Sevrage tabagique : les stratégies pharmacologiques différentes des traitements standards

[Bronchial diseases and heroin use. A systematic review]

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.

[Combinations of pharmacological treatments in smoking cessation. A systematic review]

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.

[Smoking cessation in smokers with pulmonary Langerhans cell histiocytosis - considerations from the management of ten patients]

Pulmonary Langerhans cell histiocytosis (PLCH) belongs to the spectrum of diffuse interstitial cystic pneumonias; it affects young people of both sexes and occurs almost exclusively in tobacco smokers or co-users of tobacco and cannabis. The management of this severe chronic disease is undertaken in specialized centers. A better understanding of the pathogenic mechanisms of the disease has opened up prospects for targeted therapies. However, supporting the abstinence from inhaling noxious materials which determine its prognosis remains the cornerstone of treatment. Patients with PLCH who persist in smoking despite the diagnosis may be very dependent on tobacco, experience significant difficulties in stopping smoking, and must have access to specialist smoking cessation clinics.