Asthma and smoking: still a prevailing topic

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 prevalence declined from 41.2% to 31.1% in men and from 10.6% to 6.6% in women.⁽ 1 ⁾ From 1989 to 2013, the prevalence 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 industry 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 packaging, 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 prevalence 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 development 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 factor.⁽ 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 understanding 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.