Asthma is a prevalent chronic pulmonary condition with significant morbidity and mortality. Tobacco smoking is implicated in asthma pathophysiology, diagnosis, prognosis and treatment. Smokers display increased prevalence and incidence of asthma, but a causal association cannot be claimed using existing evidence. Second-hand smoking and passive exposure to tobacco in utero and early life have also been linked with asthma development. Currently, approximately one-fourth of asthma patients are smokers. Regular smokers with asthma might display accelerated lung function decline and non-reversible airflow limitation, making their distinction from chronic obstructive pulmonary disease patients challenging. Asthma patients who smoke typically have uncontrolled disease, as shown by increased symptoms, more exacerbations and impaired quality of life. On the other hand, smoking cessation improves lung function and asthma severity. Thus, asthma patients and their caregivers should be actively questioned about their smoking status at each medical encounter, and smoking cessation ought to be strongly encouraged both for patients with asthma and their close contacts. Smokers with asthma should be provided with comprehensive smoking cessation interventions on top of other anti-asthma medications.

Bullying is quite prevalent in the school setting and has been associated with several subjective health complaints such as headache, backache, abdominal pain, dizziness, fatigue and sleep problems. The aim of the present study was to investigate the association between bullying and subjective health complaints in a sample of Greek adolescents taking into account the presence of psychiatric morbidity. A stratified random sample of 2427 adolescents aged 16–18 years old and attending senior high schools were randomly selected for a computerized interview. Subjective health complaints were assessed using a symptom checklist used in the context of a previous World Health Organization study and relevant sections of the revised Clinical Interview Schedule (CIS-R). The latter was also used for the assessment of psychiatric morbidity. Bullying was assessed with the revised Olweus bully/victim questionnaire. A series of logistic regression models were used to investigate the association between bullying and subjective health complaints. Victims of bullying were more likely to report backache (Odds Ratio [OR] = 1.92, 95% CI: 1.01-3.67), dizziness (OR = 2.83, 95% CI: 1.11-7.22) and fatigue (OR = 0.41, 95% CI: 0.19-0.86), independently of the presence of psychiatric morbidity. In addition bullying perpetrators were more likely to report backache (OR = 3.49, 95% CI: 1.49-8.18). It is worth noting that sleep problems and abdominal pain were also associated with being bullied and fatigue with bullying perpetration but these associations were all attenuated after adjustment for psychiatric morbidity. Strong associations between bullying in schools and subjective health complaints among a sample of Greek students aged 16 – 18 years have been observed. The exact nature of these associations should be investigated in future longitudinal studies.

Postpneumonectomy-like syndrome is a rare condition resulting from unilateral lung disease with severe lung volume loss leading to excessive mediastinal shift and herniation of the healthy lung into the contralateral hemithorax, mimicking the mediastinal shift observed in postpneumonectomy syndrome after pneumonectomy. We report a unique case of postpneumonectomy-like syndrome caused by an atypical bronchial carcinoid completely occluding the left main bronchus. A 25-year-old woman presented with symptoms of chronic exertional dyspnea and productive cough. Imaging studies showed complete left lung atelectasis due to a mass occluding the left main bronchus, as well as extreme mediastinal deviation and substantial herniation of the right lung into the left hemithorax. Bronchoscopic biopsy of the tumor and subsequent left pneumonectomy with concurrent lymph node dissection revealed an atypical carcinoid. Sixteen months after surgery the patient has been asymptomatic with repeat imaging studies showing no change in mediastinal shifting. Bronchial carcinoids are notorious for causing bronchial obstruction. The present case represents an extreme complication of centrally located bronchial carcinoid, resulting in postpneumonectomy-like syndrome with severe mediastinal shift and herniation of the healthy lung into the diseased hemithorax.

For decades, the primary goals of managing chronic obstructive pulmonary disease (COPD) have centered on alleviating symptoms and reducing the frequency and severity of exacerbations. These efforts, aimed at improving a patient's quality of life and functional status, have led to the concept of "clinical stability"-a desirable state where symptoms are controlled and exacerbations are absent. Achieving this stability is a tangible victory for both the patient and the clinician. It signifies that a patient is, by many measures, living well. But does living well mean living longer? A thoughtprovoking study by Loo et al in the International Journal of COPD suggests the answer is not so simple, forcing us to confront a critical disconnect between our measures of clinical success and the stark reality of mortality. 1 The Paradox of Clinical Success Without Survival Benefit Loo et al conducted a prospective longitudinal study in a multi-ethnic Singaporean cohort to identify predictors of twoyear clinical stability and the impact of comorbid cardiovascular disease (CVD) on clinical stability and five-year mortality. 1 The study enrolled 463 patients, with a mean age of 71 ± 9 years. The cohort was predominantly Chinese (81.7%), and 45.6% of participants were current smokers. A significant proportion, 55.7%, had a history of CVD. The researchers defined two-year clinical stability as no exacerbations requiring oral corticosteroids, antibiotics, and/or hospitalization, combined with a stable COPD Assessment Test (CAT) score (less than a 2-point change from baseline) over two years. They found that approximately 36% of the cohort achieved clinical stability at one year, and one-third (32.6%) achieved stability at two years. Predictors of this 2-year clinical stability included a higher body mass index (BMI) (p < 0.001), a higher post-bronchodilator FEV₁/FVC ratio, fewer baseline exacerbations, the absence of concomitant bronchiectasis, preserved hemoglobin levels, and successful smoking cessation. Additionally, the presence of hyperlipidemia and treatment with lipid-lowering agents were associated with clinical stability at 2 years. Patients who achieved stability were also less likely to be on triple therapy at the 2-year follow-up (36.7% vs 57.3%). The study's most striking and important finding, however, was what happened next. When the authors followed the cohort for five-year mortality, they discovered that achieving two-year clinical stability had no bearing on subsequent survival (p = 0.73). Instead, the factors that significantly predicted 5-year mortality were comorbid cardiovascular disease (CVD), with a hazard ratio (HR) of 1.48 (95% CI 0.99-2.22; p = 0.05). Other factors associated with 5-year mortality included older age, higher baseline dyspnea (mMRC) scores, and a history of pulmonary tuberculosis. Interestingly, in the multivariate analysis for mortality, neither lung function (FEV₁% predicted) nor BMI remained significant predictors. These findings provide a powerful, real-world illustration of the "morbidity-mortality gap" in chronic illness-a phenomenon increasingly recognized across multiple disease states. As Iwashyna et al described, advances in care can successfully reduce the daily burden of a disease (morbidity) without altering the underlying, long-term risk of death (mortality). This gap reflects the complex interplay between symptomatic improvement and fundamental disease processes that continue to progress despite apparent clinical control. It may also reflect the biopsychosocial model of health that takes account of psychological and social as well as biological factors relevant to progression of disease. 2 In

Infectious diseases are one of the greatest challenges for global health, with significant socioeconomic implications