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Smoking cessation yields large health gains, especially in times of COVID-19. Compared to measures to stop COVID-19, tobacco control is lagging behind. We studied smoking-cessation-care in the Netherlands, using qualitative interviews with physicians (N=55) and questionnaires among physicians and other healthcare providers (HCPs; N=883) in 2017. Who is responsible for what? Three actors emerged: the patient who smokes (end responsible for quitting), the HCP (quit-advice, counseling or referral) and the government (create a society that stimulates "smoke-free"). Many HCPs do not ask about smoking, nor advise to quit. The task-division is unclear, as smoking causes multiple diseases that are part of multiple disciplines and specializations. HCPs that see smoking as a serious addiction are more inclined to ensure adequate smoking-cessation-care for their patients. Fortunately, there are positive developments as well, both within healthcare as society, and ways in which you can contribute.

The Dutch College of General Practitioners (NHG) guidelines 'Adult asthma' and 'COPD' have been revised. New spirometry reference values from the Global Lung Function Initiative are recommended. Airway obstruction is defined as a FEV1/FVC ratio below the 5th percentile for the reference population. Spirometry for diagnosis takes place without use of patients' inhaled medication and consists of measurements before and after standardized bronchodilation. In monitoring spirometry, patients continue using inhaled medication and standardized bronchodilation is not indicated. The goal of asthma management is optimal asthma control, tailored to individual goals. The most important non-drug intervention in asthma and COPD is to recommend stopping smoking. The goal of COPD management is to limit symptoms, improve exercise capacity and quality of life, and reduce the burden of disease. Inhaled corticosteroids are usually not indicated in COPD treatment. Patients with comorbid asthma and COPD are treated with non-drug interventions according to the COPD guideline and with medication according to the asthma guideline.

Objective: To determine which changes take place in the interpretation of spirometric examination results when the transition is made from reference values for children (Zapletal) and adults (European Community for Steel and Coal (ECSC)) to those from the Global Lung Function Initiative (GLI)., Design: Retrospective study., Method: We analysed spirometric data (forced expiratory volume in 1 s, FEV1 and forced vital capacity, FVC) obtained pre- and post-bronchodilation in patients: 1012 children (aged 6-17 years, 47.1% girls) and 4653 adults (aged 18-91 years, 48.6% females). Prevalence rates of airway obstruction based on the lower limit of predicted values (FEV1/FVC < 5th percentile) and an abnormally low FVC (FEV1/FVC > 0.85, FVC < 5th percentile) were calculated in 9 groups of patients. Airway obstruction was also classified based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criterion: FEV1/FVC < 0.70., Results: Predicted values for FEV1 and FVC according to ECSC and Zapletal were too low. The prevalence rates of spirometrically determined airway obstruction using the three prediction equations varied little; an abnormally low FVC occurred more frequently, especially in young adults. GOLD-defined airway obstruction led to 13.5% underdiagnosis in those aged < 45 years, and about 33% overdiagnosis in elderly subjects, being markedly age-dependent., Conclusion: The prevalence rate of spirometrically determined airway obstruction is little affected by adopting the GLI reference values. The GOLD criterion for airway obstruction leads to underdiagnosis in adults aged < 45 years, and appreciable overdiagnosis in those aged > 45 years. Using z-scores to interpret test results removes biases related to age, height and sex and ethnic group and is clinically valid.

e-Health is a hot item: governments, healthcare insurers and manufacturers of medical appliances state that the expected epidemic of chronic diseases can only be countered by broad application of e-health. However, sound scientific data to support this claim is currently lacking. Several recent large trials demonstrate that results do not always keep up with expectations. The WSD Trial, published in last months' BMJ, shows the discrepancy between scientific reality and political planning. In addition to a critical comment, we attempt to make recommendations on aspects of e-health that do hold promise.