Neil C Thomson1, Rekha Chaudhuri. 1. Division of Immunology, Infection and Inflammation, Department of Respiratory Medicine, University of Glasgow, Gartnavel General Hospital, Glasgow, UK. n.c.thomson@clinmed.gla.ac.uk
Abstract
PURPOSE OF REVIEW: Cigarette smoking in asthma is associated with poor symptom control and reduced sensitivity to corticosteroids. We summarize recent evidence supporting the adverse effects of smoking in asthma and consider strategies to manage these patients. RECENT FINDINGS: Smokers have more severe symptoms and are more likely to be admitted to hospital due to poorly controlled asthma compared with nonsmokers with asthma. Possible causes of reduced sensitivity to inhaled corticosteroids in smokers with asthma are noneosinophilic airway inflammation, impaired glucocorticoid receptor function, and/or reduced histone deacetylase activity. Smoking cessation improves asthma control, but quit rates are low. The optimal drug therapy for smokers with asthma is not established due, in part, to the small number of clinical trials performed in these patients. Preliminary data, however, suggest that leukotriene-receptor antagonists may have a beneficial effect in smokers with mild asthma. SUMMARY: Cigarette smoking in asthma is a risk factor for poor asthma control and reduced sensitivity to corticosteroids. Every effort should be made to encourage individuals with asthma who smoke to quit. Clinical trials are required to identify therapies that restore corticosteroid sensitivity or directly improve symptom control in individuals with asthma who are unable to stop smoking.
PURPOSE OF REVIEW: Cigarette smoking in asthma is associated with poor symptom control and reduced sensitivity to corticosteroids. We summarize recent evidence supporting the adverse effects of smoking in asthma and consider strategies to manage these patients. RECENT FINDINGS: Smokers have more severe symptoms and are more likely to be admitted to hospital due to poorly controlled asthma compared with nonsmokers with asthma. Possible causes of reduced sensitivity to inhaled corticosteroids in smokers with asthma are noneosinophilic airway inflammation, impaired glucocorticoid receptor function, and/or reduced histone deacetylase activity. Smoking cessation improves asthma control, but quit rates are low. The optimal drug therapy for smokers with asthma is not established due, in part, to the small number of clinical trials performed in these patients. Preliminary data, however, suggest that leukotriene-receptor antagonists may have a beneficial effect in smokers with mild asthma. SUMMARY: Cigarette smoking in asthma is a risk factor for poor asthma control and reduced sensitivity to corticosteroids. Every effort should be made to encourage individuals with asthma who smoke to quit. Clinical trials are required to identify therapies that restore corticosteroid sensitivity or directly improve symptom control in individuals with asthma who are unable to stop smoking.
Authors: Xavier Soler; Janet T Holbrook; Lynn B Gerald; Cristine E Berry; Joy Saams; Robert J Henderson; Elizabeth Sugar; Robert A Wise; Joe W Ramsdell Journal: J Allergy Clin Immunol Pract Date: 2017-06-29
Authors: Glenn C Simon; Richard J Martin; Sean Smith; Jyoti Thaikoottathil; Russell P Bowler; Stephen J Barenkamp; Hong Wei Chu Journal: Am J Respir Cell Mol Biol Date: 2011-01-14 Impact factor: 6.914
Authors: M D Lougheed; C Lemière; S D Dell; F M Ducharme; J Mark Fitzgerald; R Leigh; C Licskai; B H Rowe; D Bowie; A Becker; Louis-Philippe Boulet Journal: Can Respir J Date: 2010 Jan-Feb Impact factor: 2.409
Authors: Dan F Smelter; Venkatachalem Sathish; Michael A Thompson; Christina M Pabelick; Robert Vassallo; Y S Prakash Journal: J Immunol Date: 2010-07-26 Impact factor: 5.422