BACKGROUND: Despite the established causal relationship between tobacco smoking and cancer, many cancer patients continue to smoke after diagnosis. This partly reflects ignorance of the beneficial effects of smoking cessation, even after diagnosis. The aim of this study was to demonstrate the effects of continuing or quitting smoking in patients with diagnosed cancer. METHODS: The study was based on a review of medical databases (PubMed Central, MEDLINE, Cochrane Library) in the last 30 y. All articles included in the present analysis were in English. RESULTS: In subjects with early-stage lung cancer, continued smoking after diagnosis is associated with an increased risk of all-cause mortality and decreased survival. Research has demonstrated significant differences in actuarial overall survival favoring the non-smoking group among subjects with lung cancer. In subjects with oral cancer, smoking cessation or reduction leads to a significant reduction in mortality. There is also evidence that tobacco smoking aggravates and prolongs radiotherapyinduced complications. Of particular importance is evidence that continued smoking is associated with adverse effects during anti-cancer treatment. Smoking promotes tumor progression and increases resistance to chemotherapy due to nicotine-induced resistance to apoptosis by modulating mitochondrial signaling. Continued smoking is also related to inferior outcomes of treatment with novel targeted therapies such as erlotinib. Smoking in subjects with gastric and lung cancer is also associated with an increased risk of developing second primary tumors. Quitting smoking after lung cancer diagnosis is associated with a better performance status, whereas persistent smokers have worse overall quality of life. Subjects who continue to smoke despite being diagnosed with cancer report more severe pain than subjects who have never smoked and greater pain-related functional impairment. CONCLUSIONS: Continued smoking after cancer diagnosis is related to reduced treatment efficacy and reduced survival, increased risk for second primary malignancies, and deterioration of quality of life.

The results support the view that smokers with respiratory obstructive airway diseases of any severity should be offered an intensive smoking cessation program with regular and long-term follow-up. This will help them to achieve high abstinence rates and prevent relapses.

Background: Diagnosis of exercise-induced bronchoconstriction (EIB) requires objective documentation with bronchial provocation tests (BPTs), since exercise-induced respiratory symptoms (EIRS) have poor diagnostic value. We aimed to assess EIRS, EIB and asthma in elite Greek athletes and evaluate the validity of BPTs in the diagnosis of airway hyperresponsiveness (AHR) in this population. Furthermore rhinitis and atopy were also assessed. Methods: Two hundred elite athletes (55 with a previous asthma diagnosis) completed a questionnaire. Skin prick tests, exhaled Nitric Oxide and spirometry were consecutively performed. EIB was objectively assessed by the methacholine test, the eucapnic voluntary hyperpnoea (EVH) test, the mannitol test and the exercise test. Results: EIRS and asthma-like symptoms were highly reported by athletes in both groups. Atopy was found in 43.8% of athletes without a previous asthma diagnosis and in 62.3% of athletes with asthma. AHR to methacholine had the highest prevalence among all the BPTs that were performed in athletes without a previous asthma diagnosis (63%) and in athletes with asthma (86%). Athletes with asthma had more frequently a positive result in methacholine and EVH challenges, as compared with athletes without a previous asthma diagnosis(P=0.012, P=0.017, respectively), whilst AHR to mannitol had a similar prevalence between the two groups. Report of EIRS, asthma-like symptoms, rhinitis and atopy were not associated with a positive BPT response. Conclusion: Screening elite athletes for EIB using BPTs is suggested irrespective of report of EIRS or a previous asthma diagnosis.Conflicts of interest: None of the other authors has any conflict of interest related to the present manuscript

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