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1. If the budget is poor, the programme should target the most cost-effective interventions, ask for free radio and television presentations, collaborate with various associations (medical and social, etc.) for voluntary anti-smoking interventions. Cessation programmes can be partially charged to companies and administrations. The programme should increase the awareness of the funding agencies and of the government about the cost-effectiveness of the various types of interventions, and call for external funding agencies to be involved (e.g. the Bloomberg Foundation).

In 36 severely hypoxaemic patients (arterial oxygen tension (PaO2) less than 7.3 kPa or 55 mmHg), candidates for long-term oxygen therapy, we compared the effectiveness of three oxygen-delivery systems, the standard nasal prongs, a so-called oxygen-conserving reservoir device ("Oxymizer Pendant") and the reference pharyngeal catheter, at a preset flow rate of 2 l.min-1. After 30 min, the conserving device (OX) was at least as efficient as the pharyngeal catheter (PC) and did significantly better than the nasal prongs (NP), the mean increments in PaO2 and arterial oxygen saturation (SaO2) being, respectively, 1.1 kPa (8.1 mmHg) and 1.3% higher with OX than with NP. Twenty patients did not reach the target level of 8.6 kPa (65 mmHg) PaO2 with the nasal prongs, but the reservoir cannula allowed nine of these "refractory" patients to hit this therapeutic goal, a result indicating a clear trend towards improved immediate oxygen response. Although initially designed to spare gas, we suggest that a reservoir cannula could serve another purpose, namely to optimize oxygenation in patients treated by an oxygen concentrator. Indeed, since the oxygen flow rate cannot be reliably increased over 3 l.min-1 with the available oxygen concentrators, the reservoir device could be more effective in some selected patients whose hypoxaemia cannot be adequately corrected by standard nasal prongs.

At present, the possibilities of pharmacological intervention in smoking cessation remain limited. Some products, like smoking deterrants, lobeline, amphetamine and sedatives, definitely seem to have been rejected. The efficiency of other drugs aiming to treat the withdrawal syndrome (e.g. clonidine) or to eradicate the smoking habit (e.g. mecamylamine) must still be confirmed in large controlled trials. The same is true of the "cigarette substitutes" which have appeared recently. The only effective substitute treatment currently available is nicotine, presented as nicotine gum; other modalities of administration of nicotine are in preparation. Even if it has not fulfilled all the expectations of its promoters and of the smokers who hoped for a panacea, nicotine gum, when administered to highly dependent smokers motivated to stop, with the appropriate technique, effects a moderate increase not only in the cessation rate but also in the long-term abstention rate, in so far as the necessary psychological support is provided, either by the physician in medical settings, or by other health professionals, in smoking-cessation clinics or in industrial and community settings. The addiction to psychoactive nicotine presents only one facet of the smoking process in chronic smokers. They must also be helped to face the behavioural components of their habits, so individualized counselling remains essential, in addition to the prescription of the gum, in order to achieve satisfactory rates of long-term smoking cessation.