Letter from Jordan

Smoking is a major respiratory health problem in Jordan, with more than 40% of adult men and 5% of women smoking regularly. The annual expenditure on smoking is about 494 million USD and the total annual cost of treating smoking-related health problems is about 1.411 million USD.1, 2 Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in Jordan. The most common symptoms of COPD are breathlessness, excessive sputum production and chronic cough. Most of the available information on COPD prevalence has come from industrialized countries. The BREATHE study was conducted in 11 countries (including Jordan) across the Middle East to assess the prevalence of symptoms that could be COPD related (e.g. persistent productive cough and breathlessness). A random sample of 457 258 telephone numbers was contacted. The screening questionnaire included six questions relating to respiratory symptoms. COPD symptoms were more frequent in men (5.2%) than in women (1.8%), with a significantly higher frequency of symptoms in smokers than in non-smokers.3 Not surprisingly, lung cancer is the most preventable form of cancer death in Jordan. It is common among Jordanian youth to smoke cigarettes or water pipes, called shisha or Argilah. The 2009 World Health Organization (WHO) Global Tobacco Youth Survey reported a shisha smoking rate of 11.5% among 13–15-year-old youth (Fig. 1).4 The future of respiratory medicine in Jordan is promising because of the increasing number of respiratory physicians and continuous educational improvements in the field. There are now two respiratory training centres in Amman (Jordan University Hospital and Jordanian Royal Medical Services). The respiratory training programme is guided and managed by the Jordan Medical Council. All respiratory advanced trainees have to pass the General Medicine Jordanian Board to be eligible for the respiratory medicine advanced training programme. This is a 3-year programme and, at the end of this period, the trainee has to pass the Respiratory Medicine Jordanian Board examinations. Current priorities for respiratory physicians in Jordan include public campaigns to raise awareness and to reduce smoking as well as making medication to assist smoking cessation more readily available. Volunteer doctors make an important contribution to treat refugees, and continuous work to limit the spread of tuberculosis (TB) and other infectious respiratory diseases is an ongoing priority. The total TB incidence rate is high (per 100 000 population) and was 5 (3.8–6.3) in 2018 as per the WHO's Global Tuberculosis Report.5 In 2015, Syrian refugee cases represented 13.8% of TB cases in Jordan, when Syrian refugees made up 8.3% of the country's population. All refugee TB cases were followed by the National TB Program (NTP) and the International Organization for Migration (IOM).6 Jordan is making progress in many aspects of respiratory disease. Significant challenges remain but it is clear that the importance of this area is increasingly recognized and evidenced by continuing training programmes and public health projects.