Concepts of disease severity, activity, control and responsiveness to treatment are linked but different. Severity refers to the loss of function of the organs induced by the disease process or to the occurrence of severe acute exacerbations. Severity may vary over time and needs regular follow-up. Control is the degree to which therapy goals are currently met. These concepts have evolved over time for asthma in guidelines, task forces or consensus meetings. The aim of this paper is to generalize the approach of the uniform definition of severe asthma presented to WHO for chronic allergic and associated diseases (rhinitis, chronic rhinosinusitis, chronic urticaria and atopic dermatitis) in order to have a uniform definition of severity, control and risk, usable in most situations. It is based on the appropriate diagnosis, availability and accessibility of treatments, treatment responsiveness and associated factors such as comorbidities and risk factors. This uniform definition will allow a better definition of the phenotypes of severe allergic (and related) diseases for clinical practice, research (including epidemiology), public health purposes, education and the discovery of novel therapies.

Introduction: Waterpipe smoking gained popularity during recent years. Although waterpipe smoking exposes people to the same noxious substances found in cigarettes, popular belief considers it harmless. Our objective was to evaluate the association between waterpipe smoking and dependence, and COPD. Methods: We conducted a case-control study in two tertiary care hospitals. Cases were included if diagnosed as COPD by a pulmonologist and confirmed by post-bronchodilator FEV1/FVC<0.7; controls were included if free of any respiratory disease or symptom. After oral consent, a standardized questionnaire was administered and spirometry results were collected. Results: 211 COPD cases and 527 controls were studied. In previous smokers, any smoking type was associated with COPD. The ORs were 29.0[14.3-58.8] (p<0.001) for previous cigarette smoking, 11.7[4.4-31.2] (p<0.001) for previous waterpipe smoking, and 44.1[16.3-4.4] (p<0.001) for previous mixed smoking. In current smokers, the ORs were 20.5[10.2-41.2] (p<0.001) for cigarette smoking, 1.8[0.5-5.9] (p=0.299) for waterpipe smoking, and 9.4[3.81-23.0] (p<0.001) for mixed smoking. Nevertheless, we found in waterpipe current smokers, an OR=8.9[3.9-20.7] (p<0.001) for the association between dependence evaluated by LWDS-11 scale, and COPD. These results were confirmed by stratified and multivariate analysis, after adjustment for cigarette smoking and confounding variables. A cumulative smoking of one waterpipe per week for 20years (or its equivalent) was predictive of higher risk of COPD. Discussion: Whereas evidence showing harmful effects of waterpipe smoking is sparse, this study showed a high OR between the risk of developing COPD and being an ex-smoker of waterpipe, or a current waterpipe dependent individual. Additional studies are necessary to confirm our results.

Objective:The objective is to assess factors associated with the success rate of smoking cessation among Lebanese smokers in a smoking cessation center.Methods:A cross-sectional data study, conducted between March 2014 and March 2016 in an outpatient smoking cessation center with 156 enrolled patients. The patient’s nicotine dependence and motivation to quit smoking were evaluated according to the Fagerstrom Test for Nicotine Dependence and Richmond tests respectively.Results:The number of packs smoked per year decreased the odds of smoking cessation success (p=0.004, ORa=0.982, CI 0.97-0.994), while the compliance with the offered treatment increased the odds of success by 7.68 times (p<0.001, ORa=7.68, CI 3.438-17.187). Highly dependent and highly motivated smokers had more success in the quitting process compared to those with a lower dependence and motivation respectively.Conclusion:Our findings showed that many factors can influence smoking cessation, an experience described as difficult, most significantly the number of packs per year and compliance with the smoking cessation treatment. Moreover, although these outcomes are not representative of the entire Lebanese population, we believe that health authorities could utilize these results when implementing upcoming smoking cessations programs. All attempts at cessation should have a goal of reducing the number of packs smoked per year to improve the chances of ceasing into the future.

No abstract