Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713


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Current Issue: 2016 - Volume 42 - Number 2 (March/April)


Asthma and smoking: still a prevailing topic

Asma e tabagismo: um tema ainda persistente


Ubiratan de Paula Santos1


1. Divisão de Pneumologia, Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo (SP) Brasil.




In the last 20 years, there has been a significant, progressive decline in the prevalence of smoking in both genders, worldwide(1) and in Brazil,(2) where that decline has been more pronounced. From 1980 to 2012, the worldwide prev-alence declined from 41.2% to 31.1% in men and from 10.6% to 6.6% in women.(1) From 1989 to 2013, the preva-lence of smoking in Brazil declined from 43.3% to 18.3% in men and from 27.0% to 10.8% in women.(2,3)

Despite progress brought about by successful public policies,(2) a survey conducted by the Instituto Brasileiro de Geografia e Estatística (IBGE, Brazilian Institute of Geography and Statistics) showed that the prevalence of smoking experimentation, a known risk factor for smoking initiation, was 19.6% among schoolchildren in the capital cities of Brazil.(4) Faced with the progressive decline in the prevalence of smoking worldwide and in Brazil, the tobacco indus-try has attempted not only to attract new markets in countries that do not adopt the more effective policies set forth in the Framework Convention on Tobacco Control(5) but also to attract young people with new, more appealing packag-ing, novel forms of advertising, and the use of flavored additives that enhance the efficiency of the process of addition to smoking cigarettes with lower nicotine content, as well as, recently, the introduction of electronic cigarettes.(6,7)

In an article published in this issue of JBP, Fernandes et al.(8) assessed the prevalence of allergic rhinitis, asthma, and smoking in 3,235 adolescent students (13-14 years of age) attending public schools in the city of Belo Horizonte, capital of the Brazilian state of Minas Gerais, and found the prevalence of allergic rhinitis, asthma, and smoking experimentation to be 35.3%, 19.8%, and 9.6% respectively. In keeping with the progressive decline in the preva-lence of smoking in general in the country, the prevalence of smoking experimentation observed by those authors was 50% lower than the 20.7% reported for adolescents in the general population of the city in a survey conducted by the IBGE in 2012.(4) The data presented by Fernandes et al.(8) differ from those obtained in previous studies of adults and adolescents conducted in Brazil(9) and other countries,(10,11,12) all of which showed that the prevalence of smoking among individuals with asthma is similar to or higher than that seen in the general population. However, despite the favorable findings, data from the Fernandes et al. study(8) demonstrate the need to persist in the devel-opment of interventions for adolescents with asthma, not only because of the general hazards of smoking but also because of its implications for the control, treatment, and evolution of asthma, for which smoking is an adverse fac-tor.(10,13) One recent extensive review presented evidence, albeit still inconclusive, that smoking is a risk factor for the incidence and exacerbation of asthma in adolescents.(13)

Although Fernandes et al.(8) have addressed a known issue, their data make an important contribution to the under-standing of the situation in Brazil, drawing distinctions with other countries. Their findings have implications for health professionals, as well as for the development and evaluation of public policies.


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2. Levy D, de Almeida LM, Szklo A. The Brazil SimSmoke policy simulation model: the effect of strong tobacco control policies on smoking prevalence and smoking-attributable deaths in a middle income nation. PLoS Med. 2012;9(11):e1001336.
3. Szklo AS, de Souza MC, Szklo M, de Almeida LM. Smokers in Brazil: who are they? Tob Control. 2015. pii: tobaccocontrol-2015-052324.
4. Brasil. Ministério do Planejamento, Orçamento e Gestão. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional de Saúde do Escolar 2012. Brasília: IBGE; 2013.
5. WHO Framework Convention on Tobacco Control (FCTC) [homepage on the Internet]. Geneva: WHO; c2016 [cited 2016 Mar 28]. Framework Convention on Tobacco Control [about 3 screens]. Available from:
6. Lovato C, Linn G, Stead LF, Best A. Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours. Cochrane Database Syst Rev. 2003;(4):CD003439.
7. Talhout R, van de Nobelen S, Kienhuis AS. An inventory of methods suitable to assess additive-induced characterising flavours of tobacco products. Drug Alcohol Depend. 2016;161:9-14.
8. Fernandes SSC, Andrade CR, Caminhas AP, Camargos PA, Ibiapina CC. Prevalence of tobacco experimentation in adolescents with asthma and allergic rhinitis. J Bras Pneumol. 2016;42(2):84-87.
9. Stelmach R, Fernandes FL, Carvalho-Pinto RM, Athanazio RA, Rached SZ, Prado GF, et al. Comparison between objective measures of smoking and self-reported smoking status in patients with asthma or COPD: are our patients telling us the truth? J Bras Pneumol. 2015;41(2):124-32.
10. Lemiere C, Boulet LP. Cigarette smoking and asthma: a dangerous mix. Can Respiratory J. 2005;12(2):79-80.
11. Cui W, Zack MM, Zahran HS. Health-related quality of life and asthma among United States adolescents. J Pediatr. 2015;166(2):358-64.
12. Katebi R, Williams G, Bourke M, Harrison A, Verma A. What factors are associated with the prevalence of atopic symptoms amongst adolescents in Greater Manchester? Eur J Public Health. 2015. pii: ckv139. [Epub ahead of print]
13. National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. The health consequences of smoking-50 years of progress: A report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Preven-tion US; 2014.



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