Smoking cessation help should be available at CF reference centres A Belgian national survey of smoking in patients with cystic fibrosis. Godding V 1, Stevens L2, Galanti L3, De Boeck K 4, De Baets F 5, Malfroot A 6, Hanssens L7, Knoop C8, Sacré JP 9, Pierart F 10, Van Schil L11, Desager K 12, Lebecque P 1 1 Cliniques Universitaires Saint-Luc, University of Louvain, Brussels; 2 CHU Brugman, Brussels; 3 Yvoir, University of Louvain; 4 University Hospital Leuven; 5 Ghent University Hospital; 6UZ Brussel, Brussels; 7 HUDERF, Brussels; 8 CHU Erasme, Brussels; 9 Citadelle, Liège; 10 L’Espérance, Liège; 11 St Vincentius, Antwerp; 12 AZ Antwerp, Belgium. Background Aims To identify active and passive smokers among Belgian non-transplanted CF patients followed at reference centers. To investigate physical, psychological and behavioral dependence of active CF smokers. In Belgium in 2011, 35% of the 15-29 years age group were regular smokers. No information is available about epidemiology of smoking by CF patients in Belgium. No large-scale study of active & passive smoking prevalences based on cotinine dosages is available in CF. Secondhand smoke adversely affects both cross sectional and longitudinal measures of lung function in individuals with CF (Collaco, 2008) Active smoking has been associated with a number of consequences that can be harmful for CF patients, including impaired mucus clearance, increased AW inflammation, increased risk of bacterial infection, increased risk of diabetes, loss of appetite and decreased caloric intake … In healthy active smokers adolescents, a significant association has been reported between depressive symptoms and nicotine addiction. Methods All CF patients followed at the Belgian reference centres were asked to provide a urine sample. Active and passive smokers were identified by means of urinary cotinine (UC) >100 ng/ml. Results of the dosages were not transmitted to clinicians. Patients with positive UC were asked to meet an independent tabacologist, to evaluate their expired CO, their physical, psychological and behavioral dependence to nicotine, and their Hospital Anxiety and Depression (HAD) score. Results % of recruitment in each CF Centre Urinary cotinine UC > 100 ng/ml, n = 29 (4,5%) mean UC: 631 ± 483 ng/ml 12 declined to meet the tabacologist 706 patients (78.8 % of target) 17 met the tabacologist UC < 100 ng/ml: n = 677 5 passive smokers mean UC: 234 ± 41 ng/100 ml mean Exp CO: 2.8 ± 1.6 ppm Age: 26.1 y ± 11.2 (9.5 - 41) friends 3, family 2; 3F, 2M 12 active smokers mean UC: 863 ± 464 ng/100 ml mean Exp CO: 13 ± 7.6 ppm Significant relationship between UC and 1) Exp CO (r=0.63, p=0.04) 2) n cigarettes/day (r=0.82, p=0.01) C1 C2 C3 C4 C5 C6 C7 Characteristics of 12 active smokers Active smokers: psychosocial findings Age (y) 27.9  11.4 (18 - 57) Gender 11 M, 1 F Age of onset (y) 16.4  2.8 (13 - 22) Weight (Z score) -0.99  1.53 (-3.2 - 1.6) Height (Z score) -1.10  1.29 (-3 - 0.8) FEV1 (% pr, Wang & Hankinson) 76 %  16 (52 - 94) Chronic colonization by pseudomonas a. 42 Diabetes (%) 33 F508del / F508del (%) Use of cannabis: 41% Socio Economic Status low SES: mean UC = 1,270 ng/ml other SES: mean UC = 747 ng/ml (p=0.04) HAD score: Anxiety: 11.6/21 ± 5.4 (4 – 19) Depression: 9.5/21 ± 5 (3 - 20) correlation between UC and anxiety (r=0.82, p=0.009) Active smokers: addiction to nicotine What CF smokers expect from their reference centre Fagerström score (/10) 4.1 ± 2.8 (1 - 9) De Maria score (/20) 10.4 ± 2.3 (8 - 12) Previous quit attempt 91% n.cigarettes /day Exposure to tobacco smoke (friends …) 13.3 ± 7.9 (3 à 28) The smoking problem should be adressed in a non-judgemental, guiltless manner.  It is important to refrain from rejecting the patient, when his/her smoking is discovered. « I promised to the doctor that I would quit. It is difficult to admit that I failed » Adressing the smoking issue is part of the treatment « I wish to receive scientific information, CF specific. » Conclusions Active or passive exposure to cigarette smoke was present in at least 4-5 % of CF patients followed at Belgian reference centres. Keeping in mind the limitations of the study, it is encouraging to note that no smoker adolescent was identified. Active smoking was more prevalent in men and was associated with anxiety. Smoking cessation help should be available at CF reference centres. It is suggested that smoking status should be recorded in the Belgian CF registry. Supported by the Belgian CF Association