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These exacerbations often require antibiotics and may need steroid medication and an increase in respiratory inhaled medications

In 1987, as a new faculty member at a medical school, I was strongly encouraged by one dean to back off on tobacco, which was not an area well-funded by the National Institutes of Health, and instead get into something more socially acceptable, like cocaine. Even today there is scant attention paid to smoking prevention and cessation, as well as to the impact of smoking on families and the community, during each of the 4 years of the medical school curriculum