoking; ex-smokers were similar to non-smokers, with occasional smokers intermediate between these and daily smokers. Only 25% accepted a preventive and educative role in advising patients. As regards smoking, students were concerned with their personal health and with advising patients whom they knew to have smoking-related disease, but in general had little conception of smoking as a public health problem. The differences between countries indicate that both habits and attitudes are social and cultural problems. In most of the centres there seemed to be much room for improvement of medical education in this field.

Smoking habits and attitudes of medical students towards smoking and antismoking campaigns in fourteen European countries.

The kinetics of platelets labeled with indium-111 were investigated in 13 healthy subjects as well as in 9 patients in the asymptomatic interattack stage of asthma. The survival times of platelets in healthy subjects was 8.9 ± 1 days; in asthmatic subjects it was 4.7 ±1.3 days (p < 0.001). The survival curve is of a biexponential form in asthmatics, thus suggesting the presence of 2 populations: one with a short life span (23 ± 7 h), representing a third of the total population (33 ± 9%), and the other with a normal life span. No single preferred site of platelet sequestration was found. These results suggest the presence of functional or anatomic lesions of platelets in asthmatic patients, which can be explained only hypothetically at the present time.

Platelet kinetics in stable atopic asthmatic patients.

The frequency of bronchial symptoms and the alteration of respiratory function parameters were studied in a group of 63 workers of an industrial flour-mill, and in a control group matched according to age, social class, and tobacco intake. In the exposed group the answers to a questionnaire indicated a greater incidence of cough (p<0.01) and chronic expectoration (p<0.01) as well as clinical airway hyperreactivity (p<0.01). No differences were noted for either asthma or allergy. The respiratory function parameters did not differ between the two groups studied. These results suggest that workers exposed to the vegetable dust found in fluormills are subject to develop chronic bronchial irritation.

Respiratory function in flour-mill workers.

Compliance of COPD patients with long term oxygen therapy

SUMMARY

Following a survey in 19 European countries of the habits, attitudes and knowledge of medical students regarding tobacco, World Health Organisation European Office and the International Union against Tuberculosis and Lung Disease jointly circulated to the Deans of all European medical schools a summary of the results, including figures for mortality for smoking-related diseases in their countries and a brief questionnaire concerning faculty action on the tobacco problem. The response rate was just over 50%, higher in Northern Europe (66%) than in Southern (35%) or Eastern (38%). Only 8% of faculties had a specific teaching module on tobacco. In most it was either systematically (35%) or unsystematically (55%) integrated in other teaching. Teaching hospitals, teaching areas and faculty meetings were said to be smokefree by over 90%; figures were lower for other areas. Seventy-seven per cent of Deans intended to discuss our approach with their teaching staff; 72% gave the name of a staff member with a particular tobacco interest.

European medical schools and tobacco

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