Respirology : official journal of the Asian Pacific Society of Respirology
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South Asia is a major producer and net exporter of tobacco. Over one-third of tobacco consumed regionally is smokeless. Traditional forms like betel quid, tobacco with lime and tobacco tooth powder are commonly used and the use of new products is increasing, not only among men but also among children, teenagers, women of reproductive age, medical and dental students and in the South Asian diaspora. ⋯ In May 2003 in India, the Tobacco Products Bill 2001 was enacted to regulate the promotion and sale of all tobacco products. In two large-scale educational interventions in India, sizable proportions of tobacco users quit during 5-10 years of follow-up and incidence rates of oral leukoplakia measured in one study fell in the intervention cohort. Tobacco education must be imparted through schools, existing government health programmes and hospital outreach programmes.
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China has the largest production and consumption of tobacco worldwide. It has witnessed a dramatic increase in tobacco consumption over the past two decades, with more than 34.8 million cartons of cigarettes being produced and 34.7 million sold annually. Approximately 67% of males and 4% of females aged over 15 years in China are smokers, and the total of over 320 million Chinese smokers represents about one-third of all smokers worldwide. ⋯ In future, the emphasis of smoking control should be directed at restraining teenagers and adolescents from smoking. Cigarette smoking has already caused significant ill-health to the Chinese population with over 1 million people dying each year of various disorders caused by smoking. However, the peak of smoking-induced diseases is still to come and therefore, it is very important to strengthen anti-smoking measures so as to have a far-reaching effect on the future health of the Chinese population.
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The major health impacts of smoking were established more than 40 years ago but Governments were slow to respond to the growing health epidemic. Despite laudable tobacco control strategies in many countries, globally deaths from smoking continue to rise and are forecast to reach 10 million a year by the 2030's. There is now general agreement that in order to substantially reduce smoking rates, governments need to adopt a comprehensive approach to tobacco control. ⋯ Given the enormous burden that smoking places on health services, governments in developed nations have generally responded by introducing a range of tobacco control measures. However, the picture is far from uniform and some of the best examples of strong, government-led action have occurred in less developed nations. Governments can learn much from these countries and, by supporting the impending global treaty on tobacco control, can help to reduce the smoking-related diseases and deaths of the future.
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The management of pleural sepsis involves early diagnosis, administration of appropriate antibiotics, recognition of poor prognostic features and timely intervention to drain the infected pleural space. Important recent advances in the management of pleural sepsis include better imaging techniques, the use of flexible image-guided drainage catheters, adjunctive intrapleural thrombolytic therapy and the introduction of interventional thoracoscopy. These advances have been augmented, in the past year, by results from prospective controlled studies comparing different therapeutic options. This review describes an evidence-based approach to the management of pleural sepsis which incorporates recent therapeutic advances.
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Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability. There is now a better understanding of the pathophysiology of COPD and of the effectiveness of various treatment strategies in controlling symptoms and progression of disease. Although cessation of smoking is of primary importance, the growing realization in recent years that airflow limitation in COPD can be significantly relieved with the use of bronchodilators has changed the clinical approach to treating this disease. ⋯ The use of the combination of these two classes of inhaled bronchodilators provides superior bronchodilation than treatment with either of the individual components without added side-effects or loss of the positive effects of ipratropium bromide including reduced exacerbation frequency and lack of tachyphylaxis. The use of combination therapy also improves cost-effectiveness and patient compliance. Combination therapy should be considered as an important component of a treatment algorithm of COPD.