Why are you assuming that someone living with brittle asthma equates health with longevity? Some people feel that health is more than what their body is doing - it is about enjoying your life for as long as it is. Maybe their life with asthma is so shite that ciggies give them something that makes them feel ok for a while? I don't blame this individual for treating their asthma as a mere annoyance - it sounds like it is. They aren't in denial either - this is just how they deal with their disability. However, understanding this person requires being be a bit less dogmatic in one's definition of health - and I respect that this can be tricky/frustrating when you work in 'front line medicine'.