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Tobacco control, psychosocial and medical assistance regarding tobacco cessation is still a hidden potential within the German health care system. So far doctors rarely talk to their patients about their smoking status and physical and psychological benefits of quitting.This paper focusses on recommended current diagnostic and treatment standards, as well as evidence-based methods to address the topic on how to stop smoking and its association with certain diseases such as COPD, lung cancer and COVID-19 infection. The role of e-cigarettes as a cessation tool and its health related risks are critically examined. Consequences and advice how to implement smoking cessation procedures into daily practice are presented., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background:  Almost all e-cigarettes contain flavorings that make the product more attractive. In the evaluation of e-cigarettes on health, flavors have so far played a subordinate role., Method:  Selective literature search in PubMed, supplemented by legal regulations on the use of flavors in e-cigarettes., Results:  Flavors make it easier to start using e-cigarettes and have a consumption-promoting effect. Deeper inhalation increases nicotine uptake and the absorption of toxic substances from the e-cigarette liquid. For some flavors, pathological effects have been demonstrated in addition to other toxic components of the e-cigarette. To date, no toxicological analyses are available for the vast majority of flavors contained in e-cigarettes., Conclusions:  The proven consumption-promoting effect and the health risks that can be extrapolated from preclinical data are significant for the political discussion of a ban on flavors for e-cigarettes, analogous to the ban on flavors in tobacco products already in force., Competing Interests: Klaas Franzen, Stefan Andreas, Wulf Pankow, Wilfried Kunstmann und Reiner Hanewinkel sind ehrenamtlich für das Aktionsbündnis Nichtrauchen tätig. Natascha Sommer erhielt für Ihre Forschung zu E-Zigaretten finanzielle Unterstützung der Balzan-Preis Forschungsgruppe des Deutschen Zentrums für Lungenforschung (DZL) – Erika von Mutius, Klaus F. Rabe, Werner Seeger und Tobias Welte., (Thieme. All rights reserved.)

After several years of declining tobacco consumption, the number of smokers in Germany is currently stagnating or rising again. The reasons seem to be manifold, e. g. stress caused by the pandemic with social isolation, rising cost of living and war in Europe.With tobacco use still widespread in the German population, evidence-based tobacco cessation is rarely implemented.According to recent studies, e-cigarettes are involved in the pathogenesis of lung disease, cardiac and vascular damage. In addition, their ingredients also have carcinogenic effects. However, clinical studies on long-term use are not yet available.E-cigarettes as a consumer product are not superior to nicotine replacement products and addiction-reducing medications recommended in guidelines. In the therapeutic setting, they are slightly more effective than nicotine replacement products. However, they are usually consumed continuously and thus perpetuate nicotine dependence. Their use increases the risk of relapse to tobacco smoking.Despite the various new approaches, such as Internet-based offerings, app, etc., talks and pharmacotherapy are the gold standard and more effective than any therapy on its own., Competing Interests: PD Dr. med. K. F. Franzen und Prof. Dr. med. W. Pankow sind im Pfizer Advisory Board zur Tabakentwöhnung tätig. Prof. Dr. med. S. Andreas hat keine Interessenkonflikte im Bezug auf diese Publikation., (Thieme. All rights reserved.)

In hospital, effective smoking cessation can be organized through counselling, pharmacological aids and, above all, continuous care in outpatient structures following discharge. Pharmacological treatment has proven to be effective and safe with nicotine replacement therapy as well as varenicline. Counselling plus pharmacotherapy is more effective in combination than either therapy is on its own. To better implement structures medical societies in Germany are seeking adequate funding e. g. in the DRG system for hospitalised patients.There are obvious and relevant benefits in smoking cessation. Not only for the main tobacco-related diseases such as coronary heart disease or chronic obstructive pulmonary disease (COPD), positive effects of quitting on morbidity and mortality have been confirmed by high-quality meta-analyses. Furthermore, quality of life is increasing following cessation. Presently, smoking is found to be a significant risk factor for severe disease and mortality following coronavirus infection.Do e-cigarettes offer an alternative in smoking cessation? No. Animal and human data are suggesting toxic effects especially following longer use. The long-term effectiveness of e-cigarettes in tobacco cessation is still uncertain and epidemiologic data clearly point toward ineffectiveness. Furthermore, dual use with potentiation of the toxic effects is common. Therefore, e-cigarettes cannot be recommended for tobacco cessation., Competing Interests: W. Pankow: Beratungshonorar von Pfizer., (Thieme. All rights reserved.)

History and Clinical Findings: Two weeks after returning from a trip to Thailand a 79-year-old man developed a higher fever, pain in the right flank and progressive clouding of consciousness. She had meningism on admission., Investigations: There was a marked leukocytosis (WBC count 17,700/microliter) and raised C-reactive protein (6.5 mg/dl). Cerebrospinal fluid was clear, containing 119 cells/mm3 and elevated protein (90 mg/dl). Abdominal sonography demonstrated segmental pyelonephritis, and blood culture grew Pseudomonas pseudomallei., Treatment and Course: On the basis of sensitivity tests imipenem was chosen as the antibiotic and was given for 6 weeks. Because of an inadequate response and a right renal abscess a right nephrectomy was performed. After marked improvement the septicaemia recurred one week after antibiotic treatment had been discontinued, and the patient died., Conclusion: Efficacious treatment of melioidosis (a glanders-like disease) presupposes diagnosis of the causative microorganism and testing of its antibiotic sensitivity. As Pseud. pseudomallei may encapsulate and persist intracellularly, the selection of antibiotic and the duration of treatment are crucial.

Radiological investigation of the vertebral column in two patients with low-back pain (53-year-old woman and a 52-year-old man) revealed unusually marked osteoporosis and sintering fractures of the 3rd, and 1st and 4th lumbar vertebrae, respectively. Biochemical tests failed to provide any evidence about metabolic or endocrinological abnormality. Iliac crest biopsy showed mastocytosis. There were no skin changes in either patient. Additional examinations excluded involvement of any internal organs. Despite treatment with calcium, sodium fluoride, vitamin D3 and calcitonin in the woman, and aspirin and chromoglycinic acid in the man the osteoporosis has slowly progressed during the last 7 and 5 years, but the disease has remained limited to the skeletal system. In a case of unusually marked osteoporosis, mastocytosis should be included in the differential diagnosis even in the absence of urticaria pigmentosa.